CONTINUING TO LIVE IN YOUR HOME

Home and Community-Based Options
Like many people, you may want to stay in your home for as long as possible. But you may also need help and support to stay there. That’s where home and community-based services (HCBS) can help. HCBS providers offer everything from help with housekeeping chores to healthcare services to making social opportunities more readily available. They can even provide the reassuring service of having someone just call daily to check on you. If you are a caregiver coping with a family member’s chronic illness or disability, you may also benefit from these services, particularly if you work outside the home or have other major demands on your time.

Some services can be brought to your own home while others are available at different settings in your community, usually during the day. In addition, some programs can help make modifications to your home for greater ease and safety. Check with your local Area Agency on Aging* for more information on which of the following services are available in your community and how to access them.

• Adult Day Services enable you to spend your daytime hours in an organized setting with engaging pastimes. You’ll usually find both physically and mentally stimulating activities, as well as socialization with others. Some day care programs are designed especially for people experiencing memory loss such as early stage Alzheimer’s or dementia.
• Care Managers help determine what services are needed. A care manager will work together with you on developing a plan that best fits your lifestyle and will help you arrange the services.
• Congregate Meal Programs offer free or low-cost meals in a group setting, often in a senior center or senior housing.
• Financial Counseling Programs provide assistance with balancing checkbooks, filing taxes and paying bills, as well as completing Medicaid, Medicare or other insurance forms.
• Health Education and Wellness Programs maintain your health through direct teaching, counseling and similar services.
• Home-Delivered Meals, usually provided by the Meals-on-Wheels organization, deliver nutritionally balanced meals to your home, if you are unable to prepare your own.
• Home Healthcare offers a variety of healthcare services in the home, such as providing wound care and health education, administering medication and monitoring health concerns. Home health aides may assist with personal hygiene, prescribed exercises, and other personal care under the supervision of a licensed nurse. Physical, occupational and speech therapies, and social worker services also may be provided in the home.
• Homemaker or Chore Services help with different chores around the house, such as cleaning, preparing meals or doing laundry. They also help with shopping, running errands, driving and companionship.
• Hospice delivers nursing care to terminally ill people, as well as counseling for their families. Hospice care can be provided in nursing homes, hospice centers or in the individual’s home, where nurses, social workers and volunteers can visit regularly.
• Information and Assistance Services offer information about services and resources in the area.
• Personal Care Services provide help with grooming tasks such as bathing and dressing.
• Private Duty Companions provides volunteers who will come to visit in your home.
• Rehabilitation Services offer different kinds of therapies (physical, occupational, and speech) to assist in recovery from an illness or surgery.
• Respite Care provides time off for family members caring for loved ones who are ill, injured or frail. Caregivers need time away to relieve stress, prevent burnout and attend other events in their lives. Respite care provides planned, temporary, substitute care for a day, a weekend or even longer, as in the case of a vacation. Care is usually provided in the individual’s home, but may also be provided in an adult day care center or the residential setting of an assisted living or nursing facility.
• Senior Centers provide a place where people can come together for social and recreational activities.
• Telephone Reassurance is particularly helpful if you live alone or are alone during the day. This service provides a daily check-in to make sure you are okay.
• Transportation Services make it possible to go to and from shopping centers, doctor’s appointments, senior centers and other places.

Factors to Consider…When Choosing to Remain in Your Home
In making your decision, be sure to consider all aspects. Developing a list of pros and cons is a good way to begin. The following can help get you started.

• Stay in the comfort of your home where you’ve made a life
• Remain close to neighbors and friends
• Maintain established contacts and connections in the community
• Enjoy the ease of moving about in a familiar neighborhood and community
• Incur potentially lower costs by paying only for services needed

• Dealing with costly and time consuming chores – lawn care, leaf and snow removal, maintenance and upkeep issues, heating and cleaning, etc.
• Becoming isolated
• Possibly developing mobility issues
• Having limited options, should health conditions change suddenly
• Potentially creating additional responsibilities and worries for your family

MAKING A MOVE TO SENIOR LIVING

Maintenance-Free Residential Options
If you want to continue living on your own, but don't want the responsibilities and upkeep of owning a home, then moving into a maintenance-free residence may be a good alternative for you. These residential options eliminate the hassles of home repairs, lawn care, snow removal and other similar chores, as well as offer the benefits of living among your peers. Many also provide enriching activities and convenient services.

There are several types of housing options. Understanding what aspects are most important to you will help you determine which option best fits your needs.

Senior Housing
This option consists of apartment style residences tailored to the needs and preferences of people of a minimum age, or older. The residences are often designed to make life easier with features like railings in bathrooms or power outlets higher up on the wall or even 24-hour emergency call service. Some places also offer supportive services like meals, transportation, social activities and other programs.

Fees and monthly charges vary depending on the size of the residence, the services provided and the income level the building or community is designed to serve. Subsidy programs can help make rent more affordable. The U.S. Department of Housing and Urban Development (HUD) funds the following rental assistance programs for seniors who qualify.

• Public housing was established to provide decent and safe rental housing for eligible low-income families, seniors and persons with disabilities. Public or low-income housing is owned and operated by local housing authorities. To apply for public housing, go to the housing authority in your area. The local representatives will explain their system for accepting applications and how to find an available apartment.
• HUD's Section 202 program helps expand the supply of affordable senior housing in two ways. First, private, nonprofit sponsors are extended capital advances to finance the construction, rehabilitation or acquisition of supportive housing for low-income elderly persons, including the frail elderly. Second, owners are subsidized with rental assistance funds, which are passed along to qualified residents to cover the gap between what individuals can afford (generally 30 percent of adjusted income) and the actual operating cost of rent. Occupancy in Section 202 housing is open to very low-income households comprised of at least one person 62 years or older at the time of initial occupancy. For a list of privately owned, affordable housing communities near you, contact your local HUD office www.hud.gov. To apply for housing, visit the management office at the community you select.

Retirement Communities
Living in a retirement community enables you to continue working, traveling, volunteering and enjoying life outside the community. There are two general types of retirement community: those that offer a continuum of care, called Continuing Care Retirement Communities (CCRCs), and those that don’t include long-term care services.

Both types of communities are usually arranged in a campus-style setting, with more choices in residences and a broader selection of services than senior housing. The size and style of home can range from efficiency apartments to two-story, 3-bedroom homes with garages. Homes can often be customized with special features like upgraded appliances, crown molding, hardwood floors, sunroom additions and other similar options.

Most retirement communities today include a wide variety of appealing onsite amenities. Heated indoor pools, fitness centers with personal trainers, restaurant style dining and a selection of meal plans, guest lecturers and performers, libraries, education programs and social events, woodworking shops, gardens, coordinated trips and chaplaincy programs are just some of the amenities you might find. Conveniences such as hair salons, banking and transportation services are usually available as well.

Living in a retirement community may be more costly than senior housing, but may also deliver more value in terms of residence, services and amenities. Fees vary widely depending on the features and benefits included. For example, fees charged by CCRCs may be higher, but they provide ongoing healthcare services to meet changing needs as you grow older. Having access to assisted living and skilled nursing care enables you to stay in the same community if your physical or mental health should ever change. It’s important to know what benefits and services are important to you to determine which type of community is worth considering.

Retirement communities also offer different types of financing plans. Some require a one-time entrance fee and then monthly payments thereafter. Some operate on a rental basis, charging monthly payments, but not requiring an entrance fee. Some even offer a choice of finance plans and refund options to accommodate different financial situations.

CCRCs offer similar financing choices, but their independent living contracts address housing, services and healthcare for life. There are three common types of contracts:

• LifeCare communities provide access to all levels of healthcare, including assisted living and nursing care, with little or no increase in monthly payments, but entrance and monthly fees are typically higher in these communities.
• Fee-for-service communities charge full daily rates for all assisted living or long-term nursing care, but only if services are used.
• Some CCRCs include a specified amount of nursing care in the contract, beyond which the resident is responsible for payment.

In Pennsylvania, CCRCs are regulated by the state Department of Insurance. In addition, on site assisted living and nursing care facilities are licensed separately by the Departments of Public Welfare and Health.

Factors to Consider…When Choosing to Make a Move
In making your decision, be sure to consider all aspects. Developing a list of pros and cons is a good way to begin. The following can help get you started.

• Gain freedom from the worries and responsibilities of home ownership
• Have more time for the places, people and activities you enjoy
• Live surrounded by people who share similar interests
• Enjoy access to appealing amenities
• Benefit from life-enhancing services
• Have the advantage of onsite conveniences and transportation
• Receive reassuring access to healthcare options

• Leaving a familiar home and neighborhood behind
• Incurring potentially higher costs
• Dealing with challenges of organizing possessions and downsizing
• Deciding what to do with your current home

ACQUIRING CARE AND ASSISTANCE

Moderate to High Care Needs
Today people live longer, healthier, more active lives than ever before. But sometimes, in spite of preventive measures, injury or illness can undermine health conditions and professional assistance or nursing care becomes necessary. If you, or a family member, need this type of care, there are different options to consider

Private care managers or your local Area Agency on Aging can help you determine what types of services may needed. This evaluation is called a functional assessment. (Private agencies may charge a fee for these assessments; be sure to ask about any costs up front.) If a little help with daily living tasks is all that’s required, assisted living may be a good choice. If 24-hour care and attention is needed, a skilled nursing facility may be more appropriate

Assisted living/personal care provides help with simple, routine tasks such as bathing or getting dressed, taking medicine, cooking, shopping, housekeeping, laundry and getting around the community. Services are tailored to individual capabilities, providing as much or as little assistance as needed to support and encourage independence. This type of help enables many people to stay active and in control of their own lives.

Assisted living/personal care also offers the reassuring benefit of having a professional staff available 24-hours a day. Knowing help is quickly available if needed provides immeasurable peace of mind to both residents and families. Assisted living personnel are trained healthcare professionals that may include registered nurses, certified geriatric nursing assistants and licensed practical nurses.

Assisted living services are provided in a variety of settings such as CCRCs and in stand-alone facilities. Today’s assisted living care is typically delivered in an attractive, home-like environment that respects individual privacy, encourages companionship, and helps residents feel secure and comfortable. Accommodations can range from single or double rooms, to suites or even apartments, depending on individual needs, preferences and budgets. Often there are common areas such as recreation rooms, lounges, libraries, courtyards and gardens.

In addition to supervised care, assisted living residences usually provide opportunities for recreation, social interaction and enrichment. In CCRCs, assisted living residents have access to all the same services, amenities, activities and conveniences as independent living residents. In stand-alone and nursing facilities, services typically include meals, housekeeping, planned activities, religious programs, transportation, scheduled trips and other similar services.

Nursing care facilities provide nursing care, personal care and medical services for individuals who need this type of care around-the-clock. They also offer different kinds of therapies to assist in recovery from an illness or surgery. Some nursing care facilities and CCRCs offer memory support care for people with mild to moderate memory loss due to Alzheimer’s or dementia.

Nursing care can mean a short or long term stay, depending on the level and type of care needed, and is provided in CCRCs and stand-alone facilities. Today, many of these facilities are designed specifically to create a relaxed, more home-like environment. Cozy family rooms, cheerful dining rooms and outdoor courtyards are some of the features you’ll find that help residents feel comfortable and more at home. Shared living space allows for interaction and camaraderie. Single and double rooms provide quiet settings for private moments.

Memory support care is another option that is becoming increasingly more available. This specialized form of nursing care not only addresses health issues, but also exercises the mind, rekindles memory and encourages independence. Often art, music and nostalgic memorabilia are used to spark and strengthen memory. Creatively designed floor plans provide easy monitoring, interaction, security and safety, frequently including secured outdoor areas.

Nursing care personnel are trained healthcare professionals that may include registered nurses, certified geriatric nursing assistants and licensed practical nurses. A skilled, caring staff is critical to fostering a comfortable, fulfilling quality of life.

In addition to basic services such as meals, laundry and housekeeping, nursing care facilities provide engaging activities that stimulate the mind, body and spirit.

Factors to Consider…When Choosing High Level Care Needs
In making your decision, be sure to consider all aspects. Developing a list of pros and cons is a good way to begin. The following can help get you started.

• Reassurance of 24-hour assistance if needed
• Less isolated than own home
• More opportunities for interaction, activities, and recreation
• May be less costly than receiving care in the home
• Relieves family members of worry and stress

• Not as familiar as home
• Less private than home

Among PANPHA organizations, you’ll find all the means necessary to support whichever direction you choose.