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Nursing homes, senior living, assisted living, memory care, home care, care home, skill nursing, independent living, life plan, residential assisted living, continuing care retirement community, active adult... lost? I don't blame you. Those aren't even all the different names for different options!
The field of senior living is vast, and yet there isn't a lot of readily available information about what's what - who's who - and how to navigate the process of researching options for your loved one. Throughout this blog, I'll do my best to cut through the mess one bite at a time. If you have a specific question, please sign up for the blog and comment below with your question. I'm sure others would love to know the answers too. So to get us started, here's a quick list of tips and behind-the-scenes know how for navigating the research process of senior living or care options.
1. Terminology - chances are you Googled "nursing home" in your search or maybe "assisted living" or "memory care". Chances are also good that whatever you searched, your top results are facilities (I'll get to that word later) in your area. Here, I've given a no-frills definition of some of the most popular search words and terms.
Nursing Home a.k.a. Skilled Nursing Facility - either a short-term rehabilitation stay typically covered in part or whole by insurance, or a long-term stay if your care needs require 24-hour nursing (this is typically private-pay). Abbreviated to SNF and the industry pronounced it "sniff".
Senior Living - an umbrella term to describe a wide array of living and care options. Nearly all non-nursing-home options will be private pay with a few Medicaid exceptions.
Active Adult - typically an age-restricted place where residents are 55+. No care is included typically. More of a place where you can be around other older adults.
Independent Living - a step up from active adult. Residents are a bit older and receive more services/amenities like meals, transportation, activities, and other coordinated services. If you need care, you have to bring it in with an outside agency. Abbreviated as IL.
Assisted Living - a place to live + care. This is typically what people are looking for when they're searching for care options for their older adult loved one. If you need care, this place provides it to you. Abbreviated to AL.
Memory Care - a specific form of assisted living where the residents require special care due to advancing dementia. Dementia is an umbrella term to describe a wide range of specific forms of dementia like Alzheimer's, Parkinson's, and others. Abbreviated to MC.
Care Home - different states call it by different names, but these are typically smaller than Assisted Living and set in residential locations. Could be as small as 2-3 or larger like 12-16. Less social offerings than AL but typically higher care staff to resident ratio.
Home Care - you bring in outside care through a care agency to provide support in the person's own home. Flexible but costly if they require lots of support.
2. Pricing - I'll give it to you straight - most are private pay options. There's a separate category below about insurances. A basic rule here, the higher the care the higher the monthly fee. All things considered, you're looking anywhere from $3,000/month (no frills) to $8,000/month (either high amenities or high care), and you have outliers that are less and more. But having in mind that a senior care option is somewhere in the $5,000/month average will help prepare you for pricing conversations. Bringing caregivers into the home is flexible and can range from $15 to $25/hour (depending on where you live). It's great for small tasks, but it gets really pricing to care for someone who has regular, daily care needs.
Tip - most communities you call want to know a little more about your situation before giving specific pricing. Getting a "starting at" rate is typical on the first call. They know you're worried about pricing, and most sales people are well-intended and want to help. Having a range in mind before you start your search will help you focus on the right living + care situation.
3. Insurance - except for short-term skilled nursing (paid in part or whole by insurances depending on the length and reason), traditional insurance won't pay for senior care. If you have "long term care insurance" that may help pay for Assisted Living and above. Veterans and spouses of veterans may also qualify for a VA Aid & Attendance benefit. There are some creative ways to get equity out of a home or get cash value for a life insurance, but no community does that directly. There are businesses that can help with these creative sources.
4. Online Search - while there are some good businesses that can help you with the search - called "Referral Agencies" - this process can get overwhelming for many people. It's true that for most agencies, there is no cost to you. They make money by "placing" you in a community, and the community pays them a referral fee based on a contract they have together. The upside is that you could get an expert who can coordinate the search for you. The downside with this is that your email and contact information may be shared with up to 8-10 communities (sometimes more). You'll get bombarded by calls and emails, and it will be tough to keep it all straight. My advice is that some local referral agents may protect your information and only share it to a handful of people. If you're working with a national group (just ask them if they are) then you may want to specifically tell them that you're only interested in hearing from two to three places at most. This part of the senior care business needs a little refresh, honestly.
5. Getting Organized - treat the search almost like a part-time job. Keep your notes together in one place, ask your friends and trusted advisors (physicians, financial professionals, church) if they know of any good senior communities. The best senior communities have a good reputation with people all over town. A spreadsheet may be helpful so that as you research places you can have a quick comparison of important facts. Read their online reviews with a grain of salt. Most comments are either from people who have had a really poor experience so they're venting, or people who have been asked by the company to write a positive review. Those aren't necessarily false, but it's generally vague. Trust reviews that give detail and specific reasons for their satisfaction.
The BEST way to know about a place is to talk to current residents or families. Ask the communities for a reference from a current family member. If you get a chance to tour a community, talk to staff and residents - and pay attention to the non-verbal cues. Are they smiling, genuinely joyful, and happy to chat? Are they reserved or vague? Most families make decisions in these general timelines unless there is an urgent, care-necessitated situation. Knowing these timelines can help you gauge where you might fall in your own research of options.
Independent Living - 6 to 12 months or more
Assisted Living - 3 to 6 months
Memory Care - 1-3 months
Skilled Nursing - immediate need typically
Final Word
No single blog, column, or article by anyone is fully comprehensive - including this one. They are starting places to organize your thoughts and should help you navigate the process.
Not only have I worked in senior living communities for the past 12 years, I also was on the other side of this fence when I had to find assisted living and hospice options for my own father. I felt prepared and had all the knowledge needed to navigate the process... and it was STILL difficult for me, because there's always some emotional entanglement with it. That's normal.
The search for senior living or care options will feel daunting at first. Even when you find the right place, there's tricky terrain to navigate. I'll do my best to help answer questions and provide guidance along the way. Please share my blog with people you think may benefit from it. Although this part of life can feel heavy, I promise you that there are a lot of great things that can come from it. I have known hundreds of residents and families who have said, "this is one of the best things we've done" and truly meant it. Nobody starts off thinking that, but many, many families arrive there. I hope I can help you shorten the distance between those two points.