Assisted Living for Seniors

For parents with only one child, this is a difficult situation.  And even if there is more than one child the sharing of burden can often seem difficult and unfair.  Eventually it may come to a situation where the family will seek outside help for care of the senior.

Help Outside the Family Group
Public and private agencies offer a variety of home care services that may be available to you, including the following – Home Health Care, either part-time or 24-hour care; Personal care and homemaking services, such as shopping, cooking and cleaning; Services delivered to the home, such as meals programs, transportation and home repair; Adult day care centers that offer more intensive services than senior centers – there are more than 2,000 such centers around the nation and they are usually affiliated with churches or non-profit community agencies; and Respite services which are programs that provide periodic break.

Types of Assisted Living

Senior Citizens Low Income House
Many of the elderly cannot afford private payment retirement homes.  They often qualify for various programs which are state or federal funded for low income housing.  Housing funded by government is typically owned by a housing authority which acts as the manager or landlord of the housing property.  The process of obtaining a low-income, assisted living program housing apartment starts with an application to the housing authority.  The cost of the housing to a senior is calculated as a percentage of their income.  A typical program cost is about 35% of the senior’s income. Here are some of the key points which impact eligibility for these programs:

Age – Generally the age of the head of the household must be 62 years old or older. Younger aged persons could live with the head of household as long as this requirement is met.

Availability – Today there are more people seeking low-income housing assistance than the number of units available.  Priorities for some programs are available and may include priority for: individuals facing domestic violence, for local programs – local residences, working people, US Veterans, certainly the elderly and seniors or other persons who are disabled.

Household size – This is a logical issue, the total number of people living in the housing unit must be in accordance with the legal codes of the area.

Citizenship – Federal programs require that the head of household have a legal US status; most commonly this means they are a Citizen of the United States.

If you are interested in applying for low income living assistance you can go to your state websites or this federal website:

The contracts for assisted living can be very detailed and confusing.  It is highly recommended that a senior contact an elder law attorney before signing any contract.

Respite Services
Caring for a loved one with a long-term illness is a 24/7 job. Caregivers need occasional time away from their responsibilities to rejuvenate, pursue personal interests, or socialize. Respite services give caregivers that opportunity.

There are many different types of respite services, including round-the-clock services. Assisted living facilities and nursing homes may provide overnight, weekend, and longer respite services for caregivers who need an extended period of time off. Not all assisted living facilities and nursing homes accept people for short-term stays, however, so contact your local facility.  They also include adult day care. If a caregiver works, an adult day care facility can help. Adult day care facilities provide care and companionship outside of the home and give seniors the chance to interact with peers. The facility can provide social or therapeutic activities. Some day care facilities are especially designed for Alzheimer’s patients.  And they include in-home care. If you don’t want your loved one to have to leave your home, you can take advantage of one of the many in-home services that may be available. In-home care can involve a large range of services, including companionship services to help entertain your loved one, services to help the caregiver do housekeeping chores, personal care services, and skilled/medical care services. In addition, you can have someone come in to stay with your loved one while you work or for longer stays when you need to be out of town.

The cost of respite services varies from service to service. Medicare does not pay for these services, but Medicaid may pay for adult day care services. There may be other federal or state aid available. Contact your local Area Agency on Aging for more information.

To find respite services, go to the National Respite Locator or contact your local Area Agency on Aging. If you are caring for an Alzheimer’s patient, you may have local support groups and other help for caregivers.

Assisted Living
Assisted living facilities offer room and board in a home-like, more upscale living situation.  Assisted living housing typically is a building with common areas for socializing, eating and exercise activities with private apartments.  The benefit of assisted living is it allows the senior or elderly person to retain a sense of independent living, personal freedom and privacy.   In addition to these advantages, there is support services offered around the clock, 7 days a week, year round.  Depending on the type of independent building type there may also be medical support and medical oversight.

The cost of assisted living is higher than low-income housing but generally lower than nursing homes.  Surveys show that as of 2010 the cost of living within an assisted living unit ranges between $2,200 per month and up to or in excess of $6,500 per month.  The cost also will vary depending on the area of the country and cost of living.  While assisted living is more expensive than low cost living supported house, it is less costly than nursing homes.  Here is a link to a survey of assisted living costs for seniors – click here.  Another useful website to visit to learn more about seniors assisted living is the Assisted Living Consumer Alliance (ALCA).  This organization is a non-profit organization for the elderly.  It is an advocate for consumer protection for the people who live within assisted living communities.

Removal from Assisted Living Home
An elderly person might need the help of an elder care attorney if they are facing the prospect of being evicted from their assisted living apartment.  This can happen when they have a serious change in health which can change the conditions under which they entered the assisted living home.

For a number of reasons, managers of assisted living have a wide range of control when they are considering discharging a resident.  The National Senior Citizens Law Center shows that almost 40 states allow an assisted living facility to remove a person if they are no longer able to meet the needs of that person.   When faced with this situation the senior citizen has certain rights which an elder care attorney can advise them of.  Since the laws are somewhat vague if you or a family member is in this situation it is highly advisable to seek legal advice from a senior law attorney.

If all else fails, you may be able to use anti-discrimination laws to challenge the discharge. The Americans with Disabilities Act, the Fair Housing Amendments Act of 1988, and Section 504 of the Rehabilitation Act all protect tenants against discrimination on the basis of a physical or mental disability. Landlords are required to reasonably accommodate a disability unless it would cause an undue hardship. So, for example, if the reason you are being discharged is because you are now in a wheelchair and your assisted living apartment does not have ramps, you may be able to argue that the landlord is required to install the ramps as a reasonable accommodation. Using anti-discrimination law is very difficult and would require the assistance of a lawyer.

Medicare and Medicaid – Assisted Living
Medicare and Medicaid provide some coverage of the medical portion of home health care. Although the coverage is often inadequate, when combined with other resources available to the older person and his or her family, it may be enough to keep an older person at home for a longer period of time. For an explanation of the coverage of home health care available under Medicare, click here. Medicaid offers very little in the way of home care except in New York State, which provides home care to all Medicaid recipients who need it. Recognizing that home care can cost far less than nursing home care, a few other states — notably Hawaii, Massachusetts, Oregon, and Wisconsin — are now pioneering efforts to provide services to those who remain in their homes.

Roughly one half of the several thousand private home care agencies in the country are Medicare/Medicaid certified.  Those certified agencies are eligible for expense reimbursement by the two federal programs. Here are links to the three largest organizations which accredit home care agencies.  Community Health Accreditation Program:; the Joint Commission on Accreditation of Healthcare Organizations:; and the National Association for Home Care:

Non-medical services are also available to help older persons remain independent. A federal act, The Older Americans Act funds makes non-medical services available through about 10,000 senior centers through grants to states and to Area Agencies on Aging.  The programs which are provided through this program include the well-known Meals-on-Wheels program, general transportation, respite care for caregivers of the seniors, housekeeping, personal care, money management programs as well as shopping help. For more information of these valuable, but sometimes limited programs go to the Eldercare Locator at this website: .  You can also call this toll-free number: 1-800-677-1116.

Alternatives to Nursing Homes
The reality is that it is sometimes impossible or too expensive for an elderly person in poor health to remain at home. Other seniors may simply wish to live with others rather than be isolated. Fortunately, over the last two decades there has been an explosion of supportive housing alternatives for seniors, and the options are no longer limited to an agonizing choice between staying at home and moving to a nursing home. If you (or a loved one) do not require round-the-clock skilled nursing care, one of these supportive housing alternatives may be just right.

Supportive housing options range from board and care homes to large institutional complexes. Supportive facilities provide food, shelter and personal assistance while encouraging independence and personal dignity. The services offered may include help with activities such as eating, dressing, preparing meals, shopping, as well as monitoring and other supervision.

The main alternatives are board and care facilities, assisted living facilities and continuing care retirement communities (CCRCs). But these broad categories encompass a huge range of options in terms of services and costs. Generally, the more you pay the more services you get. There is a great disparity in quality as well, with facilities ranging from excellent to sub-standard. This means you need to research the options carefully before making a choice, and this section can help you in that process. But if you can find a high-quality facility, supportive housing can make a great deal of sense. It’s reassuring to know that help is there to take care of tasks like cooking, cleaning and home maintenance.

What is a Continuing Care Retirement Communities (CCRCs)
Continuing care retirement communities, often called a CCRC, are bridge type residential housing which offers an extension from assisted independent living to an assisted living environment with around-the-clock care in one location with health care services offered.  When an elderly person enters a CCRC they pay and entry cost or fee.  In addition, they pay a monthly rental payment which is adjustable which guarantees them a place to live for the rest of their life. Typically someone would enter into such a home in good health and get increasing care as the need for care increases.   It is very common with a CCRC that some form of nursing care in a nearby location or in the CCRC itself.

A typical CCRC would range in size from 75 to over 600 living units.  They would offer very diverse services.  In terms of style a CCRC could be very urban to very suburban.  One might be a high rise apartment building, another might be low rise apartments, and still others might be like cottages, detached condos or single family homes.

The key benefit of CCRCs it that they guarantee a place to live for the life span of the elderly person.  As you might know from reading here, a normal assisted living facility or nursing home will not make a guarantee of this kind.  Of course with the guarantee, there is a cost associated with it.  It is not untypical for the one-time fee for entry into the CCRC to be from $25,000 to in excess of several hundred thousands of dollars.  The monthly cost can also range from a few hundred dollars to thousands of dollars.   The fee arrangement for payments to a CCRC is changing and expanding. In fact while the fixed entry and monthly rental is most common, some arrangements include rental or equity arrangements.  The contracts involved in a CCRC are more detailed and confusing.  It is highly recommended that a senior contact an elder law attorney before signing any contract.

As a general statement most seniors would like to live in their own homes as long as possible.  This is based on considerations of being in familiar surroundings, remaining as independent as possible, being near family and friends, and certainly cost.  Most frequently younger family members undertake the responsibility of caring for the seniors in their homes.  This includes all activities involved with daily living including food and cloth shopping for the elders, doctor appointments, exercise, house cleaning, meals, etc.  This is often very exhausting when considering the other responsibilities of the family caregivers.