How to Choose the Right Type of Senior Living Facility

Understanding the multitude of senior living options and knowing which option is right for you has become increasingly (and I would argue unnecessarily) complicated. There are countless different forms of senior living and several of them go by more than one name. This is largely a result of facets of the senior living industry periodically trying to rebrand themselves, as well as various state legislatures and regulatory agencies inventing new names for senior living options that already had names. Many websites purporting to be experts on these topics unwittingly fall into this trap of presenting seniors with seemingly endless lists of names and options.In this article, we are going to try to simplify the spectrum of senior living and give you some basic rules of thumb to follow. Like all generalities, you may come across a few exceptions in the real world, but we believe this is a better way of understanding senior living. 

Determining The Right Type of Senior Living Facility

The first choice you need to make is whether you even need and want to enter into the senior living spectrum in the first place. For many younger seniors in their 50’s, 60’s and even 70’s, access to a quality golf course and fitness center may be of greater importance than the availability of personal and healthcare services. For these healthy seniors who require no assistance whatsoever with daily living or their medical needs, a traditional retirement community such as a 55 and up or 62 and up community with desirable amenities may be a better option. While these communities are often lumped in as part of independent living, that is really not an accurate portrayal. Most of these communities are not designed to provide services to seniors and that is not necessarily a bad thing for seniors who don’t need those services. It would be more appropriate to think of these communities as resorts with an age limit.

Independent Living

Now assuming you decided that you require at least some minimum level of care or you expect to need such care in the near future, you are now entering into the spectrum of senior living.  In the broadest sense, you have two types of communities in senior living: those where residents live independently and those where residents live in a hospital-like setting. Choosing between these two options really boils down to the simple question: are you still able to live safely in your own apartment or do you require personal and medical care pretty much around the clock. If the answer to that question is that while you need some assistance, you still believe you are capable of living by yourself or with your spouse in your own apartment or small home, then you have quite a few options and independent living is usually the first place to look. 

The first thing you should realize is that independent living is not completely independent like the retirement communities mentioned above. Most independent living communities maintain the grounds as well as your apartment. Your meals are generally prepared for you and served in a community dining hall. In fact, most independent living apartments don’t even have kitchens. Finally, these communities provide a range of social activities and amenities. As you age and you being to require more help, many of these communities will provide a range of additional services for a fee, including laundry and transportation to and from doctor’s appointments^[1]. 

Assisted Living

As you age further, you may begin to require assistance with activities of daily living, most commonly with bathing and dressing^[2]. At this point, you most likely require assisted living. At its core, assisted living is not much different from independent living. In both types of communities, you likely will be able to live in your own apartment and have the service providers you need come to you. In addition to assistance with daily living, most assisted living communities also provide medication management, 24 hour supervision and other services. Today, many assisted living communities are located on the same grounds as independent living communities. These communities have the ability to either bring the assisted living services to their independent living residents in their apartments or to move the residents into the assisted living portion of the community when it becomes necessary.

Home Healthcare Services: Assisted Living Alternative

If you stayed in your home and never moved into an independent living community and now find yourself needing many of the services described above, you may also be considering home healthcare services. The level of care provided by most home health agencies is probably most on par with assisted living. The key difference is that at home you will only be receiving the services for a few hours per day or week. You should be realistic about whether these visits from home health aides are sufficient for your care and whether it is truly safe for you to be alone most of the time. If you are having regular falls, forgetting to take your medication or struggling to take care of yourself when you are alone, you should seriously consider whether you would be safer and happier in an assisted living community. 

Nursing Homes

The key point to understand is that while independent living and assisted living are similar and each provide an array of services, neither independent living, assisted living nor home healthcare is typically a replacement for a nursing home. Earlier in this article, we asked the question “are you able to safely live independently in your own apartment or do you require frequent personal and medical services?” If you require extensive medical services, there is simply no substitute for a nursing home (no matter what anybody tells you). A nursing home is the closest thing the senior living industry can offer to a medical facility^[3]. Nursing homes are staffed by licensed nurses 24 hours a day, they have a medical director who is a physician available to their patients and they are equipped to perform a broad range of medical services. If you require this level of care, a nursing home is where you belong.

Now at this point, you should realize there are two different terms used for these facilities: nursing homes and skilled nursing facilities. Generally, skilled nursing facilities provide short-term nursing home care or rehabilitation. “Nursing home” on the other hand is typically used to describe a long-term care facility where residents of advanced age or with chronic medical conditions typically spend the rest of their lives. Often this distinction is moot as many nursing homes now have their own skilled nursing facilities where their residents go for rehabilitation as necessary.

Memory Care Units

Depending on the specific medical condition that has caused you to require nursing home care, you may require specialized care. This type of care is typically provided at a nursing home in their specialized care units.The most common type of specialized care unit is known as memory care. Memory care units are designed to care for people with Alzheimer’s or dementia, where their cognitive disabilities often outpace their physical disabilities. One of the key features of these units is that they typically provide constant supervision. It is critical that you understand the level of care appropriate for your medical condition so that you choose a facility that can properly accommodate you. 

Continuing Care Retirement Communities

Continuing care retirement communities (“CCRC’s) should be classified as independent living communities simply because you need to qualify for independent living in order to get into one of these communities. However, these communities are really a hybrid of all of the senior living communities described above. Most CCRC’s have an independent living section, an assisted living section and a nursing home. Within their nursing homes, many CCRC’s have memory care units and other specialized care units. The goal of these communities is to allow seniors to enter into the senior living spectrum when they are still able to live independently and to age in place in a single community able to provide virtually all of the personal and medical services they will ever need. 

Hospice Care

Hospice care doesn’t really fit neatly into any of the categories above. Hospice agencies provide end of life care designed to make the patient comfortable rather than to provide a cure. Generally, hospice services are available to anyone believed to have less than six months to live.  We saved hospice for the end because on the continuum of care in senior living, hospice is the final step. However, it should be noted that hospice care may generally be provided in any of the communities described above. In fact, many people receive hospice services right in their homes, assisted living apartments or nursing homes.

Putting It All Together

Now that we’ve summarized all of the options, we wanted to put it all together to paint a full picture of the continuum of care in senior living. The first option many seniors look into may be a traditional retirement community. We really don’t consider these communities to be senior living because the level of services are too low and selection of these communities is based more on the amenities. Below is an overview of the full continuum of care:

• Independent Living: Independent living is much like staying at home, but residents get the convenience of 3 meals a day and having a maintenance free lifestyle.CCRC’s are the senior living industry’s attempt to allow a senior to enjoy the full continuum of care in a single community. A CCRC’s residents begin their stay in the independent living section and progress as necessary through higher levels of care that follow below.
• Assisted Living: Assisted living is often very similar to independent living, only these communities provide more supervision and are better suited to assisting residents with activities of daily living and medication management.Home healthcare services are typically an alternative to assisted living for seniors who would prefer to remain in their homes. 
• Nursing Homes: Nursing homes are the first level of care on the continuum where the decision is likely being driven more by healthcare needs than personal needs.These facilities look more like hospitals and are staffed by licensed nurses. Within nursing homes, they typically have more specialized units such as skilled nursing facilities for rehabilitation and memory care units for caring for residents with Alzheimer’s or dementia.
• Hospice Care: Finally, at the end of life, some residents will find themselves requiring hospice care to make them comfortable and improve their quality of life.In many cases, hospice care can be provided in any of the communities described above. **