Ultimate Assisted Living Facility Decision Guide – Part 2: Senior living options: which one is best for your situation?
There are a lot of resources for seniors. Here are a few options for seniors who are starting to need a little assistance through full care:
Options best for those seniors who don’t want to leave their home but need a little assistance
Private Care Givers:
Private caregivers often seem like the least expensive option for helping seniors who need care but want to keep the costs down. A few words of caution about private caregivers. First, make sure they have a national background check. There are a lot of predators who will take advantage of seniors, know who you are hiring. Second, while private caregivers may be less expensive than an in home care agency, they are just like Nannies – seniors or their families will have to pay “Nanny taxes” and other federal benefits like workman’s comp for their services. Misclassifying an employee as an “independent contractor” (using Form 1099) is considered tax evasion. You will have to manage their schedule and if they don’t show up for a shift you are left scrambling for coverage.
In Home Care Agency:
In Home Care is non-medical care by caregivers who have extensive training but are usually not certified by the state. The caregivers can do everything from providing companionship, helping with meals, shopping and light house cleaning to more personal care like showering, helping in the bathroom, dressing etc. In Home Care is usually paid by the individual although Medicaid will also pay if the client is approved for services. There is usually a 1-5-hour minimum visit (depending on in home caregiver agency). The client and the agency determine together what services are needed, frequency and length of visits. Agencies manage the caregivers so if one is not able to come the agency will find a substitute. If the client doesn’t like the caregiver the agency will find one that better suits the client’s needs. Agencies do background checks to ensure the caregivers are qualified and pay the taxes (mentioned above) so families are not responsible for them.
Home Health is for individuals who need help from medical professionals in their home. This service is prescribed or ordered by the doctor or Medical Social Worker upon discharge from the hospital or rehab. The team consists of a nurse, physical therapist, occupational therapist, speech therapist and an aide. Each patient is evaluated for his/her needs and the health care professional will visit the patient at home to help improve the patient’s health. This is usually a short-term program and ends when the patient has met his/her goals or their progress plateaus. This is a Medicare benefit, so patients do not have to pay for their services. Home Health can be provided in the home or in any of the community living options below. Many communities have home health agencies on site.
Options for those who checked the first two lines in the questions above
Moving from the home is a very difficult decision. The fear of losing independence, the fear of the unknown, the fear of the process of moving all make postponing the decision a much more attractive alternative. There are benefits, though, of moving such as having transportation available to go to doctors, stores and outings. You or your loved one will have companionship of other residents. You’ll have respect from the staff who provide the help you need. And you may have even more independence as you won’t have to worry about maintenance of your home, cooking, cleaning and other chores.
Independent Living provides a private room, usually 3 meals a day (some communities provide a meal allowance or a set number of meals per month), regular housekeeping, cable TV, all utilities, activities, transportation to stores and doctors and socialization. Rooms usually have full kitchens. This is a perfect choice for a senior who is still active and doesn’t need any personal care help but may be isolated at home and wants to be around people or is tired of cooking and home maintenance.
A big distinction between independent and assisted is that in independent living if a resident falls the staff will come to them and will call 911 for help. Staff in independent living are not licensed or trained to help people up from a fall. If somebody is “prone to falls” assisted living may be a better option.
Options for those who checked questions 3-8 above
Assisted Living includes everything in Independent Living (although the kitchen is a refrigerator and microwave only) but also provides access to a nurse, caregivers and med aides 24×7. This is an ideal option for somebody who needs help with medication management and personal care or who may be a fall risk. Caregivers can help with everything from putting on compression socks, helping with medications and dressing to showering, helping in the bathroom, escorting to meals and arranging doctor appointments. Assisted living communities can usually provide care through end of life although some may not be able to do very high levels of care such as Hoyer Lifts or help insulin dependent diabetics.
A resident in Memory Care must have a dementia diagnosis. Seniors with this diagnosis wouldn’t be safe behind closed doors and wouldn’t know to press a call or emergency button/pendant or pull a call cord if help is needed. It’s also for residents who may be “exit seeking” or “elopement” risks (they see a door and go out, potentially wandering away and getting lost) and those who need a lot more personal care and attention than they would get in assisted living. The doors in memory care are locked so residents are safe inside and can’t get out and get lost. There are courtyards for residents to get outside and often caregivers will take residents for walks or outings. In memory care ratio of caregivers to residents is smaller and activities are designed for those with cognitive impairment.
Adult Care Homes:
Adult Care Homes are ideal for seniors who need a lot of personal care and don’t care about or need the social aspects of assisted living. The homes are privately owned and operated. Only five senior residents live in the house, so residents get a lot of attention, care and love. Somebody is in the house 24×7 to ensure the residents always have somebody to help. Because the proprietors of adult care homes are with the residents all the time they notice small changes and can proactively seek medical help often avoiding hospitalizations. There are three levels of adult care homes, most are level 2 or 3. A level 3 care home can have a resident who are dependent” in four or more “Activities of Daily Living” (there are six basic ADLs: eating, bathing, dressing, toileting, transferring and continence). Adult care homes can provide very high levels of care through end of life in a home setting with a lot of expertise, compassion and love.
Nursing homes provide very high levels of care by certified medical professionals. There are doctors, RNs, MSWs, CNAs all available to help residents with all aspects of care. Nursing homes are very clinical and are expensive ($350-450/day). Often residents are encouraged to consider adult care homes as a less expensive