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How to Choose a Residential Care Facility for (And With) Your Parents

My parents speed-dated their way through (almost) every possible living situation before finding the right senior living community for them.

by Jenna Gabrial Gallagher | September 30, 2021
<p>Senior Couple looking out at Neighborhood from the window of a new home</p>

The Squeeze

  • It’s a common misconception that Medicare covers personal care for older adults. It doesn’t. Independent living, assisted living, memory care and most skilled nursing care are all paid for privately.
  • Long-term care policies can help older adults manage their payout for senior care.
  • Older adults and their loved ones should develop multiple plans in advance of where they would like to go if they need acute care. Otherwise, the choice could be out of their hands.
  • Choosing a continuing care retirement community may streamline the process for many families.

In the ten years between my parents’ moving out of their home and my mom’s death last year, they moved more often than college undergrads. 

There were four different assisted-living (AL) apartments; two independent-living communities; countless hospital stays that lasted a week or longer; probably a dozen stints in rehab; one heartbreaking week in a hospice; and an even more harrowing few months, during Covid lockdown, in memory care. 

Some of the moves were their choice, such as when they decamped without telling us from their AL facility (“Everyone there is so…old!”) to a much hipper independent living community down the street. 

Other moves were out of medical necessity: they were in the original AL because my mom had had a debilitating toxic reaction to a combination of medications she’d been taking for her multiple myeloma. After she recovered, they couldn’t get out of there fast enough. 

Needless to say, finding the ideal senior living situation took lots of trial and error. 

In my parents’ case, they had to balance their desire to live as independently as possible in an active, vibrant community with my mom’s whiplash health fluctuations and a long-term care policy (LTC) that only covered a total of three years. They couldn’t afford to run out the clock on their policy because they had no way of knowing how long they’d need it. So, they would move—a lot.

When older adults leave their home, some of the living options available to them include: 

  • Independent-living communities Residences in a senior community for people who need minimal assistance average between $2,000-$4,000 a month, nationally, and are typically private-pay.
  • Assisted-living communities For those who need a little more help or health supervision, these average about $4,500 a month nationally but can be thousands more depending on how much assistance is required. Add-ons can include medication management, bathing and dressing help, blood sugar checks etc. AL is also private-pay but can be partially funded by long-term care insurance (LTC).
  • Memory care facilities Safe, locked communities that provide a secure, structured environment, are ideal for adults with dementia. Whatever the base cost of assisted living is for the level of care you need and your region, add another $1,000-$4,000 a month for memory care services. This can also be partially funded by LTC policies.
  • Skilled nursing facilities For older adults who need full, round-the-clock care, this option can range from an average of $7,650 for a semi-private room to $8,700 for a private room. Medicare will cover a total of 100 days of care in a Medicare-certified skilled nursing facility (minus a daily copay that the patient must cover) if certain criteria, such as a recent hospital stay, are met.

The Importance of Long-Term Care Insurance

As much time and money as they spent moving, my parents still considered their LTC insurance one of the best investments they’d ever made. 

People have a common misconception that they can rely on Medicare for the higher levels of care needed as they age. The fact is (with the limited exception of skilled nursing mentioned above), Medicare doesn’t pay for ongoing personal care for older adults. That means seniors living on a fixed income have to make decisions based on their savings and their LTC insurance if they’re fortunate enough to have it.

“In the old days, we used to say, you’re going to need this much to pay for your retirement,” says Holly Barstow, president of Barstow and Company, a wealth management firm based in Omaha, Nebraska that specializes in retirement planning and generational wealth. “Now, with people living longer, that’s an overly simplistic way to look at it.”

Barstow urges her clients to purchase an LTC policy. Most provide about 3 to 5 years of coverage. She says that it’s best for someone to buy a policy by the time they’re in their 60s, but it’s never too late to try to prepare for the future. Adult children may even be able to obtain LTC insurance for their parents via their own benefits plans. “You can always get a quote for free. Something is better than nothing.”

Plan for A, B and C

Despite all the moves, for the most part, my parents had a positive experience. My husband, their designated financial power-of-attorney, helped ensure they always knew what they could afford. My sister, their healthcare power-of-attorney, advocated to ensure they lived in bright, comfortable, vital communities that were conveniently located near their medical appointments. 

But for many families, it can easily go another way — particularly when a decision has to be made quickly, such as after an unexpected hospital stay. 

“Hospital stays are short. If a patient isn’t able to take care of themselves at home after discharge, they’re going to go where they can get the care they need,” Barstow says. “If you don’t have a plan for that, the hospital social worker has all the rights you don’t. The first place with a free bed is probably where your loved one will go— and it could be the place they stay for the rest of their lives. You have to do your research and think through the problem before it’s a problem.”

Navigating Levels of Care

The overwhelming majority of LTC stays — about 80 percent — are women. Although my mom was the first to develop serious health issues, my dad’s condition took a sudden downturn and he predeceased her by five years. 

Following his death, my mom moved to a continuing care retirement community (CCRC), so she wouldn’t have to worry about changing communities based on changes in her required level of care (although she did have to move within the building a few times).

“Some older adults may simply need medication reminders and prepared meals, while others require help with activities of daily living, such as bathing, dressing or dementia care,” says Sue Johansen, senior vice president, community network at A Place for Mom, the largest senior care referral service in North America. “Seniors in CCRCs may start in independent living and eventually transfer to assisted living or memory care within the same community as their health and medical needs evolve.”

No matter what type of community you’re considering, Johansen advises preparing questions about cost, care plans and general lifestyle amenities. Some other key questions A Place for Mom recommends include:

  • Is transportation provided for medical appointments?
  • Is there an ongoing process to evaluate what level of care a resident requires?
  • What is the staff-to-resident ratio?
  • What is staff turnover?
  • What is the procedure for responding to a medical emergency?
  • Which organizations audit the facility, how often and what do they look for?

Be Sure Your Parents Like the Food

Last but certainly not least, don’t underestimate the importance of having a meal in a perspective community before you move in. As my parents once rehashed an old chestnut about lunch at one of the places they toured and didn’t wind up living:

Mom: The food wasn’t very good.

Dad: And they give you such small portions.

About the Author

Jenna Gabrial Gallagher is a writer, editor and content developer who specializes in topics related to lifestyle and design, women entrepreneurs, family aging, travel and sustainability.

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