Elder/Adult Dependent Care

Family Homes and Assisted Living

Leaving home can be traumatic for an older person. It can end special life patterns, including friends and routines, producing great anxiety and feelings of loss. However, if an elder is socially isolated, if it's too hard to finance upkeep or home repairs or if the home design cannot accommodate disability, then you should consider alternate housing arrangements.

There are more options than ever as a new "seniors housing" industry jumps into full swing. As the U.S. population ages, there has been a shift away from institutional settings toward "assisted living"—homes or large communities that offer independent living with limited health and personal care services.

Here are some options to consider:

Living with Family Members
Some elders are able to move in with their adult children and family, or vice versa, perhaps after some home reconstruction. If you consider this option, be sure everyone in your family is involved in the process. Be aware of the possibilities of lifestyle conflicts, the physical demands of 24-hour oversight, and changes in marital and familial relationships. Be sure to work out the finances and living arrangements before the move, especially if it's long distance. On the plus side, multi-generation households offer a special quality of life, especially if there are grandchildren, and it is much easier to monitor diet and medications with your elder in sight.

Sometimes children move into their parent's home, perhaps after modifications. Be sure you consider all the financial and lifestyle ramifications, as well as issues of control and interdependence.

By making some changes in the house, a separate self-contained unit called an accessory apartment can be created - if zoning laws allow. Entrance is usually separate from the main house.

Sharing a home is also a common solution. In this situation, your elder can be matched with another applicant who may split housing and utility costs in exchange for services. There are also social advantages, especially if your elder lives alone. An extra bedroom can be rented or your elder can join a group residence.Check with your local Area Agency on Aging or shared housing service for details. Word of mouth, newspaper ads, and community bulletin boards can also be helpful. Before making any change, however, be sure that the responsibilities and expectations of all parties are clearly defined, such as how household duties and finances will be split, how disputes will be handled and what happens if your elder's housemate becomes ill.

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Assisted Living
No longer is a nursing home the only alternative to living at home. If your elder does have to move, there are several "in-between" options, depending on your elder's medical and mental condition. Many of these facilities have requirements, including what levels of care are provided, what happens if your elder deteriorates or is no longer ambulatory, and under what conditions your elder will be forced to find another facility if his or her care can no longer be maintained at current conditions. Make sure all requirements are thoroughly spelled out.

Age-segregated apartments or " independent living."
This setup is often referred to as " senior housing " and is apartment living with age peers, usually 55 and up. Check with your local Public Housing Authority or AAA for details.

" Congregate living " or " assisted living. "
These are mostly rental units that offer a moderate level of support services in addition to meals. The range of services might include housekeeping, transportation, health and wellness programs and emergency response systems. These homes typically provide private living quarters with a central dining room. Transportation, shopping and housekeeping services are often provided, as well as professional staff such as social workers, counselors and nutritionists. In some cases, costs are subsidized by the U.S. Department of Housing and Urban Development under Section 8. Call the Housing Authority, program coordinator for senior housing, for details at 510-747-4300.

" Board and care " or " residential care for the elderly " (RCFE)
These homes offer room and meals and some level of supervision or personal assistance, but not skilled medical care. They are bridges between living independently and living in an intensive medical setting. This rental housing system provides housekeeping and personal care services for as few as three or four people to as many as 150 or more. The larger homes offer more activities and services. California puts serious restrictions on what levels of care RCFEs can provide. They are not required to have nursing staff and are not allowed to care for clients who need that level of service. Check the Yellow Pages under Homes | Residential Care for listings.

In board and care homes, administration and staff are required to report significant health changes to the resident's doctor and family. Assessments must be made regularly, and residents must have access to medical and dental services.

Some board and care homes are specifically for those with a dementing disease. Others will not accept anyone who causes disruptions or who wanders. In some cases, a resident must leave when a medical or mental condition worsens beyond the home's ability to care for him or her. All states require these homes to be licensed; check with the State Department of Social Services for the record of any home you are looking into. In California, call the Community Care Licensing Division at 916-229-4530.

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Questions to Ask When looking for Assisted Living
When considering a board and care or residential care home, find out the following:

Is the facility licensed? If not, it means the care is not being monitored.
Is it adequately staffed? Are staff members cheerful, helpful, clean, energetic?
Are the meals nutritious and adequate?
What is the level of activity? Do residents just sit around, or are there planned outings, reading materials, music, etc.?
Is the facility clean, tidy, odor-free?
Is the contract clear? Make sure all the services you have arranged for, as well as the fees and levels of care, are spelled out clearly in the contract.
What are the restrictions on medical conditions under which a resident can be admitted and continue to live there?
What are the facility's home inspection records? Check with the state Department of Social Services, Community Care Licensing Division, 916-229-4530.
How much privacy will your elder have? Are pets allowed? How much personal furniture, etc., will be allowed? Is the bathroom shared?
What are the real costs, including add-ons? Most facilities are not covered under Medicare though in some cases Medicaid or Supplemental Security Income qualifies. Check with our local office of the Social Security Administration, or call 1-800-772-1213.
Do the residents have outings, go to religious services? Do they seem well-groomed, happy, active?

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