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Housing Alternatives
for Well-Seasoned Adults -
An Overview of Options
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CLAUDIA ELLANO-OTA, LCSW EXECUTIVE DIRECTOR (800) 543-8312
OBJECTIVES √ Review triggers for moving from independent living to
alternative housing and care
√ Talking with family about housing and care needs
√ Increase understanding of housing options for older adults
√ Increase awareness of the variety of levels of residential care
√ Provide general overview of paying for care
√ Q & A
Reference:s “Residential Care Options” Fact Sheet. Family Caregiver Alliance. SF, CA. 2006.
“Supportive Housing” AARP Public Policy Institute. Washington, DC. 2010.
www.canhr.org
www.cahf.org
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Serving Orange County since 1988
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Mission:
“To Increase the Quality of Life of
Caregivers by Helping Families and Communities
Master the Challenges of Caregiving”
A program for family caregivers Education, Support and Counseling • Professional staff focusing on issues specific
to successful family caregiving and self care. • Services are provided in a variety of
modalities i.e., individually, in groups and through a variety of events and classes.
• Grants for respite and other services
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INFORMATION CENTER
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Specialized referrals to various community resources, as well as fact sheets and general information related to caregiving. Online information is available at
www.caregiveroc.org
Is it Time for a Move? • Most people want to remain in their homes as
long as possible
• Moving is a difficult decision for elders or persons with disabilities
• Caregiver challenges
• Independent Living, Health Care, or Personal Care?
• Costs?
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Triggers for Considering a Move • Increase in “special care needs”
– Incontinence – Wandering – Sleeplessness – Combative behavior – Dementia – Skilled nursing needs such as tube feeding or
wound care – Transferring concerns
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Triggers for Considering a Move • Need for increased safety or supervision
• Easier home maintenance
• Financial considerations
• Enhance family support geographically
• Care needs increasing
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TIPS FOR TRANSITION PLANNING
• Plan ahead – Don’t wait for a crisis!
• Have a Family Meeting
• Explore the specific housing needs – Level of care
– Privacy and independence
– Physical and cognitive needs
– Future needs
– Socialization needs
•Get support and assistance!
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HOLDING A FAMILY MEETING • Who Should Attend?
– Include everyone who is or will be part of the caregiving team!
– Including the ill family member (their life and rights; dementia concerns and misunderstandings)
• How to Begin? – Communication! Create Agenda
– Technology
• Problem-Solving – timelines and assignments; communication!
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HOLDING A FAMILY MEETING
• The Meeting – where to hold? – All have a chance to participate and be heard
– Use “I” messages and “needs” not “shoulds”
– Review decisions and plan before conclusion
– Ongoing!
• Potential Challenges – family history and secrets! FOCUS!
• Win/Win – Consensus! Respect! Compromise!
• Getting Outside Help
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GETTING STARTED • Contact the Area Agency on Aging in your county
Elder Care Locator – 800-677-1116
OC – Office on Aging 800 – 510 – 2020
• Seek guidance for your Family Meeting (Caregiver Resource Centers may may assist www.cacrc.org )
• Get lists of licensed facilities, licensing regulations, long-term care ombudsman info, Medicare and Medicaid info, etc.
• Case Manager or Geriatric Care Manager
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HOME & COMMUNITY-BASED CARE
• Hiring In-Home Care
– Private pay
– Agency
– In-Home Supportive Services
• Adult Day Services
• Independent Living
Reverse Mortgage
HUD – Section 8 –Section 202 Housing
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TYPES OF FACILITIES • Residential Care Facilities for the Elderly
(RCFE) – “Board & Care” – Number of Residents: Usually up to six. – Cost: Often lower than other facilities; – Setting: Traditional homes in residential neighborhoods.
Residents may share bathrooms, bedrooms and living spaces.
– Services: Meals; help with daily activities and sometimes social activities.
– Medicare/Medicaid Reimbursable: Medicare does not cover; SSI may also be used for payments.
– Features: Personal, family-style care; some with population/diagnostic specialty.
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TYPES OF FACILITIES Assisted Living Facilities – (also RCFEs) • Number of Residents: Varies widely; 40 to 100 rooms is typical. • Cost: Midlevel; CA average is $3,000/month (www.CANHR.org ) , up to
$5,000/month. Depends on level of service and increase as the number of services increases. Most facilities charge a basic monthly rate that covers rent and utilities, and then charge separately for services. Many facilities also charge a one-time entrance fee.
• Setting: Bedrooms or full apartments, with a large dining room and common area lounge.
• Services: Housekeeping services (as in a hotel); meals; help with daily activities; transportation to appointments; medication reminders and administration; social and recreational activities; 24-hour supervision.
• Medicare/Medicaid Reimbursable: Medicare does not cover; Medicaid 1915c waivers (Limited waiver in select CA counties – not OC)
• Features: Apartment-style living; privacy and independence with a menu of services to choose from
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TYPES OF FACILITIES Skilled Nursing Facilities – SNF – Nursing
Home • Number of Residents: Average of 109 beds per nursing home nationally. • Cost: High. In 2012, the reported average cost per patient day for a skilled
nursing facility was approximately $226 ($82,500 annually). Medicare and private pay costs are usually higher. (www.cahf.org )
• Setting: Large facilities, often in a hospital- like setting. • Services: Medical services and 24-hour nursing care; help with daily
activities; recreation; rehabilitative care (e.g., physical therapy). • Medicare/Medicaid Reimbursable: Medicare pays for up to 100 days of
care, however, individuals must be referred by a physician upon hospital discharge and have the need for skilled nursing care. Medicare will pay only for a few weeks of rehabilitation services after hospitalization. Medicaid is accepted by many homes for ongoing care, but a person’s eligibility must be established.
• Features: Highest level of supervision and medical services.
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TYPES OF FACILITIES
• Special Care Units – SNF Level
– For individuals with Alzheimer’s disease/dementia
– Secured grounds
– Special architectural design
– Trained staff
– Therapeutic activities
– Costly/Private Pay
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TYPES OF FACILITIES Continuing Care Retirement Communities – (CCRC )- Life Care Communities • Number of Residents: Many. • Cost: High. Buy-in fee and monthly payments can range from lows of
$100,000 to highs of $1,000,000 and more. Monthly payments can range from $3,000 to $10,000 depending on level of care and amenities. Annual rate increases. (www.canhr.org )
• Setting: Large campuses with many buildings, usually including separate homes, assisted living facilities and nursing homes.
• Services: Depend on which type of facility person resides in. All levels of care are accommodated.
• Medicare/Medicaid Reimbursable: Medicare does not cover; Medicaid may pay for services in nursing home.
• Features: Ability to move to higher level of care if needed without having to relocate to a different community.
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PAYING FOR RESIDENTIAL CARE
• Medicare does not cover housing costs!
• Medicaid covers only SNF for low-income people or those who have spent all assets paying for care
• Reverse mortgages (www.aarp.org)
• Long-term care insurance (http://assets.aarp.org/rgcenter/health/fs7rltc.pdf ) (http://www.cahealthadvocates.org/_pdf/facts/H-003-CHAFactSheet.pdf )
• Out of pocket private pay 19
HOW CAN I TELL IF IT’S A GOOD FACILITY?
• Visit the facility
• Talk to current residents
• Use your senses – look, smell, listen
• Observe interactions between staff and residents
• Talk with staff
• Observe social activities and recreation
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HOW CAN I TELL IF IT’S A GOOD FACILITY?
• Ask about policies and procedures:
– Grievances
– Discharge, admission, and retention
– Transfers and room changes
– Refund policy
– Rate changes
– Medical and pharmacy partnerships
•Look at Licensing Inspection Reports
•Long-term Care Ombudsman
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SETTLING IN TO A NEW HOME
• Personal possessions help make the new residence feel homelike and safe
• Visiting a loved one frequently in the beginning may offer support and help ensure that facility staff are responsive
• Visiting in the beginning may be stressful for some elders who are confused and may beg to return home
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RESOURCES TO LEARN MORE • California Association Nursing Home Reform
www.canhr.org • California Association of Health Facilities
www.cahf.org • www.medicare.gov • AARP www.aarp.org • www.calqualitycare.org • California Health Advocates/HICAP
www.cahealthadvocates.org/HICAP/ • California Caregiver Resource Centers
www.cacrc.org
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A Great First Call for Caregivers!
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Caregiver Resource Center - Orange
St. Jude Community Services
130 W. Bastanchury Rd.
Fullerton, CA 92835
Phone (800) 543-8312 or (714) 446-5030
TAKE ADVANTAGE OF RESOURCES!
Aging and Disability Resource Connection www.adrcoc.org (800) 510-2020
http://www.ocagingservicescollaborative.org/find-senior-housing
TAKE ADVANTAGE OF RESOURCES
• Eldercare Locator: www.eldercare.org
• Administration on Aging: www.aoa.gov
• Family Caregiver Alliance National Center on Caregiving: www.caregiver.org
• AARP: www.aarp.org
• National Family Caregiver Association: www.nfcacares.org
• Well Spouse Foundation: [email protected]
• National Council on the Aging: www.ncoa.org
• Administration on Aging: Housing Info: www.aoa.gov/eldfam/Housing
QUESTIONS, COMMENTS & SHARING
Thank You!
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