Choosing Long-Term Care: Alternatives to Enhanced Assisted Living

Many older adults will eventually need long-term care. On average, adults age 65 and older can expect to need at least 3 years of this type of care. 1 What level of care will depend on many factors, like ongoing health concerns, availability of family support and help, financial ability to pay for the cost of long-term care, and more.

The process of choosing the best long-term care option for yourself or a loved one can be daunting. There are multiple choices to pick from, each with its own pros and cons. To narrow down the right fit, it is helpful to understand the differences between these options and which ones might best meet your needs.

If you are considering enhanced assisted living as a long-term care solution, you will also want to weigh it against the other choices available before making a final decision. We’ll help by taking a closer look at enhanced assisted living, as well as other common long-term care options available to older adults.

What is enhanced assisted living?

To understand enhanced assisted living, we have to first understand the different levels of care. Older adults will have different care needs depending on their cognitive abilities, memory, and physical challenges. While some older adults can live independently, there is a 70% chance that someone age 65 or older will need long-term care services for a portion of their life. 2

When an older adult needs assistance with activities of daily living (ADLs), there are several care options available to meet those needs. Often, family is relied on for some help with these ADLs. But if the need for help is ongoing, with a person needing regular assistance with personal care needs and daily tasks, more intensive care is needed.

This is where options like assisted living facilities become a consideration. While these facilities can offer intensive help with ADLs, an enhanced assisted living facility adds another layer of care to the services available. This allows an older adult to remain in a private, independent living arrangement while receiving help with ADLs and medical care, without the higher level of care (and reduced independence) of a nursing home.

Nursing homes as an alternative to enhanced assisted living

To understand the difference between enhanced assisted living and a standard assisted living arrangement, let’s look at nursing homes as an alternative.

Also called skilled nursing facilities, nursing homes offer the highest level of long-term care services available. Older adults residing in skilled nursing facilities must qualify for this level of service. The requirements depend both on Medicare and Medicaid regulations and individual state rules.

Nursing homes offer care to residents that include management of cognitive and behavioral problems due to dementia, and treatment of medical conditions.

A person who is admitted to a nursing home for care can receive care for conditions such as:

Medicines that can’t be given at home, especially intravenous (IV) medications
Medical problems that are difficult to control
Medical problems that have required long hospital stays in the past
Complex wounds, including surgical wounds
Rehab after joint replacement surgery
Stroke
Renal (kidney) disease (including patients new to hemodialysis)

This care can include nursing care, physical therapy (PT), occupational therapy (OT), and speech therapy.

Because of the level of skilled care offered in nursing homes, they are one of the more expensive options, with a national median monthly cost of nursing home care of $7,908 for a semi-private room and $9,034 for a private room. 3

Enhanced assisted living can offer some of these care services, like medication management, assistance with feeding, and wound care while allowing an older adult to stay in their own private apartment.

Assisted living as an alternative to enhanced assisted living

If you require assistance with ADLs but don’t have an ongoing need for a higher level of medical care, simple assisted living may be the right fit. In assisted living facilities, residents enjoy the privacy and independence of their own living unit but receive daily help with care needs such as:

Personal care, like bathing and dressing
Housekeeping and laundry
Social and recreational activities
Transportation to activities like shopping and doctor’s appointments
Meals

This type of long-term care is not covered by Medicare, but portions of it may qualify for Medicaid reimbursement. The median monthly cost for assisted living facilities is $4,000. 4

CCRCs as an alternative to enhanced assisted living facilities

Continuing care retirement communities, or CCRCs, are another option for long-term care that can meet the changing needs of an older adult. A CCRC offers a spectrum of long-term care, starting with independent living and moving through 24/7 care.

By offering all of these services in one community, older adults who want to maintain familiarity throughout each transition in their lives can access the same services whether they are in assisted living or skilled nursing care, for example.

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

CCRCs often require an entry fee, with the average fee at $402,000, and monthly costs thereafter of $3555 (not including annual increases). 5

Home care as an alternative to enhanced assisted living

Home care is increasingly preferred by older adults as an option for long-term care. As many as 90% of adults age 65 and older prefer to age in place. 6 For these older adults, bringing long-term care services to their homes allows them to meet care needs and the desire to stay in their home environment.

Non-medical, professional in-home care services include:

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

In-home care can be used occasionally as respite support for family caregivers, or this service can offer part-time, 24/7, or even live-in caregiver assistance depending on your needs.

If medical care is needed, additional services must be brought into the home to provide this care.

Like assisted living, in-home care is not covered by Medicare. The national median monthly cost for in-home care is $5,148. 7 Some programs do exist to help offset some of these otherwise out-of-pocket expenses: HCBS and PACE.

HCBS

Medicaid offers waivers for in-home care called Home and Community-Based Services (HCBS). These can help to cover some of the long-term care costs associated with home-based care. Eligibility rules vary from state to state, and there are also caps on enrollment.

PACE

Medicaid and Medicare offer a program called the Program of All-Inclusive Care for the Elderly (PACE). This program is not offered in all states. Designed specifically to help you avoid leaving your home to receive long-term care, you must meet these criteria to be eligible: 8

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 as alternatives to enhanced assisted living:

If assisted living, in-home care, skilled nursing, or CCRCs aren’t quite the right fit for your needs, there are also some other options for long-term care:

Adult day care centers- these can be used by older adults who have family caregivers the majority of the time, but sometimes need to stay in a safe and supervised environment during the day while their family caregivers work or tend to other responsibilities. In these centers, an older adult can receive help with ADLs and access to social activities during daytime hours and then return home with family.
Board and care homes- also called group homes, these facilities offer non-medical care in a small facility that is usually in a large home, with residents sharing bedrooms. This can be a lower-cost alternative to assisted living facilities.

Long-term care can help you live your best life

No matter which long-term care option you choose, these services all offer support to help you improve your quality of life. By considering the level of care you need and comparing it to the available choices, you can make the best decision.

Another resource that can help you finalize your care decision is the National Council on Aging (NCOA) or your local council on aging. Along with offering resources and assistance in figuring out eligibility for care services and Medicare coverage, they can help you find services in your area. The NCOA’s AgeWell Planner is one example of the tools available.

If you’ve decided that in-home care is the best option for your needs, Caresify can help you coordinate these services in your home. You can read more here, or call 888-799-5007.

Providing personalized in-home care to seniors