Transition. The word operates as both a noun and a verb. As a noun, it is defined as “a passage from one state, stage, subject, or place to another;” as an intransitive verb, it refers to the act of making a transition.
Life is comprised of transitions great and small, but the later years are certainly rife with them.
Getting an AARP membership, needing bifocals when reading the morning paper, taking advantage of a senior discount at grocery stores – these are among the simpler transitions that boomers and seniors experience every day. Then, there are the more difficult transitions of adjusting to an empty nest, retiring after decades in a particular job/field, losing a spouse/life partner, or watching a loved one’s health decline.
Perhaps one of the most common transitions among boomers/seniors: making the move into a senior living community.
This can be a terribly complex transition for some; others may welcome it. Before we begin to peel away the layers of this process – and the players involved – let’s break down the types of senior living communities/care options available today.
What are my options?
According to this timeline from PBS.org, which traces the evolution of nursing home care in the United States, the first nursing homes officially arrived on the scene in 1954, after “a change in federal law provided grants for the construction of nursing homes ‘in conjunction with a hospital.’” Many nursing homes today still have that “hospital” feel, a reason many put forth as the primary objection for choosing another type of care facility.
However, in our current senior living market, options abound. (Note: These levels of care vary greatly from state to state in terms of regulatory oversight, cost, and range of services provided, so be sure to research carefully when the time comes for a transition in your household.)
Home Care – Home care is a great option for those who feel, like Dorothy, “there’s no place like home.” Maybe your Mom has complex physical care needs; maybe she just needs some help with the household chores a few times a week. Home care provides a spectrum of services from non-medical care (grocery shopping, housekeeping, companion services) to highly skilled medical care (wound care, IV infusion, PT/OT) – and everything in between.
Active Adult Communities – Sometimes called “55+ communities,” these living arrangements boast a luxurious, resort-style, low-maintenance lifestyle targeted to boomers/seniors who are in the early years of retirement and still very active and independent.
NORCs – Essentially, Naturally Occurring Retirement Communities (NORCs) is “a demographic term to describe neighborhoods or buildings in which a large segment of the residents are older adults.” NORCs are popping up across the country as a result of the recent economic downturn; consequently, some are being recognized in a more official way, allowing these organic organizations to draw down private/public funding. Seniors in NORCs may receive limited social services/other types of assistance while aging-in-place.
Personal Care Homes – While these may be a dying breed due to the explosion of assisted living communities, many states still have personal care homes. In this level of care, residents receive minimal services and assistance (housing, meals, and supervision) in a home-like setting, as most PCHs are quite small and often set up in private homes.
Assisted Living Communities – An assisted living community (ALC) is probably the most popular care option on the market these days, and for that reason, it is also perhaps the most dynamic in definition. Quite simply, these care facilities offer assistance with ADLs (activities of daily living), like bathing, dressing, and eating, and IADLs (instrumental activities of daily living), like paying bills, shopping, and taking medications.
Independent Living Communities – Independent living communities are similar to the aforementioned active adult/55+ communities, but the population is usually older. Some independent living communities offer minimal services (thus welcoming the very independent senior).
CCRCs – Continuing Care Retirement Communities offer several levels of care in one centralized location. While some senior living companies apply the title loosely, a true CCRC should offer skilled nursing, assisted living, and independent living care in one location (sometimes in one building, sometimes on one campus).
Alzheimer’s/Memory Care – Specialized services in a specialized setting for those with Alzheimer’s, dementia, and other types of cognitive/memory impairments are another type of senior living care that is increasing in popularity and prevalence. Most are not stand-alone units and generally are connected to a CCRC/ALC.
Short-term Care – After a long hospital stay due to an illness, surgery, or injury, some folks need a few weeks to fully recover before moving back home; accordingly, many senior living facilities offer short-term care options.
Respite Care – Sometimes, caregivers needs a break, or they must undergo a surgical procedure which will render them unavailable/unable to meet the daily needs of the person entrusted their care. Respite care serves that purpose.
Skilled Nursing Care – Also known as nursing homes, this level of highly specialized medical care is generally provided in a hospital-like setting. Although traditional nursing homes have changed over the past few years, and probably will continue to do so as ALCs become more desirable and expand their roster of service offerings, nursing homes are still the senior living facility that offers the highest level of care.
Hospice Care – Hospice care services can be provided in a senior’s personal home, or brought into a senior’s assisted living/skilled nursing apartment/room as needed. There are, however, some stand-alone facilities that provide housing and hospice care services; these types of care settings are also on the rise.
Decisions, decisions – see why transitioning into a senior living community is such a difficult process? (And we haven’t even talked about the logistics of moving from a sprawling six-bedroom home to a one-bedroom apartment… although, we’ll get to that.)
And yet, crisis situations – i.e., a bad fall resulting in a broken hip, the sudden loss of the spouse who was the primary caregiver, a rapid decline due to dementia – are typically the catalysts for these complex transitions. Families and individuals make decisions from a place of stress and anxiety, with sometimes disastrous results. Don’t let that happen. Know the resources that are available in your virtual and physical community and take full advantage of them.
- Scenario 1: Individual/couple is willing to move – Three meals a day, regular shopping excursions, and I don’t have to mow the lawn? Sign me up!
- Scenario 2: Individual/couple is unwilling to move – Leave the home we’ve lived in for 40+ years to live amongst strangers? No thanks.
- Scenario 3: Family disagrees about best living arrangement/plans for the individual/couple – I can’t believe my brother just wants to put Dad in a home. Or, doesn’t she realize that if they move to this community, there will be no money left for our inheritance?
So unless the senior making the transition is completely on her own, with no spouse or children or friends to consult/consider in the process, it all begins with a conversation.
This conversation has many origins: “Dad, we’re all concerned about how you can care for Mom when the cancer spreads.” “I don’t think you should live alone now that Grandpa has passed away, Grandma.” “I’m worried about my sister, who has dementia and lives alone. She leaves the stove on sometimes and I’m afraid for her safety.”
Depending on how many people get involved in this conversation, how the senior at the center of it feels about the transition (which is ultimately the most important facet of the discussion), and numerous other factors, the introductory conversation alone may be the reason that families avoid it altogether and simply wait for the crisis catalyst.
Check out the transcript from a recent Tweet Chat on dealing with difficult family dynamics for insights and advice: #ELDERCARECHAT on difficult family dynamics.
Also, you may want to consider hiring an elder mediator or unbiased third party representative to join you at the table. Read more about these professionals at: http://www.seniorsforliving.com/blog/2011/03/04/business-booming-for-elder-mediators-as-boomers-aging-parents-collide/.
The Bottom Line: Covering the Cost of Care
Money is still the number one reason for failed marriages, and it can also cause much damage to and disagreement among the family circle when expensive care options are on the table for Mom and Dad.
Thus, the almighty dollar is a pivotal piece of the transition process. Specialized Alzheimer’s care might sound like the best setting for your loved one, but it is very expensive.
Funding sources like long term care insurance, Medicare, Medicaid, and Social Security do come into play for many boomers/seniors making a senior living transition, but many Americans operate under the incorrect assumption that “everything will be covered” by one or several of these support streams.
Here is a brief outline of the types of funding available for long term care:
- Medicare – It doesn’t cover everything, but Part A can pay for some hospital care, skilled nursing, hospice care, or home health services.
- Long term care insurance – visit the national clearinghouse for detailed information on this funding option.
- Private pay – There are some senior living communities where care can only be paid for one way: out of your own pocket.
- SSI – Supplemental Security Income can be used in certain states/senior living communities. Find out if you’re eligible and what levels of care may be subsidized at http://www.ssa.gov/ssi/.
- Medicaid – In some states, Medicaid covers skilled nursing care only; in others, Medicaid funding can be applied to home-and-community based services like home care or assisted living.
- Veterans’ Benefits http://www.va.gov/healtheligibility/coveredservices/SpecialBenefits.asp
- Others (Reverse Mortgages, retirement, health care, pension, disability, state programs, federal programs, etc.)
Signing on the Dotted Line: Elder Law Attorneys
Just a glimpse at the various funding options makes me sweat, since I’m not what you’d call a “numbers person.” Yet even people who are good with finances and figures need assistance in assembling the financing package for the senior care community of choice and executing the legal paperwork to make it all happen.
Thus, working with an elder law attorney is a fundamental part of the process when transitioning into a senior living community. That being said, an elder law attorney does more than just drum up the legal documents you need to sign at the end of the transaction. Check out this lengthy list of coverage areas:
To find an elder care attorney in your area, read more about the profession, and determine what public/private benefits are available to you, consult this comprehensive and clearly laid out site: http://www.elderlawanswers.com/.
You can also peruse the fine resources at http://www.naela.org/Public/, and learn more about what distinguishes an elder law attorney as certified (CELA – certified elder law attorney).
The Next Step: Selecting a Facility
The best – and simplest – advice I can offer for selecting a facility is this:
- Visit as many communities as possible. And for those senior living communities that ranked high on your list, make several visits at different times of the day/night to get the big picture.
- Be choosy; don’t settle for second-best. If you feel unsure about the vibe of a community or are unsatisfied with the services offered, move on to the next one.
- Ask tons of questions: the only foolish question is the unasked one.
- Read the fine print: there can be hidden costs. Know what’s covered and what’s “a la carte.”
- Know your rights: most senior living communities are required to post/distribute a document of residents’ rights. Study it carefully.
(Hint: Your elder law attorney can also help you with many of these items. Don’t be afraid to ask for their guidance.)
You can also refer to this blog post I wrote in January for a guideline on selecting the best senior care facility for your loved one (or yourself): http://www.sandwichink.com/help-for-the-hard-sandwich-generation-issues-choosing-the-best-assisted-living-community-for-your-loved-one.
More resources on selecting the senior living community that’s right for you:
Making the Move: The Logistics of a Senior Living Transition
Congratulations! You’ve fought it out with your siblings, visited tons of senior living facilities in the area, consulted with an elder law attorney, determined how to pay the bill, and finally selected a new home for the boomer/senior in your life.
Now comes the last, and perhaps most exhausting, leg of the journey: the physical move.
So much is involved in this final step, which is physically exhausting as well as emotionally taxing, as it symbolizes the finality of this transition, the “end of an era” – and provides another battle ground for siblings and relatives as they sort through their senior’s “stuff.”
Remember the scenario mentioned earlier, about the transition from a sprawling six-bedroom mansion to a one-bedroom apartment? Daunting, wouldn’t you say?
As if simplifying 70, 80, or 90+ years’ worth of possessions isn’t enough, some seniors are hoarders. Read more about this serious condition, and how to get help.
If you have a large family/support network, you might choose the DIY path, enlisting grandchildren, friends, neighbors, siblings, and other willing volunteers for the move.
But you don’t have to do it alone. These days, there are professional organizations/individuals that are ready to help you through the process from beginning to end, including such services as packing, organizing, and running estate sales.
Read more about those in business of senior living transitions:
Making a senior living transition is a cumbersome process. Don’t wait until the last minute to prepare for it. Use these resources to guide you, and even if you’re not ready for the move, start the conversation today!
As always, we welcome your questions, suggestions for additional resources, and positive feedback. Sound off here, and if you’re ready to begin the senior living community search, look no further than our site: http://www.seniorsforliving.com/.