Options for Senior Living

Excerpted from Nursing Homes & Assisted Living Facilities by Linda H. Connell, Attorney at Law © 2004

There are a number of options available when choosing the living arrangement and type of care needed for a senior. What follows are very general descriptions of the various types of communities available to seniors.

Each state has its own legal definition of and regulatory scheme for these communities. Some types of communities are not licensed by every state—some are not licensed at all. Federal regulations exist that govern long-term care facilities.

The United States Department of Health and Human Services has published regulations that apply to all skilled care facilities in this country. Each individual state must enforce the regulations in order to be eligible to receive various federal funds. As a result, each state has enacted its own set of regulations, which are at least as strict as, and in many cases more strict than, the federal regulations.

Active Adult Community
An active adult community generally describes a planned, age-restricted development. Residents own and maintain their own homes and are responsible for providing for their own needs. Such communities usually require that at least one homeowner be over a certain age, such as 55, and may or may not provide amenities for residents such as sports facilities, community centers, or scheduled social events. The advantages to a senior living in such a development are the ability to maintain a completely independent lifestyle and the opportunity to socialize with others in the same age group. There is no contract and residents may usually move elsewhere without penalty.

The disadvantage to living in this type of community is that, should the resident decide to relocate for whatever reason, the market for the home will be limited to a smaller section
of the general population—that is, other seniors.

Independent Living/Retirement Community
In some cases, a senior will decide that, although in good health, he or she would prefer to not have to worry about caring for a home and yard. He or she may not know many other seniors or simply may not wish to live alone. A lifestyle option known as either an independent living community or a retirement community may be most appropriate.

In this type of community, residents live in their own space, often either a room or apartment-style home. In some such communities, residents have meals together in a main dining room, while in others, residents provide their own meals. Housekeeping and laundry services may or may not be included. There may be an activity staff that runs regular social events for the residents. Skilled nursing care is not provided by these facilities, although a resident should be able to hire home health-care professionals as needed.

Home Health Care
As the name suggests, this lifestyle option allows a senior with health-care issues to live in his or her own home, thus allowing independence. Home health care refers to the hiring of health-care aides or professionals to attend to the senior’s medical needs and daily living activities, without the senior having to relocate to a health-care facility. Such a lifestyle option would be best suited for the senior who has a fulfilling life at home, is satisfied with his or her opportunities to socialize, and has no major physical or mental health concerns that would require a skilled nursing facility.

The home health-care agency and its employees are subject to federal regulations only to the extent that the agency receives payment from the federal Medicare program. Otherwise, home health-care agencies are regulated, if at all, by the states in which they do business. Home health-care aides are generally subject to some regulations from the state, but that does not mean that a senior is required to have a caregiver who is subject to such regulations. Sometimes, the caregiver is a family member, friend, or other person who may not have any formal training.

Assisted Living
Many seniors are fortunate enough to be in fairly good physical and mental health, able to perform some day-to-day activities, and not in need of constant medical oversight. However, sometimes these people have the need for some assistance, for example, with getting bathed, dressed, or even with walking to another room to eat a meal. Assisted living communities may provide the best lifestyle for these seniors. Such facilities generally do not provide skilled nursing care but do have staff to assist with grooming, housekeeping, and other daily activities. Some assisted living facilities are geared toward a specific group of seniors, for example, those suffering from Alzheimer’s disease. These facilities provide specialized services to a particular segment of the senior population.

The advantage to placing a loved one in an assisted living facility is that the philosophy of such a community generally is to promote the independence of the residents and their freedom of decision-making as much as possible. If the senior is functionally able to live in an assisted living facility, the transition from his or her own home to the new surroundings is likely to be easier than if he or she had been moved into a skilled care facility.

As a general rule, Medicare does not cover assisted living expenses. Some facilities do accept Medicaid patients, but many do not. Assisted living facilities generally are not subject to federal regulation, unless they accept Medicaid patients. Many states regulate assisted living facilities, but some do not.

There is not even one single name or definition for such facilities. Sometimes they are called residential care facilities, retirement homes, or semi-independent communities. Because of this, it is difficult to pinpoint an exact definition of such a facility. Even more difficult may be comparing two or more such facilities and the services that they offer.

Long-Term Skilled Care (Nursing) Facility
A skilled care facility is the present-day term for what has traditionally been called a nursing home. It is a facility that not only provides living assistance for those who are not able to care for themselves, but also provides health care in the form of staff nurses, and often various types of therapy programs, such as physical and occupational. Physicians are usually required to be on call to respond to particular needs of skilled care facility residents. Health care is provided in these facilities around the clock.

Skilled care facilities are subject to a myriad of federal and state laws and regulations. Among the most important is the federal Nursing Home Reform Act. This Act provides a
uniform minimum standard for all such facilities across the country.

Continuing Care Retirement Communities
Continuing Care Retirement Community (CCRC) refers to a mixture of some of the living situations previously discussed. Usually, a resident will enter into a contract for continuing care and the facility will guarantee whatever level of care the resident needs, even as the need changes over the years. Such communities will often have an independent living facility, some type of assisted living facility, and skilled nursing care—all in the same building or complex. Many CCRCs also have specialized Alzheimer’s disease units.

The senior may enter the community as an independent living resident, but may move over to the skilled care facility at a later time if the need arises. In some ways, CCRCs are the best of all worlds, because they al

As Featured in the Book

Nursing Homes and Assisted Living Facilities

Linda H. Connell, Attorney at Law

Practical guide to making the right decision about long-term health-care

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