Adult Living Facility Options

Definitions and Descriptions

The following is a summary of different types of adult living facilities, the Activities of Daily Living (ADL) issues that may be required for admission, and the approximate costs involved.

Note: The prices listed here are for California, and will vary depending upon location and the local economy.

INDEPENDENT FACILITIES

Often referred to as Retirement Communities, these may consist of apartments, single family homes, condominiums, or mobile homes. It is common for meals, laundry facilities, local transportation and social activities to be offered. No physical assistance is offered. Some facilities allow residents to hire outside help just as they would in their own homes. $2000 TO $2600 PER MONTH PLUS $500 FOR THE SECOND PERSON*

ADLs Required:

• Able to do own grooming and self care
• Capable of remembering meals and medications
• Socially appropriate behavior

ASSISTED LIVING or RESIDENTIAL CARE

Licensed and regulated by the State, these facilities vary from the small 4-6 bed Board and Care homes to large Residential Care Facilities. Some states are licensing Intermediate Care Facilities. $2000 - 4000 PER MONTH *May have a one time processing fee of $1000.

ADLs that may require assistance:

• Assistance with meals, laundry and housekeeping
• Grooming, bathing and dressing assistance
• Medication and safety supervision
• Toilet assistance
• Ambulation assistance
• Reminding and prompting
• Emergency care during the night

NURSING HOMES

Licensed and regulated by the State, these facilities offer room and board, personal care, medical and protection services. There are three levels of care:

Basic Care: Personal care, ambulation, and supervision needs at a more intense level than offered at a residential care facility.

Skilled Care: Basic care above and medical situations that require the services of a registered nurse, on a regular basis, for treatment and procedures.

• Feeding tube, N/g tube or colostomy
• Administration of oxygen
• Injections or wound care

Sub-Acute: Inpatient care for those who have an acute illness, injury or exacerbation of a disease process.

$4599 Semiprivate room to $9000 private room PER MONTH*. Additional charges may be made for medical equipment, dressings, tissue, liquid food, etc.

MEDICARE BENEFITS

AFTER a qualifying 3-day hospital day stay. As of 2003, Medicare pays all of the first 20 days of skilled care at a SNF (Skilled Nursing Facility). You will pay up to $101.50 per day for days 21–100 and you will pay everything after that. Under the MEDICAID Program (MEDI-CAL in California), some states offer residential care coverage. CHECK WITH YOUR LOCAL COUNCIL ON AGING FOR REFERRAL FOR INFORMATION.

CONTINUING CARE RETIREMENT COMMUNITIES (CCRC)

These CCRCs offer the continuum of care from independent living, to assisted living to nursing home care all in one facility. There are two types of these facilities.

Continuing Care Facility (CCF): There is a charge for entry to this community, and the monthly charge is increased as the client moves from one level of care to another. All levels of living are usually contained within the physical community.

Some offer a DIMINISHING RETURN ENTRY FEE: $30,000 to $120,000.* (If client leaves or dies within the first 5 years, there is a prorated amount returned to client or the estate. After 5 years there is no refund).

Monthly fees:
Independent Living: $1600 to $3050*
Assisted Living: $3046 to $5170* (If more than 2 hours/day of assistance is required, there may be an added charge of $3350 to $5775)
Skilled Nursing: $5070 to $5880*
Alzheimer's Unit: $4600 to $4800*

Lifecare Facility: The charge to enter this community is larger than the CCF, however there is no increase in monthly fees as the client needs to move from one level of care to another. May include financial coverage for all medical needs. All levels of living are usually contained within the physical community.

Example 1: DIMINISHING RETURN ENTRY FEE: $86,000 to $365,000.* Same rules apply for any return of funds as with CCF. Monthly fee $1900 to $4000. *Require age 65, Medicare Part A and B.

Example 2: 90% REFUND OF INITIAL ENTRY FEE: $550,000 to 1.6 Million.* $25,000* for second person in unit. Monthly: $3100 to $5700* with second person charge of $1500. *May include an Alzheimer's special unit. No age restriction. Client is responsible for own health care costs outside of care offered in facility.

Some offer a Buy-In plan where you purchase the real estate instead of having an entry fee, and it becomes an asset.

ALZHEIMER'S / DEMENTIA CARE FACILITIES

These are special units or services offered within the SNF or Residential Care facility. They offer assisted living and skilled nursing care as needed. $4800* semiprivate room to $6200* private room. There may be a one time entry fee of $1000.*

SHARED LIVING

Programs such as Project Match will match those seniors who want to stay in their homes, but need someone living there with them for safety purposes or companionship. In exchange for options of room and board, small salary, etc. individuals needing housing offer housekeeping, meals preparation, and transportation services.

ADULT DAY SERVICES

Usually community or non-profit based programs tailored to support seniors requiring supervision, assistance with personal care and daily living activities. These are particularly important when an elder lives with their adult children, and daytime supervision is needed, or for respite. Prices vary and may be on a sliding scale.

HOME CARE

Use of agency assistance or private hire of caregivers.

Agency example: RN Case Manager fee of $160* per month required. Non-medical caregiver: $20 to $24/hour.* RN coverage $48/hour. *

Private hire: $150 to $200* per 24-hour day plus room and board, and you are responsible for all employee federal and state law and tax issues. Unless covered by your homeowner's insurance, expect to be responsible for workman's compensation insurance for your employee. Medicare or Medicaid may have some assistance under certain circumstances.

HOSPICE

Comprehensive services offered to those who have a terminal illness, have a life expectancy of 6 months or less and are only pursuing palliative care. Usually offered only in the home where there is a primary care giver or at a SNF (Skilled Nursing Facility), few hospices have their own inpatient facilities. If the agency is a Medicare Approved Hospice, and the client is eligible for Medicare, Part A of the Medicare Benefit covers most services and medical expenses. Custodial care is not included. Hospice benefits change occasionally, check with your local hospice. If there is no Medicare coverage, expect expenses to be similar to the Home Care above - although the hospice may have a non-profit foundation to help defray patient expenses.