For adults aged 50+, seniors or the elderly (Older Adults) needing or anticipating a move from their current home to a new home better suited for their needs and/or desires, their new housing options include: (i) owning a home, (ii) renting a home, (iii) living in a group setting, or (iv) living in a nursing home.
For a list of questions to ask yourself when deciding which option is best for you, visit Questions To Ask.
Owning a Home
Remaining in your home or purchasing a new home better suited to your needs and/or desires are attractive options. The types of homes available for ownership include: single family home, condominium, cooperative or manufactured or mobile home. Continued ownership of a home (current or new) would provide you the best opportunity to live independently. Additionally, if needed at some point in the future, you may be able to obtain in-home support services and community services to support your continued independence.
Many Older Adults want to stay in the homes where they have lived for many years. For others, downsizing to a smaller home is an attractive alternative. Also, active adult communities and retirement communities are increasingly an option. While remaining in one’s own home may be highly desirable for an Older Adult, the wisdom of doing so depends on making certain that health, social and financial needs are met.
Possible Benefits of owning your home:
- Staying close to family, friends and neighbors
- The comfort and familiarity of existing social networks, neighborhood and community
- The privacy of your own home
- Maintaining an existing (and perhaps your largest) financial asset
- You may want to purchase a home in a community with others in your age range that offers activities and amenities to serve your needs and interests
Challenges of owning your home:
- The responsibility for the home’s physical maintenance and upkeep
- The home may need modifications to make it possible to live in comfortably and safely
- Social isolation
- Potential need for support services and home healthcare or monitoring
- Potential financial burden if on a fixed or limited income
Personal Considerations—Questions to Ask About Home Ownership:
- Is remaining at home a short-term or a long-term plan?
- If I remain at home, how will my social, health and financial needs be met?
- Do I have equity in my home? If so, what are ways to obtain a loan and use it?
- Is house sharing an option to consider?
- Am I eligible for any home repair programs that are completed by volunteers?
- Are there programs available to help me pay for the costs of home repairs, home modifications, home heating expenses, weatherization, utility bills and other expenses of maintaining a home?
- Would modifying my home permit me to continue living there? If so, how do I find a qualified remodeler? Is the remodeler I am considering a Certified Aging-in-Place Specialist? Are there volunteers from my local Area Agency on Aging who can help me?
- What universally design products and features should I consider to make my home safer and more comfortable?
- Am I eligible for any property tax relief programs in my state?
- Am I eligible for any in-home support services through federal, state or local programs, such as Medicare or Medicaid?
- Can I use my long-term care insurance policy to pay for in-home support services?
Key Legal Issues to Consider
- The uses for reverse mortgage loans – these loans can be used to pay for expenses, such as medical and long-term care needs, and home repairs and modifications
- The impact that a reverse mortgage loan or the income from house sharing may have on eligibility for public benefits
- The effect of receiving Medicaid services on the transfer of the title of the home after the home owner dies
- The use of a life estate to allow the homeowner to remain in the home if the sale or transfer of the property is being considered
- The importance of having a will, if a homeowner’s wishes are to be followed regarding the person or entity to receive the home after the homeowner’s death.
Renting a Home
Renting a home may be an attractive choice. Many housing options are available as rentals, and some offer special services and amenities. Rental options include single-family houses, apartments, mobile homes in parks, retirement communities, and apartment complexes specifically designed for Older Adults. Most rental units are private, although it is possible to pay rent to share a home, or to rent a single room in a home. Rental housing may be publicly or privately owned, operated or managed.
Benefits of Renting a Home
- A range of housing choices
- Choice of locations
- Freedom from many of the financial and physical responsibilities of being a homeowner
- When owners sell their homes prior to renting, they may use the equity to help pay some of their expenses
- Some renters may be eligible for either public housing or subsidized housing, such as Section 8
Challenges
- Less independence for tenants, restrictions on pet ownership, etc.
- Must rely on others to make necessary repairs and modifications
- Landlords may end tenants’ leases before residents want to move
- In some communities, suitable or affordable rental units may not be available
Personal Considerations – Questions to Ask About Rental Housing
- If physical changes to the unit are needed to make it more accessible, who is responsible for the cost of the modifications?
- Are pets allowed, and is there a pet deposit?
- If a pet deposit policy is in place, is it refundable if there’s no damage when I move out?
- Can the landlord object or ask me to move if I receive in-home support services?
- Am I eligible for any in-home support services through federal, state or local programs?
- Can I use my long-term care insurance policy to pay for in-home support services?
- Am I eligible for any state or federal rent subsidy programs?
- Am I eligible for any state rent rebate programs?
Key Legal Issues to Consider
- The renter’s rights and responsibilities under state landlord/tenant laws and under the federal Fair Housing Act
- The landlord’s duties and obligations under state landlord/tenant laws and under the federal Fair Housing Act
- The frequency with which the landlord can raise the rent
- The options if the new amount is unaffordable
- The question of whether or not a landlord can ask to see medical records before renting a unit
Living in a Group Setting
Group living arrangements are an attractive option to many Older Adults. Group settings provide housing, a range of in-home support services and some social activities.
Both the housing and in-home support services are designed to meet the individual needs of persons who require help with “activities of daily living” or “instrumental activities of daily living” (see below). Group housing, however, does not offer the level of medical care provided in nursing homes.
“Activities of Daily Living” are activities relating to personal care, such as:
- Bathing or showering
- Dressing
- Eating
- Getting in or out of bed or chairs
- Using the toilet
“Instrumental Activities of Daily Living” are activities related to independent living, such as:
- Using the telephone
- Doing light or heavy housework
- Preparing meals
- Shopping for groceries or personal items
- Managing money
Group Living Options
It is important to determine whether a particular type of group housing is the right match for an individual. Making sense of the names for categories of group housing options can be difficult. There are almost 30 terms that states use to refer to these types of group settings and most states describe and license group housing for Older Adults differently.
Following are some of the terms used for group housing for Older Adults. They may refer to very similar group settings and the only difference may be what they are called and how they are licensed in a particular state.
- Board and Care Homes
Board and care homes are private and in residential settings. A board and care home is often a converted or adapted single-family home. This type of home provides the following services: a basic room, which may be shared with another person; meals; help with instrumental activities of daily living; the arrangements for or provision of transportation to medical and other appointments; reminders to take medications; and daily contact with staff. Services such as meals, supervision and transportation are usually handled by the home’s owner or manager.
- Adult Foster Care Homes
An adult foster care home provides room, board and in-home support services in a family setting. Generally, an adult foster care home provides more in-home support services than a board and care home. These homes may meet the needs of adults who require periodic or regular assistance with activities of daily living. Some adult foster care homes may offer more complex care if the staff has experience and is trained to provide it. In some cases, visiting nurses provide the necessary assistance.
- Adult Care Facilities
Adult care facilities provide room, board and in-home support services to six or more adults who are not related to the operator. Services for residents may be similar to a board and care home or an adult foster care home. Adult care facilities generally have more residents. They are therefore less likely to resemble family life. Adult care facilities may also be called congregate housing. These facilities are available for Older Adults who are no longer able or willing to live completely independently. Generally, residents live in a private apartment and are capable of getting to the communal dining area independently. They usually receive help with grocery shopping, meal preparation and housework.
- Residential Care Facilities
A residential care facility is a group residence that provides each resident with, at a minimum, assistance with bathing, dressing, and help with medications on a 24-hour-a-day basis. The facility may also provide medical services under certain circumstances.
- Assisted Living Facilities
This term is probably the most confusing. In some states, the term “assisted living” or “assisted living facility” includes all types of group settings that provide some level of in-home support services. In other states, assisted living facilities are specifically licensed and regulated by state law. In these states, assisted living facilities must provide the services and features the state requires.Assisted living facilities are a housing option for those who need a wide range of in-home support services to help them with activities of daily living. However, residents in these facilities do not require the level of continuous nursing care that a nursing home offers.Older Adults who live in newer assisted living facilities usually have their own private apartment. Private apartments generally are self-contained, with their own bedroom, bathroom, small kitchen and living area. Alternatively, individual living spaces, consisting of a private or semi-private sleeping area and a shared bathroom, may resemble a dormitory or hotel. There are usually common areas for socializing with other residents.
- Continuing Care Retirement Communities (CCRC)
A CCRC provides a comprehensive, lifetime range of services, to include housing, residential services and nursing care. An Older Adult moving into a CCRC is required to sign a contract with the provider which contains information on the services that are available and the costs of those services. All housing is usually part of one campus setting.In CCRCs, residents live in the type of housing appropriate for their needs and desires. They can move from one level of care to another, while remaining in the CCRC. For example, a resident could start out living independently in a private individual home or apartment. If daily care becomes necessary, the resident could then move into an assisted living facility. The CCRC’s nursing home cares for those who require higher levels of care. CCRC contracts usually require that residents use the CCRC nursing home if the resident needs nursing care. CCRCs generally require a large payment, called an entry fee, before new residents move in. CCRCs also charge a monthly fee.
These general descriptions of the various group settings portray some of the basic differences between them. Many of these options are available throughout the country. It is not a good idea to rely on advertisements to learn about these various group housing options. It is best to get the most objective information available. What is most important when considering group settings is this: focus not on what it’s called but on the type of housing units that are available, and the types and costs of services that can be provided.
Older Adults considering group settings in specific locations can obtain information and assistance from the Eldercare Locator at 800.677.1116 or www.eldercare.gov. The Eldercare Locator connects callers to the appropriate local Area Agency on Aging. The agency staff will have information about the specific types of group housing available in the local area. The information will include state licensing and regulatory requirements, ways to obtain information about specific facilities and whether the facility accepts individuals whose costs are paid by Medicaid.
Benefits
Group housing options offer a wide range of in-home support services, a variety of housing types and the choice of location of facilities. They also give residents opportunities for socializing with others.
Challenges
Group settings may limit privacy. Residents who need more care or supervision may need to obtain additional services or relocate. Some Older Adults may not be able to afford certain group settings.
Personal Considerations – Questions to Ask About Group Housing:
- What is the basic monthly rate and what in-home support services are included in that rate?
- How many hours of service are included?
- Can I save hours that I do not use during a day or week for a later time when I do need them?
- Is there an entrance fee? Is it refundable?
- Is there a waiting list?
- Am I eligible for any in-home support services through federal, state or local programs?
- Can I use my long-term care insurance policy to pay for in-home support services?
- Can I purchase additional services? If so, what types of services and how many hours a day or week are they available? What would those additional costs be and how would I be billed?
- What happens if my needs change or increase?
- Will I be asked to sign an admissions agreement or a contract before I move in? Are there resources available to help me understand the contract?
- Are my utilities included?
- How will I be assigned a room?
- Can I bring my own furnishings?
- Can I have a pet?
- Will the facility honor my special food and dietary preferences?
- Can I have guests in my unit?
- What is the provider’s background and experience? Is the provider financially sound?
- What are the professional qualifications for staff and how many people does each staff person serve?
- What are the training requirements for the facility administrator and for the staff?
- Is the facility close to shopping, senior centers, religious facilities, medical facilities and other amenities that are important to me?
- Do rooms have a telephone and television? How is billing for those handled?
- Does the facility have safety features? Does it have a disaster relief plan?
- What happens if the facility asks me to leave?
- Have I received a copy of the facility’s statement of resident rights?
- Is there a resident council? Can I participate in facility management and decision making?
Key Legal Issues to Consider
- The terms and conditions of the admissions agreement
- The terms and conditions of a CCRC contract
- The standards for quality of care and services, and who is responsible for enforcing and monitoring those standards
- The rights of those who are abused or neglected
- A negotiated risk agreement, if asked to sign one
- The transfer or discharge process and the rights of residents in the process
- The facility policy for residents who temporarily leave the facility
- The eviction process and the rights of residents in the process
Living in a Nursing Home
Nursing home care provides help for a seriously ill care recipient. These facilities offer 24-hour supervision, nursing care, rehabilitation programs, and social activities. If you are not sure if a nursing home is an appropriate care facility for you or a loved one, ask these questions:
- Does you or your loved one need specialized health care services?
- Is a nursing home the only option where you or your loved one will receive the medical care you or he or she needs?
- Are you emotionally and physically exhausted and ready for a break from your caregiving role for your loved one?
- Does you or your loved one need post-hospital rehabilitation following an illness or injury?
- Have other alternatives been exhausted?
- Is a nursing home more cost effective than other living alternatives?
The level of care provided by a nursing home can be either intermediate or skilled. Intermediate care is given to individuals who need assistance with activities of daily living and some health services and nursing supervision, but not constant nursing care. This type of care is usually requested by a doctor and given by a registered nurse. In contrast, skilled nursing care is given to individuals who need 24-hour medical supervision, skilled nursing care, or rehabilitation. Again, a physician’s request may be needed for admission. Additionally, a few facilities offer a third level of care – custodial care. Individuals receiving custodial care need supervision with personal care and other daily living activities, but do not require the help of a practical nurse. Individuals suffering from dementia, including Alzheimer’s disease, are often given this type of care.
You should investigate nursing homes as soon as possible for two reasons. First, it is always easier to make critical comparisons when you are not facing an immediate emergency. Additionally, you should give yourself time to consider more than one facility because these types of facilities are often in high demand.
When investigating nursing home options, find out whether the facility is government certified. If you or your loved one plans to use Medicare or Medicaid for payment, check the limited coverage of these as well by contacting the local Social Security Office.
Some of the information provided in this Section was published at: https://www.helpguide.org