Because We Care

Introduction

There are many times when it is not possible for a caregiver and care receiver to live together.

• The level of care that your spouse, relative or friend needs may require highly skilled health care personnel on a regular basis. In this case, an extended care facility, such as assisted living or a nursing home, may be a better care alternative.
  
• Your relative or friend may live in another town and does not want to move.
  
• There may not be room in your home, or family members, including your relative, may not want to live together.

Whatever the reasons, living in different housing does not mean that you cannot be a good caregiver. You and your relative will, however, need to make arrangements for additional help and/or services as needed--either in his or her present home or in a new housing arrangement.

Points to Consider When Choosing Housing and Living Arrangements

When providing services to older persons who have limitations in their mobility and multiple needs, the type of housing and living arrangements you choose become critical keys in assuring that they get the care they need. Housing and care in this instance go hand in hand. There are many types of housing arrangements available for older persons, and they often overlap in the types of care and services they provide.

Before making a housing choice, you and your older relative should assess present needs and envision, as best as possible, how these needs may change in the future.

What options will be open to you if the need for more supportive housing and living arrangements arises?

• Will your family member need to move to another care arrangement?
  
• Are these facilities available in the community, and how much will they cost?
  
• How are you going to pay for housing and services now and in the future?
  
• If you enter into housing that requires a substantial deposit at the time of admission, will some of the money be returned if your relative decides to leave?
  
• What guarantees do you have that the facility is financially secure?

You and your older relative will want to ask these questions before making a decision about moving into a new housing arrangement.  If this arrangement involves a large entrance fee or deposit or the signing of a contract, you also will want to consult a lawyer before making the commitment.

Guidelines for Choosing Housing Options

Regardless of what the facility is called, check it out thoroughly before making a decision. The types of facilities listed below range from informal home-share arrangements to commercial enterprises, government-sponsored facilities, and housing options administered by nonprofit organizations. Some are licensed or accredited, others are not.

• Accreditation is an evaluation of a facility’s operation against a set of standards. The Continuing Care Accreditation Commission--a membership organization of continuing care communities--is one such organization.
  
• Licensing is an evaluation of a facility’s operation in accordance with government regulations. About half of the states currently regulate assisted living facilities.
  
• Many skilled and intermediate care nursing facilities are accredited to accept patients under the Medicare and/or Medicaid programs, which means that they must meet certain standards and provide certain services.

Regardless of these considerations, you are responsible, in large part, for ensuring that the facility is the right one for your spouse, relative or friend.

Even if you are not thinking about housing options in the foreseeable future, it is wise to have several in mind in case an emergency arises and you need temporarily care for your relative. Home care agencies often do not have staff available to fill in on short notice, and you may need the services of a long-term care facility.

You can:

• Start your preliminary search by phone.
  
• Visit those facilities that have the services your care receiver wants and needs.
  
• Take your older relative to see the facility. Better yet, visit several and let your relative make the final choice, if at all possible.

If your relative is able to make sound decisions, and does not like any of the housing options or does not want to move into a facility after visiting several, keep looking or further explore the possibility of home care in her home or yours. Use a check list (this check list can be used as a general guide for all types of housing) to ensure that the housing arrangement is the right one for your relative.

Types of Housing and Living Arrangements

Listed below are types of housing and living arrangements, what they generally offer, and for whom they are intended. Added to these considerations are those of costs. While some housing options are modestly priced, others, especially those that are for-profit, tend to be expensive. You can go to the section entitled “How Can We Afford Long Term Care?” for information about government assistance programs for housing and care.

• Retirement communities are planned towns with a range of housing, services, and care options.
  
• Continuing care communities offer varying levels of care in the same building or on the same campus. When Selecting a Continuing Care Retirement Community or retirement community, remember they may encompass everything from housing for independent living to assisted living and skilled nursing home care. Therefore it may be difficult to identify what is offered simply because a facility has a certain name. These communities are usually designed for older persons with substantial financial resources.
  
• ECHO Housing is a self-contained housing unit temporarily placed on a relative’s lot that is suitable for older persons who are largely self-sufficient.
  
• Accessory Apartments are self-contained apartments in the care receiver’s home, your home or the home of another caregiver. Designed for older persons who may be largely self-sufficient or need help with housekeeping, cooking, and personal care—commonly referred to as activities of daily living (ADL’s).
  
• Shared Housing can be in the home of the older person or in some else’s home. Common areas, such as kitchens and dining rooms, are shared. This type of housing offers the older homeowner added income or the older renter an inexpensive place to live. It may offer companionship, and the possibility of having someone else around, at least part of the time, to help out with chores or in case of emergencies, but this depends on the persons sharing the house. This type of arrangement can work well for those elderly who are independent, but who would welcome a little extra income and/or help. It is important, however, to check the person’s references carefully before making a decision.
  
• Congregate Senior Housing usually offers small apartments. Some offer group meals and social activities. They are designed for persons who are largely independent and do not need personal care or help with activities of daily living.
  
  Adult Foster Care is usually provided in private homes--often by the owner of the residence. The home usually provides meals, housekeeping and sometimes personal care and assistance with ADL’s.
  
• Senior Group Homes are located in residential neighborhoods and offer meals, housekeeping, and usually some personal care and assistance with Activities of Daily Living (ADL’s). Usually a caregiver is on site, with medical personnel making periodic visits.

Both adult foster care and group homes may be referred to as Board and Care Homes or Residential Care Facilities.

• Assisted Living may provide everything, including skilled nursing care. Others provide only personal care, assistance with ADLs and/or social activities. These may also be called Retirement Homes or Residential Care facilities to name a few.
  
• Nursing Homes provide an array of services including 24-hour skilled medical care for total care patients; custodial care; therapy for patients convalescing from hospitalizations; and personal care and help with activities of daily living for persons with dementia, chronic health, and/or mobility problems.

Additional Resources and Reading Lists

Visit this site for information on the U.S. Department of Housing and Urban Development (HUD) housing programs for seniors.

National Organization Web Sites

This National Resource and Policy Center on Housing and Long-Term Care web site offers information on home modification, and government-supported housing programs for older persons as well as links to other useful sites.

This web site, produced by the Family Caregiver Alliance, includes a reading list and articles in the Fact Sheet section that discuss Out of Home Care Options and Assisted Living, as well as many other topics of interest to caregivers.

For additional information on various types of housing options go to the Senior Resource Senior Resource web site.

The American Association of Homes and Services for the Aging (AAHSA) web site describes the types of residences available, what to look for, and offers a search device for member facilities by community. The AAHSA sponsors the Continuing Care Accreditation Commission, which accredits qualified continuing care retirement communities.

The Assisted Living Federation of America (ALFA) is a national nonprofit trade association dedicated to enhancing the quality of life in assisted living residences and representing the interests of the assisted living industry.

The American Health Care Association (AHCA) is a professional organization that represents the interests of licensed nursing homes, assisted living, and sub-acute care facilities. This web site offers information on the types of facilities and how to choose one.

AARP is the largest membership organization of older persons in the U.S. This web page is the gateway to several pages on housing.

The National Hospice and Palliative Care Organization (NHO) promotes quality care for terminally ill patients and provides information about hospice services. Hospices provide medical care for dying patients, as well as counseling and supportive services for the patient and family members. The NHO web site provides information about hospices and performs a search for services in your area. Some hospices help families care for patients at home, some offer services in a hospice center, others are located in a hospital or skilled nursing facility. Many offer a combination of services within a single program.

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