In this episode, Lisa Shoalmire and John Ross discuss lots of different living options that seniors have when it comes to their retirement years.

Episode Transcript
Lisa
Welcome back to another episode of Aging Insight. I'm Lisa Shoalmire and I am here with John Ross, and we are Elder Law attorneys based here in the Four States Area. And we help clients day in, day out with all sorts of matters that relate to aging, and disability, and planning for their legacies, as well as planning for their continuing care. And we know that the information that is provided on our program, like Aging Insight, is so very important to seniors. Life gets complicated as we get older, so we want you to be able to have access to the type of information right here in your living room. So we appreciate you being with us today on Aging Insight.
Lisa
Today we're going to talk about lots of different living options that seniors have when it comes to their retirement years. And it's a glorious time to be a senior and a retiree because there are so many options. And many of these options cater to interest, or a person's sociable requirements, or the kind of care that they may need, or the care they may need in the future. But the bottom line is all these different options, John, are really designed so that seniors can find the place that best fits their needs and to have that happy and enjoyable retirement years.
John
Absolutely. The problem is, because there's so many options, sometimes you can just get overwhelmed.
Lisa
Yes.
John
It's like going to a restaurant that's got a 20-page menu, and you're trying to... You're hungry, but you don't know what to eat 'cause you just have too many options. And we see this all the time where we'll have families come in, they'll sit down and they'll say... Maybe it's the senior who's coming in and saying, "You know, I know that home is just not the best place for me any longer. I know I need to move some place else, but I've heard all of these different things. I've heard about independent living, and retirement communities, and assisted living, and nursing homes, and continuing care retirement communities, and all of these different things." But they'll say, "John, which one's appropriate for me?" And that may be the senior asking. It may be that family member who is trying to help their parent or loved one and guide them through this process, but knowing the difference between these options can help you figure out what's most appropriate for you under any set of circumstances.
Lisa
Sure. So, one of the first options that we look at is whether just a senior community would be the place to be for this family. A senior community is often just a cluster of housing. It might be in duplexes, or patio homes. It may be even in stand-alone homes where that particular community is really restricted to those 55 and older. And there's some great things about this type of community. Usually the housing is designed to better meet the needs as we grow a little bit older. The bathrooms are larger and better designed for our needs. The other thing is we have a peer group in our neighborhood that are similar in age to the resident, to where you can really enjoy, hopefully, your neighbors and you've all had those similar life experiences.
John
Right. So you've kind of got the community of maybe a small, little neighborhood where you each have your own little home or duplex. So you've got the privacy of a home, but the benefits of being surrounded by people that are gonna share your age and experience and life, and you can make new friends and that sort of thing, which can be a great deal. Of course one of the other things that's a great deal is that this is usually a cheaper alternative.
Lisa
Yeah. It's one of the cheaper alternatives for senior living because, essentially, whether you're purchasing in a senior community or, more often, leasing in a senior community, this is not a community that's providing any type of in-home care, or that type of assistance, so the monthly cost is cheaper. However, there is one caution. Many senior communities provide neighborhood services, such as lawn care and maintenance. There might be some amenities that are offered with the senior community such as a swimming pool, that type of thing. So oftentimes, the residents of that community do have to contribute to the neighborhood association, and those dues and costs do need to be taken into account when you choose a senior community.
John
Yeah. Now, of course, when you're talking about some of these community environments like this, you've got a whole range from places where you really couldn't differentiate that neighborhood from any other neighborhood, and then you've got others that are a bit less fancy. And again, depending on your price point and what you're looking for, you can spend as much as you want, all the way down to... There are some of these communities that fall under certain programs provided under the Housing and Urban Development, or HUD, which is the government programs that provide low-cost housing. And HUD has programs for seniors that will help subsidize the cost of some of these places, and so some of them can be quite cheap if you meet the income and/or asset requirements that make you eligible. So really a broad range when it comes to these sort of things.
Lisa
Yeah. And, of course, the deal is go check the places out. Go, cruise through the neighborhood at different times of day. Before a move, make sure that this is a community that you would wanna be a part of. So, that is really kind of what I would consider a site-built, senior community, John, like you said, lots of privacy, lots of very traditional-type housing. But when we come back from the break, we're gonna start talking about some of the more communal-type housing options for seniors, including independent living, continuing care, and assisted living. So, stick with us.
John
Welcome back to Aging Insight everybody. I'm your host, John Ross, here with my partner, Lisa Shoalmire. And today we're talking about the different living options that are out there and trying to give you a little bit of guidance as far as what to look for, and what the costs are, and what the differences are between the two. And we started by talking about senior communities, and these are more like small, residential neighborhoods where you've got houses, or duplexes, or fourplexes, but it's very similar to any other neighborhood. It just happens to be restricted to people of a certain age group, typically 55 and above. And those can be great, but then again, it's really more like a private residence. The next level we usually see are independent living environments. And frankly, Lisa, many of the independent living places that I have been in, they kind of remind me of a cruise ship.
Lisa
Oh, I knew you were gonna say that. I feel the same way. Usually it's a larger structure. Maybe it looks more like apartments or condominiums, and there's common areas such as dining rooms, and game rooms, and libraries, and barbershops, and ice cream parlors. [chuckle] And it does remind of you being on a cruise ship, where your cabin is your room, and of course, it could be anything from looking much like a two-bedroom apartment with a full kitchen to, maybe, an efficiency-type room. But essentially, again, restricted to seniors, but essentially you are still independent. But there are some amenities offered with this community, as well as things like security, and usually some optional services, such as dining and meal preparation, that could be available right there in the building.
John
Yeah, so one of the benefits of a place like this... It's not that you need any sort of medical assistance because the reason they call it independent living is because you are still independent. Most or many people that live in independent living, they still have their own vehicle, they have their own assigned parking spot, they can come and go as they please. For those who don't drive, oftentimes the facility will provide transportation, meal preparation, and things like that. And of course the cost of this gonna be a little bit higher than, say, just a continuing or a community environment, but you're probably looking at somewhere in the neighborhood of around $1,500 to $2,000 per month and up. Now, of course, with all of these senior living arrangements, you can spend as much as you would like to spend. And so there are, of course, very, very, expensive places out there. But, for most people, that $1,500 to $2,500 range, it's gonna be about right for an independent living environment. And of course it might go up if you're paying for meals, or things like that.
John
Now, generally, there's not going to be any sort of financial assistance for this sort of thing, so it's gonna be something that you're gonna pay for out of pocket. It's not gonna be something that's covered by Medicaid, or subsidized by HUD. You probably wouldn't even be able to use veteran's benefits to pay for this type of facility because they don't provide any medical services. Same thing if you have long-term care insurance. This is not something that your long-term care insurance is gonna pay for because, again, it's independent living. Much like a cruise ship. They've just got... They're cleaning up after you and they're cooking some meals, down in the dining hall, and they're providing a lot of entertainment.
Lisa
Right. There's a lot of socialization and entertainment opportunities in an independent retirement community.
John
That's right.
Lisa
Continuing care retirement community. These are retirement facilities that have really several stages within those communities. There's the stand-alone, senior community, site-built, patio home. Then there's an independent retirement living, much like we just described. And then often these communities also have an assisted living area portion of their community. And then finally, skilled care where the persons who need the most medical care can reside. But it's all in one place.
John
That's right.
Lisa
With continuing care retirement communities, the cost really depends, of course, on which level of care that you need as you enter into that community. And, John, one of the things about continuing care retirement communities that I think is a little confusing, is often there is a sort of an entry fee.
John
Yeah, a buy-in.
Lisa
A buy-in for that community, and...
John
Yeah, the idea really is that because they're... Essentially, what the community is promising, is that, "Although you're independent now, we know that at some point in time in the future you're gonna need more care." That might be assisted living. That might even be nursing home care, which we'll talk about in a bit. But the idea behind the community, continuing care retirement community, is that you pay a lump sum, initially. A large, upfront payment, and sometimes it can be quite large, but essentially what you're doing with that is guaranteeing that you have a place to stay, throughout your life. And no matter what level of care you need, you would just transition from that independent to the assisted, from the assisted to the nursing, maybe even back to the assisted if you got better, maybe even back to the independent. But you've got this whole range of care, but again, oftentimes, there is an initial buy-in which, in some cases, can be tens of thousands of dollars, depending on the facility, and then there're oftentimes, is a monthly due after that.
Lisa
Well, that's right, but that buy-in, John, like you said, essentially, with that buy-in, the facility, and the community that you're buying into, is assuming the risk for all the care that you're going to need and what your needs are going to be through the remainder of your life. So it can be large upfront, but you have to remember what the facility is promising you in return.
John
Right, so many folks are worried that they're gonna go broke. And it can happen, but with the CCRCs, that they like to call them, the continuing care retirement communities, that large payment is essentially where they're now guaranteeing that if you do go broke, you're still gonna have a place to live. That even if you can't afford everything, you've still got that place and they're gonna take care of you no matter what the costs are. So those are the continuing care retirement communities. Of course, finally we get to your assisted livings and your skilled nursings, and we're gonna talk about those in a little more detail. But before we get into all of that, we've gotta take one more break. So, stick around and we'll explain the difference between assisted living and nursing homes. So, be right back.
Lisa
Welcome back to Aging Insight. I'm Lisa Shoalmire, and I'm here with my partner, John Ross. We're Elder Law attorneys here in the area, and today we've been really just talking about the differences between the type of living options that are available to our seniors and retirees, right here in our community. So we've talked about just senior communities where it's just a gathering of seniors, 55 and older, that pretty much live like you always have, in an independent way. We've talked about independent retirement communities, the cruise ship experience, I guess, and then we've talked about continuing care retirement communities that offer a promise of care in exchange for a buy-in and monthly fees. Well, that brings us to the final two options that we see in our area, and that is assisted living and skilled nursing care, or the nursing homes. Assisted living, John. Again, the type of care offered is really in the name.
John
Right. They're gonna be providing assistance, and when they talk about assistance, typically what we're talking about is a phrase known as "activities of daily living," or ADLs. These ADLs are used throughout Medicare and Medicaid, and various government benefit programs, and throughout the medical community, and these activities of daily living are things like being able to feed yourself, bathe yourself, if you need help going to the bathroom, if you need help with mobility, getting from one place to the other, if you need help transitioning, say, from sitting to standing, or from laying to sitting. So these ordinary things that everybody has to do on a daily basis. If you need help with some of those that's where an assisted living place is gonna come in. They're gonna help with medically needed assistance.
Lisa
Right, and so assisted living facilities, they're structured several different ways. There are some assisted living facilities that you pay a base rent and then you pay an a la carte charge, or a fee for service, for additional assisted services that you may need such as medication management or continence assistance, hygiene assistance, and you may pay an additional fee but it's tailored to your needs that you have. Some assisted living facilities are structured differently. They evaluate the needs that you have and they classify you according to the facility's classification schedule as a basic needs, moderate needs, or advanced assistance needs, and they charge a monthly fee, a rent if you will, based on your classification. So, with assisted living, the key there is you always wanna review your lease and contract that you're making with the facility and to understand what services are covered by your rent that you're paying for, what other services may be available and if they have an additional cost. And John, what has been your experience about the cost of assisted living?
John
Yeah, assisted living can vary quite a bit. I would say that on the very low end that you can expect to spend in the range of $1,800, $1,900, $2,000 per month and up. I would say probably a more average is in the $2,500 to $3,000 range per month for something like assisted living. Although, if you have specialty assisted livings, and there are many of these assisted livings that cater towards things like dementia care or Alzheimer's care, the cost of those can be even higher in the $4,000 a month range. Now, one thing about that is that these type facilities are generally gonna make you eligible for, or could you make you eligible for, things like being able to make claims against your long-term care insurance policy, making you where you might/could be eligible for veterans benefits, if you meet other qualifications. Some of these assisted living facilities are even eligible for Medicaid. So there can be some financial assistance for assisted living.
Lisa
Okay. Well, and that brings us to our final area of residence choices, and that is skilled nursing care. And typically this is... Some people call these a rest home, a nursing home, but these are facilities that have licensed nurses on staff, 24 hours a day, seven days a week, and they offer very important medical care that's needed by the residents. This is an area of care where you certainly... Medicaid is a potential payor for this type of care, but it's much less independent and it's much... Typically for that medically needy patient.
John
Right. It's gonna be much more expensive, typically in the $4,000 to $5,000 range, at least in this area, but, again, there are options like Medicaid to help pay for that. And oftentimes, people are trying to figure out the difference between what assisted living, where they're helping with medical assistance, and a nursing home, where they're also helping with medical assistance. And one way I typically describe it to my clients is, ask yourself, the person who's gonna be in the facility, could they get out of that facility on their own if there was a fire? And if they could then, but they still need some medical attention, then assisted living is probably appropriate. If they probably couldn't get out of the facility in the event of a fire then it's probably nursing home. And that can be an easy way for the layman out there to tell the difference between assisted living and nursing home care. So, lots of options.
Lisa
Lots of options and we're fortunate that our community has a number of providers in all of these option areas. So you just have to get out there and investigate what you might like.
John
That's right. And of course, if you have questions about these sort of things, you could always call us during our live radio show which is every Saturday on 107.1 FM. That's the Aging Insight Radio where we're there to take your questions to answer, answer all questions you might have out there. And of course, you can always keep tuning in to Aging Insight TV, or even check out our website which is aginginsight.com.
Lisa
Well, John, we've come to another end of Aging Insight, but we hope that you have learned something today about what your options are for living in your retirement years, and we can't wait to see you next week on Aging Insight.
John
Bye-bye.

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