Explanation of Housing Types

Explanation of Housing & Care Types

There are many different types of senior housing and care options available.  The sheer variety and the terminology can be confusing.  In this document we try to explain the major types of housing and care that are out there.

Adult Communities / 55+ Living / Age Restrictive Communities

These communities are age-restricted housing developments.  They may consist of single-family dwellings, condominiums, mobile homes or apartments.  Adult communities are characterized as active environments, typically offering some type of activities or social interactions with neighbors.  Quite often the management of adult communities do not provide care services.  Individuals may arrange to obtain in-home or other types of care to continue living independently within such communities through community-based service providers.  A requirement of an adult community may be that a resident be capable of managing his/her own affairs.  Age restrictions may require that one or all of the residents in a home be 55+ or 62+.  All Adult Communities require that you pay privately for services.

Adult Family Homes / Adult Care Homes / Adult Foster Care / Residential Care Home

All of these terms refer to private homes licensed by the state to provide a certain level of care to older adults.  Adult home are located within neighborhoods throughout our cities.  Each individual home varies in the types of care offered, the physical layout of the home and the services extended to residents.  Homes may be operated by nurses or medical professionals; such homes serve as an alternative to skilled nursing care.  Other homes may be operated by caregivers who support older adults with their activities of daily living.

These types of congregate residential homes offer an individualized approach to meeting a person’s unique needs.  They can care for the physically frail and for people with cognitive impairments such as dementia and Alzheimer’s disease.

Home providers establish their own policies for admitting residents.  Some homes will only admit seniors who pay privately for services.  Others will admit seniors who are receiving benefits from long-term care insurance or who are receiving funding from the state through Medicaid/COPES.  Still others will admit seniors who are receiving any of these types of funding.

Alzheimer’s & Dementia Care

There are specific and specialized care communities who provide care for individuals with memory impairments and memory loss.  In addition to and in cooperation with these communities there are in-home care, home health, chore and companion services that support individuals and families dealing with memory loss.  By providing care for a certain number of hours per day or week, or by providing 24-hour live-in care these services allow individuals to remain in their own homes.  The factors that must be considered when choosing a memory care community or care option are varied and complex.

Assisted Living / Residential Care

These communities vary widely in the services they offer.  It is important to fully understand the services provided by each specific community.  The term ‘Assisted Living’ is not well-defined and may change based on the regulations and interpretations of the management and/or nursing staff providing care to an individual.

Consumers should not equate Assisted Living with “one-on-one care.”  Assisted Living subscribes to the concept that one or more caregivers can provide support services to multiple residents.  Frequently you will find that there are levels of supervision and management to ensure that care is being delivered in a consistent and safe manner.

The care community may license only certain apartments or rooms for assisted living, or they may choose to license their entire building to provide such services.  This license allows certain staff members to provide certain personal care services for an individual. These tasks are typically non-medical in nature such as assisting residents with activities of daily living (bathing, dressing, toileting, medication reminders or management, and assistance to meals and activities).

Some assisted living communities offer much higher levels of care and provide support regarding transfer assistance (getting up out of a chair), or assistance with walking, using the bathroom, and incontinence care.  Some communities have Licensed Practical Nurses or Registered Nurses supervising the care, overseeing the resident care or actually providing nursing services.  Many assisted living communities have contracted with outside health care professionals to provide more extensive, nursing-type services and health care related support such as therapies and treatments.

Assisted living is also a term used to define a special type of dementia care community for individuals with memory loss or Alzheimer’s disease.  You may find that such a community offers a more secure environment as well as activities and services that are designed for people with cognitive impairments.

The majority of assisted living services are provided to individuals who either pay privately for care or that have long-term care insurance with specific provisions for assisted living.  A limited number of apartments may be available for individuals receiving state assistance through Medicaid/COPES.

Apartments

There are hundreds of apartment homes available in most every part of our state.  Very few apartment communities are age-restricted.  Those apartments which cater to older adults (which are very few) are listed on our web site.  You may also consider picking up a For Rent magazine at your local supermarket.  This specialty publication lists most all apartment rental homes.  Your local newspaper is also a valuable resource for finding a rental unit.

Continuing Care Retirement Communities (CCRC)/Life Care Communities (LCC)

These communities offer different levels of care ranging from independent to assisted living and possibly skilled nursing care, all within one building or campus.  The primary advantage CCRC/LCC is this: as your needs change, you can remain within the same community.  Some CCRC/LCCs require an entrance fee.  Some may also offer a month-to-month payment plan.  In our area, these types of care communities mirror your living choices, from large buildings in the heart of the downtown area, to suburban campuses.

Some of these communities only allow initial admission to their retirement living apartments and reserve their assisted living and/or skilled nursing services for their current residents.  Other communities may open their services for direct admission to their higher levels of care for short-term or even long-term stays.

Almost all CCRC/LCC’s require that you pay privately for services.  There are various skilled services that may be covered by Medicare.  The community may have specific guidelines for the acceptance of Medicaid / Medical.

Skilled Nursing Facilities

(Also known as Nursing Homes, sometimes as Transitional Care Units or Rehabilitation Facilities)

These communities offer the highest level of care in a non-acute care setting.  Skilled nurses are available to provide health care to physically or cognitively impaired individuals.  Care in a nursing home may be for a short-term recovery basis or for long-term care.

Transitional Care Units and Rehabilitation Facilities focus on therapies and treatments to allow an individual to return home or to gain a more independent lifestyle.  The professional support team may include nurses, doctors, physical-, occupational- or speech-therapists and social services staff.

Nursing homes accept private payment as well as payment from long-term care insurance.  It is likely that these facilities have also contracted with Medicare to provide housing and care under certain guidelines and for specific purposes.  Additionally, many nursing homes accept state funding through Medicaid.

Retirement Living or Independent Living

Many communities offer arrangements that allow for living independently but within the framework of a senior community.  The actual, physical housing might be an apartment, condo, cottage or townhome but then these communities may offer additional support services.  They often include one or more meals per day, housekeeping services and other support such as activities and transportation.

Some retirement living communities require either a deposit or a move-in fee.  Most options are offered on a monthly-rental basis; however, various types of retirement living are becoming available in our area.

Some retirement communities have licensed part of their community to accommodate assisted living services.  Yet others have contracted with in-home care agencies, nurses, therapists and physicians to provide on-site, in-home services.

Retirement living communities allow the option of hiring private-duty caregivers to provide support services, if and when needed.  Communities must comply with certain state laws to ensure the safety and well-being of their residents and to ensure that they are not providing care services that would otherwise require additional specific licensure through the State.

The benefit of this arrangement is that it negates maintenance of a home and eliminates many chores that residents may no longer care to do, such as cooking or driving.  Management staff generally keeps a watchful eye over residents.  There may be 24-hour staffing or building security.

Opportunities for social interaction with peers and staff abound.  You may still live on your own, but you are not living as secluded as you may be if you were living in a single family dwelling.

A limited number of communities require that you pay privately for services.  A few communities offer reduced rates based on income level.

In-Home Care / Home Health Care / Chore Services

Whether you’re interested in having someone come for just a two-hour visit, or whether you’re in need of live-in care, in-home agencies can meet the changing needs of individuals with personal care needs or with dementia, without necessarily requiring a change of living situation.

The first thought many people have when the need arises for help in the home is, “I’ll find someone that can live with my mom/dad and simply exchange rent for their services.”  Although this sort of trade of services was common twenty years ago, it likely won’t work in today’s economy.  People with dementia rarely need someone just to live in their home – they need a great deal of personal care and a diligent eye – many times 24-hours a day.

The next thought may be, I’ll place an ad in the paper and find someone to work for $12 an hour.”  The only problem with this is that you’ve now become an employer, a part-time business.  Operating a business requires training, supervising, paying taxes, etc.  This is typically much more than what most people want to do!

So, what’s the alternative?  The option thousands of families are choosing is to arrange for care through an in-home care provider.  In our area there are different levels of providers ranging from skilled, professional providers to non-medical chore-type staff.  Prices range from $15 to $135 an hour, based on the skill set of the agency you’re hiring, the types of benefits the agency is paying to their staff members, and the types of services you need for your family member.  Rates also vary based on the regularity of scheduling and amount of coverage you desire.

Home Health Care Agencies

This is the highest level of in-home care licensed in the State of Washington.  These providers may be Registered Nurses, Licensed Practical Nurses, therapists or well-trained health care providers.  These individuals provide hands-on care, inclusive of nursing tasks.  They may offer chore-type services, or they may have a partner agency or separate in-house agency that offers such services.

Home Care Agencies

This type of agency provides non-medical assistance, but likely helps older adults with almost all of their activity of daily living needs.  They provide bathing assistance, medication reminders, assistance with toileting, dressing, grooming and other personal needs.  They also likely provide light housekeeping, cooking and other chore-related services.  Agencies that employ their staff, rather than working with subcontractors, are likely to charge a bit higher hourly fee to cover employee taxes and possibly benefits.

Chore or Companion Services

This type of agency is likely a non-licensed agency with the state of Washington.  They provide little or no hands-on care.  Chore providers perform household duties, watch out after someone with dementia and act more as a “watchful eye” and companion to an older adult.

Families benefit from selecting the right agency to meet their own specific and unique needs.  CHOICE Advisory Services can provide you with assistance in defining which in-home providers will be of most interest to you.  By advertising in the CHOICE Guide, the agencies listed in the directory are letting you know that they have interest in working with you and that they have a passion for serving people older adults.  Please call upon these agencies to help you – even if it’s only to give you a bit of a rest from the task of being the primary caregiver for your loved one.

Affordable Housing/ Subsidized Housing / Low-Income Senior Housing

The CHOICE web site has limited information about subsidized housing for older adults.  The best source of information for affordable senior housing, section 8 housing, HUD Housing and Mobile Home Parks is available by contacting the appropriate Senior Information & Assistance office in the county in which you live, or want to reside.

Medicaid / COPES

These programs are for people who have outlived their savings or who are facing financial hardship due to care and housing needs.  The process of applying for state assistance requires knowledge of the laws regarding entitlements, an understanding of the application process and an awareness of the assessment process.  You are best served by consulting our Articles of Interest / Medicaid section to educate yourself regarding the options available to you.