1. 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, such as grooming, toileting and dressing.
Cost
Nearly $6,000 per month on average, depending on the kind of home care you receive, according to Genworth Financial’s 2023 Cost of Care Survey (the most recent data available). Additional costs can include home 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 only covers 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. Medicare doesn’t cover aides who come in to help with activities of daily living, and those expenses can add up over time.
2. Senior apartments
Available to adults age 55 and older, senior apartments are often a compromise between a long-term care facility and an independent living community.
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
— Resident independence
Cons
— These residences typically don’t provide any services for seniors, who will need to make their own arrangements for meals, transportation and housekeeping.
— Without personal care services or community social activities, some older adults may feel isolated or lonely, particularly if they’re less mobile or lack personal connections within the community.
3. 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. Sometimes known as residential care homes, these homes may also specialize in memory care.
Cost
The monthly cost of board and care homes varies largely by location, but this option typically runs a little less than assisted living communities, which average $5,350 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 often come with fewer amenities and social activities.
— 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.
— Quality of care may be varied or limited, as group homes are often smaller and have fewer resources or oversight than larger senior care facilities.
4. 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 an average price tag of about $5,350 per month for assisted living.
Pros
— Assisted living residents generally have 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.
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.
5. 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. A majority of CCRCs follow an entrance-fee model, requiring a hefty upfront payment fee of $100,000 or more, which is often coupled with a monthly service fee.
Alternatively, with a monthly rental model, residents may pay a lower upfront fee followed by a monthly rental charge, averaging $3,450, according to nonprofit National Investment Center for Seniors Housing ? Care.
Pros
— Transitioning to a CCRC enables residents to age in place, limiting 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.
6. Medicare PACE programs
The Centers for Medicare & 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 enables 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 prescription medications.
7. 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 $207 per day, while adult day care runs about $95 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.
8. Adult foster care homes
Depending where you live, this option may be referred to as an adult family home, family care home or residential care home. These home-like facilities with on-site staff differ from other live-in care options because they’re much smaller. States often regulate the number of residents that can reside here, and typically, this can mean only one to six residents at a time, as opposed to dozens or hundreds even in nursing homes.
Adult foster care programs provide assistance with activities of daily living, such as daily personal care, household chores and meal preparation. Some adult foster care homes may also provide transportation and opportunities for socialization.
Adult foster care differs from adult day care, as day care is a daytime only program, whereas foster programs are round-the-clock permanent living arrangements.
Cost
The cost of adult foster care homes can vary considerably. However, they generally run lower than assisted living facilities or nursing home facilities, which average $5,350 and $9,733 (for a private room) per month, respectively, according to Genworth Financial.
Pros
— The small number of residents can mean more personalized care.
— A home-like environment can provide comfort and the feeling of independence for residents.
— Adult foster care can be a more cost-effective alternative to other senior living options.
Cons
— Quality of care can vary considerably.
— Medical care is not offered generally, making aging in place a challenge if care needs change and if the home is not integrated with a larger facility.
— With a small number of residents, socialization may be limited, or residents may not get along with one another.
Personalize, prioritize and prepare
It’s important to weigh all your 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,” Resnick 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, activities and other benefits seniors can’t get at home. These can make life joyful, purposeful and safe, which improve quality of life for your loved one and peace of mind for you.
Assessing your loved one’s care needs
To get started, 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.
A geriatric assessment considers several aspects of a senior’s overall health, including:
— Physical function
— Nutrition
— Medical conditions
— Mental and cognitive health
— Emotional and psychological well-being
— Social support and environment
“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 examines medication-related risk factors, such as polypharmacy, which is the use of five or more prescription medications. It’s possible that medications could be the cause of fatigue, lethargy or cognitive concerns.
Once your loved one has completed an assessment, you can hone in on appropriate care options.
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
— Adult foster care
More from U.S. News
The Most Unique Nursing Home Activities for Seniors
Pros and Cons of Assisted Living
Nursing Home Alternatives to Consider originally appeared on usnews.com
Update 11/04/24: This story was previously published at an earlier date and has been updated with new information.
