Choosing Long-Term Care: Alternatives to Assisted Living Facilities

For many older adults, there comes a time when considering long-term care options becomes necessary. Changes in the ability to perform daily activities independently, along with chronic health conditions and limited mobility, often mean extra help is needed.

A common choice for long-term care is an assisted living facility. In the US today, over 800,000 older adults live in assisted care facilities, for a median stay of 22 months. 1

How do you know if an assisted living facility is right for you, and what are the alternatives? In this article, we’ll help you evaluate and understand each choice, so you can make the right long-term care choice for you or your loved one.

What is an assisted living facility?

Older adults who require assistance with activities of daily living (ADLs) like meals, light housekeeping, and personal care, may choose to live in an assisted living facility. This allows access to caregiving services and common areas and activities. It also provides residents with their own living quarters.

Residents of assisted living facilities may receive help with medication management and special services like dementia care (sometimes called memory care), but do not need the level of medical care provided by a nursing home.

The national monthly median cost of an assisted living facility is $4,500.2 The cost of this type of long-term care is not covered by Medicare. Medicaid may cover a limited portion of care in an assisted living facility (not including room and board costs). 3 The remainder must be either paid out of pocket, through long-term care insurance, or a combination of strategies.

When is a nursing home the right choice?

As mentioned above, a nursing home (also called a skilled nursing facility) offers a certain level of medical care. Residents of a nursing home may need temporary nursing care and services like physical therapy (PT) and occupational therapy (OT) to recover from a long hospital stay, for example. Or ongoing skilled nursing care may be required for certain chronic medical conditions.

Conditions treated include:

Complex wounds, including surgical wounds
Rehab after joint replacement surgery
Stroke
Renal disease (including patients new to hemodialysis)
Medicines that can’t be given at home, especially intravenous (IV) medications
Poorly controlled medical problems, or problems that have required long hospital stays

Each state has its own rules about who qualifies for the nursing home level of care. These four areas are often part of determining who qualifies for this level of care: 4

Physical functional ability- what level of help a person needs with ADLs

Health issues/medical needs- whether assistance is needed with tasks like injections or catheter care

Cognitive impairment- the impact of Alzheimer’s, other dementias, or conditions like Parkinson’s on a person’s ability to live independently

Behavioral problems- the presence of dementia-related behaviors like aggression and wandering

The national median monthly cost of nursing home care is $7,908 for a semi-private room and $9,034 for a private room. 5

If Medicaid (based on your state’s criteria) certifies that you are eligible for a nursing home level of care, it covers the cost of nursing home care. Eligibility is re-evaluated at least annually.6

Medicare also partially covers the cost of nursing home care, depending on what program you are enrolled in and other factors. This includes very limited coverage for certain medical needs, as well as prescription drug coverage, and coverage for short-term stays. 7

Continuing care retirement communities (CCRCs)

These retirement communities offer multiple living options for older adults who have a range of needs, from independent living to 24/7 supervised care.

Because different levels of care are all available within the same community, a CCRC may offer an easier transition from one type of service to another, without losing familiar surroundings, resources, and activities.

An example could be starting out in assisted living, and then transitioning to more medically advanced care in a nursing home setting.

Some long-term care options offered in a CCRC include:

Private apartments or homes
Assisted living
Nursing home/skilled nursing care
Home care services for those living independently
Healthcare services

The average monthly charge for this type of care is $3,555, with annual increases of around 2% and a hefty initial entry fee averaging $402,000 in some cases. 8

Home care

If you’re faced with health and mobility challenges but not ready to make the move to assisted living or a nursing home, you’re not alone. Most older adults would prefer to stay in their own homes for as long as possible.

Fortunately, there are options to help you receive the same kind of help you can expect from an assisted living facility, but in the comfort of your own home.

Professional home care services can provide daily assistance with care needs, including:

Bathing & dressing
Light housekeeping
Bathroom assistance
Transportation
Meal prep
Companionship
Help with safe ambulation (walking)

This non-medical care can be part-time, 24/7, or even occasional respite help. Advantages can include staying in a familiar environment and community, the potential for continuing to live with family caregivers (if applicable), and less exposure to contagious illnesses.

In-home care usually requires some assistance from family for a portion of caregiving needs.

The national median monthly cost for in-home care is $5,148. 9 Like assisted living, it is not covered by Medicare. Along with self-pay options, some other resources can also help cover the cost of this care.

HCBS

Medicaid’s Home and Community-Based Services (HCBS) waivers can help to cover some of the long-term care costs associated with home-based care. Eligibility rules vary from state to state. There are caps on enrollment as well.

PACE

A Medicaid and Medicare program called the Program of All-Inclusive Care for the Elderly, or PACE, can also offset in-home care expenses to help you avoid leaving your home to receive long-term care. It is not offered in all states. To qualify, you must: 10

Be 55 or older
Live in an area serviced by a PACE organization
Need a nursing home-level of care (as certified by your state)
Be able to live safely in the community with PACE assistance

Other long-term care options

Along with the above options for long-term care, some other choices can meet care needs as well. These can also offer alternatives to assisted living facilities:

Adult day care centers- available to supplement family caregiving tasks, by allowing an older adult to stay in a safe and supervised environment while a family caregiver works or tends to other responsibilities.

Board and care homes- also called group homes, these facilities may offer a lower-cost alternative to assisted living facilities, depending on your area. Typically a small private facility housed in a large home, a board and care home offers non-medical care under one roof. Residents may share bedrooms.

Long-term care should enhance your life

No matter which option you choose, long-term care should offer you improved safety and quality of life. With high-quality caregiving services, you can even stay healthier longer, by avoiding common problems like falling and skin breakdown.

If you’ve decided to use home care as a long-term care option, Caresify offers professional caregiving services to meet any personal care and companionship needs you may have at home. You can read more here, or call 888-799-5007.

Providing personalized in-home care to seniors