Housing
Housing Choices: How to Determine the Best Housing
The housing needs of older adults are unique and so are the solutions. As an adult grows older, there are often physical limitations that require families to explore options outside of living in the home. Children or other family members should consider alternative living arrangements for their parents before their parents have an accident at home or have another event that might result in their needing to make a quick, and therefore often poorly informed decision.
There are many housing possibilities for older adults. Options include private pay as well as subsidized living options. Subsidized housing is available to low-income residents including the elderly. Subsidized housing can be a valuable option for seniors wanting to continue living in their own residence. The United States Department of Housing and Urban Development subsidizes homes and apartments throughout the United States.
When considering housing options, the most common housing arrangements are:
Living with Adult Children
Parents may move into the adult child’s residence, live in an accessory apartment attached to it, or stay in Elder Cottage Housing Opportunity (ECHO) housing (a temporary cottage put up on the adult child’s property).
Homesharing
As at any age, two or more unrelated older people can share a house or apartment. Each person usually has his or her own bedroom, but they share the kitchen, other living space, and sometimes the bathroom. For an older homeowner who prefers not to live alone (or who needs the income), renting rooms in the home to other older persons is one solution. Some homesharing occurs when the older homeowner shares the home with someone in exchange for assistance with cooking, cleaning, etc.
Foster Care
Some families will take in an older person who needs some help with daily living. The foster family provides services such as cooking meals and doing laundry. Ideally, the older adult becomes a surrogate family member and receives emotional support and companionship as well as housing. Supplemental Security Insurance (SSI) may cover the cost of foster care.
Senior Retirement Communities
These communities are also called Senior Apartments or Senior Retirement Apartments. Residents who are mobile and can take care of themselves live in their own apartments in these buildings, but they share some meals in a central dining room and receive housekeeping services. The residence often provides a variety of social and recreational activities. Rental fees vary widely, and meals and other services are usually extra. There is usually no entrance fee. Some residences (subsidized congregate housing) receive public subsidies that keep rents down, but these often have long waiting lists and stringent income requirements.
Assisted Living
Assisted Living Facilities are residences that provide housing for those who cannot live independently but do not need skilled nursing care. The care in these facilities may include assistance with Activities of Daily Living (often called ADLs—this includes eating, bathing, dressing, laundry, housekeeping, and assistance with medications). These facilities still allow the resident to live as independently as possible for as long as possible.
Assisted living exists to bridge the gap between independent living and nursing homes. Residents in assisted living centers are not able to live by themselves but do not require constant care either. It should be noted that Assisted Living is not an alternative to a nursing home, but an intermediate level of long-term care appropriate for many seniors. Most assisted living facilities create a service plan for each individual resident upon admission. The service plan details the personalized services required by the resident and guaranteed by the facility. The plan is updated regularly to assure that the resident receives the appropriate care as his or her condition changes.
In the State of Utah, there are two levels of Assisted Living Facilities:
Assisted Living Type I is a residential facility that provides assistance with ADLs and social care to two or more ambulatory residents who are capable of achieving mobility sufficient to exit the facility without assistance of another person.
Assisted Living Type II is a residential facility with a home-like setting that provides an array of coordinated supportive personal and health care services, available 24 hours a day, to residents who have been assessed.
Assisted Living is the generic term used across the country for this level of care. Other terms that may be used include: Residential, Care, Adult congregate living care, Board and care, Domiciliary care, Adult living facilities, Supported care, Enhanced care, Community based retirement facilities, Adult homes, Sheltered housing, Retirement residences.
It is important to learn the differences in care in each of these facilities as it may change by state or even by community.
Nursing Homes or Skilled Nursing Facilities (SNFs)
This is an option for those who need skilled nursing care and substantial, long-term assistance. This setting provides medical and personal care and meals. Bedrooms and baths may be private (although only for private-pay residents) or shared. Medicare may provide brief, short-term coverage following a hospitalization. Medicaid may offer coverage to residents who meet medical and financial eligibility requirements.
For more detailed information about Nursing Facilities, please refer to the longer explanation and discussion about Skilled Nursing Facilities on this website.
When considering housing options, here are some factors to consider:
While the choices may seem overwhelming, your parent’s stated preferences, level of need for assistance, and finances will help narrow the focus. To make an informed decision about housing, consider the facility’s Business Practices, Quality of Care and Service, Safety, Amenities, Location, Policies and Family Issues:
Questions to ask:
• Is the facility currently licensed and operating legally?
• Has its license ever been revoked, and why?
• Are recent inspection reports available?
• How long has it been in business?
• Are financial records available?
• Are references obtainable?
Quality of Care and Service
Questions to ask:
• Do current residents appear to have their needs met?
• Seem to be content? Interact well with the staff and owners?
• Do staff and residents treat each other with dignity and respect?
• Does staff take the time to listen and respond to resident needs?
• What is the staff-to-resident ratio?
• Are residents’ rights posted?
• What training does the staff receive?
• What do current residents or their relatives say about their care?
Safety
Questions to ask:
• Does the facility have requisite safety equipment, such as fire extinguishers and smoke detectors?
• Is there a sprinkler system (in larger facilities)?
• Are conditions sanitary?
• Are doors and locks secure?
• Is someone on duty 24 hours a day, or is there an emergency call service?
• Is a doctor available around the clock?
• Are there any obvious hazards?
• Are medications and medical care handled professionally?
• Are facilities safely accessible for those with physical disabilities?
Amenities
Questions to ask:
• Is the facility attractive and in good repair?
• Does it have the style of living desired (private apartment, private room, private bath)?
• Does it have the level of comfort desired (equipment, electronics, garden areas, adequate space for entertaining or hobbies, windows)?
• What meals are provided?
• Are the quality and quantity of meals adequate?
• Does the food style suit your parent’s taste, nutritional requirements, and cultural preferences?
• Are the social interactions and recreational programs appealing?
Location
Questions to ask:
• Is it in a safe neighborhood?
• Is it convenient for shopping, doctor visits, religious services, and social contacts?
• Is it reasonably close to adult children’s homes?
• Is public or private transportation provided or easily accessible?
Policies
Questions to ask:
• Are there restrictions on behavior, such as smoking or drinking alcohol?
• Are pets allowed?
• Are guests (including overnight guests) welcome?
• Are there formal visiting hours?
• How much flexibility is there in meal times?
• In a shared setting, how are responsibilities determined?
• How are rate increases handled?
• What are the facility’s discharge policies?
Family Issues
Questions to ask:
• Will this move cause family problems?
• If a parent and child are considering living together, can they (and the others living in the house) get along?
• Is the space adequate?
• Is the house equipped for the older adult?
• Can you give the parent the attention he or she needs and expects?
• Are your lifestyles compatible?
• What are the advantages and disadvantages for both parties?
• Are you comfortable with this serious commitment and reasonably sure it will work?
(Special thanks to AARP and its Web site where some of this information was found.)
