Thursday, March 5, 1998
Many seniors choose to remain in their family homes for as long as they live.
Others decide that the financial and emotional advantages of remaining in their own homes are outweighed by the burden of home maintenance and repairs. They may decide to buy or rent in a retirement community, which are usually set up to provide a rich social and cultural life for the over-55 age group. Or they may decide to enter a residential facility that will provide daily assistance and easy access to medical care when the need arises.
Still others may not be able to make the decision for themselves. Perhaps their mental condition has deteriorated, or they have suffered a sudden stroke or heart attack. In these cases, their adult children or spouse may decide to place them in a skilled nursing facility.
Often, the kind of care you need will influence where you choose to live. If you are at the independent living level, or need assistance with some daily activities and can afford to stay home and hire home care or home health care providers, your first call after completing the self-assessment guide might be to the Alliance on Aging''s Information and Referral department at 646-1458.
If you are at the assisted living level, and are looking for a residential facility for the elderly (RCFE) or skilled nursing facility, your first call might be to the placement counseling service of the Ombudsman for Long Term Care at 333-1300.
Most people prefer living in their own homes for as long as that is possible. The increased popularity of home care and home health care agencies attests to a growing desire among older Americans to live out their lives in the comfort of home.
On the other hand, safety should be a primary consideration. If an older person is continually leaving the burner on, or lives alone and is prone to falling, or is becoming increasingly confused, AND is unable to pay the high cost of round-the-clock home care, moving to a specialized facility may be the best decision.
What are the differences between these various living arrangements?
First, they don''t all look alike. A small, six-bed residential care facility like Carmel Villa in Mid-Valley, Carmel, where residents sleep in private rooms but share a common family-style living and dining space, looks a lot different than a 200-unit independent living complex like Carmel Valley''s Pacific Meadows. You can''t expect a skilled nursing facility such as Monterey Pines, which takes care of very elderly and frail people in need of constant supervision, to look as home-like as the elegantly-appointed apartments at The Park Lane in Monterey.
Second, each facility offers different lifestyles. People who like a lot of social action, who enjoy weekly outings, daily Tai Chi classes and regular concerts, may prefer a large complex such as Villa Serra in Salinas. Other people may prefer the quiet and serenity of a small, "Mom-and-Pop" facility, which more nearly mirrors the atmosphere of a private home.
Knowing your own preferences is important: Do you enjoy a more urban or rural setting? Would you rather be close to hiking trails or a shopping mall? Do you have a pet?
Third, different living arrangements offer different levels of medical and non-medical assistance. A post-operative heart attack patient may be more comfortable in a residential care facility for the elderly, where nurses look in on him regularly, than in an independent living community where he is expected to care for his own needs.
Finally, finances certainly come into play. If money is no issue, Monterey County offers a rich smorgasbord of elderly living arrangements. But low-income county residents may find that their options are severely limited. Executive director for Monterey County Ombudsman for Long Term Care Vicki Bamman points out that of the county''s 60 licensed residential care facilities for the elderly (RCFEs), just one on the Peninsula and 11 in Salinas agree to accept low-income seniors. Where you live, elderly or not, depends largely on what you can afford to pay.
Above all, be sure to visit any prospective place before you or your family member moves in. Visit several times, at different times of day. Taste the food in the dining room. Notice smell and cleanliness. Does the staff greet you with a smile? Are the rooms cheerful? Do the residents look happy and well-groomed? Meet administrators and ask for a financial statement. Talk to residents, and their families. Take your time, and look around. Visit your loved ones often after they move in. It''s your life--it''s your right.
Independent Living--Private Home or Retirement Community
(Examples: Pacific Meadows, Del Mesa Carmel, Hacienda Carmel)
Thisoption is appropriate for seniors willing and able to take care of their own needs, or who are able to pay for private home care or home health care as required. In retirement communities, there is a certain sense of shared, communal activities, but no responsibility for residents'' changing state of health.
Accommodation is private. Residents buy or rent their own home, apartment, mobile home, condominium or "cottage," often in a neighborhood restricted to the over-55 crowd.
Services and amenities range from no services provided in a private dwelling, to building and lawn maintenance and limited recreational facilities in apartment complexes, condos and trailer parks. Some places, such as Del Mesa Carmel, offer dining services on a pay-per-meal basis as an added attraction, but communal meals are not required.
Care provided is minimal. None is required, as independent living communities need no special license. Residents who need help in daily living activities, or who require nursing or other medical care, must contract for it on their own.
Funding depends either on private finances or, in some cases, government subsidies for low-income seniors. "Affordable housing" options such as Pacific Meadows set aside a certain number of their units for low-income seniors, based on state and federal guidelines; discretion is assured, and no distinctions are drawn between residents paying full-price versus subsidized rentals. In these cases, monthly rent is calculated based on income.
Congregate Living/Senior Housing
(Examples: Villa Serra, The Park Lane)
Thisoption is appropriate for seniors willing and able to take care of their own needs, but who prefer a more communal setting with more organized shared activities, communal dining, laundry and housekeeping, and an optional social and cultural calendar.
Accommodation is most often in a group living environment that typically includes a common dining room and public areas for social programs and private events. Residents may live independently in apartments, single houses or cluster homes. Monthly rental and/or service fee is charged, and a purchase option may be included. Utilities and amenities are either included in the monthly fees, or are paid for separately.
Services and Amenities are more far-reaching than in an independent living retirement community. Shared meals, housekeeping, laundry and scheduled transportation to cultural events, medical appointments, shopping malls, and so on are usually covered by monthly fees, but are sometimes available on a pay-as-you-go basis. Health and fitness classes, on-site beauty salon, bank and convenience store are usually offered. Security services, an emergency-call system (pull cords in bathrooms and bedrooms) and 24-hour staff are expected.
Care provided is usually minimal. Some provide a licensed on-site assisted living arrangement, which usually means moving to a different apartment within the complex. More often, residents contract for their own home care or home health care services through private agencies, or are moved to a skilled nursing facility when they become incapacitated.
Funding is private. Some limited funding options for low-income seniors, depending on the facility. No license is required, unless the place also operates as a Residential Care Facility for the Elderly (RCFE).
Assisted Living/ Residential Care for the Elderly (RCFE)
(Examples: Carmel Villa, Park Lane''s assisted living floor)
Thisoption is appropriate for seniors who need regular assistance with such daily tasks as eating, bathing, dressing, walking and toilet functions, but who are alert and able to administer their own medications. Residents do not require constant medical supervision at the time of admission, but staff is available round-the-clock.
RCFEs are licensed by the California Department of Social Services, and must adhere to state guidelines.
Accommodation is in a group living environment ranging in size from a two-bed "Mom-and-Pop" facility run out of the owner''s home, to a corporate-owned operation containing more than 200 separate living units. Rent is paid monthly according to an admission agreement that spells out all basic services and individualized optional service requests.
Particularly in smaller facilities, residents usually live in a private bedroom but share bathrooms. All other rooms are common areas, used for dining and socializing.
Sometimes an assisted living facility may be a separately designated part of a larger congregate living/senior housing complex, as at The Park Lane.
Services and Amenities are wide-ranging.
1. Basic services include all meals, including physician-prescribed diets; laundry and housekeeping; furnishings; basic hygiene items; care in arranging and keeping medical appointments, including taking medications at the right time and providing transportation to doctors'' offices. A schedule of planned activities, including social and recreational programs, is required in facilities with more than six residents.
2. Optional services may include anything the resident desires and the facility is willing to provide, for a separate fee. This may include a private telephone, subscriptions to a newspaper or concert series, or regular visits to a favorite off-site manicurist.
Care provided includes regular monitoring of residents'' mental and physical condition, and assistance with activities of daily living such as dressing, eating, bathing and walking. This care component is required by the state license, and is considered part of the facility''s basic service.
No medical care may be provided by RCFE staff, although residents may contract for 24-hour private duty nursing care on an individual basis. For example, RCFE staff members may remind a resident to take his pills, but may not place them in his mouth or administer injections.
Hospice services may be provided to a terminally ill resident who has been living in an approved residential care facility for at least six months.
Funding is either private, from savings or long-term care health insurance, or may be public. Typical fees range from $1,250 to more than $3,500 per month. If resident receives SSI/SSP through MediCal, the RCFE will provide all basic services at no additional cost to the resident.
Continuing Care Retirement Community/Life Care Community
(Canterbury Woods, Forest Hill Manor and Carmel Valley Manor are the only Life Care Communities in Monterey County; There are no local Continuing Care Retirement Communities)
Thisoption is appropriate for seniors presently able to take care of all their own daily living needs, who satisfy a certain minimum financial requirement set by the facility, and who want the peace of mind that comes from knowing that their medical needs will be taken care of until their death even after their own financial resources have run dry.
Life Care and Continuing Care Communities require a significant entrance fee, ranging from just under $100,000 to well over $250,000, plus monthly fees of from $1,000 to $2,500 to cover meals, housekeeping and maintenance. In exchange, the resident receives a lifetime guarantee of care. Upon the resident''s death, the apartment reverts back to the facility.
The main difference between the two options is that in a Life Care Community, monthly fees remain the same for as long as you live, whereas in a Continuing Care Retirement Community, monthly fees increase as you move to a higher level of care.
One Life Care Community director put it bluntly: If you live longer, and get sicker, you''re better off financially in a Life Care Community, whereas if you stay healthy and die younger, you''re better off in a CCRC. Either way, you''re taken care of, but your heirs are not. Resident''s assets will not necessarily be preserved, if needed to help defray living costs.
Accommodation is comprehensive. CCRCs and Life Care communities provide all levels of living arrangements, from independent living on to assisted living and, if needed, skilled nursing, which may be on-site or off-site. Residents enter the facility at the independent living stage, and move on to the second two stages as their mental and physical condition requires. The decision to move on to the next stage living arrangement is made by the facility''s medical director and resident care team, in tandem with the resident and/or the resident''s family or designated guardian. Once a resident vacates his or her independent living apartment, that unit reverts to the facility and may not be passed on to the resident''s heirs.
Services and amenities vary according to the resident''s present living arrangement. Independent living units typically provide one to three meals per day, housekeeping, transportation for medical needs, shopping and entertainment, and a program of social activities. Assisted living services include meals, housekeeping, laundry, an activities program and assistance with personal care. Skilled nursing services include all of the above, plus nursing care, therapy, restorative care, social services and personal hygiene. n
Life Care Communities provide all the above services, plus acute care and physician''s services.
Care provided is according to the level of services needed by the resident. Most CCRCs and Life Care Communities have a resident RN, and Life Care Communities offer physician and surgeon services at no extra cost to residents.
Funding is private. After the substantial entrance fee, residents in a CCRC pay sliding-scale monthly fees, with costs increasing as they require additional medical services. Monthly fees in a Life Care Community remain fixed, except for cost of living increases, for the duration of the resident''s life, no matter what medical services are required. The facility does a pre-admission financial screening, to ensure that you have sufficient funds to cover reasonable costs determined by your life expectancy. If you outlive your funds and all your assets, the facility absorbs the costs of your care for the rest of your life. Medicare and MediCal may pay towards skilled nursing costs.
Skilled Nursing Facility
(also called nursing or convalescent home)
(Examples: Monterey Pines, Carmel Convalescent Hospital, Ocean View Care Center in Monterey)
Thisoption is appropriate for seniors requiring licensed nursing and custodial care. Many residents are convalescing from a serious illness or surgery, and require constant skilled observation. Most residents require custodial care, including assistance with the activities of daily living (ADLs) due to a cognitive impairment, such as Alzheimer''s, or due to extreme physical frailty which makes them unable to perform such tasks by themselves.
Skilled nursing facilities are licensed by the California Department of Health.
Accommodation is in a furnished private or shared room. Residents typically may not furnish their own rooms, although they may bring in small personal decorations.
Residents are cared for and monitored round-the-clock.An RN must be on duty at least eight hours a day. Some facilities are "locked" to prevent confused residents from wandering.
Services and amenities overlap with care provided, as medical and personal care are the major services required by these residents. Twenty-four hour skilled nursing care is provided, including therapeutic diet, restorative care, social services and activities program, housekeeping and laundry, barber and beauty services. All residents'' daily needs are taken care of, from bathing to meals to transfer in and out of bed.
Many skilled nursing facilities maintain a certain number of beds for patients recovering from surgery or serious illness, where rehabilitative, restorative and subacute care is provided.
Some skilled nursing facilities have specialized units to care for patients with dementia, including Alzheimer''s. More than half of all nursing home residents suffer from cognitive impairment such as Alzheimer''s.
Funding is usually covered by Medicare for the first 100 days. After that period, fees are private pay unless the facility accepts MediCal and the resident qualifies. Fees range from $3,500 to more than $4,000 per month; fees are paid on a daily basis, with a charge for added extras such as beauty services, telephone, laundry, and pharmaceuticals not covered by Medicare or MediCal.