Living Options for Older People Run a Wide Gamut

Living situations come to the forefront as Finger Lakes residents worry about aging parents – or spouses, other older relatives, friends, even themselves. This segment of our four-part series focuses on options in senior life services.

Many older people are adamant about not moving to a nursing home. Luckily, many people do not need that level of care, even if staying in the family home is no longer viable.

Staying home
Recent trends in housing options for older people focus on “aging in place” or continuing care at home, making it possible to stay home safely and comfortably, even for those who need long-term health care and other support services. Services may include a care coordinator available 24 hours a day, some levels of nursing and assisted-living care: registered nurses, home-health aides, occupational therapists, meal delivery and preparation, and home-repair services. Services are billed on a monthly basis; members pay entrance fees.

If parents insist on staying in a current home but are not using a continuing care service, make the home safer by getting rid of throw rugs, rearranging furniture to reduce clutter and create clear paths, installing grab bars in bathrooms and handrails along staircases, getting an emergency call button that connects directly to an ambulance service (the local phone company should be able to help), and setting up regular daily phone calls or visits so someone would be found quickly after a fall or stroke. If you live out of town, make sure that friends and neighbors know how to reach you.

In-home assistance
Some older people can stay in the family home, or in a new one rather than a nursing home, as long as they have help with cooking, light housekeeping, bathing and dressing. A doctor’s office, local hospital social-work department or association, gerontology association, Area Agency on Aging, Visiting Nurse Association, religious affiliation, Meals on Wheels service, and family friends can help identify what is needed and how to find reliable providers. Never hire anyone to help in the home without checking references.
Newer trends

Many older people would be happy in a new place with fewer responsibilities, as long as they can still live life (mostly) their way. A current trend is “senior villages,” membership-based retirement groups that “mainly serve as one-stop-shops to join seniors in a community with the services they need to remain in their own home(s) as they age,” according to Leigh Anne Ott at the OurParents.com website and blog. “They also sometimes create services that don’t already exist.”

This model makes sure that people have everything they need nearby, and provides low-cost home, medical, shopping, and social services and activities. It is an outgrowth of Naturally Occurring Retirement Communities (NORCs), a movement to let older people stay in familiar neighborhoods.

Luxury apartment buildings often may not be seen as protecting against the risks of aging, but many have resources that mean older tenants can live comfortably without needing to do a lot of driving, resources like restaurants, fitness clubs and swimming pools, driver and cleaning services, small shops, and even doctors’ or dentists’ offices. Most let residents have home- and nursing-care aides, either live-in or visiting. Onsite management, front-desk, maintenance, and security staff mean not having to do risky maintenance tasks, and that someone will notice fairly quickly if there is a crisis.

A new residential community currently under construction in Rochester (St. John’s/Brickstone) will include some marketplace aspects and a mix of living space including apartments, townhomes, and one-story detached homes, and will be unusual because it will be a rental option.

Traditional options
Old friends are often the best incentive for at least thinking about moving from a beloved home. Ask your parents what their friends have done, and your friends what their parents have done, to cope with this stage of life; yours might be the last holdouts still in a family home, and you could find invaluable support in convincing them that it is time to make the move.

These are among the more-traditional options.

• 55-plus communities: developments or buildings for people aged 55 and older (one spouse of a couple can be younger), where children or grandchildren may visit.

• Senior Apartments (Section 202 Housing): apartments rented exclusively to seniors through a U.S. Department of Housing and Urban Development (HUD) program that gives grants to not-for-profit religious and civic groups to construct buildings; the main source of subsidized, low-income housing for seniors. At least one member of a household must be 62 or older; gross annual income limit is $22,000 for one person and $25,100 for two people.

• Shared Housing/Accessory Apartments: self-contained apartments in single-family homes for people who are comfortable with roommates or family members who are willing to accommodate older relatives or friends under the same roof; sometimes called “granny units.”

• Assisted Living Facilities (ALFs): alternatives to nursing homes for people who need light to moderate help with activities of daily living such as bathing, dressing and using the toilet. Many operate with or are associated with nursing homes. Usually include three meals a day. Criteria for admission vary; usually not open to people with dementia. Often require sizable, nonrefundable upfront investments and can be expensive per year. Not covered by Medicare, although Medicaid waivers may be used. Usually not licensed.

• Continuing Care Retirement Communities (CCRCs): full-service facilities, marketed as all-encompassing housing options under one roof or a “continuum of care” where people remain in the same setting as their health-care needs change. Most require one-time, upfront entry fee, usually nonrefundable; cost can be prohibitive.

• ECHO (Elder Cottage Housing Opportunity): a modular structure that can be placed temporarily on the property of a single-family home. No stairs, wheelchair-accessible, and can be customized to accommodate various disabilities; best for people with mild medical problems who can live independently, but want to be close to family or friends.

• Congregate Housing: separate apartments or rooms in a large or multifamily house, such as old-fashioned boarding houses, college dormitories and group homes; meals often shared in a central dining room; sometimes have shared living areas; costs typically low to moderate, depending on level of service.

• Nursing homes: for those who need full-scale nursing and other medical services, have serious health conditions or dementia.
Selecting a new home

Before committing to a new place for aging parents to live, get the inside scoop. Set aside time to take a tour of appropriate-looking options with your parents if they are up to it; plan to visit more than one place. If you live out of town, consider making a special trip and spending a week on just such visits. “We went on a two-week tour of every nursing home in Rochester,” recalled Victoria Brzustowicz, about finding a place for her mother recently.

Make a list of questions to ask at each community about licensing and staff turnover, training, and accreditation. Try to speak with a chief administrator and director of nursing if there is one, as well as residents.

The fourth and final article in the series will provide resources for adapting to this time of life.


by Ruth E. Thaler-Carter

Ruth E. Thaler-Carter is an award-winning freelance writer/editor who is co-author, with Jill R. E. Yesko, of The Who, What and Where of Elder Care: A handy, step-by-step guide to help navigate the maze of caregiving (Johns Hopkins University Press, 2006) and is looking after her mother in Rochester. Learn more about Ruth at www.writerruth.com.