Housing Options For Seniors
||Dr. Jodee Graifman Meddy, DO, MS, LNHA|
Co-founder of SeniorSite.com.
Dr. Jodee Meddy is a nationally acclaimed Doctor, Licensed Nursing Home Administrator and an expert on Long Term / Extended Care issues and Nursing Homes.
"As long as I am able, I want to
live in my own home."
This is the firm desire of most older adults, and the wish of their
children for them.
Many, however, will eventually need to make different decisions about
moving their parents or themselves into a different kind of living
arrangement, one well-suited to their physical, emotional, and social needs
as they grow older
Until recently few alternatives to Nursing Homes existed for people who
could no longer take care of themselves. People who cannot live completely
independently may chose from a variety of living arrangements that offer
different levels of care. For many, these alternatives are preferable to
Some of these services are:
- Home and community care
- Subsidized senior housing
- Adult homes
- Assisted living and Continuing care retirement communities
- Nursing Homes
Our purpose is to share with you what these options are, in the event you
are faced with an injury or illness requiring some type of care.
Home Health Services
As just mentioned, many people requiring medical care would refer to
remain in their own homes for as long as possible. Home Health Care could be
an option in this case.
Home care is an excellent and cost-effective alternative to hospital care
or other institutional care.
The home care industry is dedicated to providing high quality care and
support services in the home. Home care services are available on a basis of
daily visits, monthly visits, or hourly care, up to 24 hours a day.
Imagine yourself disabled, too ill to take care of yourself or with a
condition requiring regular medical attention.
You can choose to receive health care at home with the assistance of a
health care agency. Through these agencies, a family with an ill child or a
disabled parent is able to be together.
Retirement Homes & Communities
Retirement communities ,often referred to as Independent or Congregate
Living, are designed specifically for independent senior adults that desire
to live with their peer group. These communities offer an enriched lifestyle
as organized social and recreational programs are usually part of everyday
Continuing Care Retirement Communities (CCRCS) CCRCs are housing
communities that provide different levels of care based on the needs of
their residents - from independent living apartments to skilled nursing in
an affiliated nursing home. Residents move from one setting to another based
on their needs, but continue to remain a part of their CCRC’s community.
Many CCRCs require a large payment prior to admission, and then charge
monthly fees above that. For this reason, many CCRCs are too expensive for
older people with modest incomes.
Services usually include, but in some cases are optional, meals,
housekeeping, laundry, van or scheduled transportation. Additionally, there
are Senior apartment, that may be shown as a Retirement Residence, that may
not offer the variety of services found in Retirement Residences, but do
allow active senior adults to live in a community with their peer group with
certain apartment features that are conductive to a healthy and secure
Retirement Centers or communities are most often associated with
"Independent Living" although many of them offer Assisted Living and/or
Skilled Nursing Facilities as well. Usually a wide range of services and
amenities, from transportation for medical appointments or shopping to
on-site social activities and beauty salons, are offered. While living
arrangement can very significantly, typical residents live independently in
private apartments, receive at least weekly maid and linen service, and
obtain most meals in a community dining room.
These are group living arrangements (sometimes called group or
domiciliary homes) that are designed to meet the needs of people who cannot
live independently, but don’t require nursing home services.
These homes offer a wider range of services than independent living
options. Most provide help with some of the activities of daily living,
including eating, walking, bathing, and toileting.
In some cases, private long-term care insurance and medical assistance
programs will help pay for this type of living.
If you are planning to pay for nursing home care out of your own pocket,
ask for a list of services that are covered by the basic daily rate.
Those services included in the daily rate. At the time of admission, a
written copy of the following basic services must be made available to all
- The daily, weekly or monthly rate
- Board, including therapeutic or modified diets, as prescribed by a
- Lodging - a clean, healthful, sheltered environment, properly
- 24 hour per day nursing care
- The use of all equipment, medical supplies and modalities used in the
care of nursing home residents, including but not limited to catheters,
hypodermic syringes and needles, irrigation outfits, dressing and pads,
- Fresh bed linen, as required, changed at least twice weekly, including
sufficient quantities of necessary bed linen or appropriate substitutes
changed as often as required for incontinent residents.
In addition to basic services, there are:
- 24 hour skilled medical/nursing care
- Recreational therapy programs social services
- Rehabilitative services including OT/PT and speech
- Nutritional services
Nursing Home today are equipped to handle much sicker patients with
complex medical needs such as Strokes, FX, TBI, Vent Care, Tube Feeding, IV,
Who pays ????
1 - Private
Most homes require full financial disclosure from
residents who will be paying privately. Since many nursing home residents
who enter as private pay residents eventually use up their funds and go on
Medicaid, the homes want to know how long the resident will be able to pay
privately and when to apply for Medicaid.
Once they are eligible for Medicaid, you have the right to have Medicaid
pay for your care. When this happens, the nursing home should assist in
completing the necessary forms.
Also, your spouse need not spend all
his/her personal resources on your care if you are institutionalized.
The law guarantees residents the right to control
their own financial affairs as long as they are willing and able to do so,
or to assign that responsibility to a friend or family member. The nursing
home may be given control over a residents finances if no one else is
willing to handle them.
Private long term care insurance policies are
becoming more and more available. They are advertised as a possible
alternative to Medicaid or as a way to avoid exhausting resources when
nursing care is needed.
The federal government is now permitting NYS to
authorize Medicaid without someone exhausting his/her assets. That person
first purchases a long term care insurance policy sponsored by the state.
Such a policy must cover at least 3 years of long. term care, six years of
home care or an equivalent combination of both. of that person.
Medicaid, established by Congress in 1965, is a government
health insurance program for people of all ages whose income is too low to
provide for routine care costs, or whose health care costs are too high to
be covered by their income.
This health insurance covers the cost of nursing care for as long as the
care is required, if a resident is eligible.
A comprehensive application
process is used to determine eligibility for the Medicaid program. This
process requires that applicants provide detailed information and
documentation regarding income and assets.
Currently, a Medicaid recipient
in a nursing home is allowed to retain $50 of monthly income as a personal
needs allowance to meet personal expenses that are not covered by Medicaid.
3 - Medicare
Medicare is a federal health insurance program for
disabled people and people over age 65. Skilled nursing services must be
needed on a daily basis to be eligible for Medicare.
Medicare will pay a maximum of 100 days of care in an approved nursing
facility for patients in need of skilled care following a hospitalization of
at least three full days. To qualify, the patient must be admitted to the
nursing home within 30 days of discharge from the hospital.
not pay for a nursing home stay if it is determined that only custodial care
is required, or if skilled nursing home care and/or rehab services are
needed only on a periodic basis.
Finding the right home
1. Gathering information on Nursing Homes
Once you have decided that a nursing home is the right choice for you, it is
time to gather information about the nursing homes in your area.
Finding the nursing home that will best meet your needs can be a
difficult and time consuming task. The more info you have, the easier this
task will be and the more likely that you will find the home that is right
Making a decision that a nursing home is the right place for you
and looking around at different homes is important to do before you are
hospitalized for a medical crisis.
It is best to have several nursing
homes in mind should the need arise.
2. There are several ways
that you can learn about the nursing homes in your area:
- Phone book
- Local Office on Aging
- Long Term Care Ombudsman
- Word of Mouth
- Friends and neighbors - ask if they know people who have stayed in
local nursing homes.
Watch for articles in newspapers and magazines and for television
programs that deal with nursing homes. Pick up information on nursing
homes from social service agencies or local officer for the aging and
local health departments. Contact community groups and advocacy groups.
Ask family and friends about their own experiences. If you know someone
who is in a nursing home, visit that person and ask questions. Ask
questions of key personnel at the facilities you visit: the administrator,
social worker director, nursing director, medical director. Make your own
judgments. A caring home should welcome both your desire to visit and the
questions you ask.
Call the nursing home you are interested in and make
an appointment to meet with the admissions staff (usually a social
worker). Ask to take a tour.
Evaluating a Nursing Home
When you visit a nursing home, look for its license.
governing the operation of a nursing home are set and governed by federal
law. These standards intend to assure the highest possible quality of care
and most meaningful quality of life for all residents in nursing homes.
Standards cover a range of requirements including but not limited to
residents rights, clinical services (including nursing, dietary, medical and
rehabilitation services, for example) and administrative (including quality
assurance and the physical environmental, for example)
Look for the latest
state survey (inspection report of how The home met the standards set by
What is a Survey???
All nursing homes that are certified to
participate in the Medicare or Medicaid programs are visited by a team of
trained State surveyors approximately once a year.
These surveyors (like inspectors) examine the home over several days and
inspect the performance of the nursing home in numerous areas - including
quality of life and quality of care.
At the conclusion of the survey, the team reports its findings. Nursing
homes with deficiencies are subject to fines and other penalties if they are
In New York State, the Department of Health has the
responsibility to monitor quality of care in nursing homes.
State surveyors inspect each New York State Nursing Home every nine to 15
months. Surveyors interview residents, review residents records, inspect the
premises and assess compliance with state and federal standards.
hope this article has helped you in explaining and showing you the different
seniors housing options that are available.