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Work Life

The Handbook of Elder Care Resources for the Federal Workplace

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Housing Options

ECHO Housing

If you and your parent don't wish to live together, having your parent live in a cottage on your property might be a workable alternative. Elder Cottage Housing Opportunity (ECHO for short) units are small, self-contained, portable housing units that can be placed in the back or side yard of a single family house. They were first manufactured in Australia to enable parents to remain near their adult children and families. ECHO units provide closeness, while retaining privacy for both parties. The cost of ECHO housing is less than a new home. For example, companies in California and Pennsylvania offer completely installed one-bedroom units with more than 500 square feet of living space for around $25,000.

Consider these issues:

  • Do zoning laws restrict this type of structure? Check with your local zoning or planning board.
  • Is there adequate yard space for both structures?
  • What will the local tax treatment be? Will it add to the value of your property?
  • Are utility hook-ups available?

Board and Care Homes

Board and care homes go by many names (including personal care homes, residential care facilities, assisted living, and domiciliary care). In exchange for rent, generally they provide room, meals, laundry and house-keeping, and regular contact with staff to ensure that "all is well." The daily contact with staff is what distinguishes "board and care" homes from the more familiar boarding houses. Your parent would share this home, of course, with a number of other residents.

Visit the home with your parent before a decision is made. Look at the private room your parent may occupy. Ask lots of questions about the services and evaluate the staff. Ask for references and check the home's record with the local or State licensing agency.

Consider these issues:

  • Will your parent have privacy and independence?
  • Is common space available?
  • How much will it cost, including add-ons to the rent?
  • Is it near public transportation, places of worship, and shopping?
  • Can your parent's special dietary needs be met?
  • Does the home comply with local licensing, fire, and zoning laws? Is it licensed by the State?
  • What are the arrangements for sharing bathrooms?
  • Will your parent have to climb stairs?
  • Are there security locks on each room?
  • Will your parent have access to a telephone?
  • Are pets allowed? Who will care for them?

Congregate Housing

Congregate housing is usually an apartment complex that provides each tenant a full apartment, serves meals in a central dining room, and provides housekeeping services. It is different from board and care homes because the individual units include kitchens and because it provides a professional staff that may include social workers, counselors, or nutritionists.

Today, most congregate housing facilities are sponsored by non-profit agencies and range in size from 35 to 300 living units. You may find congregate housing facilities listed under "Retirement Communities" in your local telephone directory.

The rents vary, and Federal subsidies often help cover a portion of rental fees.

Consider these issues:

  • Is transportation to stores, places of worship, and other services available?
  • Can the facility accommodate your parent's special dietary needs?
  • Is there adequate security for your parent's personal belongings?
  • What in-house services are available? Look for services such as occupational and physical therapy, counseling, recreational and social activities, a library, and daily telephone monitoring.
  • Do services like physical therapy cost extra? Be sure to check for all costs in advance.
  • What is the policy on bringing personal furniture?
  • Are pets allowed?
  • How does your parent feel about the overall atmosphere of the facility?

"Life Care" or Continuing Care Retirement Communities (CCRCs)

Continuing care communities offer the benefit of independent living in apartments and houses, but with health care services and a nursing facility on the premises. Payment for nursing care and many other services is sometimes made in advance.

The cost of a continuing care community can be high. The entrance fee can range from $50,000 to $250,000 (which may or may not be refundable) and you must also pay monthly fees (that can increase while you are a resident).

The difference between a continuing care community and board and care homes or congregate housing is that continuing care communities provide a commitment to take care of residents regardless of any changes in their health, for as long as they reside in the community.

If your parent is considering a move to a continuing care community, BE CAUTIOUS. Some continuing care communities have financial problems. You may wish to review the facility's financial statement with an attorney or accountant and note its cash reserves and its policy for using them. Check with the local or State Long-Term Care Ombudsman and the Better Business Bureau or the Consumer Protection Office in the CCRC's locality to be sure it has not generated complaints of any kind.

Consider these issues:

  • How complete is the nursing facility? What services does it provide?
  • What medical costs does the contract cover?
  • What is the policy for transferring residents between apartments and the nursing facility?
  • Is the management open and responsive to resident concerns?
  • Do the fees cover all of your parent's costs?
  • Does your parent have to pay extra for anything (such as laundry)?
  • Are places of worship nearby?
  • Is transportation to needed services, like grocery stores, available?
  • Is there access to a telephone?
  • What is the refund policy for deposits and entrance fees? How is the amount of the refund calculated? When is your parent entitled to receive a refund?
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