Making the decision to move Mom from the home she lived in for many years into a long-term care community can be one of the most gut-wrenching decisions a caregiver will ever face. There is so much guilt associated with making such a huge change. There are promises once made to loved ones that are broken, there are difficult waters to navigate with differing opinions of siblings, and there is the daunting and overwhelming task of choosing a place that is the very best match for your family member. Usually, when the decision to move Mom is made, you as the caregiver are at your wit's end. You are either so very tired from trying to coordinate and manage all your Mom's - or any loved one's - needs at home for so long, or your loved one experiences a sudden health crisis that has pushed you into a decision you likely have never contemplated.
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There are many options for your loved one, particularly in this geographical area. Some would say this is a blessing, others would say this is a curse because so many options may leave you feeling paralyzed. Thinking about future care options long before you are put into a situation where you are forced to make a choice in a crisis is best; however, most people are not wired to plan for such things in advance. Trying to make this decision alone can be very tricky so check out the list below of long-term care living opportunities, how they are typically paid for, and the levels of care that are minimally provided by each type.
When thinking about the living arrangements that best match your loved one's needs, first have an understating of the limits of care that can be provided at the community you choose and the income limitations of your loved one. Weigh those against any chronic conditions they may have and the typical progression that they face with their ailment. When it comes to long-term care communities (even of the same type), an apple is not an apple meaning even within the same level of care or type of community, the services provided may look very different. If you had a crystal ball, you would be able to tell what the ultimate course of your family member's life will be, but we are not given crystal balls when we take on the care of another. However, one thing is for certain: the fewer moves a person must make, the better quality of life they will have so really thinking things through will hopefully give you the best outcome possible.
Long-term care living opportunities
Senior housing (apartments and 55+ housing communities)
A senior living apartment offers two main features: accessibility and a sense of community. Senior apartments are designed to accommodate the typical needs of its older, frailer residents. For example, a senior living apartment building may have no or limited stairs, handicap accessible units for wheelchairs, and handrails in the bathrooms. These apartment buildings also restrict residents according to age. Most senior apartments require residents to be at least 55 years old. Oftentimes, senior apartments have communal activities as well as trips and clubs to aid in the sense of community and decrease isolation. Some senior apartments even have care coordinators on staff to assist residents with community resource needs.
Independent living communities
Independent living communities cater to older adults who have very few medical issues. These adults function well independently but would also enjoy more amenities than living home alone. Typically, independent living communities provide one or more communal meals per day, coordinated activities, transportation to and from appointments, 24-hour security, concierge services, and housekeeping. Some independent living communities even contract in services such as rehab, podiatry, physician services, and homecare to assist the older adult to "age in place" for as long as possible. Most of the communities are paid for with private funds and the monthly costs vary just as widely as the decor and atmosphere. It's important to know that if the community feels that your loved one poses a safety risk to others, they can ask the person to leave as it is their responsibility to ensure all residents can live safely in their community.
Assisted living communities
Assisted living communities are for seniors who are no longer able to remain safely at home. Typically, they need assistance with activities of daily living (bathing, dressing, grooming, meal preparation, and medication management). Assisted living communities in North Carolina are regulated by the NC Division of Health Services Regulation (DHSR) and must meet certain standards of care to operate. Assisted living communities offer communal housing and vary in their available living quarters. Some offer private rooms that may look like a hotel room while others offer more apartment-style rooms, and yet others offer semi-private rooms where your loved one would share a room with another resident. Assisted living communities receive regular "surprise" inspections and their ratings can be found online at Star Rating Program. In addition to all the types of services you would find available in an independent living community, assisted living community staff can provide hands-on care to the residents. Assisted living communities are paid with private funds, Medicaid, or long-term care insurance. The monthly fees vary. Some communities charge a flat monthly fee while others their serviced depending on the care needs of your loved one.
Family care homes
Family care homes are very similar to assisted living communities and are licensed and regulated by the same governing body. They offer a much more intimate setting and are often located in neighborhoods where you may reside! Family care homes typically have fewer than six residents living in a communal setting. Most of the staff are cross-trained to provide for all the needs of the residents. Some family care homes cater to all women, some to all men, while others specialize in care for those afflicted with dementia, and others provide care for a mixed population. Typically, family care homes are paid for privately, via Medicaid, or through long-term care insurance.
Nursing homes
Nursing homes are often what folks think of as a "facility." Nursing homes, just like assisted living communities and family care homes, offer around-the-clock care to your loved one but at a more in-depth level. Many family caregivers jump to the conclusion that their loved one belongs in a nursing home, but the reality is most people do not require such a skilled level of care. The percentage of people living in a nursing home for the long term is significantly lower then what is commonly believed. According to the U.S. Census Bureau (January 2016), slightly more than 5 percent of the 65+ population occupy nursing homes, congregate care, assisted living, and board-and-care homes, and about 4.2 percent are in nursing homes at any given time. The rate of nursing home use increases with age from 1.4 percent of the young-old to 24.5 percent of the oldest-old. Almost 50 percent of those 95 and older live in nursing homes.
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Skilled nursing facilities, most historically known as "nursing homes" also provide short-term rehabilitation stays when individuals are recovering from an acute illness, surgery, or hospitalization. Individuals who have such severely complex medical needs that they can otherwise not be cared for in a less intense setting are candidates for skilled nursing facilities. Long-term nursing home stays are paid for either privately, through long-term care insurance, or with Medicaid, while short-term rehabilitation stays are typically paid for in full or in part by Medicare. In many nursing homes, residents typically share a room with another person and eat their meals in a dining room unless they are so ill that they must eat in their room. It is also important to note to be covered under Medicare for a rehabilitation stay you must have a three-midnight inpatient stay to access the Medicare benefit for rehabilitation services. Many families don't realize this and their loved one who has only had an observation stay does not qualify for Medicare to pay for services. Asking the hospital case managers if the stay qualifies for Medicare is wise. The national Medicare website has a tool you can use to compare nursing homes: Nursing Home Compare.
Continuing care retirement communities (CCRCs)
CCRCs are a combination of all the above-mentioned residential and care options. The idea behind these "life care" communities is that residents move in when they are healthy. As their care needs progress, they move along the continuum, all while staying on the same campus. This option is particularly attractive to married couples who ultimately may experience need of different levels of care. One of the huge advantages of CCRC living is that for individuals who are planners, there is peace of mind knowing that as care needs increase they will be able to be taken care of by the staff they have gotten to know, and they won't have to move to another property. CCRCs have many different payment models and typically require a sometimes-hefty buy-in fee and monthly service charge while other CCRCs have more of a traditional month-to-month rental arrangement. The NC Department of Insurance regulates all CCRCs in NC. They have a very nice Resource Guide that is free and online for consumers.
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In this area, we have for-profit and nonprofit CCRCs as well as rental and non-rental types. Just as with all the other levels of care, it is important to do your homework and explore the options before deciding which model best fits your lifestyle needs and wallet's capacity!
Memory care
Many assisted living facilities and nursing homes have separate living quarters that specialize in what is commonly known as "memory care." With the incidence of individuals in a long-term care setting having a dementia diagnosis, many long-term care communities have tried to specialize in these individuals' unique needs. Memory care units have a higher staffing ratio and very specialized activities for the residents to participate in to improve their quality of life. Most long-term care communities that have memory care units keep the residents secure in the community, thus decreasing the risk of them wandering away. This is typically accomplished by having all exit doors specially coded so that residents cannot exit unless accompanied by a staff or family member who has the code.
Evaluating your choices
A note on comparing long-term care communities and inspections: Please know that the inspections of the types of long-term care communities listed above are done at random by the applicable state regulating body. The inspections are truly a snap shot of care and quality measures. While you should take the inspection reports into consideration when making a placement location decision, it should not replace a tour and the general feeling you get when you visit the community. Talk to the current residents and family members you see on the tour and talk to the staff - not just the administration but the actual staff that will be involved in the delivery of care for your family member. If you have the opportunity, try a meal. Use all your senses while you are visiting. How does it smell? What are the lighting and décor like? Do the residents seem engaged? Most of all, trust your gut feeling about things. Prepare yourself for the sights and sounds of some individuals who may not be as physically or cognitively compromised as your loved one and others who may be frailer.
While making the decision to move your loved one can seem very daunting for you as a caregiver, similar to helping a child pick out a college, spending the time and doing your research will help you feel more confident in your decision. Join our online community of caregivers to continue this conversation.