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SENIOR HOUSING CHOICES
In this section, we’ll address the following questions:
• What are my options?
• How do you select a senior living facility before you need to be in one?
• What will it take for you and your family to be happy with a senior housing facility?
• Can this facility grow with you if you require additional care, or will you need to move to a different facility?
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If you’re planning ahead, use this information to determine what services are required and find a couple of facilities that meet your needs. There are many benefits to planning for senior housing before it’s needed. You and your family will have peace of mind knowing you are prepared.
BENEFITS OF PLANNING EARLY
SUPPLY AND DEMAND
Senior housing is typically more expensive than people realize, and high-quality places can fill up fast, so you want to have these places on your shortlist and figure out how far in advance you need to reserve a spot.
In many parts of the country, new senior housing facilities are being built all the time. There is more supply in many cities than demand, but as more seniors reach retirement age and new seniors move into those areas, that could shift.
Check our sections below to help you decide.
However, if you’re ready to look at some Local Retirement Communities, CLICK HERE.
BEFORE YOU CONSIDER MOVING, LET'S TALK ABOUT SOME DIFFERENT HOUSING OPTIONS
Independent Living
Age-Restricted Communities
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Age-restricted communities can be apartments, single-family homes, garden homes, and even townhouses. These communities have a “connected” feel and attract seniors who want access to activities ranging from arts and crafts and bingo to a gym and a swimming pool. Some facilities with higher-end amenities may add golf or tennis.
This type of facility is typically geared towards independent seniors who could live alone in their own houses but want to socialize with other people their age. They are also looking for less home and yard maintenance than if they lived independently.
Most independent living age-restricted communities do not allow people under 55 to live there. If your adult child currently lives with you and you are considering moving to an age-restricted community, be sure to check with that community to make sure that this would be possible.
One of our partner companies bought a home from a couple who were moving to a 55+ community. The house was beautiful, but the couple wanted a place that required less maintenance. Living in an apartment, they could work their regular jobs and go camping in their towable camper on weekends and holidays.
Senior Apartments, Townhouses,
and Garden Homes
These types of senior housing are similar to age-restricted communities but usually have fewer amenities and are less expensive, making them an excellent option for folks who are downsizing but still want privacy.
Some of these senior communities have a percentage of units available to lower-income seniors that qualify. Also, these communities may have a gated entrance and ADA-compliant units. They can be a great opportunity for someone who does not desire as much socialization but still wants to live in a community of seniors.
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Move In with a Family Member
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Renting a Room
Many seniors will rent out a room in their homes to help cover expenses and create a sense of community. Usually, tenants that live with seniors will help them around the house in exchange for free or reduced rent. Some may be skeptical of this arrangement after hearing random stories from others who have allowed strangers to live in their homes.
Other seniors may rent a room in a home to save money on housing costs, such as maintenance, insurance, taxes, etc.
We do not recommend either of these options unless you really know the person you will be living with, and you should get a full background check and always trust your instincts.
If there is a situation where three people have been best friends for 30 years, and they are all widows in their 80s, that might work. They would each need their own space and should set ground rules for the home.
Set up personal boundaries. It is a lot easier to be friends with somebody you occasionally see for two to three hours at a time than to live with them.
As you can imagine, there are many pros and cons to this option. Living with a family member is becoming a popular choice for many reasons, one of which is financial. Although there is competition among senior housing providers, most senior housing is more expensive than the average home mortgage.
All senior housing is more expensive than living with a family member. If something does not go according to plan or there is no plan, living with a family member can be one of your only options. It can also strain even the best family relationships. You should count the cost beyond just the financial cost.
Living with family can be a good or bad idea, depending on the family dynamics. If you have a strained relationship with your family, they may not be amenable to you moving in with them. On the other hand, if your relationship is really great, having you move in may not be a burden.
Some clients have their parent(s) move in for health and safety reasons or so that the grandparent(s) can be at home when the grandkids get home from school.
For this arrangement to work, everyone needs to be on the same page, which goes back to planning. We have met families where the husband feels great about their parent(s) moving in, but the wife or grandkids do not.
Start this conversation today (if you have not already). If my kids do not want to take me in, I would rather find out now —while I still have time to create a plan B—than have them resent me when my physical condition is poor.
Ask your spouse or family this simple question: “If my mom (or dad) needs to leave her (his) home, can she (he) move in with us? Why or why not?”
If you are a senior who is considering moving in with your kids or a family member, ask them what they think about the idea. The best way to get an honest answer is to ask a “yes” or “no” question and tell them whatever answer they give is acceptable.
If you move into a family member’s home, learn the house rules. Get some space and privacy for yourself. Having a room or quiet place to be alone will help everyone. Set boundaries in advance. For example, “After 7 pm, I like to have some time by myself to think.”
We worked with a senior couple who sold their house, and their adult son sold his house at the same time. They pooled their resources to buy some land with two houses, one for each family.
If the porch light was on, that meant they were accepting visitors (grandkids and other family members). If the porch light was off, they needed alone time. That sounds like it could be fun if you get along with your family.
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Assisted Living Homes
Before we discuss your assisted living options, let’s understand who assisted living is really for.
AARP did a survey and asked its members, “Would you rather stay at home or move into an assisted living facility if you need help with your Activities of Daily Living?”
The response was exactly what you would expect. 90% of members who responded said they would rather stay at home and get the help they needed. Unfortunately, 70% of us will need assistance with our ADLs for an average of 3.5 years during our lifetimes, and those are whom Assisted Living is designed to help. No one moves into Assisted Living unless they need assistance. Those that can afford to may move in earlier when their level of care is lower. But remember, it’s not a vacation home or a “retirement” community with pickleball, golf, and tennis. It is for people that need assistance but does not need daily nursing care. The challenge for many of us is that we may not recognize that need for ourselves, and we may not want to admit it if we do.
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Large Corporate Locations
Assisted living facilities can give you access to a broad range of services, from help with basic personal care, such as getting dressed, taking medicine, and bathing, to more advanced assistance. Assisted living facilities can feel like living in a hotel, and most facilities are fully furnished. If you enjoy staying in hotels and having lots of people around, this option could appeal to you.
Some facilities have sections with independent, apartment-style rooms and a separate area that focuses more on hands-on care. Services at these facilities can include meals, daily activities, transportation, and security.
If seniors start to have memory problems but can still live independently, they may live in an assisted living facility with adequately trained staff and appropriate safety features. If the senior needs more advanced memory services, those are handled in a special care unit that usually falls under skilled nursing care.
You can choose from national brands or local non-chain facilities. Look at each location on a facility-by-facility basis before making your selection. Your decision will come down to the mix of people living and working there and the price for the value that you are getting. A great management team is a must-have. For a list of some of the Assisted Living Homes, click here.
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QUESTIONS TO CONSIDER
• How close is the facility?
• Can the kids and grandkids easily visit?
• How do the managers interact with staff and residents?
• Does it feel like a “team,” or is there obvious stress amongst the staff?
• How long has the management team been in place?
• How do the workers interact with the residents and with each other?
At most of the facilities we visit, the managers and workers want to be there.
Residential Assisted Living Homes
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With the recent health concerns surrounding the COVID-19 pandemic, especially in nursing homes, Residential Assisted Living (RAL) homes are becoming more popular every day.
There are more than 29,000 RAL homes across the country today. They’re not as easy to find as large nursing home facilities since they aren’t built on 10 acres of land along a busy road with a sign in the front. Typically, there will be five to 15 residents in each home, and residents can choose private rooms with private baths or shared rooms with shared baths. Unlike larger Assisted Living communities, RAL home charges usually cover all costs, so there are no surprises. RAL homes have a “family” feel, not a big institutional feel.
RAL homes with ten or more residents are usually larger homes (4,000+ sq ft) in nice neighborhoods. There’s enough room for the residents to have private space with the option of being active and involved in a smaller community. It’s the best of both worlds for many reasons. It’s not a hotel trying to feel like home but an actual home in a residential neighborhood.
With fewer residents and visitors, there are not as many opportunities to spread germs. It is becoming more important to ensure that anyone in assisted living is well
cared for and safe.
These homes offer many of the same services as larger assisted living communities. One of our clients who moved into a RAL home was able to stay in a neighborhood similar to where she previously lived. She told us that her favorite aspects of the home were the friendships with the residents and the large back porch and yard.
RAL properties attract residents who like the idea of being in a home, sharing a meal with a small group of
people, relaxing in the backyard and feeling like they are still in their old homes.
Most RAL homes have a staff member who arrives in the morning, someone who comes in the evening and stays overnight, and an on-call nurse. The management team is often led by individuals who worked at larger facilities but preferred to be at a smaller location. Many
of these RAL homes have services to provide meals for the residents.
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RAL Before you consider moving into an Assisted Living community, large or small, make sure you know the ratio of “direct caregiving staff” to residents. Larger facilities with 100 or 200 beds may claim to have a 10:1 ratio. But, when you take out the landscaper, kitchen help, administrative staff, and management, that ratio may be closer to 20:1. At night, it could be 50+:1.
In a RAL home, the care is much more personal.
States typically do not require a specific ratio within a community, large or small. They leave it up to the owner. Many times, those decisions are driven by the financial effect they produce. In a typical RAL home, the resident to direct care staff may be closer to 5 or 6 to one, which also represents the biggest cost for the business. The RAL home spends most of its budget on great caregivers rather than maintaining large buildings and properties. For a list of some of the Licensed Assisted Living Homes in San Mateo County, click here.
QUESTIONS TO CONSIDER
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How Close Are You To Your Kids?
Would you rather live in a large community with 200
residents or a residential home in a neighborhood?
Would you rather live somewhere with a 5:1 or 20:1
caregiver to resident ratio?
If they are within 20 minutes, they will likely visit more often. Maybe that’s good, or perhaps that’s not so good. If it’s easy to come and see you without being required to make an appointment, they will be more spontaneous and drop by when they can. If it’s easy to park and walk in the front door to see me instead of parking in a large lot and walking a long distance to the entrance, which would I choose?
I’d rather see my kids twice a week for an hour than once a month for an afternoon.
With a 20:1 ratio, you may not get the attention you
need. The caregivers would not be able to spend enough time with you even if they wanted to.
Memory Care Facilities
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Memory care facilities, or special care units (SPUs), are specifically for patients with Alzheimer’s or other forms of dementia. These units are specially designed to protect patients from getting lost. Treatment options are available to address behavioral needs since Alzheimer’s and other forms of dementia evolve with each stage.3
The staff at memory care facilities are skilled at identifying changes in these stages and adjusting the patient’s treatment plan accordingly. Patients are encouraged to live as independently as possible.
The benefits of memory care facilities include fewer patient falls and hospital visits and a more consistent administering of medicine than if a resident lives at home in a confused state.
Although these facilities may be in a separate area of an assisted living facility, the residents interact with other community members and are not isolated.
Nursing Homes
Skilled nursing facilities (SNF) are for individuals who require skilled medical care. These facilities have Registered Nurses (RNs) on staff 24/7. They may also have licensed practical nurses (LPNs) and licensed vocational nurses (LVNs).4
Care at these facilities can include:
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Personal care (housekeeping, laundry, meals, bathing)
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Monitoring medical signs
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Managing a patient’s care plan
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Observing a patient’s conditions
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Tube feedings
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Rehabilitation services
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Therapeutic exercises or activities
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Dental services
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Recreational activities
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Treatments are provided by skilled staff and other specialists, such as occupational therapists and speech therapists, who come to the facility to treat patients. Not all services are available at every facility, so make sure you know what each facility offers. Examples of specialized care include:
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Rehabilitative therapy
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Dialysis
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Working with Alzheimer’s and dementia patients
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IV drug therapy
Continuing Care Retirement Communities (CCRC)
To be classified as a CCRC (life-plan community), a community must offer independent living, assisted living, and skilled nursing care in the same facility or campus.
If you are a senior, you must move into a CCRC when you are healthy and live independently. Communities consist of houses, townhouses, or apartments, while the amenities available can be resort level, frequently including golf, tennis, and other higher-end amenities. CCRCs generally have an ownership option, which we will discuss in the next chapter.
If your budget is not limited, you are looking for a resort-style retirement, and you like the idea of having more services available as you need them without having to move, look into a CCRC. For a list of some of the retirement communities in the area, CLICK HERE.
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Things to Consider before Looking for a Facility
Needs and Wants
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Identify your current needs, forecast your possible future needs, and identify your wants or “wish list.” Price is important, but do not let it be the sole determining factor in your decision.
When calling local facilities to ask about the costs, most will tell you, “It depends on what you want or need.”
Pricing is more complicated than booking a hotel room. Determine your needs and preferences, have a basic idea of your budget, and see where the process leads you. Answer each one of the following questions with your team.
Setting Up Your Checklists
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Your Plan Checklist
❏ Are you currently facing any problems or challenges?
❏ What is the biggest problem you are trying to solve?
❏ How soon do you expect to move into a senior facility?
❏ In what geographical location do you want to live?
❏ Do you have a specific housing need right now?If so, what is it (e.g., independent, assisted, nursing, specialty)?
❏ What prompted you to start this search?
❏ Where do you currently live?
❏ How long will it take to sell your home and/or move?
❏ Who are the members of your advisory team (e.g., spouse, children, family members, religious leader, medical team, or professionals)?
❏ Is your advisory team part of your planning process?
❏ If price were not a factor, where would you want to live?
❏ In which type of environment do you want to live (e.g., private, community, social, private room, shared room, private house, or first floor)?
❏ What amenities would you like to have available (e.g., entertainment, recreation, food, pool, classes, and transportation)?
❏ What personal care services do you need now or want to be available (e.g., dressing, mobility help, laundry, bathing, and food)?
❏ What medical care services do you need now or want to be available (e.g., treatments, specialty care, medicine, and diabetes care)?
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Your Team Checklist
❏ Do you have the following professionals on your team? If so, list them below:
❏ Attorney
❏ Financial advisor
❏ CPA
❏ Medical doctor
❏ Family members and other advisors
❏ Are there any other needs or wants you have that are important to you but have not yet been men- tioned?
❏ What is important to the members of your advisory team? Ask them if you have not already. For example, “I am creating a Senior Housing Plan that
expect to begin following (next month, next year, or in ten years). What is important to you?”
❏ Ask your advisory team, “Is there anything else you want me to consider as I am creating my plan”?
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Your Closest Advisor Checklist
❏ Do you have any concerns regarding my health, safety, and overall happiness?
❏ What challenges are you facing as my top advisor?
❏ Is moving in with you or a family member an option?
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Other Planning Questions
❏ Are you married?
❏ Do you currently live with anyone else?
❏ If you move, where will your current house partner (e.g., friend, family, or spouse) live?
❏ If your spouse were to die before you, would you want to stay in your current home?
❏ Would you prefer to move into a facility that has all the care options available—from independent to nursing—or would you be fine moving to a new facility if you needed more care?
❏ Do you want to be close to a place of worship?
❏ Is there a friend or family member you want to live near?
❏ If you are considering moving across the city, state, or country, will you need to find a new doctor or other professionals?
❏ If you are moving into a furnished facility, what is the plan for your current furniture and personal belongings?
❏ If you plan to give items from your home away to family members, have you let them know?
❏ Will you get input from your family members be- fore you give them any of your personal belongings?
❏ When you give a family member or friend your personal belongings, is it for them to keep or are you just asking them to store the items for you?
❏ Will you need to rent a storage facility? If so, where?
❏ How will you know when it is time to make a decision?
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Your Budget Checklist
❏ Do you use a monthly budget?
❏ What monthly amount can you afford for senior housing and care expenses?
❏ What financial sources are available to pay for housing?
❏ If you do not need senior housing right now, have you inquired about long-term care insurance?
❏ Do you expect family members to help pay for your housing? If so, how much do they plan to contribute?
❏ If you plan to sell your home, how much do you expect to receive?
Once you map out what is important to you and your team and know what you want and need and how much you have available from your budget, you can start identifying and interviewing facilities. You can find facilities online, from print media, through referrals from friends, or by contacting local or national referral services. For a list of some of the Local Retirement Facilities click here.
Right Idea,
Wrong Plan
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Margo never told her adult children, James and Mary, that she had been falling at home. When James took his mom to the doctor, the doctor noticed marks on Margo’s shoulder and hip.
Margo said she had scraped up against a shrub and bumped into the wall, but the doctor knew something was not quite right. He questioned her story, and eventually, Margo came clean.
The fact is Margo needed help. She didn’t want to tell her kids and cause them stress, knowing she needed more help than her busy family could provide. They all felt terrible, but the good news was that options were available to her.
Margo’s family worked on a Senior Housing Plan to allow her to get more care and feel more secure. Margo had some mobility issues, but she took her medicine, cooked for herself, and even did her chores.
The family tried to do their best, but they did not understand the various senior housing choices. They put Margo in a facility with many wonderful services, most of which she did not need, however, such as medication assistance, food preparation, and laundry services, among other activities.
Unfortunately, Margo was now paying almost double what she would have been paying if she was in a facility that better met her needs. Even though the facility was great, the level of care was too high for Margo’s needs, and the enormous monthly bill created a financial strain on the family.
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An unexpected side effect of Margo living at the new facility with all its services was that she no longer did things for herself. She became more dependent on others. She lost her independence little by little in the process, which could have been avoided if the family had had more information about the options available for Margo.
There is a wide range of options, services, and prices for senior housing. Make sure you understand what is included and what is not (extras) when looking for a new residence. Think about the type of care you need now and what type of care you may need in the future. Hopefully, you are looking at senior living facilities before you need to be in one. If there has been a recent and sudden health change, you may not have the luxury of time.
An unexpected side effect of Margo living at the new facility with all its services was that she no longer did things for herself. She became more dependent on others. She lost her independence little by little in the process, which could have been avoided if the family had had more information about the options available for Margo.
There is a wide range of options, services, and prices for senior housing. Make sure you understand what is included and what is not (extras) when looking for a new residence. Think about the type of care you need now and what type of care you may need in the future. Hopefully, you are looking at senior living facilities before you need to be in one. If there has been a recent and sudden health change, you may not have the luxury of time.
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VACANCY
The best cost-to-value facilities in our area fill up quickly, and it can be challenging to secure a spot. A client called one of our offices saying she needed to quickly sell her home because an apartment had opened up at a facility where she had been on the waiting list for over 12 months.
The facility required her to put a deposit down and quickly decide before they moved on to the next name on the list.
If you wait until the last minute to make a senior housing choice, you may end up paying more than you had budgeted or living somewhere you do not like.
Information Overload
Blogs, websites, online reviews, and advertisements intended to create clarity often result in information overload. Not all of the information online about senior housing is true or objective. An online article about senior housing may, in fact, be a clever sales letter.
Some clients start their research online, but after reading several “Top 5” articles and looking at reviews on websites, they are more confused and are no closer to making a senior housing decision.
Pricing for senior housing is rarely disclosed online or over the phone. Each facility is unique, so it isn’t easy to compare one facility to another.
By the end of this section, we hope that you will be able to map out what is important to you, know how to locate facilities, and be able to choose the right one.
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PICTURE
PERFECT
Imagine having a Senior Housing Plan prepared in advance that you can hand to a family member if needed.
This plan would break down the three major categories of senior living facilities with one or two places pre-screened and selected.
Because you were not in a rush, you had ample time to pick the senior housing facility with the right mix of values, staff excellence, service, and price. However, if there has been a recent loss of mobility or memory or more medical care is required than you can manage by yourself, use the information and checklists in this section to identify the level of care needed and start your search today.