I'm Looking to Start a New Chapter in my
Life. What Should I be Doing?
To begin, you must determine what your needs are. This would include
such things as:
Are you divorced
Do you currently
own a home?
Do you want
to sell the home?
of new living situation are you considering?
Do you have
Are you active?
Do you require
any medical attention?
How Can I Prepare My Safety Net From a Position of Security?
The truth is none of us can predict our personal future or that
of a loved one. Early planning provides us ways to protect our property
and maintain our well-being. It's better to prepare for your future
from a position of health and security than to wait for a crisis
and make decisions in grief or haste.
What Issues Should I be Most Concerned With?
There are many. A partial list includes:
Be aware of your overall health, your problem areas, and your future
risks. Take all necessary precautions, including physical and mental
workout as well as diet. Secure a good physician and hospital that
you trust with your personal health. Your physician will evaluate
your diet and exercise needs as well as other influences on your
health. It is never too late to begin an exercise program or to
give up bad habits. Working with your trusted specialists can add
years of active living.
Do what you can to become educated on all matters concerning your
finances. Some things to consider include:
You cannot rely on Medicare to cover all payments, despite the
revisions made in the area of health care coverage. The cost of
nursing homes, long term care, assisted living or private nursing
care must be considered and planned for. Opportunities available
through retirement plans, insurance riders, and state programs should
be obtained and studied with a trusted financial advisor.
These should be attended to when you are of sound mind and in full
control of your possessions. Protecting your personal property and
finances is imperative so that they are available for your care
when needed. When you are not competent due to ill health, you may
not be able to initiate the legal documents necessary to allow a
friend or family member to handle your affairs. Now is the time
to explore who will have your power of attorney to execute decisions
on your behalf when you are incapable of doing so. You should also
consider the implications of a living will.
Determine what housing alternatives would be acceptable and available
to you should your independence be threatened by illness, disability,
or loss of income. Visit locations in your community and make your
plans known to your family. Safety, security, cost of upkeep, accessibility,
types of residents who share the facility, and even geographic location
are important considerations. Assuming that someone else will make
a decision to your liking when the time comes is unfair to that
"someone", and risky to your future peace of mind. Being
informed about deposits, waiting lists, nursing standards and eligibility
requirements will lead to a good feeling of control over difficult
Activities and Lifestyle
As studies have shown, one of the secrets to longevity and health
is a peace of mind found through renewed or continued interest in
the world and its activities. Whatever your passions or hobbies,
seek out furthering your education, get involved in artistic endeavors,
correspond with a pen pal, or start a new business.
This is a general term for surrounding yourself with friends, relatives,
and resource persons that will serve to inspire you, keep you vital,
entertain you, and who will be available when help is needed. This
is an area often neglected by seniors, especially after the passing
of a spouse. Making plans for your future in later years deserves
the same attention, excitement and positive outlook you gave to
choosing a college, planning for children, and your career. A safety
net of information about health, finances and legalities while continuing
to develop personal interests and friendships will support and sustain
you through times of difficult decision making.
What are the Different Types of Living Facilities Available
Facilities are organized into the following categories:
Care Retirement Communities
Often referred to as Retirement Communities, Congregate Living or
Senior Apartments, this is a residential living setting for elderly
and senior adults that may or may not provide hospitality or supportive
services. Under this living arrangement, the senior adult leads
an independent lifestyle that requires minimal or no extra assistance
but offers the security and conveniences of community living. Independent
living also includes rental assisted or market rate apartments or
cottages where residents usually have complete choice in whether
to participate in a facility's services or programs.
Some independent communities offer organized social and recreational
programs as a part of everyday activities (Congregate Living or
Retirement Communities), while others provide housing with only
a minimal amount of amenities or services (Senior Apartments).
Prices for units in these communities generally depend upon local
market conditions. Most communities that provide services are market
rate, but some subsidized senior apartments cater to seniors with
limited incomes. Private Funds are most often used, although some
senior apartments are subsidized and accept Section 8 vouchers.
Medicare and Medicaid do not cover payment since no health care
Since independent living communities are independent, health care
is not provided as part of the fees. However, many communities will
allow you to pay for a home health aide or nurse to come into your
apartment to assist you with medicines and personal care.
These facilities are licensed and regulated by the State Departments
of Public Health and are individually certified by the State for
Medicare and Medicaid. They are available to seniors who do not
require acute hospitalization but do need 24-hour skilled care.
Some of what is provided includes:
for most or all daily living activities such as bathing, dressing
supervision and rehabilitation therapy are mandated to be available,
and nursing homes are eligible to participate in the Medicaid
These facilities are State Licensed.
The Nursing Home's medical staff sets them apart from other types
of senior housing as care is provided by registered nurses, licensed
practical nurses, and nurses aides at all hours of the day. Facilities
service staff-activity director
rooms with housekeeping services
and physician services (on call)
respiratory, and speech therapists
on the facility, some of these services may have extra charges
associated with them.
a nursing home, ask the following questions of the administrator
or admissions coordinator:
of care do they offer?
Do they accept
Medicare or Medicaid?
any restrictions on the type of patients they admit?
What is provided
in the basic daily rate?
a volunteer program?
an adequate staff?
do nurse call lights stay on?
Do the patients
look clean and are they dressed in clean clothes?
members kind and responsive when they talk to residents?
Is the food
good? Ask a resident how it tastes. See if it looks good and if
it is served hot.
Do the patients
seem to get enough to eat? Are they offered second servings, diet
home serve snacks?
Is the dining
room clean and well furnished?
assisted with eating when required?
an activity program?
a full-time activity director?
Is a list
of activities posted?
something for patients to do who are confined to their rooms?
many patients sitting around with nothing to do?
facility have community TV with good reception?
a volunteer program?
Nursing Home facilities generally charge a basic daily or monthly
fee. In most cases, however, residents and or their families will
have purchased long-term care insurance in anticipation of the cost
or seek alternative forms of financing. These facilities do accept
a variety of Medicare, Medicaid, private insurance carriers, and
There are three care programs. They are:
- These are services required to maintain a resident's activities
of daily living. Basic Care includes personal care, supervision
and safety. A nurse aide, practical nurse or a family member can
provide this care.
- This is the level of care which requires the regular services
of a registered nurse for treatments and procedures. Skilled care
also includes services provided by specially trained professionals,
such as physical and respiratory therapists.
- This is comprehensive inpatient care designed for someone who
has had an acute illness, injury, or chronic illness. Sub-acute
care is generally more intensive than traditional nursing facility
care and less than acute care, requiring frequent (daily to weekly)
recurrent patient assessment and review.
Continuing Care Retirement Communities (CCRCs)
Generally, CCRCs are communities which provide several levels of
continuum of care for elderly persons. This continuum of care is
sometimes referred to as the levels of care and may include the
Living - Residents live independently in their daily activities
in their independent living units. Some services are generally
provided to these residents such as housekeeping, meals and laundry
Living - Residents need some assistance with the activities of
daily living such as bathing, dressing, eating or taking medications.
Care - Residents generally require round-the-clock nursing service
in a nursing facility.
CCRCs are different from other housing and care facilities for
seniors because it usually provides a written agreement or long-term
contract between the resident (frequently lasting the term of the
resident's lifetime) and the community which offers a continuum
of housing, services and health care system, commonly all on one
campus or site.
Questions to Consider
If you are thinking about a CCRC, the following are some questions
you might want answered:
Are the owners
the CCRCs long term plans?
CCRC be around to deliver services as long as you need them?
have they been managing it?
likely to continue?
What is the
turnover rate among the staff with whom you will be interacting
on a daily basis?
If the CCRC
is a condominium, individual housing unit or a co-op, are there
any restrictions on selling it?
a waiting list? If so, how long do they estimate it will take
for you to be admitted?
are you getting for your monthly fee?
services available if you need them? At what cost?
available? At what cost?
and for what reasons can the monthly rate increase?
Is the increase
predictable and is it tied to something like the consumer price
a basic entry fee? How much is it and how long do you have to
pay it? Is the entrance fee refundable and under what circumstances?
care will you get for your monthly fee?
is available and who chooses the care provider, you or the CCRC?
is available at additional cost and at what cost?
Will it cost
extra to use your own doctor?
if you can no longer afford to stay in the CCRC?
certified for Medicare and Medicaid?
How are medical
Is a hospital
close by and what services does it offer?
cost rise if you need assistance with daily living or you need
to move to assisted living or skilled nursing care?
What if you
are a couple and only one of you moves?
if you get Alzheimer's disease?
Can the CCRC
provide care for you on the premises?
If not, where
can you obtain the care?
for all of this? If it's you, how much will it cost?
anything that gives the CCRC the right to ask you to leave?
If so, what
is it, and what happens to the money you paid as an entry fee?
always rules for residents. Can you live happily with them?
Can the CCRC
handle your dietary needs and your tastes in food?
CCRCs offer a variety of residential services, including the following:
apartment, townhouse, or other unit
and laundry service
common dining areas (number of meals per day may vary)
and cultural programs
Care is covered
for contracted services
care and help with daily activities
& special care clean, furnished rooms
The agreements or contracts used by CCRCs differ, but are generally
based on the health care provided. The three most common types of
health care coverage in the CCRC agreement are listed below.
agreements - These include housing, residential services and amenities,
and unlimited, specific health related services with little or
no substantial increase in periodic (monthly) payments
agreements - These include housing, residential services and amenities,
and a specific number of long term nursing care days with no substantial
increase in periodic (monthly) payments. After you have used your
allocation of nursing care, you are then charged the daily rate
for each additional day
agreements - These include housing, residential services and amenities
for the fees stated in your agreement. You also pay for any health
related services as you use them, at the current rate, either
daily or monthly.
The three general types of payment or fee arrangements are:
and monthly fee
The entry fee is a one-time, up-front fee that is combined with
monthly fees to cover the living unit, services and care items
covered in your resident agreement. CCRCs may charge an entrance
fee that depends on the individual CCRC. The entrance fees charged
can be minimal to several hundred thousand dollars. This is the
most common type of fee arrangement offered. The entry fee may
or may not be refundable. If it is refundable, it will be under
certain conditions as specified in the mandatory disclosure statement
There is no lump sum entry fee. The cost of your living unit,
services and care are covered in your monthly fee payment. Sometimes,
however, there is a small up-front fee or deposit charged
or equity (condominium, cooperative or membership).
These types of CCRC agreements involve the actual purchase of
real estate and/or a membership. The purchase of the real estate
can be an expensive undertaking, especially if a large down payment
is required. Additionally, there can be a mortgage associated
with the transaction. The service and health care package is generally
separate from the real estate transaction and is covered through
monthly fees or assessments.
Monthly fees generally cover the following:
Active Adult Communities
The terms "Active Adult", "Senior" or Resort
Communities, refer to rental communities where you must be 55 years
or older and sometimes 62 years or older to live. These options
are designed specifically to attract "age qualified" retired
persons and those nearing retirement age who wish to get a start
on owning a place where they will eventually retire and who desire
the maintenance-free lifestyle. They offer an independent lifestyle
in addition to social and recreational activities with older adults.
These communities may offer facilities and amenities such as:
rooms and a variety of clubs and interest groups.
gated communities that offer a high level of security and some
have health care facilities on site
as art, dancing, woodworking, ceramics, chorus, yoga, etc.
have a clubhouse or country club with dining facilities, and depending
on location, a marina and beach.
may live in individual single-family homes, condominiums, town
houses or suites in high rise towers.
At some point, the needs of the Alzheimer's patient may be too great
to continue home care or prior care in an Assisted Living Facility.
Transferring to an Alzheimer Care Facility presents the patient
with a treatment center whose focus is geared toward supervision.
These facilities are part of a new trend to provide specialized
care for those with Alzheimer's. Some of what differentiates these
facilities from Nursing Homes or Assisted Living Facilities are
elements like design features within the facility that assist with
the problems associated with this disease such as: color-coded hallways,
visual cues, and secure wandering paths for additional security.
Questions to Consider
about the facilities specialties - This should include information
about dementia training (both past and on-going) for employees,
specialized activities and a calm environment.
Report - Request to see the most recent facility inspection report.
This document is public information, must be posted in a visible
area, and highlights the kind of care provided.
Staff - Inquire
about the size of the staff and what their availability is throughout
the days, evenings, nights and weekends. This will help determine
how much individual attention your family member will receive.
your individual needs - Inquire about whether the facility offers
a cognitive assessment as part of the screening. Such an assessment
helps assure the family and the facility that the residence is
capable of meeting the individualized needs of the resident.
- This pertains to the facility's ability to safeguard potential
wandering of their patients.
Care - Learn about the staff's ability to care for your loved
one as the disease progresses. Not all facilities provide care
throughout the progression of the disease.
your families involvement - Identify the facility's plans for
maintaining and involving family in the care, support, and problem-solving
of the patient
Similar to Assisted Living communities, most provide assistance
with dressing, grooming, bathing, and other daily activities. Assistance
with medications differs according to state regulations. Meals,
laundry and housekeeping are usually provided within private and
semi-private rooms in a residential type setting.
Assisted Living Facility (ALFs)
Assisted Living Facilities are privately owned facilities which
provide room, board and limited personal services (such as help
with bathing and dressing) as well as access to available community
services. ALFs can range in size from a few residents to a facility
housing as many as several hundred older adults. ALFs also vary
considerably in monthly rent, types of services offered, and physical
amenities. Some ALFs accept certain low-income adults who are certified
eligible for state-supported assistance as determined by the Department
of Children and Families. ALFs usually are appropriate for persons
in the early to middle stages of Alzheimer's disease.
ALFs will generally provide a range of services that promote resident
quality of life and independence, including:
care services (help with eating, bathing, dressing, toileting,
of persons with cognitive disabilities
and educational activities
a day plus snacks in a group dining room
If you decide
that assisted living is the right solution, consider the following
when evaluating the assisted living choices in your area:
Is the management
Do they have
genuine concern and respect for the residents?
Are the residents
and families happy and satisfied?
friendly and caring?
What is the
staff to resident ratio?
Is the community
clean and comfortable?
Is this a
place children would like to visit?
appealing and well balanced?
and wellness services are available?
Is the location
convenient to friends and family?
are planned for residents?
prospective residents like these activities?
prospective resident enjoy the daily life as compared to the other
and quality of living meet your standards?
Is the value
comparable to cost?
the residency criteria?
all...will assisted living improve the quality of life for a resident?
While costs vary across the nation, assisted living generally costs
less than home health services or nursing home care. The following
factors should be considered:
Size of accommodation
of community, etc.
Most assisted living residences charge monthly rates and do not
usually have an entrance fee. Many also have daily rates for short-term
stays (respite care).
What should I Know Before Choosing a Senior Housing Facility?
Perform a thorough review of the services, operations and finances
of the establishment, including a review of their audited financial
Consult an attorney and/or a financial advisor to determine if
the establishment is appropriate for your lifestyle and financial
Spend as much time as you can visiting the establishment and try
to participate fully in its activities.
Compare Establishments. Do as much research as possible. Make sure
that whatever place you choose, your choice is right for you.
Interview residents and staff. Objectively evaluate the services
and amenities based on your lifestyle and your condition.
Share the details with someone you know and trust. They might be
able to be more objective than you and assist in your evaluation.
What Should I Know About Private Insurance Policies?
Some insurance companies offer private insurance policies specifically
for long-term nursing home care. These policies vary widely in coverage
and cost, and it is important to understand precisely what kind
of policy you are purchasing.
Make sure the policy being considered does not duplicate skilled
nursing facility coverage provided by any coordinated care plan
such as Medicare or Medicaid or other coverage already received.
Check for any prerequisites required before the company will pay
benefits. For example, ask if the company requires that a patient
have prior hospitalization before any benefits are paid out. Some
diseases such as arthritis-related problems and Alzheimer's do not
require hospitalization before the need for nursing care arises.
If possible, seek an insurance policy that pays benefits immediately
upon entry into a nursing care facility. Many insurance policies,
which are purchased prior to the need for nursing care, require
a waiting period after entry into a nursing care facility before
payments are made. It is highly unlikely that nursing care insurance
can be purchased after a person has entered a nursing care facility.
Another private insurance policy, Medigap supplemental insurance,
is designed to close the gap between medical costs and amounts paid
by Medicare. However, both Medicare and Medigap are primarily designed
for short term, acute care and, consequently, are unlikely to meet
the long-term needs of nursing care residents