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Caregiving Forum Most people prefer to age in place comfortably, but resources are not always available in every community to make sure that happens.

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Assessing Housing Options

Leo is the only child of elderly Chinese immigrants who came to the United States in 1969 when he was two years old. His father, now 87, and mother, 76, have lived in the same apartment in San Francisco's Chinatown for 27 years. Leo lives on the East Coast.

"My parents are modest, stoic people, not financially well off," says Leo. "In recent years my dad has had major surgery and my mother has had a heart bypass. My father also has mild dementia. We're fortunate that he qualifies for a senior health care service that allows him to continue to live at home. The service includes an adult day care program. Three times a week, he is picked up and taken to the center, which provides breakfast and lunch, hosts activities like mah-jongg, and schedules his medical appointments and therapy. Someone from the center also comes to the apartment every morning to help him with his medication. Because he is eligible for Medicare, Medicaid, and Supplemental Security Income benefits, the costs of his care are covered. I speak with the social worker there quite a bit to monitor what's going on with my father."

Adapted from Caring for Your Parents

Older parents like Leo's may soon need to consider alternatives to how they live. But they may be reluctant to leave a long-time residence and give up some independence. Ultimately it's got to be their decisions. What you can do is help them review their options.

Use the long-term care calculator to find out how much different care options will cost.

What Are the Options? The good news is that older adults have plenty of choices, such as:

  • Move In With Adult Children Parents may move into the adult child's home, live in an accessory apartment attached to it, or stay in an Elder Cottage Housing Opportunity (ECHO), a temporary cottage put up on the adult child's property.
  • Homesharing In this option, two or more unrelated older people share a house or apartment. Each usually has his or her own bedroom, but they share the kitchen, other living space, and sometimes the bathroom. They share household chores too. Sometimes an older homeowner who prefers not to live alone or who needs the income rents rooms to other older persons. Some homesharing occurs when the older homeowner shares the home with someone in exchange for assistance with cooking, cleaning, and other chores. Some larger homes are sponsored by faith-based or community groups. Shared housing usually costs less than other rental options. While public assistance will not typically cover the rent or shared expenses, people sometimes contribute chores as a share of their rent.
  • Foster Care Some families will take in an older person who needs help with daily living. The foster family cooks meals and handles laundry. Ideally, the older adult becomes a surrogate family member and receives emotional support and companionship as well. Supplemental Security Income (SSI) may cover the cost of foster care.
  • Board and Care Homes In these homes, the residence provides room, meals, and help with daily activities. It's an attractive option for folks who need some assistance. In general, board and care homes are smaller in scale than assisted living residences. But they're not always licensed, and aren't always monitored by local authorities. In some states, board and care homes can provide some nursing services, but they are not medical facilities.
  • Congregate Housing/Senior Retirement Communities Call these senior retirement apartments. Residents who are mobile and can take care of themselves live in their own units in buildings but share some meals in a central dining room and take advantage of housekeeping services. The residence often provides a variety of social and recreational activities. Rental fees vary widely, and meals and other services cost extra. There is usually no entrance fee. Some residences receive public subsidies that help keep rents down, but these places often have long waiting lists and stringent income requirements.
  • Assisted Living Residences These residences provide housing for those who cannot live independently but don't need skilled nursing care. The level of assistance varies among residences and may include help with bathing, dressing, meals, and housekeeping. Costs at assisted living residences vary sharply depending upon the services required.
  • Nursing Homes The most widely recognized option, these residences offer skilled nursing care and substantial long-term assistance. These homes provide medical and personal care and meals. Bedrooms and baths may be private√≥although only for private-pay residents√≥or shared. Medicare may provide brief, short-term coverage following a hospitalization. Medicaid may offer coverage to residents who meet medical and financial eligibility requirements.
  • Continuing Care Retirement Communities These facilities provide a variety of housing options and services located on the same campus. These communities are designed to meet the changing needs of older people. A common scenario involves the older resident, who starts out living independently in a separate apartment, moving to an assisted living unit when he or she needs help with daily activities. Residents can stay periodically in the nursing unit when they need ongoing skilled nursing care. Prices vary, and this option may not work financially for some older people. Be ready for a sizable entrance fee and monthly charges.
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Inform Yourself While the choices may seem overwhelming, your parents' desires, finances, and degree of need will help narrow the focus. Here are some factors to consider when making your decision:

  • About the Business Questions to ask: Is the facility currently licensed and operating legally? Has its license ever been revoked, and why? Are recent inspection reports available? How long has it been in business? Are financial records available? What about references?
  • About the Quality Questions to ask: Do current residents look like they have their needs met? Do they seem to be content and interact well with the staff and owners? Do staff and residents treat each other with dignity and respect? Do staff take the time to listen and respond to residents' needs? What is the staff-to-resident ratio? Are residents' rights posted? What training does the staff receive? What do current residents or their relatives say about their care?
  • Most Important, Safety Questions to ask: Does the facility have requisite safety equipment, such as fire extinguishers and smoke detectors? Is there a sprinkler system in the larger facilities? How's the sanitation? Are doors and locks secure? Is someone on duty 24 hours a day, or is there an emergency call service? Is a doctor available around the clock? Are there obvious hazards? Is medical care handled professionally? Can those with physical disabilities get around the facility?
  • Amenities Questions to ask: Is the facility attractive and in good shape? Does it have the style of living desired, such as a private apartment, private room, and private bath? Is it comfortable enough, with conveniences such as equipment, electronics, gardens, and adequate space for entertaining or hobbies? What meals are provided, and is the quality and quantity up to par? More important, does the food suit your parent's taste, nutritional requirements, and cultural preferences? Are the social interactions and recreational programs appealing?
  • Location Questions to ask: Is it in a safe neighborhood? Is it convenient for shopping, doctor visits, religious services, and social contacts? Is it reasonably close to adult children's homes? Is public or private transportation easily accessible?
  • Policies Questions to ask: Are there restrictions on behavior such as smoking or drinking alcohol? Are pets allowed? Are guests, including overnighters, welcome? Are there formal visiting hours? How much flexibility is there for meal times? In a shared setting, how are responsibilities determined? How does management handle rate increases and discharge policies?
  • Ultimately, It's About Family Questions to ask: Will this move cause or solve family problems? If a parent and child are considering living together, can they and the others living in the house get along? Is the space adequate? Is the house equipped for the older adult? Can you give the parent the attention he or she deserves? Are your lifestyles compatible? What are the advantages and disadvantages for all those involved? Are you comfortable with this serious commitment and reasonably sure it will work?
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Some of this material appears in slightly different form in Caring For Your Parents: The Complete AARP Guide.

© 2003, 2004, 2007 AARP. Reprinting by permission only.

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