Making the Best Choice

*Elderaction: Action Ideas for Older Persons and Their Families

A service of the Administration on Aging, U.S. Department of Health and Human Service

Decisions About Retirement Living.

There really is no place like home. When asked about their preference for housing, most seniors answer, "What l would really like to do is to stay right here." The person's own home represents security and independence to most Americans. Most housing, however, is designed for young. active and mobile people. To live at home, a person must, at the very least, be able to drive, go shopping, cook. and do household chores. Many of us will lose one or more of these abilities as we grow older.

One option is to purchase in-home services, to cope with declining abilities. For a fee, an army of workers will appear to cut your grass, wash your windows, cook your meals, do the shopping, and even provide personal care and/or skilled nursing care. This may be the option for you, depending on the amount of help you need. However, this can be expensive and will require a lot of management and coordination. For people willing to relocate, there are plenty of options, although there may be some confusion about what all the terms mean. You may hear about "board and care homes," "personal care homes," "life care" and "continuing care retirement facilities." All refer 'to some type of "assisted living" or service-oriented housing.

Housing options generally fall into three categories, based on level of services and/or care provided: 1 ) independent retirement housing, providing meals, activities, house- keeping and maintenance to more active seniors; 2) "assisted living," providing housing along with supportive services for seniors needing assistance with personal care or medication-taking; 3) housing providing nursing care services for seniors who become temporarily ill or who require long term health care. Some examples of these retirement options are:

Nursing Homes
For individuals already disabled to the point of requiring daily nursing care as well as other support services, nursing homes provide comprehensive care services in a single setting. While most older persons and their families see nursing home care only as a last resort, they may in fact be the best setting for disabled persons with multiple problems and requiring multiple types of services.

Continuing Care Retirement Communities
Continuing Care Retirement Communities, sometimes also called Life Care Communities, combine all three levels of care — independent living, assisted living and nursing home care in a single setting. Traditionally, such communities required a sizeable entry fee, plus monthly maintenance fees, in exchange for a living unit, meals, and eventual health care coverage, up to the nursing home level. More recently, such communities have also begun to make their services available on a pure rental basis, rather than on the shared-risk basis of the traditional life care endowment. In short, CCRCs provide residents with the independence of retirement home living and the security of long term care.

Some Other Housing Options
Group Homes provide independent, private living in a house shared by several senior citizens who split the cost of rent, housekeeping services, utilities, and meals.

Shared Housing is offered by home owners who are willing to share their house with others. Service provision must be negotiated on a case-by-case basis.

Adult Foster Care involves a family caring for a dependent person in their home. Meals, housekeeping and help with dressing, eating, bathing, and other personal care are provided. Ask the local social services department if adult foster care is available in your area.

To Move or Not to Move
The main advantage of living in some type of congregate housing is security. The presence of others provides continued monitoring of health care. Another big draw of such facilities, especially for those with limited mobility, are the built-in social contacts and activities. Experts agree that social contacts increase satisfaction with life and have a positive impact on physical health. Other seniors report relief at relinquishing housekeeping tasks. Weighing the advantages of service oriented housing against the independence offered by a single family home is a complicated task. Timing is all- important. The most useful way to approach such decisions is to begin early by getting all the information possible on one's various options.

Duplication of this document is encouraged to provide information to older Americans. Source should be noted in all cases.

*ElderAction was developed by the National Eldercare Institute on Long Term Care and Alzheimer's Disease at the Suncoast Gerontology Center University of South Florida.