Types of Senior Housing
55+ Retirement Active Adult Communities & Apartments
These are age-restricted planned housing developments created for seniors who enjoy participating in various physical and social activities. This type of community attracts people who want to own their own homes in an environment that offers many amenities for seniors. These communities may offer condominiums, townhomes, or freestanding houses, while senior apartments are multi-unit properties. In summary:
- Independent living with (some communities offer no maintenance)
- Typically offer spacious housing of all sizes
- Full kitchens
- Front and back yard and/or patio
- Garages
- Community amenities
- Month to month rent or purchase options
Independent Community Living
These are typically apartments that only accept people over a certain age – usually 55. The apartments are found in many communities. Some are under federal housing guidelines and will only accept low-income seniors, but most are privately owned and operate much like an apartment complex. A growing trend in these apartment complexes is to provide services that typically are not found in apartment buildings – like an on-site activities program, van services, and meals in a communal dining room. In summary:
- Those who want to and can live independently, but do not want to maintain a home.
- Many prefer ILF because they can be more social with others of the same age and have similar interests. Most ILF's plan many daily social activities and trips throughout the month.
- Some have full kitchens for those who still enjoy cooking and some may also offer meal plans.
- Cost not covered by any insurance.
- The senior or their family must pay out of pocket.
Assisted Living
These facilities provide professionally managed personal and health care services in a residential environment. Assisted living facilities are appropriate for individuals who may no longer be safe living in their own homes but do not need the level of service provided in a nursing home. The older adults who live in these facilities are often dealing with physical and functional disabilities. Some assisted living facilities may offer a secure unit that provides services for people with Alzheimer’s disease or other dementias. These facilities are generally private pay (meaning that neither Medicare nor Medicaid covers the costs). They typically provide non-medical care and do not provide 24-hour medical supervision or nursing care. Some facilities may offer respite care to give a break for at-home caregivers. Respite care can also be an excellent way to introduce a senior to the assisted living environment.
It is important to compare fees and services. An all-inclusive fee may seem expensive, but when the costs of additional services in a fee-for-service arrangement are added up, an all-inclusive agreement may be a lower-cost option.
Often times, licensed communities can be broken down into 2 categories.
Assisted Living & Assisted Living Memory Care
- For those seniors that need assistance with activities of daily living (ADL's), but do not require constant care.
- Assistance could include: eating assistance, cooking, bathing, dressing, laundry, housekeeping, toileting, medication management, and assistance with incontinence.
- Communities either have wings specifically for or only take care of Alzheimer's/Dementia clients
- Provide a variety of social activities - some are at an additional charge
- Have staff to help 24/7 and many have a nurse on staff.
- Some provide 3 meals/day and housekeeping included in the rent and others will charge extra
- Many communities may also add additional costs depending on care needs.
- Residents are assessed prior to move-in to determine care needs and reassessed periodically and charges adjusted accordingly.
- Most will accept private funds, LTC Insurance, VA Aid & Attendance Pension, and some will take Medicaid or allow spend down to Medicaid. Medicare will not pay for this.
Residential Board and Care Homes
- Licensed homes that offer more of a “at home” feel. Usually have no more than 8-10 residents.
- Resident has a bedroom in the home vs. an apartment in a community.
- Usually these are remodeled homes in a normal sub-division or neighborhood.
- Some provide 3 meals/day and housekeeping included in the rent and others will charge extra
- Many communities may also add additional costs depending on care needs.
- Most care homes have an activities program to keep residents engaged
- Resident is assessed prior to move-in to determine care needs and reassessed periodically and charges adjusted accordingly.
- Most will accept private funds, LTC Insurance, VA Aid & Attendance, and some will accept Medicaid or allow spend down to Medicaid. Medicare will not pay for this.
Nursing Care Facilities
These facilities provide care for individuals who need ongoing medical care but do not need to be hospitalized. The care is directed by a physician and is administered by nursing or other related professionals. These facilities provide 24-hour medical supervision and offer rehabilitation, sub-acute, respite, and other short term needs.
For Medicare to pay for nursing home costs, a patient needs to have stayed at least three days in a hospital and have a improving condition. Medicare will pay for most skilled nursing care costs for up to 100 days (see Medicare chapter for details). Other funding sources for nursing home costs include individual health insurance, Medicaid, Long Term Care Insurance, and personal funds. The social worker and nursing home administrator can help determine what is covered, by whom, and for how long. When looking for a nursing home, tour several facilities, and inquire about their specific costs. In summary:
- For those who need personalized medical care from a skilled nursing team.
- Most SNF’s provide both rehab and long-term care.
- Some SNF’s offer secured memory care.
- Rehab is covered by Medicare. Long term care & memory care can be paid from Medicaid, LTC Insurance, the VA Aid & Attendance Pension, or the senior/family must pay out of pocket.
Continuing Care Retirement Communities (CCRC)
These are communities where a continuum of care levels is offered (also known as Lifecare Communities). They are designed to provide active seniors an independent lifestyle while enjoying the privacy of their own home. Coordinated social activities, dining, and healthcare are provided as needed.
Some communities may require the purchase of Long Term Care Insurance as criteria for acceptance. Typically the insurance premiums are built into the purchase price and monthly fees. Additional fees may provide for: meals, scheduled transportation, housekeeping, unit maintenance, linen and personal laundry, health monitoring services, utilities, coordinated social activities, emergency call monitoring, and around-the-clock security.
Many of these types of communities require an entrance fee that may or may not be refundable, and this fee may be substantial in some cases. Therefore, it is imperative that the financial stability of the facility be thoroughly investigated. Although these facilities may help one “age in place,” inquire as to where a resident would be relocated if the nursing center became full or unavailable. Many reputable CCRC’s contracts with rehabilitation centers in the event they cannot keep the resident on site. In summary:
- Continuing care retirement communities are retirement communities with a combination of independent living, assisted living, and nursing home care, offering residents a continuum of care. A person can move between levels of care as needed.
- Most require residents to pay an entry fee and an adjustable monthly rent in return for the guarantee of care for the rest of their life. Entry fees can run from $30,000 up to $1 million, with monthly rates ranging from $3000 to $4,500. There are others that offer rental or equity arrangements.
- Entry fees may or may not be returned to the estate at time of death or move out. Contracts vary from community to community.
- Most CCRCs require that a resident be in good health, be able to live independently when entering the community, and be within the minimum and maximum age limits.
- Generally, have a robust activities program