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Exploring Housing Alternatives for Older Adults


Hello, and welcome. My name is Debra Levy, and I am a social worker and a professional geriatric care manager. I hold a Masters Degree in Social Work and a Masters Certificate in Aging, and am certified by the National Academy of Certified Care Managers. Perhaps more importantly, I have worked helping seniors and their families in various settings for the past 30 years. I have maintained a private practice in geriatric care management since 1988, which currently employs both registered nurses and social workers as professional geriatric care managers. Our mission is to offer seniors and families like yourselves the very best in caring, individualized and effective support as they face the challenges of aging and disability.


Right now, and every single day, families all over the nation (and overseas) are struggling to care for their elderly loved ones. What they do not know is that help is available. I am so glad that you are listening to this presentation, which contains important information for caregiving families, and especially those of you who are long distance caregivers. By learning more about housing alternatives for older adults, you will be prepared to communicate with your family members with increased knowledge and understanding, to minimize future conflicts, and to obtain the best solutions to the almost universal question, “What do we do about Mom or Dad?” Moreover, being prepared and planning ahead gives you more options and choices than just waiting and responding to crisis situations.

Senior housing is a huge topic because the need is great, and fortunately, there are many options for today’s seniors. It becomes challenging for families to sort through all these choices. I will give you an overview today, and encourage you to consider contacting a local geriatric care manager who will have expert knowledge about your geographic area. You can find a directory of care managers on the website of the National Association of Professional Geriatric Care Managers,


When possible, most seniors and their families prefer “Aging in Place,” with seniors staying in their own homes. Issues to consider for older adults include: safety, care needs, and social needs. Safety can be addressed, in part, by ordering an emergency response system, such as Lifeline, where your loved one can push a button if they need assistance. We must also consider the accessibility of the rooms seniors need to enter, especially the bathroom, and what modifications can be made to improve the safety of the home environment. Access to transportation will determine whether the senior staying at home can obtain needed services, medical care, and social support.


Many older adults eventually require some type of care in the home. This might include skilled services such as a registered nurse or physical therapist, which Medicare covers only for short-term, acute needs. What we see more often in our elderly clients is a need for long- term hands-on care in the home, provided by a companion or nursing assistant. While there is some government assistance for low-income individuals, this type of direct care is usually provided by family members and/or privately paid caregivers. Hiring personal care at home is expensive, and if needed 24/7, will be more expensive than a nursing home. Some seniors can attend Adult Day Care, where they will receive personal care, recreation, and other support in a group setting.


The alternative to staying at home, or moving in with family members, is relocating to a senior community. I will briefly review with you the different types of housing for seniors. We begin with Independent Living, where healthy, self-sufficient seniors can enjoy the security, comfort and social activities of a senior community. This category includes subsidized, low-cost apartment buildings as well as luxury high-rises, which may offer meals, transportation, recreation, and a variety of amenities.


For those who need more assistance, the type of housing called Assisted Living offers help for people who do not have severe medical problems but require help with some personal care, such as bathing, dressing, or meal preparation. There is a great deal of variety in the services provided by Assisted Living, with only limited government regulation. Assisted Living ranges from high-rise apartment style, with individual apartments or suites, to small group homes, sometimes called board and care homes, where groups of seniors live in a family style home with 24-hour caregivers. These can be very comfortable…I recall an older woman we worked with whose niece was concerned about her aunt’s growing inability to live alone safely. When we first moved her to the group home, the aunt was trying to smuggle out notes saying “I’m a prisoner here, save me.” She would grip the arm of visitors and beg them to help her get away. Within a couple of weeks, she had settled into the role of social butterfly, welcoming all, and when we overheard another resident asking her “Where is your home?” she answered happily, “I don’t remember, but this is my home now.” Small group homes work very well for care of those with Alzheimer’s Disease. There are also larger Assisted Living specially designed for people with Alzheimer’s Disease or other dementias, including such features as enclosed outdoor areas for safe “wandering.”


Nursing homes are facilities with 24-hour medical care for short-term rehabilitation, and long-term care for people who require a higher level of help with their medical care and personal care needs. Unlike other housing options, nursing home care is often covered by Medicare for the short term, with Medicaid available long term after a person has exhausted their own financial resources.


Lastly, Continuing Care Retirement Communities and Life-Care communities combine all of the above, offering multi-level complexes that provide independent living, assisted living, and nursing home, enabling residents to move from one level of care to another without having to move from the community.


Hospice care helps patients and their families nearing the end of life to receive comfort and comprehensive assistance with the dying process. Hospice can be provided in the home, in a nursing home, or in a free-standing hospice facility. Medicare generally covers hospice care, and the people who work in hospice are some of the most dedicated professionals I have ever met. Hospice is a wonderful service, and the families we know who use hospice often say they wish they had called sooner.


Most families ask the question, “How do we pay for all of this?” The majority of the services for seniors are paid for privately. Long-term care insurance, for those that have it, is very helpful in paying for care either at home or in a facility. Most states have some subsidized programs for low-income seniors, which can include such things as housing assistance, home care, meal delivery, utility assistance, transportation, and home repair. Resources are limited and waiting lists can be long. To find out more about programs for low income and other seniors, contact the federal government Eldercare Locator at 1-800-677-1116. There are many websites with senior housing information including Nursing Home Compare at,, and the Assisted Living Federation of America at


As mentioned earlier, Medicare and other health insurance generally cover only short-term, acute, skilled care. Medicaid (or Medical Assistance) for long-term care, requires proof of both medical need and financial need. While Medicaid is used mostly for nursing homes, Medicaid waivers in some states can also cover home care and assisted living. When one spouse goes to a nursing home under Medicaid, there are legal provisions to protect the other, or “community” spouse from impoverishment. Particularly where a couple with some financial means is involved, consulting an Elderlaw attorney can help with planning to maximize eligibility for government assistance. You can reach the National Academy of Elderlaw Attorneys at Additional help and information for Foreign Service members is available from the American Foreign Service Association, the American Foreign Service Protective Association and especially the Senior Living Foundation of the American Foreign Service


As you further explore the options for senior housing, you will learn about additional factors to consider in your choices, including the level of care needed, budget, geographical area, and specific services or amenities that are important to the individual senior. You can use checklists (found on many websites including and [e1] for evaluating the staff, other residents, food, activities, and décor. Seek recommendations from your personal and professional network, visit the prospective facilities more than once, and include the senior as much as possible.

Many of you may find that your loved one is resistant to accepting the need for more care. We advise that you move slowly and incrementally, if possible. Consider a short-term trial of a new setting, which many senior communities will allow. Where possible, older adults must be allowed to make their own decisions, unless they have memory loss and safety becomes a serious concern. It may help to involve the physician, a trusted advisor, or other family members in the discussion. If you’ve done everything you can, and your loved one is still refusing assistance, you may need to step back and wait for something to change that requires action - some people will only change when a crisis requires it. Hire a Geriatric Care Manager if you have the ability, and monitor the situation as best you can so that you know when to step in.


Thank you for spending this time with me today. I have given you a very broad overview of the many options for senior care at this time. We have discussed home care, independent living, assisted living and nursing homes, and the financial aspects of paying for care. You have been introduced to some of the factors in choosing housing options, and how to cope with loved ones who are resistant to care. I salute you for your efforts to educate yourselves about resources for seniors, and wish you well in your journey of caregiving.



WEBSITES FOR DVD: Debra Levy Eldercare Associates Medicare Nursing Home Compare American Association of Retired People Assisted Living Federation of America National Academy of Elderlaw Attorneys Eldercare Locator Senior Living Foundation of the American Foreign Service American Association of Daily Money Managers State Health Insurance Assistance Project National Association of Professional Geriatric Care Managers


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