Facing the public-financed and private housing choices

Good humor is very inexpensive. If you don’t learn to laugh at troubles, you won’t have anything to laugh at when you’re old.  — Edgar Watson How,U.S. editor, novelist and essayist

As an older adult, it is best for you to decide where you want to age, retire or live if you need some types of help before the time comes when someone physically, mentally and emotionally stronger than you makes that decision for you.

Where older adults should live depends on many factors—health, available money, safety, family, community support services and personal preferences. Because this country has more senior citizens than ever, there are now more public-financed and private housing choices than ever before. Today we’ll do a quick summary of some of the housing options available.

The first type of housing I’ll refer to as “retirement communities.” These vary significantly in costs and benefits offered, and they are not subject to any particular regulation by any governing body. Basically, these communities provide “over-55” or age-segregated units for what is known as “independent living.” They tend to offer personal care services, social activities and limited nursing supervision for generally active adults.

A popular type of retirement community is called a Continuing Care Retirement Community (CCRC). These communities offer a broad level of care. They offer eligible individuals the option to receive guaranteed care in a skilled nursing facility as part of the price of admission. In other words, the typical agreement is that this type of facility will “take care of you until you die.” Options range from independent living apartments to assisted living to skilled nursing home care. Most require a substantial entrance fee as well as monthly fees. A few may allow you to buy an ownership interest in your living unit, with a personal and health services package included. These ownership arrangements are very complex. They have special advantages and definite risks. Further, the possibility of receiving Medicaid if you are in the nursing home section of a CCRC , even if you have spent everything you have to live there, is extremely problematic.  At that point, you most likely would have to move.  .

If you are considering this retirement option, legal advice is a must because CCRC contracts are complex and, of course, strongly favor the facility. You should investigate whether the facility is accredited, its financial stability and what type of consumer protections it has in place.

The next type of housing, labeled Supportive Housing by the American Bar Association, ranges from single-family homes that offer board and care to larger institutional complexes. Their common characteristic is that each provides some combination of housing and supportive services. Residents usually have their own furnishings in their room or apartment and come together to share meals or participate in activities such as field trips, book clubs, classes or exercise programs. In small facilities, residents often live like members of a family, even sharing some chores and responsibilities. Staff members provide help with activities of daily living (ADLs) such as eating, dressing, transferring (for example, moving from bed to chair), using a toilet and bathing. They also provide help with instrumental activities of daily living (IADLs) such as preparing meals, taking medications, walking outside, using the telephone, managing money, shopping and housekeeping. Finally, they provide protective oversight by monitoring, reminding or other supervision of the resident.

Public housing is obtainable through the federal Department of Housing and Urban Development or the county housing authority. Homes and apartments are available where landlords agree to accept prearranged reduced rent. Waiting lists are very long for this type of housing.

Assisted living facilities (ALFs) have many forms, and this term has different meanings in different parts of the country. ALFs are generally more residential than medical. Although some of the residents may be frail, they usually don’t need continuous skilled nursing care. In ALFs, residents have their own bedroom, social opportunities afforded by common areas and shared meals, regular monitoring of needs and 24-hour staffing and personal care support. These facilities appeal to elders who can’t (or no longer want to) live at home or alone, yet don’t need professional nursing care. Maryland ALFs must be licensed by the Maryland Department of Health and Mental Hygiene before they can operate. Costs for this type of housing depend on the level of care required.

Nursing homes provide skilled care for chronically ill people. They also offer rehabilitation services that allow people to return to their homes following therapy, for example, for a broken leg whereby the senior needs to learn how to manage a wheel chair or walker. Nursing homes provide 24-hour attention, activity and care. There are many wonderful nursing homes and, unfortunately, many not so wonderful that would best be avoided. If time allows, you should do a lot of research and make several personal visits in order to make an informed choice. Consider whether you, personally and in particular, would want to live in this or that place when you are in an older-age situation.

Happy Thanksgiving!  Thanks for reading. See you next week. Stay well.