Gone are the days when “retirement housing” was just a nice way of saying “nursing home.” Today, many different senior living options exist, yet many older adults and their families are not aware of the choices. An overview of the alternatives reveals that retirement housing is as varied as the lifestyles and needs of residents.
Continuing Care Retirement Community (CCRC)
A CCRC, also referred to as a life-care community, combines residential accommodations with health services. The purpose of a CCRC is to allow residents to receive the appropriate care across a continuum, from
independent living to assisted living and skilled nursing care, as their needs change, without having to leave the retirement community. This model ensures residents will be cared for through end-of-life online projects. CCRC’s usually charge residents an entrance fee as well as a monthly payment. The entrance fee may include the cost of purchasing a unit, or it may be a one-time fee.
Paying for a CCRC is decided by the level of care that you require and where you reside, from independent living to assisted living and skilled nursing care. In independent living, the only option is private payment. Assisted livi
ng is not covered by Medicare, Managed Care and Medicaid, but is covered by certain long-term care policies (LTCI) and Veterans Benefits. Skilled nursing is covered by Medicare, Managed Care, Medicaid, long-term care insurance (LTCI), and Veterans Benefits.
Assisted living is a general term used to describe residential communities that provide care for individuals who cannot live independently, but do not require twenty-four hour skilled nursing care. These communities typically serve individuals age sixty and older, although younger persons with similar needs may be served as well. Some communities also offer Alzheimer’s and / or dementia care.
Assisted living communities proved room and board, some housekeeping, social activities, supervision and assistance with basic activities (personal hygiene, dressing, eating and walking). Community staff either provides or arranges transportation for residents. Most communities offer three meals per day, and snacks in between meals.
These communities are considered non-medical communities and are not required to have nurses, certified nursing assistants or doctors on staff, although many communities do have medical staff either onsite or on call. Medications can be stored and distributed for residents to self-administer.
Medicare and Managed Care do not cover care in assisted living communities. In some states, Medicaid will pay for assisted living; however, very few communities accept Medicaid as reimbursement. Long-term care insurance policies (LTCI) and Veterans Benefits sometimes can cover the cost of assisted living communities. Most assisted living is private pay.
Some Assisted Living communities stratify costs along three or four levels of care, with all costs of care included in the monthly fee. A higher level of care results in a higher monthly fee. Others have a basic monthly cost and costs for additional services are added on a fee-for-service bases. Some have a hybrid of the two systems with stratified costs by level of care plus additional fees for certain services. In short, cost structures vary considerably and can be quite complicated.
Although the components of each level of care vary from community to community, some basic guidelines do exist. Many communities use a point system to determine the required level of care. No cost-of-care fees applies if the resident is considered independent and doesn’t require any help, as well as residents who only need verbal instructions to complete the activities of daily living (ADLs). Residents who require care are assessed prior to moving into the community. The components that typically determine the level of care a resident requires are: bathing, clothing, grooming, mobility, continence, caregivers, eating, medication, laundry, and dementia.
Nursing homes / convalescent homes are also known as skilled nursing facilities, or SNF’s (pronounced ‘sniffs’). SNF’s are live-in facilities that provide medical treatment prescribed by a physician. These nursing care facilities accept several types of patients: some require short-term rehab while recovering from surgery; others require long-term nursing and medical supervision. In addition, some SNF’s offer specialized care programs for Alzheimer’s or other illnesses, or short-term respite care for frail or disabled persons when a family member requires a rest from providing care in the home.
SNF’s provide 24-hour nursing care; rehabilitation services such as physical, speech and occupational therapy; assistance with personal care activities such as eating, walking, bathing and using the toilet; coordinated management of patient care; social service; and activities.
The primary ways to pay for skilled nursing facility care are Medicare and Managed Care, Medicaid, long-term care insurance policies (LTCI), Veterans Benefits, or private payment. Most skilled nursing care at a facility is covered initially by Medicare. After Medicare coverage stops, your options are LTCI, Medicaid, private payment or a combination thereof.