What You Need to Know
Conversations surrounding senior housing options are rarely comfortable ones. All too often, the mere suggestion of leaving home seems to pit children against their parents – locking both in a struggle between the desire for independence and the choices that are in the best interests for all involved.
And while there’s no easy answer to major life decisions such as these, education can help. By understanding the serious issues faced by seniors in isolation, as well as familiarizing yourself with the numerous – and always-expanding – housing options that are available for those 55 years and older, you’ll be able to approach this delicate conversation from an informed, thoughtful place.
The Growing Problem of Senior Isolation
The question of senior housing is often posed as a pragmatic one. What level of care do seniors require, and who is available to provide it? Is there a child or family member nearby who can assist with care? If not, what financial resources are available to support aging parents?
All too often, seniors’ well-being is left out of the equation. While it’s common for aging adults to want to remain independent in their homes for as long as possible, emerging research described below suggests that they may pay a price due to the isolation inherent in this arrangement. And given that the U.S. Census Bureau estimates that 28% of people aged 65 and older lived alone (as of 2010), these are critically important concerns all families with aging relatives must consider.
Social isolation and loneliness in adults aged 52 and older are associated with a higher risk of mortality.
According to a 2012 study published in the Proceedings of the National Academy of Sciences, living alone puts senior citizens at a higher overall risk of dying from all causes. While there are many possible explanations for this effect, the absence of another housemate who would notice acute health symptoms at their onset is one likely factor.
Loneliness in seniors is correlated with long-term illness.
The same study cited above also associates the following conditions with loneliness and social isolation in seniors: arthritis, impaired mobility, depression and chronic lung disease. A further study published in Psychology and Aging in 2010 identified a direct link between elder isolation and unsafe increases in blood pressure.
Seniors who feel lonely have a higher risk of dementia.
Research conducted by Dr. John Cacioppo of the University of Chicago has found that feelings of loneliness are correlated with poorer cognitive performance and declines in cognitive function.
Seniors who experience loneliness are more likely to need long-term care.
Interestingly, a 2004 report published by the British Columbia Ministry of Health found that social isolation is one of the top predictors of seniors using home care or entering nursing homes.
Socially isolated seniors are more vulnerable to elder abuse.
The National Center on Elder Abuse cites a number of studies that demonstrate a link between senior isolation and higher incidences of elder abuse, potentially due to the fact that abusers are able to minimize their risk of discovery while working with isolated patients.
While living independently as a senior isn’t guaranteed to lead to these results, it’s important for families caring for aging elders to be aware of potential health and safety risk factors and to make decisions for their loved ones’ care with a full understanding of the options available.
Senior housing is no longer the institutional monolith it once was: a number of alternatives exist to suit residents at all ends of the care spectrum.
Senior Housing Options
What Is It? Assisted living communities represent the next level of care beyond independent senior apartments. Residents of assisted living facilities generally do not require the type of skilled nursing care offered at traditional nursing homes, but do need daily assistance with daily activities such as taking medication, preparing meals and maintaining hygiene. Assisted living facilities typically offer private apartments with kitchenettes, along with a staff that’s available 24 hours a day to support residents social programs, activities and exercises.
What Does It Cost? As in the case of independent senior living, the cost assisted living facilities varies with the amenities provided. Genworth lists the average cost of a one-bedroom assisted living apartment as $3,500 per month. Prices are also determined by whether the community charges a flat fee or “a la carte” prices based on the specific services required (state licensing and regulation requirements often dictate which services and care types can be offered).
Who Is It For? There are typically two groups of seniors that opt for assisted living: those who require the level of care they provide, and those who anticipate needing it in the near future. Because wait lists can be long, many prospective residents apply to their preferred facilities in advance of needing their services to increase their odds of securing a spot in the future.
How Do You Get Started? Any of the strategies described above for home care and independent living communities can be used to identify assisted living options in your area, including referrals from local resources and traditional ads. Due diligence is important here, as it is in all cases of senior care.
Residential Care Homes
What Is It? Residential care homes offer a similar level of support as assisted living facilities, but to a smaller number of seniors (typically fewer than 10) and often in a more home-like setting. Though they may offer fewer activities and amenities than traditional assisted living homes, they still retain 24-hour care and provide a more intimate, family-like experience.
What Does It Cost? As of 2014, Genworth reports that average costs run from $2,200 per month for a shared bedroom to $3,400 per month for a private bedroom. As with many of the other estimates found in this report, prices vary based on geographic region, the level of amenities offered and the amount of care required by the resident.
Who Is It For? Residential care homes are one possible alternative for older adults who feel overwhelmed by the thought of living in assisted living communities with dozens or hundreds of other residents. Those with social anxiety, agoraphobia or other mental health conditions, as well as those who simply prefer a smaller community, may do better in these more close-knit environments.
How Do You Get Started? Because residential care homes are not as widely available as traditional assisted living facilities, locating one may require some extra due diligence. As your current care team, state or local agencies, your caseworker or any other friends or relatives with older adults in your area. If you believe your loved one may benefit from a residential care home placement, begin asking around early; given their more limited nature, wait lists can be long.
What Is It? Nursing homes represent the most advanced level of care for senior citizens, apart from end-of-life hospice. In addition to supporting residents in their ADLs, including bathing, dressing, eating and housekeeping, nursing homes provide long-term medical care to seniors who are bedridden, wheelchair-bound or who require 24-hour monitoring and medical assistance for severe physical or mental health conditions.
What Does It Cost? Nursing home costs often depend on the length of the resident’s stay. Many residents remain in nursing homes for only short periods of time following hospitalization for an illness or injury (Medicare often covers these short-term stays for those who are eligible). The cost of longer-term stays are, on average, $212 per day for a semi-private room and $240 per day for a private room, according to Genworth. These averages may vary based on the size of the room offered and the geographic location of the facility.
Who Is It For? As described above, nursing home residents are those who either require short periods of rehabilitation following injury or illness, or those who need longer-duration, round-the-clock care for the management of severe, debilitating mental and/or physical health issues.
How Do You Get Started? The decision to move to a nursing home is often made in consultation with the senior’s medical team, as well as representatives from the senior’s assisted living community or home health care aid (as applicable). Nursing homes can be found through the same channels as assisted living facilities and should be evaluated just as thoroughly.
What Is It? Many assisted living facilities and nursing homes now offer separate memory care communities, which are secured by alarmed exit doors to prevent residents from wandering off and becoming disoriented. Though not available in all areas, most memory care programs include structured activities designed by those who have been specially trained to care for dementia patients.
What Does It Cost? Genworth estimates put the national average cost at $5,000 per month, with prices fluctuating by community from $2,000 per month up to $7,000 per month. These significant price variations can be attributed to the scope of services offered by the programs, their geographic locations and their reputability within the community.
Who Is It For? Patients experiencing Alzheimer’s and other forms of memory loss or dementia may benefit from placement within an embedded memory care community. Often, these facilities offer specialized programming – such as art and music therapy – in order to meet the unique needs of those suffering from memory issues.
How Do You Get Started? Memory care is often introduced as a “next step” in accordance with the progression of memory and thought disorders among patients in assisted living or nursing facilities; therefore, placement may be as simple as speaking to program management about the transition. Those seeking memory care for older adults who have been cared for at home can contact local and state agencies, their caregivers or caseworkers, or the directors of nearby assisted living or nursing home programs.
What Is It? An estimated 65 million Americans provide some level of care for aging or disabled loved ones. Respite care programs allow for short-term stays (typically, no longer than one month) at existing assisted living facilities to permit caregivers to travel or recharge, as well as to ease seniors requiring higher levels of support into residential communities.
What Does It Cost? Average costs range from $75 to $200 per day, though long-term care insurance policies may pick up some of the costs. Costs vary based on the length of the stay, the type of room supplied, the geographic location of the facility and the level of services provided.
Who Is It For? Respite care serves an important function for seniors who remain at home under the care of either family or professional caregivers by providing support in the event caregivers are taken away from their duties, due to vacations, business travel or the need for personal rest and relaxation. Caregiving is a demanding undertaking, and respite care can provide the temporary relief needed for caregivers to avoid the negative consequences associated with caregiver burnout.
How Do You Get Started? Respite care is typically offered at assisted living facilities, though independent programs may be operated by local elder care agencies or caregiving programs. Enrolling a resident in a temporary respite stay can be initiated by reaching out to the program’s intake line for more information.
What Is It? Surprisingly, this senior housing option described here isn’t a residence-based alternative at all. Indeed, many seniors are able to remain in their homes with the support of qualified nursing staff who may assist with such activities as bathing, dressing, preparing meals, providing transportation assistance or offering emotional and social support. Some home care providers may also support elders in paying bills and making appointments, though these tasks are typically handled at the family’s discretion.
What Does It Cost? According to Genworth.com, the median cost of home care in 2013 was $20 per hour. Medicare may cover part of the cost of home care, but typically only if it’s provided in conjunction with nursing care or other skilled care, such as physical therapy, occupational therapy or speech-language pathology services.
Who Is It For? Home care schedules may range from a few hours a week to 24-hour care, though most families that require such intensive care will likely find a residential program to be a more cost-effective alternative. Ideal candidates for home care include those seniors that are still able to live relatively independently, but need some level of assistance with activities of daily life (ADLs).
How Do You Get Started? You may be able to obtain referrals for home care through the senior’s doctor, through other families, through local community organizations dealing with elder issues, or through nursing homes in your area. As with any professional who would be working alone in a loved one’s home, be sure to carefully check references and background checks before hiring a home health care aid.
Adult Day Services
What Is It? Essentially “daycare for adults,” these programs offer half-day or full-day activity programs outside of the home for senior citizens, which may be particularly beneficial in mitigating social isolation and in providing a much-needed break for full-time familial caregivers.
What Does It Cost? The average cost, according to Genworth, is $65 per day. Prices vary based on whether half-day or full-day programs are elected, the activities involved and the level of participant care required.
Who Is It For? Adult day service programs are typically intended for older adults who remain in their homes, but who enjoy the social aspect of joining together with others on a temporary basis. They can be equally as beneficial for family caregivers in providing needed respite without compromising the loved one’s care.
How Do You Get Started? Local or state elder care resources can refer you to adult day service programs, as can your doctor’s office and internet search engines. Vet adult day services as thoroughly as you would infant and child day care programs for your children. Pay particular attention to negative reviews or any state regulatory violations to ensure safe care for your loved one.
Independent Senior Living Communities
What Is It? Independent senior living communities – also referred to as retirement communities, senior apartments and active senior living – resemble traditional apartments, townhomes or condo communities, with the simple restriction that all residents be above a certain age (typically either 55 or 62). Apart from the housing itself, amenities offer typically include meals prepared in a common dining room, periodic housekeeping, maintenance and repairs, utilities, and activities and entertainment.
What Does It Cost? Prices for independent senior living communities vary based on the type of property. Some are quite spartan, while others are luxurious in styling. The size of the unit being rented also impacts its price, though Genworth put the average cost of a one-bedroom senior apartment at $2,750 per month in 2014. Many such facilities rent for significantly less when fewer amenities are offered, and some subsidize rent based on the senior’s income.
Who Is It For? Independent senior living communities are best suited to older adults who are generally self-sufficient, but who prefer the companionship of living with others their own age. Active retirees and those who seek a simplified style of living where all cooking, cleaning and maintenance needs are handled are ideal candidates.
How Do You Get Started? Many independent senior living communities advertise through traditional means, such as newspaper ads, TV ads, radio ads, local magazine ads and billboards. You may also be able to locate programs in your area using the state-specific agency contact list at the end of this guide.
As with any major life decision, careful consideration and proper planning are of the utmost importance. Rather than acting rashly, take the time to gather recommendations and research existing options. If possible, carry out your planning well in advance of your loved one’s anticipated need for housing options in order to secure necessary waitlist placements and/or to prepare thoroughly for a smooth transition.
As you prepare to transition an aging loved one into a senior housing program, you may find any or all of the following resources helpful:
Senior Living Resources:
- Alzheimer’s Association
- Ask Medicare
- Association of Retired Persons (AARP)
- Center for Excellence in Assisted Living
- Government Benefits Eligibility
- Centers for Medicare and Medicaid Services
- Eldercare Locator
- Elders and Families
- National Clearinghouse for Long-Term Care Information
- National Center for Injury Prevention and Control
- National Council of Certified Dementia Practitioners
- National Institute on Aging Information Center
- CareSprout Assisted Living
- National Association of Professional Geriatric Care Managers
- National Association of Social Workers
- National Adult Day Services Association:
- National Academy of Elder Law Attorneys:
- Planning for Move-Out
- Caregiver Resource Directory
- Connect With Other Caregivers
- eCare Diary
- Family Caregiver Alliance
- Family Caregiving 101
- National Alliance for Caregiving
- SeniorCare Organizational Systems (SOS)
- Working Caregiver Online Community
- Paying for Senior Care
- American Association of Daily Money Managers
- Reverse Mortgages
- Compare Living Options
- Home Health Care
State-Specific Resource Listing
Compiled by the Assisted Living Foundation of America (ALFA), the following list of state level chapters and affiliates provide local sources of information regarding state-specific licenses, regulations and available programs:
President: Frank D. Holden
5921 Carmichael Rd
Montgomery, AL 36117-2518
PO Box 230968
Montgomery, AL 36123-0968
Phone: (334) 262-5523
FAX: (334) 262-4603
President: Karen Barno
2345 E. Thomas Road, Suite 290,
Phoenix, AZ 85016
Phone: (602) 322-0100
FAX: (602) 322-0118
Executive Director: Kent Schroeder
692 Honeysuckle Ln
Cabot, AR 72023-8276
Phone: (501) 941-2075
FAX: (501) 941-2075
President: Sally Michael
455 Capitol Mall Ste 222
Sacramento, CA 95814-4439
Phone: (916) 448-1900
FAX: (916) 448-1659
President & CEO: Laura Landwirth
303 E. 17th Avenue, Suite 880
Denver, CO 80203
Phone: (303) 837-8834
FAX: (303) 837-8836
President: Christopher Carter
100 Halls Road
PO Box 483
Old Lyme, CT 06371
Phone: (860) 434 5760
FAX: (860) 434 5790
Contact: Gail G. Matillo
9445 Buck Haven Trail
Tallahassee, FL 32312
Phone: (850) 296-ALFA (2532)
President/CEO: Genia Ryan, CAE
2023 Grayson Highway, Suite 202-A
Grayson, GA 30017-4139
Phone: (678) 407-2060
FAX: (678) 407-2002
Interim President: Karen Messer, MS
1001 Warrenville Rd., Suite 150
Lisle, IL 60532
Phone: (630) 325-6170
FAX: (630) 325-0749
Executive Director: Liz Carroll
5460 Bearberry Lane
Indianapolis, IN 46268
P.O Box 68829
Indianapolis, IN 46268
Phone: (317) 733-2390
FAX: (317) 733-2385
Executive Administrator: Shellie Petek
9001 Hickman Rd, Ste 220
Des Moines, IA 50322
Phone: (515) 278-8700
FAX: (317) 733-2385
Executive Director: Robert White
133 Evergreen Road, Suite 212
Louisville, KY 40243
Phone: (502) 225-5201
FAX: (502) 225-5206
Executive Director: Sharla Aloisio
PO Box 10258
New Iberia, LA 70562
President: Isabella Firth
10280 Old Columbia Rd Ste 220
Columbia, MD 21046-2382
Phone: (410) 381-1176
FAX: (410) 381-0240
President: Michael Banville
135 Beaver Street, Suite 202
Waltham, MA 02452
Phone: (781) 622-5999
FAX: (781) 622-5979
General Counsel: Kathleen Murphy, Esq
15441 Middlebelt Rd
Livonia, MI 48154-3805
Phone: (734) 525-0831
FAX: (734) 525-2453
Toll Free: (800) 482-0118
President/CEO: Gayle Kvenvold
2550 University Ave W Ste 350South
Saint Paul, MN 55114-1907
Phone: (800) 462-5368 or (651) 645-4545
FAX: (651) 645-0002
Executive Director: Keith Sappington
2407 B Hyde Park Road
Jefferson City, MO 65109
Phone: (573) 635-8750
FAX: (573) 634-7344
Executive Director: Rose Hughes
36 S Last Chance Gulch St Ste A
Helena, MT 59601-4126
Phone: (406) 443-2876
FAX: (406) 443-4614
Executive Director: Walter Perry
53 Regional Dr., Suite 1
Concord, NH 03301-3520
Phone: (603) 228-1231
FAX: (603) 228-2118
Toll Free: (800) 544-0906
Director-Division of Assisted Living/Alternative Care: Kathy Fiery
4 Aaa Dr Ste 203
Hamilton, NJ 08691-1803
Phone: (609) 890-8700
FAX: (609) 584-1047
Directors: Nancy Hodes and Ginger Landy
284 State St
Albany, NY 12210-2194
Phone: (518) 465-8303
FAX: (518) 465-8320
Executive Director: Frances Messer
3392 Six Forks Rd
Raleigh, NC 27609
Phone: (919) 467-2486
FAX: (919) 467-5132
Executive Director: Jean Thompson
1335 Dublin Rd Ste 221B
Columbus, OH 43215-7013
Phone: (614) 481-1950
FAX: (614) 481-1954
Executive Director: Melissa Holland
P.O. Box 18576
Oklahoma City, OK 73154
Phone: (405) 235-5000
FAX: (800) 375-6788
Director of ALF/RCF & Quality: Linda Kirschbaum
11740 SW 68th Pkwy Ste 250
Portland, OR 97223
Phone: (503) 726-5260
FAX: (503) 726-5259
Executive Director: Jeremy Adlon
105 North Front Street, Suite 106
Harrisburg, PA 17101
Phone: (717) 695-9734
Fax: (717) 695-9735
Executive Director: Kathleen Kelly, MA Gerontology
2224 Pawtucket Ave
East Providence, RI 02914-1716
Phone: (401) 435-8888
FAX: (401) 435-8881
Executive Director: Nina Buckelew
PO Box 1763
Columbia, SC 29202
Administrative Director: Lethia Marienau
PO Box 818
Yankton, SD 57078
Phone: (605) 679-4606
FAX: (605) 679-4605
Executive Director: Martha M. Gentry
611 Commerce Street, Suite 2702
Nashville, TN 37203
Phone: (615) 256-2376
Executive Director: Gail Harmon
4505 Spicewood Springs Rd., Suite 250
Austin, TX 78759
P.O. Box 684642
Austin, Texas 78768
Phone: (512) 653-6604
FAX: (512) 342-2858
Executive Director: Corey Fairholm
3042 Wilkins Peak Ct
South Jordan, UT 84095-8473
Phone: (801) 569-2240
FAX: (801) 569-2256
Executive Director: Judy Hackler
PO Box 71266,
Henrico, VA 23255
1403 Pemberton Road, Suite 304,
Richmond, VA 23238
Phone: (804) 332-2111
Executive Director: Nancy Cartmill
1704 Central Ave
Barboursville, WV 25504-2116
Phone: (304) 736-9594
FAX: (304) 736-7040
Executive Director: Jim Murphy
PO Box 7730,
Madison, WI 53707-7730
1414 MacArthur Rd,
Madison, WI 53717
Phone: (608) 288-0246
FAX: (608) 288-0734
Have another resource that you’d like to see included on this list? Leave a comment below so that all who are seeking information about senior housing options can benefit: