In this column, I've noted that caregivers often need information to help their loved ones. This is particularly true when it comes to choosing a new place to call "home".
As the Peter, Paul, & Mary song goes, "Home is where the heart is," and as a caregiver, your goal is to have your loved one be content with his or her new home. You have to be sure that the housing provides the support your loved one needs to live safely and comfortably while aging.
For some people, staying in their current homes works. For others, there may come a time when everyone agrees that a different housing option is needed.
The good news is that today, there are more and more housing options to choose from.The bad news is that today, there are more and more options to choose from.
The trick is to make the right choice—matching the housing to the needs, wants, and personality of your older family member. I'll explain some of the options, so you will know a little more about each and will be better prepared to help yourself or your loved one make an informed decision.
Specialized Housing Choices
Age-Restricted Communities - Also known as "active adult" or "[age] 55+" communities, these places cater to older adults who have a common preference to not have younger folks around. There is usually a mix of housing types—single-family homes, townhomes, or apartments—often connected by sidewalks or paths. There is a focus on an active lifestyle, so many communities have well-equipped clubhouses and other amenities, such as tennis courts and golf courses.
Active-adult communities are most appropriate for older people who are healthy, independent, and interested in the social benefits of living among peers. If your loved one considers this kind of residential setting, be sure to ask about regulations regarding adult children or grandchildren moving in with residents. Many age-restricted communities don't allow multigenerational living arrangements.
Senior Apartments - Age-restricted apartments are typically available to people age 55 and older. Although some are luxury apartments with high price tags, many are priced at market rates or below. Some are even built specifically for low-income people. Because the units are constructed for older adults, they are often designed to be accessible and include transportation services. Many offer recreational and social services, too.
Cohousing - "Cohousing" designates "a type of 'intentional neighborhood' in which residents actively participate in the design and operation of the community." Residents privately own their homes and do not pool their incomes, but there are common facilities for daily use. Decisions are made cooperatively, rather than by top-down hierarchy or majority-rules voting. Cohousing communities are vibrant places where there are many opportunities for multigenerational interactions and social connections. In elder or senior cohousing communities, the "intentional community" is only for older people. Homes and facilities are designed for aging in place, and residents often share the cost of health aides or an on-site health-care provider.
Needing Some Help
Often the reason families are looking into different housing options is that their older family members need help on a daily basis. Depending upon the level of care needed, options include assisted-living residences and nursing homes.
Assisted Living - Assisted-living arrangements help people stay as independent as possible while offering necessary help. They provide personal care and support services or help with basic daily activities, such as bathing, dressing, and medication management. Most assisted-living residences provide apartment-style living, though there are also "board-and-care homes" and "personal care-group homes," which are single-family dwellings licensed at the state or local level to provide care. They offer meals, activities, housekeeping, transportation, and some level of security.
Nursing Homes - These facilities provide skilled nursing care for older adults who require it. While the homes have doctors on staff, nursing assistants provide most of the help with basic, daily activities, and nurses direct medical monitoring and intervention when necessary. Their work is often supported by speech, occupational, and physical therapists, who work to keep residents as strong as possible. The nursing-home decision is one of the most difficult housing choices that families have to make. Quality can vary among these facilities.
To find a certified facility, use Medicare's Nursing-Home-Compare Web portal to assess homes on a variety of measures. And if everyone decides that a home is the best option, be sure to stay involved with the facility. If there is not a "family council," start one. A council provides valuable information on services and facility management and allows caregivers to be advocates for their loved ones. For more information on advocating for your family member, see the National Citizens' Coalition for Nursing-Home Reform Web site.
Planning for the Future
It is important to remember that everyone in your loved one’s life is seeking to find the best housing fit for him or her. However, health conditions can change, and what seemed like a good fit last year may not be sufficient this year. There is, however, an alternative-housing option that adapts to accommodate people, no matter what their care needs are.
Continuing-Care Retirement Communities - These facilities feature independent-living apartments and homes and offer the various social, recreational, and cultural activities of other retirement communities. But they also have assisted-living and nursing-level care. In this "continuum-of-care" system, residents usually enter the facility at the independent-living level. Later, if their health and abilities decline, they can move to the assisted-living tier, and then, if necessary, to the nursing-home tier.
Many people enter CCRC's and never leave their independent-living units. Others need the extra help. The most important feature of continuing care is that all needs can be met. Family members can be assured that if their loved one's health status changes, the on-site resources are there to provide support. Because these communities provide so many levels of support, they can be expensive; but for many families, the comfort in knowing that any change to Mom's health condition can be addressed without necessitating another move is worth it.
Steps in the Process
Once you decide that a loved one needs a change in housing, you and your family members are advised to meet and evaluate what is best for your loved one. Here are some tips to guide you:
Determine what help your loved one needs. This could mean getting a professional assessment, which will provide everyone with specifics when selecting among options.
- Visit a number of residences; don't see just one.
- When you take a tour, be sure to talk to residents, staff, and visiting family members.
- Ask staff members how long they've worked there; a good sign of quality is low turnover.
- Check with the Commission on Accreditation of Rehabilitation Facilities. Many assisted-living residences, nursing homes, and CCRCs voluntarily apply for accreditation, which means they meet many quality measures.
- Be sure you get clear information on costs and the details for all financial arrangements.
- Talk with your loved one about what is important to him or her as you narrow your options.
A Simple Refrain
Be kind to yourself. Together with your loved one, you're making the best decision you can with the information and resources you have at hand, so try not to get caught up in the emotion of the moment. None of us has a crystal ball that tells us everything about the future.
Again, remember that the situation could change in the future. The senior apartment might not work if your mom ends up needing help with bathing. The assisted-living residence might not be able to help your dad if his skilled-nursing requirements increase.
Again, as the song goes, "Home is where the heart is, no matter how the heart lives. Inside your heart where love is, that's where you've got to make yourself at home."
As you and your family members make decisions about what housing option is best for your loved one, keep the "heart" in the "home."