Your loved one and aging
It’s a common scenario: Adult children see an older family member is no longer able to live independently. Their loved one may have difficulty cooking meals or keeping up with personal hygiene. Maybe they’re showing signs of memory loss and can no longer manage technology or their finances.
Nursing homes are a go-to option for many families. These facilities tend to be for those who need help with activities of daily living, such as medication management, feeding and toileting. Residents also have at least one chronic condition, such as hypertension or arthritis, notes the National Center for Health Statistics.
But nursing homes may not be for everyone. Your loved one’s functional and medical needs, budget and preferences could dictate an alternative care facility.
Assessing your loved one’s care needs
The first step is to have your loved one take a comprehensive geriatric assessment, a questionnaire usually used for people age 65 or older who have a serious illness, such as cancer, or are showing signs of frailty to help evaluate their health and well-being. This assessment considers a senior’s physical function, nutrition, medical conditions, mental health, social support and other aspects of health. Together, these factors can help determine if a senior can stay safely in their home.
“Typically, this assessment takes about two hours and can shed light on specific needs, issues and concerns,” says Steven Buslovich, a New York-based geriatrician and general manager and vice president of Patient Pattern.
He notes that this geriatrician-administered assessment also explores medication-related risk factors, such as polypharmacy (the use of five or more prescription medications). It’s possible that medications could be the cause of fatigue, lethargy or cognitive concerns.
Once you’ve completed an assessment, you can hone in on appropriate care options. Here are seven alternatives to nursing homes:
A physically impaired, real life, real person 95 year old senior adult man had been struggling a bit to get out of the family car after a shopping trip. His muscles are weak, he is very frail overall, and his balance and stability have deteriorated significantly as he’s gotten older. Now that both feet are finally out of the car and firmly planted on the driveway – and after a minute or two to catch his breath – he’ll begin the long, slow shuffle up the inclined ramp walkway to his front porch. He relies heavily on his medical orthopedic equipment mobility walker for support these days, but even with that help, it takes extra time and concentrated effort for him to push all the way up to the front porch. When he gets there, his full time home caregiver daughter is waiting for him to help get him settled into his favorite recliner chair.
Home care
Home care offers support and services for those who don’t require institutional care but may need help with activities of daily living.
Cost
About $5,000 per month, depending on the kind of home care you receive, according to Genworth Financial’s 2021 Cost of Care Survey (the most recent data available). Additional costs can include safety enhancements.
Pros
— Seniors can stay in their homes, maintaining familiarity with their surroundings and connections with neighbors, notes a 2022 commentary in the Delaware Journal of Public Health.
— Aging in place can be more cost-effective than other long-term care options, depending on the outside services or safety changes needed.
Cons
— Safety is a major concern, so modifications, such as widened doorways or strategically placed ramps, grab bars and other aids, may be necessary. You should also tackle obstacles that can contribute to falls, such as furniture that presents a trip hazard, loose rugs or slippery flooring.
— Home care lacks some of the social activities that residents would get in a senior living or long-term care facility.
—Medicare Parts A and B cover only some home health services, such as physical therapy, occupational therapy, medical social services and durable medical equipment — canes, commode chairs and hospital beds, for example. It doesn’t cover aides who come in to help with activities of daily living, and those expenses can add up over time.
Senior apartments
Available to adults age 55 and older, these communities are often a compromise between a long-term care facility and independent community living.
Cost
Prices vary based on location, unit size and amenities, such as pools, on-campus dining and high-end recreational offerings.
Pros
— Low maintenance costs.
— Smaller living spaces.
— Pet-friendly housing.
— Security and grounds maintenance.
Cons
These residences typically don’t provide any services for seniors, who will need to make their own arrangements for meals, transportation and housekeeping.
Board and care homes
Reminiscent of the boarding houses popular in the 1930s and ’40s, board and care homes are group homes in which residents may have their own room or suite but share common spaces for dining and socialization. Some of these homes also specialize in memory care.
Cost
The monthly cost of board and care homes depends on location, but this option typically runs a little less than assisted living communities, which average $4,500 per month, according to Genworth Financial.
Pros
— This option comes with a home-like setting (versus the potentially more institutional feel of nursing homes).
— Residents receive help with daily tasks, such as bathing or dressing.
— Residents may also get some support with services like meals or laundry.
— Because board and care homes are limited to a handful of people, there may be a higher ratio of caregivers to residents.
Cons
— Privacy can be limited.
— These homes may not come with many amenities.
— Residents may not be compatible.
— Medical costs not covered by Medicare may include personal care or room and board, which can vary considerably. However, it will cover some medical costs, such as hospital or ER visits and lab tests, incurred while someone lives in this setting.
Assisted living communities
First developed as a social model of senior housing, assisted living communities have evolved into a type of long-term care facility. These communities attract residents who have some physical limitations or cognitive impairment and could benefit from assistance with activities of daily living.
Cost
According to Genworth Financial, you can expect a price tag of about $4,500 per month for assisted living.
Pros
— Assisted living residents generally get their own apartment or unit, with access to common areas and amenities, including a laundry room, on-site dining halls or restaurants and outside spaces, such as gardens, patios and pools.
— There are plenty of socialization opportunities, which can reduce feelings of isolation and loneliness.
Cons
— Assisted living facilities do not offer the level of medical care that nursing homes do. Unlike nursing homes, they aren’t required by federal law to have a medical director and may have fewer clinical staff, such as registered nurses and certified nursing assistants.
— Most assisted living costs aren’t covered by Medicare. Depending on the policy, long-term care insurance can help pay for assisted living care that isn’t covered by Medicare or other private health care insurance.
Continuing care retirement communities
Continuing care retirement communities are a one-stop shop for senior care. Also referred to as a life plan community, these facilities include independent living, assisted living and nursing home care on one campus.
Cost
Monthly costs can vary, depending on the setting, location, amenities and the size of the housing unit. Most CCRCs also require a hefty entry fee of $100,000 or more.
Pros
— Transitioning to a CCRC enables residents to limit their moves as they get sicker or require more care and services.
— CCRCs have a high staffing ratio and a significant number of registered nurses on staff.
— There tends to be a wide range of housing options, including houses, cottages, townhomes and duplexes.
Cons
— These facilities can be expensive.
— Medicare doesn’t cover CCRCs, nor do most long-term care insurance plans.
Medicare PACE programs
The Centers for Medicare and Medicaid Services’ Program of All-Inclusive Care for the Elderly (PACE) falls under Medicaid’s home and community-based services program. PACE offers a combination of services that enable seniors to continue living in their homes or with family members while receiving some long-term care.
Cost
While PACE fees vary, costs average $4,000 to $5,000 per month, according to the American Council on Aging.
Pros
— Services can include adult day care, meals, physical therapy, emergency services, social work counseling and transportation.
— Person-centered care, provided by a group of health care professionals, is a priority.
— Medicaid beneficiaries do not have to pay monthly premiums for the long-term care part of PACE.
Cons
— Enrollees are often required to use a PACE-preferred doctor, so you’ll need to check if a specific practitioner qualifies.
— Those with Medicare must pay monthly premiums for both long-term care with PACE and for Medicare Part D drugs.
Respite care
For short-term needs, consider respite care. This option can take many forms, such as:
— Visits from an in-home care worker.
— Adult day care.
— Temporary stays at an assisted living community.
Cost
Prices vary, depending on the type of respite care you’re using. A home health aide, for instance, costs an average of $169 per day, while adult day care runs about $78 per day, according to Genworth Financial.
Pros
— Family caregivers can take a break to go on vacation, go to work, run errands or just rest and refresh.
— Services often include bathing and hygiene assistance, recreational activities and opportunities for socialization.
Cons
— There may be a transition as your loved one adjusts to a new temporary caregiver or caregiving situation.
— Costs can add up, depending on how often services are required.
Personalize, prioritize and prepare
It’s important to weigh all the options and be realistic about what your loved one will need now and in the future. Cost alone isn’t an adequate determinant of the best level of care for an individual, nor what facility or community is the best.
“Needs, issues and other factors vary from person to person. The most important things to think about are safety and quality of life,” says Barbara Resnick, a professor of organizational systems and adult health at the University of Maryland School of Nursing. “Knowing the individual and being open to the fact that their situation and wishes can change is key.”
It’s important to do your research and get past misperceptions or preconceived notions.
“You have to put yourself in the mindset of being impaired, physically ill and needing two hours to get dressed or ready for bed,” she adds.
Despite what you may think, it’s not always best or desirable for an older person to stay in their home. An assisted living community or other facilities, including nursing homes, can provide socialization, meals and snacks, activities and other benefits seniors can’t get at home. These can make life joyful, purposeful and safe, which improve quality of life.
Nursing home alternatives to consider:
— Home care.
— Senior apartments.
— Board and care homes.
— Assisted living communities.
— Continuing care retirement communities.
— Medicare PACE programs.
— Respite care.
More from U.S. News
The Best and Most Unique Nursing Home Activities for Seniors
How Assisted Living Can Improve Quality of Life
Nursing Home Alternatives to Consider originally appeared on usnews.com
Update 11/13/23: This story was previously published at an earlier date and has been updated with new information.
