Last week we looked at tips for navigating long-term care options to support living at home. Successfully managing care at home depends on many factors, including finances, health status, transportation, mobility, a supportive physical environment, a willingness to accept care, and having a realistic view of the care needs.
There may come a point when the person in your care can no longer be safely and adequately cared for at home. For example, when your parent has a progressive health condition such as Alzheimer’s disease or Parkinson’s, there may come a time when the care needed at home exceeds your capacity to support them safely.
Be prepared for this reality; it’s never too early to research, visit, and reflect in preparation for a possible move. It’s always best to be proactive.
You also need to consider yourself. Too often family members neglect their own needs and health when caring for a parent or other older loved one. Self-care is essential. Making your own health a priority helps you to help others. You may find this article encouraging: Ten Tips You Should Know to Manage Caregiver Stress.
When care at home is no longer working
Why care at home can fail
- When your home is not optimized for safe mobility and overall accessibility
- Care needs are increasing and/or challenging (due to medical complexity or behavioral/mood disturbances) and difficult to manage in a home environment
- Cost of care and support is unsustainable
- Transportation outside of the home is more challenging
- Social isolation (for person receiving care and spouse/family member)
- Excessive family caregiver burden
When care at home is no longer working, it’s time to look at alternatives to home — supportive care environments.
Alternatives to Home
- Continuing Care Retirement Community (CCRC)
- Assisted Living
- Memory Care
- Adult Family Home (AFH)
- Skilled Nursing Facility (SNF)/Nursing Home
Senior housing and long-term care communities can be a refreshing and affordable alternative to living at home. In addition to the safety and security of a community that is staffed 24/7, there are wonderful health, social, and mental benefits to a congregate setting.
Our team of Certified Care Managers spend a lot of time visiting clients in their homes as well as in all these settings. We’ve watched clients’ lives be transformed by a move from a single-family home. At home, mobility issues and design of their homes can often present a challenge.
A move to the right long-term care community offers nutritious meals, well-designed buildings that accommodate a change in mobility, and social activities and engagement that open their world to new friendships and enrichment.
Continuing Care Retirement Community (CCRC)
You move into a CCRC as an independent resident and if you need more support over time, there are different levels of care within that building or campus that can support you over a continuum. CCRCs typically include Independent Living, Assisted living, Memory Care, and Skilled Nursing. Some include Short-term rehab.
CCRCs are usually high-end communities with lots of amenities. They require a buy-in or entry fee ranging from $300,000 to $1 million. This is in addition to your monthly maintenance or service fee. Each CCRC offers different contracts. It’s important to understand the type of contract, what is covered, and if cost will increase as your needs change.
If the person you are supporting already needs care, they may not be a candidate for this setting.
Assisted Living
Assisted Living is housing designed for individuals who need support with various levels of personal and medical care. Assisted living can benefit those needing assistance with transferring or functional mobility (transferring from bed to wheelchair, for example), showering or bathing, toileting, dressing, personal hygiene, and meal preparation, as well as medication management, housekeeping, laundry, transportation, and socialization. Those with early stage to moderate stage dementia may also be appropriate for this setting.
There’s lots of variability from one assisted living to the next in terms of the care they can and cannot provide. It’s important to ask very specific questions that apply to your family’s situation. In Washington state it is a requirement that every facility provide a Disclosure of Services that clearly outlines what that facility does and does not provide. Sometimes it’s a starting point and helps you know where to ask more questions.
Costs highly variable. Most will have a one-time community fee of $3K to $50K. Costs for the apartment + care can be $6K-$12,000/month. There are a limited number of Memory Care communities that accept Medicaid and wait lists are common for the Medicaid licensed rooms.
Some of the limiting factors at communities that provide lighter Assisted Living support that we’ve seen specific to care needs includes:
- Transfers, also called functional mobility: how much help someone needs getting from bed to chair or standing.
- Incontinence care.
- Physical help with feeding or accommodating a modified diet.
- Challenging behaviors related to dementia.
- Diabetic management
Memory Care
Memory Care is specifically designed to provide a safe, supportive, and structured living environment, be it a stand-alone community or a separate unit within assisted living or a CCRC. Staff provide support with activities of daily living, medication management, and meals, just like in assisted living, but are specially trained to support individuals living with Alzheimer’s or another dementia. Staff provide added structure and extra assistance for those with middle stage to advanced dementia. Staff also offer social engagement and life enrichment activities.
While units or communities are often secure to protect residents, many offer enclosed exterior spaces for walking, access to greenspaces, gardening activities, fresh air, and sunshine. Others have circular interior walkways with supportive handrails, and windows offering comforting views of nature.
Costs highly variable but likely in the $7-$12,000/mo range. There are a very limited number of Memory Care communities that accept Medicaid and wait lists are common for the Medicaid licensed rooms.
Adult Family Homes (AFH)
Adult Family Homes are residential homes licensed to care for up to six non-related residents. They provide room, board, laundry, necessary supervision, and necessary help with activities of daily living, personal care, and social services.
The adult family home model has created a space for people to get a high-level of care, but in a comfortable home-like setting. AFH are especially wonderful for residents who would benefit from more one-on-one support and a calmer environment due to either advanced illness and/or dementia.
AFHs in our area range from $7 to $12,000/month. Some offer conversion to Medicaid after a period of private pay (i.e. “Medicaid spenddown). There are more AFH options for Medicaid spenddowns than the other settings described above.
Skilled Nursing/Nursing Homes
Skilled Nursing, also known as Nursing Homes, are for individuals that have ongoing physical or mental conditions that require constant care and supervision or need rehabilitation following a hospitalization. Their services focus on medical care. These services typically include nursing care, 24-hour supervision, three meals a day, and assistance with everyday activities. They provide physical therapy, occupational therapy, speech therapy, and medical oversight. The goal of rehab is to get patients back to their baseline and stabilize them so they can move on to the next step. Rehab is typically a Medicare-covered stay, following a hospitalization.
Many who live in a skilled nursing facility long-term are either relying on Medicaid funding or paying privately at $500+ per day.
How do you choose the right community?
Picking the best environment is important. It can also be daunting. And just like searching for home care and professional caregivers, an online search will provide hundreds if not thousands of choices. How do you narrow down the options?
As I shared earlier, we regularly visit clients at who are residents in many different long-term care communities through out King and Snohomish Counties. We have extensive knowledge of long-term care communities, including assisted living, rehab and nursing home facilities, adult family homes, and specialized memory care services. We can also advise on costs and quality of care when evaluating options.
Our Care Managers also understand the more nuanced needs of a client’s well-being and enhance quality of life, and which communities would be the most supportive for your parent’s unique circumstances, goals, and personality.
Time to begin planning for a move? We have the knowledge and expertise to help guide the journey. Click here to schedule a free, get-acquainted call with one of our Certified Care Managers.
You may also enjoy this online course we created — Should I Move Mom? – to help you further understand the options and build confidence in helping an older loved one to move to a retirement community or stay at home.
*We use the Genworth Cost of Long-Term Care survey as a baseline for median long-term care costs.
