When some people hear the phrase “independent living community”, they think of traditional retirement communities and 55+ communities. This is really not an accurate image of independent living. To this end, the phrase “independent living” may be a bit of a misnomer. The reality is that if you are interested in independent living, you likely require some additional assistance. Otherwise, you wouldn’t even be looking at senior living to begin with.
For seniors who are completely independent and merely want to live among their senior peers, traditional retirement communities and 55+ communities are a great fit. The defining feature of these traditional retirement communities is the age of their residents and the fact that the available amenities (i.e. golf courses, restaurants, pools) will be designed to serve that population. On the other hand, if you need some assistance, but don’t require the broader scope of services provided by assisted living communities or nursing homes, then independent living may be right for you.
Independent living comes in many forms, ranging from apartments to free-standing houses and includes a wide range of amenities. Much like traditional retirement communities, the amenities at independent living communities are geared towards their residents, so you’re much more likely to find a golf course or club house than a playground in one of these communities. Club houses in these communities may include anything from arts and crafts or movie theaters to fitness centers and just about everything in between. When selecting an independent living community, you should always try to choose one that provides recreational activities and amenities that interest you.
Generally speaking, the defining feature of independent living communities is that the residents are slightly younger and significantly healthier than residents of assisted living or nursing homes, such that the residents are able to live on their own with little or no healthcare or medical services or assistance with activities of daily living. On the other hand, independent living communities do provide groundskeeping, interior maintenance of apartments, meals in dining halls and other services intended to make residents’ lives easier.
The essence of independent living is typically a place to live with house-keeping and a grounds crew, three meals a day, and an itinerary of optional social activities. Most residents simply want to downsize out of their house and into a smaller home, apartment or condominium with minimal upkeep. Of course, minimizing upkeep isn’t the only advantage. Many communities provide a vast array of services (some of which may result in additional fees), including, but not limited to:
In particular, communities referred to as congregate housing tend to offer more of these additional services than most other independent living communities. In addition to the services listed above, many higher end independent living communities also provide an array of amenities (as mentioned above), including golf courses, swimming pools, movie theaters, spas, fitness centers and even restaurants. In addition, regardless of the level of services provided by the community, you can generally supplement your care on your own with various home healthcare services, such as hiring your own home health aide to come to your residence for a few hours per day or week.
Finally, even if you require more services than the community provides, most independent living communities permit residents to bring in home health aides for additional support. In fact, many communities even have their own network of outside caregivers to facilitate the process. However, not all communities are as open to home healthcare and some communities even restrict their residents’ rights to bring in home health aides. If you require some assistance with personal care beyond that which is provided by the community or you anticipate a future decline in your physical condition (i.e. you have early stage Alzheimer’s), you should confirm that the community will permit you to obtain the level of care you require.
While the previous sections paint an accurate picture of most residents and their priorities when they enter these communities, for many residents the reality is that their needs continue to evolve as they age. This effect has been compounded by a growing trend of people waiting longer and being older and usually less healthy when they go into senior housing. This trend has been supported by the emergence of the home health care industry which often allows seniors to stay in their own homes for longer than in the past.
In response to these market forces, many independent living communities have begun offering a range of additional services to their residence at an additional charge, in many cases including some assistance with activities of daily living and in limited cases even medical services (although those services will likely be outsourced). In this regard, for at least some of their residents, many independent living communities have begun to function almost like assisted living communities. In fact, most assisted living communities are actually located under the same roof or at least on the same property as independent living communities. The goal of communities with both independent and assisted living is to allow residents to stay there as long as possible before needing to relocate to a hospital or nursing home. Others actually arrange for assisted living services to be provided right in the independent living community in the resident’s apartment.
Many of the assisted living portions of these communities now allow their residents to receive hospice care in their apartments as they reach the end of their lives. Due to this expansion of the scope of care provided by independent living communities, some residents are able to spend the rest of their lives in these communities without ever needing to relocate.
Nevertheless, for residents with more serious medical conditions requiring extensive medical care in addition to the services described above, a typical independent living community will not be a permanent solution. Similar to seniors who remain in their own homes, many residents of independent living communities will eventually require personal and medical services beyond the scope that any independent living community (or even assisted living community) can provide. No matter how hard an independent living community tries to meet its residents’ need, these communities are staffed more like a hotel or resort than a full blown medical facility. Few of these communities have nurses available to supervise care and it is doubtful that any of them have physicians available.
Independent living communities are simply not designed to accommodate the oldest and sickliest residents. Residents on this end of the spectrum will likely end up in nursing homes or equivalent facilities. This is often an unpleasant development for seniors who thought they had made their final move and who had become settled in an independent living community. Ripping these people from their social networks and homes can be a traumatizing experience. For those with sufficient resources, there may be a solution to this problem. Meet the continuing care retirement community (“CCRC”).
We provide a more in depth look at CCRC’s in another article, but the purpose of these communities is to turn an independent living community into a more permanent option. CCRC’s are basically just independent living communities that offer assisted living services as their residents age and also have a nursing home on site (or at minimum a contract with a nursing home off-site) to ensure that their residents can receive any level of care (short of hospital care) at a single location. While residents must meet the requirements of independent living when they enter these communities, they will be able to age in place knowing that the community has a nursing home on site staffed with nurses, a medical director and other medical equipment not available at other types of independent living communities.
Generally, independent living communities cost between $2,000 and $4,000 per month with prices varying based on location and the level of services provided. Congregate housing and communities providing services equivalent to assisted living will typically be on the higher end of the spectrum. Keep in mind there will typically be additional charges for residents who require any of the additional services described above. Independent living communities are most frequently the option of choice for relatively healthy seniors with incomes between $25,000 and $75,000 per year and assets between $100,000 and $500,000 per year. Wealthier seniors will typically opt either to stay in their home and receive home healthcare services or for the more expensive CCRC’s. CCRC’s typically require a significant entry fee as well as monthly fees. A more detailed breakdown of CCRC costs can be found [here].
Electing to move to independent living communities is often a personal choice and not one driven by a resident’s medical needs. As such, with very limited exceptions, Medicare and Medicaid generally do not provide any coverage for independent living. As a result, most independent living communities are open exclusively to seniors who can private pay.
Nevertheless, in limited situations, a resident who entered an independent living community on private pay may eventually exhaust their resources and be able to qualify for Medicaid long-term care as long as their medical condition has deteriorated to the point where they require the kinds of services usually provided by assisted living communities or nursing homes. Medicaid is more likely to become an option for residents living in independent living communities that also have assisted living or perhaps even CCRC’s where residents end up in the communities’ nursing homes towards the end of their lives and have exhausted all of their financial resources. In any case, it would be very unusual for a senior to enter any independent living community with Medicaid as the payor.
For seniors with more limited financial means who are struggling to afford regular housing, a better option would be to contact the local office for the U.S. Department of Housing and Urban Development (“HUD”) and inquire about its subsidies and low-income housing options available for low-income seniors. HUD has programs available for these seniors under both Section 8 and Section 202. However, these subsidies are driven more by your general housing needs than your healthcare needs.
For seniors who have sufficient financial resources and are looking to plan ahead and enter the senior living spectrum while they are still relatively young or healthy, independent living communities can be an amazing option. Many of these communities have first class facilities and are more like country clubs than nursing homes. Independent living communities offer a wide array of services and amenities, as well as the camaraderie that comes with living among your peers. Like most choices though, independent living is not for everybody. If you have limited financial resources or extensive medical needs, there may be better options for you, including home health care services or a nursing home. If you find yourself somewhere in between the extremes of independent living and nursing home care, an independent living community that also provides assisted living services or a CCRC may still be an excellent option.