Living Options for Older People

Reasons Older People Evaluate Living Situation and Consider Alternatives

  • House & yard maintenance – more than you want
  • Living alone is isolating and inconvenient
  • Health problems make independent living a struggle
  • No longer driving
  • Require significant help & can’t afford in home care

What You Should Know

  • There are many living arrangements and housing possibilities
  • The range of options is constantly changing
  • Learn about your choices and consider alternatives
  • Evaluate the best option for you and your family
  • Narrow the choices by…
    • Knowing your preferences – or those of your love one
    • Understanding level of need for assistance
    • Reviewing financial resources

Living Options: Factors to Consider

  • Amenities
    • Style of living wanted?
    • Level of comfort desired?
    • Attractive and in good repair?
    • Availability & desirability of meals?
  • Location
    • Is it convenient?
    • A safe neighborhood?
    • Reasonably close to family members?
    • Transportation accessibility?
  • Quality of Care
    • Do current residents…..
      • …appear to have needs met?
      • …seem content?
      • …interact with staff and owners?
    • Do staff & residents interact with respect?
    • What is staff-to-resident ratio?
    • Staff training?
    • What do current residents/families say?
  • Policies
    • Are there restrictions on behavior (alcohol/smoking)?
    • Pets allowed?
    • Guests welcome? (including overnight)
    • Formal visiting hours?
    • Flexibility in meal times?
    • In a shared setting, how are responsibilities determined?
    • How are rate increases handled?
  • Safety
    • Are there requisite safety equipment (ie; smoke detectors or fire extinguishers)?
    • A sprinkler system?
    • Sanitary conditions?
    • Secure doors and locks? Emergency call service? Someone on duty 24 hours?
    • Around the clock nurse?
    • Safe accessibility for those with physical disabilities?
    • Medications and medical care handled properly?
  • Business Practices
    • Is facility currently licensed and operating legally?
    • Has facility license ever been revoked?
    • Any recent inspection reports?
    • Can you get references?
    • Transportation offered for appointments and shopping?
    • Review activities calendar – outings?
    • Freshly cooked meals? Snacks provided?

Housing Possibilities

Independent Living (or minimal assistance)

  • Modification of existing home
  • Senior Retirement Communities
  • Home-sharing
  • Accessory Apartments
  • 55+ Communities
  • Continuing Care Retirement Communities (CCRC)

For Those Needing Assistance with Everyday Activities

  • Existing Home with In – Home Care
  • Retirement Communities with In- Home Care
  • Assisted Living
  • Small Residential Group Homes
  • Nursing Homes

Definitions and Overview

Senior Retirement Communities


  • More often referred to as Independent Living, Congregate Living or Senior Apartments
  • Designed for independent senior adults who want
    • to enjoy a lifestyle filled with recreational,
      educational and social activities with other
      seniors, or
    • for seniors able to live on their own, but desire
      the security and conveniences of community
  • Communities generally provide meals, local transportation, planned social activities, laundry facilities, etc.
  • Can be “Age Inclusive” or “Age Exclusive”

Cost/Payment Options:

  • Price generally dependent on local market
  • All private- pay, but some senior apartments subsidized
  • Plans can include meals, housekeeping &/or transportation


  • These communities not licensed – no formal regulations
  • Rules often set & governed by management company


  • Health care not provided with your normal fees
  • May bring in home health aide or nurse for assistance
  • Some communities now offering fee-for-service, contracted non-medical home care by private companies

Assisted Living


  • Provides special combination of residential housing, personalized supportive services & usually healthcare
  • Purpose is to maximize independence
  • May offer same services as Independent Living, with added assistance of personal care and transportation
  • Transportation to medical appointments – standard
  • Meals– at least one time daily – standard – may or may not include kitchenette
  • Designed to meet the needs of those requiring help with activities of daily living
    • ADL’s – Feeding, dressing, bathing, transfers, toileting, ambulation and often medication management
  • These communities are often free standing, but sometimes affiliated with a CCRC, a Retirement community, or a Nursing Home.


  • Although level of care varies, most provide assistance with dressing, grooming, bathing, and other daily activities
  • Most larger facilities provide round-the-clock nursing services but not all

Cost/Payment Options:

  • Prices depend on the number of services provided; base price plus a la carte services
  • Most plans include meals, laundry, housekeeping (although meals may be limited)
  • Private Pay only – some long-term care insurance policies may cover Assisted Living


  • Facilities are regulated and licensed at state level.
  • No Federal regulations exist

Small Residential Group Homes


  • Designed for seniors requiring more care than available in Assisted Living but 24 hr. nursing not necessary
  • Also designed for seniors who prefer a more home-like setting in a residential neighborhood
  • Homes typically house 8-10 seniors in single or double rooms


  • Staffing may be 1 to 4 during day time hours
  • Awake staff at night
  • All meals provided
  • Transportation often NOT provided
  • Typically will not do two person assists


  • Often licensed and regulated by the State
  • Some States require licensing only if 3 or more residents
  • Typically no nurse on call

Nursing Homes


  • Designed for seniors who are in need of 24-hour nursing care
  • Facilities provide many of same residential components mentioned, ie; room and board, personal care, protection supervision –may offer other types of therapy
  • Onsite medical staff sets facilities apart from other types of senior housing


  • 3 levels of care provided –
    • Basic Care; required to maintain ADL’s. Includes personal care, supervision and safety.
    • Skilled Care; requires the services of a RN for treatments and procedures. Also includes professional specialties
    • Sub- Acute; Comprehensive inpatient care designed for acute illness, injury, or chronic illness. This care generally more intensive and requires frequent patient assessment/review


  • Licensed and regulated by State Departments of Public Health and individually certified by State for Medicare and Medicaid.
  • Health care is supervised and authorized by a physician.
  • They must also meet federal requirements.

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