by Pearlbea Labier, Geriatric Care Manager

Your home becomes harder to maintain. Transportation and shopping seem to be a burden. You may decide the time has come to make a move. The questions you are faced with are: Where shall I go? What kind of place would suit you now and in years to come?

I receive frequent calls from relatives of elders in the area, as well as from elders themselves asking me for advice on just these questions. Here is an overview of what I would say if you asked me for help in making a move that is the right one for you.

Twenty years ago, the options were limited. A nursing home was considered the next step after independent living, since few facilities offered anything less comprehensive than the highly skilled care and supervision of a nursing home. Facilities which offered limited services,such as prepared meals and help with dressing likely to be run by a religious denomination, and you couldn't apply unless you were a member.

Today the picture is very different. There is an impressive array of residential options from which you can choose, depending on your needs, tastes, and of course your pocketbook. Facilities range from downright plush (and expensive) to modest and comfortable and affordable on an income of mainly Social security benefits. A major advantage nowadays is that you can choose to live in a facility which allows you as much independence as you want when you move in, but which has the capacity to provide more assistance if and when you need it.

Because there is such a variety of choices, you may find it hard to know where to begin. There is one major point to keep in mind: plan ahead! Some facilities have waiting lists. Therefore, if you wait to make plans when you are ill or in declining health, you may not be able to get into the place you like best. You also want to take time to visit the places that appeal to you, and talk with the residents to see how they like living there.

These are the basic types of facilities available to you:

Independent Living Facilities

The main differences between you own home and an Independent Living Facility are that you won't have to worry about home maintenance, you will eat at least one meal each day in a communal dining room, and you will have many opportunities to meet people and participate in various activities.You also will have the security of a 24-hour desk staff which screens visitors to the building. Fees are monthly and range from very reasonable in nonprofit, subsidized facilities to expensive in places with more extravagant amenities. You need to match your interests with the atmosphere as well as the services offered by the facility.

Continuing Care Retirement Community (CCRC)

This kind of facility embraces the concept of "life-care", an idea that evolved from the realization that people don't want to move from place to place seeking different levels of care. A CCRC allows you to live with maximum independence until such time as you need assistance. Since various services are offered by the CCRC, you can get the help you need without another move.

The CCRC will require you to sign a contract for services provided. Usually you pay an entrance fee as well as a monthly fee. These fees vary a great deal depending upon the amenities of the facility and the comprehensiveness of the services provided. Entrance fees may be non-refundable or refundable on a sliding scale. Extensive and modified contracts generally include your living space, meals, housekeeping and a specified amount of nursing care. Fee-for-service contracts cost less than extensive and modified contracts because they exclude nursing care. If you should require such care, you have to pay extra for it. If you sign a contract for a CCRC, or any other facility, make certain you understand what you are signing, that you agree with its provisions, and that you be will be able to meet its financial obligations.

Assisted Living Facilities

Assisted Living Facilities add another dimension to independent living by offering personal care services as needed. They do not offer skilled care and are therefore an interim step between independent living and a nursing home. If, for example, you need help bathing or dressing, but are otherwise able to live without supervision, an Assisted Living Facility would be an excellent choice. Unlike living in a nursing home, you will enjoy the privacy of your own apartment furnished with your own possessions. You may also have available the benefit of nursing or other health care staff if needed.

Assisted Living Group Homes

Assisted Living Group may offer care similar to Assisted Living Facilities. However, they usually house no more than 15 residents and are located in residential neighborhoods, often in private homes converted for this purpose. Generally fees for both kinds of facilities are monthly. Again, be sure you understand what is included in the fee. I often refer elders who benefit from a smaller, more supervised setting to these facilities because they feel less institutional and may have more consistent staff than larger facilities.

Nursing Care Facilities

Nursing Care Facilities are suitable on a long term basis for elders who require skilled nursing care and/or 24 hour supervision. Medicare covers nursing home costs only for limited periods and under certain conditions which require skilled care. If you must remain in a nursing facility and can no longer afford the monthly fees, you may qualify for the state-administered Medicaid program which reimburses some (but not all) nursing facilities for patient costs when their funds run out. Since many nursing facilities are reluctant to accept patients who cannot afford to pay at least one full year or more, it is a good idea to plan ahead if a nursing facility seems a likely choice in your near future.


The American Association of Homes and Services for the Aging issues a directory of Continuing Care Retirement Communities 202-783-2242

Assisted Living Facilities Association of America
9411 Lee Highway
Fairfax Va. 22031
Print brochures that help you know what to look for in assisted living.

Nursing Home Information Service

National Council of Senior Citizens
1331 F Street NW
Washington DC 20004
202-347-8800 ext. 340


Pearlbra LaBier, a licensed geriatric social worker is the founder of ElderOptions, a private geriatric care management firm in the Washington Metropolitan Area. She has been in geriatrics for over twenty years. She can be reached at 8008 Quarry Ridge Way Bethesda Maryland 20815 301-767-0121 fax:301-767-0120


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