How Do I Choose the Right Senior Care Housing?

What Should I Consider When Selecting Senior Living Options? Insights from a Personal Story.

The challenge of finding the right living arrangement for our aging loved ones is deeply personal and often complex, marked by a series of transitions that are as unique as the individuals themselves. My family's experience with my father's evolving care needs illustrates the fluidity and person-specific nature of this process. First moving him from a spacious family home into a more manageable independent living complex to ultimately welcoming him into our own home supplemented by professional care, each step was guided by a careful consideration of his needs, safety, and quality of life.

Initially, my father's move to an independent living complex seemed to strike the perfect balance between autonomy and available support. However, after he crashed his car and ceased driving, the value of services like the complementary shuttle became unequivocally clear. The addition of part-time home services and a certified nurse's aide further supported his independence. Yet, following a series of trips to the hospital and followed by stays in a rehabilitation hospital, it became evident that his needs had surpassed the support available in his current setting. The decision to move him into our home, providing round-the-clock care with the aid of home health agencies, was daunting but the right decision for us.

This series of transitions, while specific to my father, underscores a universal truth in senior care: the path is unpredictable but navigable with the right knowledge and resources. In this blog series, we aim to share insights into the myriad of housing and care options available, from in-home care to nursing homes, and everything in between. The goal is to equip you with the information needed to make informed decisions that best fit the needs and budget of your loved one.

In our first post, we'll provide an overview of common housing options, highlighting the specific characteristics and services of each. Following that, we'll delve into how tools like the Katz Index and Lawton-Brody Scale can help assess care needs and match them with appropriate services. Lastly, we'll explore the costs associated with these options and potential funding sources.

What Are My Options in the Senior Care Housing Market?

The landscape of senior housing and long-term care in the United States is both vast and varied, catering to a diverse array of needs across the aging population. Drawing from comprehensive data gathered by the Centers for Disease Control's 2020 National Post-Acute and Long-Term Study, along with other reputable sources, this overview presents a detailed snapshot of the sector's current state and future projections.

In 2020, approximately 68,200 paid, regulated long-term care service providers operated across five major sectors, serving 7.3 million people. This broad network is comprised of 4,130 adult day services centers, 11,400 home health agencies, 5,200 hospices, 15,300 nursing homes, and 30,600 assisted living communities highlights the wide range of senior living options for consideration.

Number of Senior Housing Providers by Type in 2020

Enrollment and residency figures further illustrate the scale and scope of long-term care services: 237,400 individuals were enrolled in adult day services centers, 1,294,800 resided in nursing homes, and about 818,800 lived in assisted living communities. Additionally, by year's end 2020, home health agencies had served approximately 2,977,900 patients, while 1,534,600 patients received hospice care.

Number of Senior Citizens Using Senior Housing and Support Services in 2020

A significant aspect of assisted living communities is their provision of specialized programs for residents with Alzheimer's disease or other dementias. Specifically, 18% of these communities feature a dedicated dementia care unit, wing, or floor, and 11% exclusively serve adults with dementia, underscoring the critical role these facilities play in supporting individuals with cognitive impairments.

The 2020 data presented below reveals gender distributions across various types of senior living facilities. Overall, women make up a higher percentage than men in most of the facilities, averaging 57.8% across all types. Hospice care and nursing homes show a slightly more balanced gender presence, with women accounting for 58% and 62%, respectively. Assisted living facilities have a higher proportion of female residents, with 69% being women. In contrast, long-term care hospitals have a majority of male residents at 54%. Inpatient rehabilitation facilities and home health agencies show a near even split, with women at 52% and 59%, respectively. Adult day services centers also have a higher percentage of female participants, at 57%. This distribution highlights the varied gender demographics that senior care facilities cater to, reflecting the differing care needs and preferences among older men and women.

Senior Housing and Support Service Use by Gender and Provider in 2020

The U.S. long-term care market, valued at around USD 490.6 billion in 2022, is poised for continued growth, with projections estimating a Compound Annual Growth Rate (CAGR) of 6.05% from 2023 to 2030. This expansion is driven in part by an aging population, with the U.S. Department of Health and Human Services (HHS) estimating that approximately 69% of the U.S. population will utilize long-term care services for an average duration of three years.

A Side-By-Side Senior Housing Analysis for Smart Choices 

With a wide array of senior housing options available, serving millions across the country, determining the best fit for your needs can become an overwhelming task. Fortunately, there are numerous online tools, such as Eldercare Locator, designed to help you locate senior housing options in your area. Before using into these resources, it's beneficial to become knowledgeable about the different types of housing available. To facilitate this, we're providing a detailed side-by-side comparison of each of the four most common options and additional specialized services to possibly address your needs. This guide aims to simplify your decision-making process by clearly outlining the distinctions, ensuring you're well-educated and equipped to make the smartest choice for senior living.

What’s the Ideal Fit Across the Senior Care Spectrum

Researching senior living options requires a nuanced understanding of the spectrum of care and lifestyle each choice offers. This section provides a high-level overview of the four primary living arrangements available for seniors so you can determine where to investigate more deeply.

Senior Housing Room Layouts for 4 Most Common Settings

Here you’ll find that each option is tailored to fit individuals at various stages of independence and care needs. Whether seeking the companionship and ease of an Independent Living community, the supportive embrace of Assisted Living, or the comprehensive medical oversight of a Nursing Home, this comparison aims to illuminate the ideal resident profile and care spectrum offered by each setting. Our goal is to arm you with the insights needed to align you or your loved one's care requirements and personal preferences with the most fitting living environment.

In-Home	Independent Living	Assisted Living	Nursing Home
(Aging in Place)	(Active Adult Community or 55+ Community)	(Group Home or Residential Care Facility)	(Skilled Nursing Facility)
Aging in Place enables older adults that want to continue living in their own homes, potentially requiring renovations for improved accessibility. Support may come from loved ones, community services, or hired professionals to assist with daily living, nursing, and medical needs without relocating to a retirement facility. For safety monitoring, families may contract with third parties for alerts, as concerns warrant.	Designed for adults aged 55 and older in relatively good health seeking a maintenance-free lifestyle. These communities provide opportunities for social interaction among peers and often include amenities and activities. If required, optional 24-hour alert monitoring systems may be utilized for an additional charge.	Offers a blend of independence and support for adults who can no longer live alone and may need access to around the clock staff for emergency assistance and help with select ADLs and IADLs including medication management. Facilities are equipped with 24-hour alert monitoring and emergency response systems.	Provides comprehensive care, including long-term support and post-acute care for those needing constant assistance. Skilled nursing services are available for recovery and rehabilitation. Licensed physicians oversee a 24-hour nursing staff. Incorporates 24-hour health monitoring and emergency response systems, ensuring constant access to medical care.

Comparative Look at the Physical Living Spaces

When selecting a senior living option, the physical space and its features play a critical role in ensuring the comfort and well-being. This section offers a side-by-side comparison of the "Type of Units" from private residences to shared rooms, and the amenities they offer, we aim to provide a clearer picture of what daily living might look like, assisting you in finding a space that feels like home while meeting specific care needs.

In-Home	Independent Living	Assisted Living	Nursing Home
Private traditional residence – house, apartment, condo, or townhome – often with modifications for accessibility. Includes a kitchen and a place to park your car.	Typically located in a large complex, it provides private housing units equipped with a kitchen/kitchenette, full bathroom, and parking space. Complementary shuttle services for errands and appointments are common. The mix of units varies, offering studio to three-bedroom condos, apartments, cottages, or townhomes, all centered around communal spaces.	A building offering a combination of private and semi-private rooms, often with an ensuite toilet and shower. Facilities do not provide kitchens for personal meal preparation or parking for personal resident vehicles. Size ranges from small group homes with as few as three rooms to larger facilities with up to 200 beds, averaging around 43 units.	Offers both private and shared rooms, with common areas for dining and activities. Rooms are more clinical, resembling a hospital setting, and often share centralized restroom facilities down the hall or on another floor. The number of certified nursing beds ranges from 41 to 185, with an average of 107 beds per facility.

Matching Seniors to Housing Settings

Selecting the right senior living solution involves more than just assessing care needs and facilities; it’s about finding a match that resonates with the lifestyle, preferences, and personal circumstances of the individual. This section suggests the "ideal candidate" for each housing option. Through this exploration, we aim to shed light on whom each option serves best, guiding you toward a choice that not only meets care requirements but also aligns with personal values and desires for senior living, ensuring a fulfilling and comfortable environment. The ultimate decision is your own.

In-Home	Independent Living	Assisted Living	Nursing Home
Older adults with a strong desire for independence, a supportive network for potential caregiving needs, and those who prefer the familiarity and comfort of their own home.	Seniors looking for a community setting with minimal maintenance responsibilities, social engagement opportunities with peers, and a variety of on-site amenities and activities.	Individuals needing more daily assistance than what can be provided at home, but not the extensive medical care of a nursing home. Residents benefit from a community setting with readily available care.	Elders requiring 24/7 medical monitoring and assistance with most or all ADLs, those in need of rehabilitation services, or individuals with conditions that require frequent medical attention and monitoring.

Continuing Care Retirement Communities (CCRCs) or Life Care Communities

For those seeking a balance between independence and access to care, Continuing Care Retirement Communities (CCRCs) or Life Care Communities offer a comprehensive solution. These communities provide a continuum of care, encompassing independent housing, assisted living, and skilled nursing care all within one campus. This arrangement allows residents to transition between levels of care within the same community as their health and wellness needs change, without the need to relocate to a different location. Notable CCRCs features include:

• Accommodations for Couples: It's not uncommon for spouses or partners to have different health and care needs. CCRCs accommodate this reality by allowing partners to reside in different sections of the same community, ensuring that each person's health conditions are appropriately addressed while maintaining close proximity.

• Size and Capacity: While CCRCs can vary greatly in size, the average community comprises over 330 units. This typically includes around 231 units dedicated to independent or congregate living, 34 assisted living beds, and 70 beds for skilled nursing care. Such diversity in housing and care options within a single community provides a seamless transition for residents as their care needs change.

Choosing a CCRC means opting for a living arrangement that adapts to the resident's needs over time, providing peace of mind for families and individuals alike.

What Social and Recreational Perks Can I Expect in Senior Living Communities?

When picking a living arrangement for older adults, it's crucial to consider not only the health and care support available but also the social and recreational services that can significantly enhance their quality of life. Available services vary widely from place to place.

Adult Day Care Services

In-Home care offers the possibility of utilizing adult day care services, which provide a coordinated program of social and some health services. These programs are designed for adults needing supervised care outside the home during the day, offering a valuable respite care option for caregivers. Activities at adult day care centers can include social gatherings, arts and crafts, and other light recreational activities, although the scope is generally more limited compared to facility-based options.

Institutional Settings (Independent Living, Assisted Living, and Nursing Homes)

All three settings strive to offer enriching programs and amenities tailored to their inhabitants. However, as one moves from Independent Living to Assisted Living and then to Nursing Home facilities, the range and frequency of social and recreational activities tend to decrease, reflective of the residents' changing demands and abilities. Here is an overview of potential options.

Planned Activities

Facilities may vary, but residents can often find an array of planned activities designed to keep them engaged and socially connected. These can include:

• Social and holiday gatherings to foster a sense of community and celebration.

• Art and craft classes for creative expression and skill development.

• Visiting lectures and concerts, providing educational and cultural enrichment.

• Gardening activities, which offer therapeutic benefits and a connection to nature.

• Organized outings to museums and sporting events, encouraging exploration and active participation in broader community events.

On-site Amenities

Many facilities also boast a variety of on-site amenities aimed at enhancing daily life, such as:

• Dining options that may include a take-out service, café, or coffee shop, serving up to three prepared meals daily alongside snacks.

• Fitness facilities, possibly featuring pools and group fitness classes for physical well-being.

• Libraries and computer rooms for intellectual stimulation and connectivity.

• Clubhouses available for private parties and social gatherings.

• Beauty parlors or barbershops for personal grooming and care.

• Recreational options like golf courses, pickleball, and tennis courts for leisure and physical activity.

• Movie theaters for entertainment and social interaction.

Given the variance in offerings between facilities, it's essential for potential residents and their families to inquire specifically about the activities and amenities of interest when considering a facility. Each individual's interests and abilities should guide these inquiries to ensure the chosen environment provides the desired level of social and recreational engagement.

Making an Informed Senior Housing Choice

Understanding the support services and available social and recreational activities is key to making an informed decision about which senior living environment fits your needs. We provide the following chart to give you visual snapshots of the ADL challenges and diagnoses being supported in different care settings in hopes that this information will help guide you in finding the type of facility that may address your family’s needs.

The first chart illustrates the increasing need for support with Activities of Daily Living (ADLs) as the level of care provided by different facility types intensifies. On average, 32% of individuals in Adult Day Services Centers require assistance with ADLs, while this need jumps to 44% in Assisted Living facilities. The demand for support peaks within Nursing Homes, Home Health Agencies, and Inpatient Rehabilitation Facilities, with averages of 87%, 89%, and 92%, respectively. Notably, the highest percentage of residents requiring help is observed with dressing and bathing, indicating these as the most challenging ADLs across the board. The data underscores a clear correlation between the complexity of care provided by a facility and the percentage of residents experiencing difficulties with ADLs, reflecting the targeted care approach of each service level.

% of Seniors Receiving Assistance with ADLs by Senior Facility and Support Service in 2020

The data from 2020 also illustrates a clear trend in senior living facilities. As individuals progress from Adult Day Services Centers to more intensive care settings like Inpatient Rehabilitation Facilities, the number of medical diagnoses per resident tends to increase.

Percent of Senior Housing and Support Service Diagnosis Distribution in 2020

Whether opting for in-home care with access to adult day care services or considering a move to a more institutional setting, it's important to align the choice with the older adult's preferences, needs, and overall wellness trajectory. Remember, the right environment can significantly impact an individual's happiness, social connectivity, and quality of life.

To give you a sense of how greater dependence aligns with senior care housing options we offer you a high-level snapshot of the continuum of care based on the care needs identified in the previous charts.

Senior Housing and Support Option by ADL and IADL Need

Choosing the right living arrangement for an older adult is a decision that can evolve over time, based on their changing needs and preferences. Initially, many families opt for In-Home care, allowing loved ones to age in place within the comfort and familiarity of their own home or a family member's residence. This setup provides the flexibility to add more support services as required, ranging from adult day care for social and health services to professional in-home caregiving for assistance with daily activities.

However, as needs become more complex, transitioning to an institutional setting may become necessary or more practical. These settings offer a spectrum of social, health, and recreational services tailored to various levels of independence and care requirements. Importantly, the choice to move from in-home care to a more structured environment can be made at any point, ensuring that the individual's needs are adequately met.

What Tailored Support is Available for Specialized Senior Care Needs?

As our loved one’s age, their care needs can become more specialized, requiring specific support services that go beyond basic assistance with daily activities. When considering which setting is right for you, it's essential to understand the availability and scope of specialized care services. Here's a look at additional options designed to address specific needs:

Memory Care

Memory care units in Assisted Living facilities specialize in supporting seniors with Alzheimer's Disease or dementia. Staff in these units are trained to manage memory problems, confusion, and communication difficulties, focusing on creating a safe and nurturing environment. While these caregivers are skilled in memory care, they generally are not medical professionals, and the care provided is centered around supervision, basic first aid, and medication management rather than regular medical care.

For individuals requiring 24-hour supervision, regular skilled care, and immediate access to medical professionals, some Nursing Homes offer dedicated memory care units. These units are designed with secured entrances and exits to prevent wandering and ensure resident safety.

Skilled Nursing

Following a hospital stay due to surgery, injury, or illness, a hospital social worker may recommend transitioning to skilled nursing care when hospital-level care is no longer necessary, yet professional healthcare attention remains essential for recovery. This intermediate level of care is designed to bridge the gap between hospitalization and return to everyday living, providing patients with the targeted medical support they need to recuperate effectively.

For those residing in In-Home or Independent Living settings, this transition may involve home health agency visits to deliver professional care directly in the comfort of one's home or a short-term admission to a skilled nursing facility for more concentrated care.

In Assisted Living, residents requiring heightened medical attention might temporarily be placed in a separate skilled nursing facility that can cater to their more demanding healthcare needs.

Conversely, Nursing Home residents benefit from a seamless transition within the same facility, moving to a dedicated skilled nursing section designed for more focused and intensive care. This integrated approach within nursing homes ensures that residents receive the requisite healthcare support while remaining in a familiar environment, facilitating a smoother recovery process.

Rehabilitation Hospital

For individuals on the mend from surgery or injury who require focused therapy—be it physical, occupational, or speech—a short-term stay in a rehabilitation hospital or unit is often a pivotal phase in their recovery process. The pathway typically begins with a discharge from an acute care hospital, progressing to a rehabilitation center equipped with an array of specialized equipment, resources, and ample space dedicated to facilitating therapy sessions.

These centers are designed to offer an intensive, resource-rich environment for recovery that surpasses what could be provided In-Home, in Independent Living, or Assisted Living settings. Following a stint in a rehabilitation center, individuals may transition back to their principal residence. It is at this stage that skilled nursing support and follow-up therapy through a Home Health Agency come into play, continuing the care journey in the comfort of the individual’s home.

Nursing homes also offer rehabilitation services as a standard part of care, enabling a smooth transition for residents in need of therapy post-hospitalization. This comprehensive care trajectory—from acute hospital care to specialized rehabilitation centers, and then back to the home environment with continued support—ensures a holistic approach to rehabilitation, addressing both immediate recovery goals and longer-term health maintenance.

Companion Care

Within all senior living environments, the option to contract companion care services offers a valuable layer of additional support tailored to enhance the daily lives of seniors. Companion care extends beyond mere assistance; it embodies a blend of practical help, emotional support, and the nurturing of a personal human connection. These services are especially beneficial in providing companionship, facilitating transportation to appointments, conducting light housekeeping, managing laundry, and preparing meals.

Companion care stands out by offering a presence that can fill the gaps when family members or informal caregivers cannot be available throughout the day. It’s about creating meaningful interactions and a sense of companionship that bolsters a senior’s sense of well-being and connection to the world around them. For seniors living independently (In-Home or Independent Living), in Assisted Living, or even in more clinical settings like Nursing Homes, companion care can serve as a bridge to the broader community, preventing feelings of isolation and loneliness.

Moreover, companion care is adaptable; it can be customized to meet the individual’s specific needs and preferences, whether it’s engaging in favorite hobbies, going for walks, or simply having someone to share meals. This flexible and personal approach ensures that seniors receive not only the practical support they need but also the invaluable benefit of human connection, significantly enhancing their quality of life and promoting independence.

Respite Care

Respite care plays a crucial role in the continuum of senior care by offering short-term relief for primary caregivers, who are often spouses, family members, or close friends dedicated to the day-to-day support of a senior. Unlike companion care, which focuses on providing companionship and assistance to the senior, respite care specifically aims to support the caregiver, allowing them essential time to rest, recharge, or attend to personal matters with the assurance that their loved one is in safe hands.

For In-Home and Independent Living, respite care can be tailored to the needs of the caregiver, offering hourly or overnight support managed through arrangements with other family members, friends, or professional aides. This flexibility ensures that caregivers can take the necessary breaks for their well-being while their loved ones continue to receive care in the comfort of their home or independent living environment.

Some Assisted Living and Nursing Home settings, respite care may extend to offering temporary residence for seniors, providing a safe and caring environment for individuals whose primary caregivers need to travel or simply require a longer period of respite. Think of it as a hotel option with greater ADL and IADL support. This arrangement not only grants caregivers the peace of mind needed to take a well-deserved break but also introduces seniors to a supportive community, potentially easing future transitions into more permanent care settings.

Respite care is an invaluable service that acknowledges the immense dedication of caregivers by ensuring they have the opportunity to attend to their health and personal needs. Whether it's arranged as in-home support or through temporary stays in assisted living or nursing homes, respite care is designed to maintain the continuity of care for the senior while offering caregivers the breather they need to sustain their caregiving role over the long term.

Serious Illness and End-of-Life Care: Palliative and Hospice Care

When navigating care options for individuals facing serious illnesses or approaching the end of life, understanding the nuances between Palliative Care and Hospice Care is essential. Both focus on enhancing quality of life, but they serve distinct purposes and are suitable for different stages of illness. Here, we provide you with a high-level overview of these options and encourage you to explore other GeriScope blogs for more detailed explanations.

Palliative Care

Palliative Care is specialized medical care aimed at providing relief from the symptoms and stress of a serious illness. It is a supportive service that can be provided alongside curative treatments to individuals with conditions such as cancer, dementia, or heart failure. The goal of palliative care is to improve quality of life for both the patient and their family, addressing physical, emotional, and spiritual needs. This type of care is accessible in various settings, including hospitals, nursing homes, outpatient clinics, and at home, making it a versatile option for those managing chronic or life-threatening illnesses.

Hospice Care

Hospice Care, on the other hand, is care specifically designed for individuals in the final stages of a terminal illness, where the focus shifts from curative treatments to comfort and support. It emphasizes pain relief, symptom management, and emotional and spiritual support, tailored to the patient's needs and wishes. Hospice care is available in multiple settings, such as at home, in hospitals, nursing homes, or dedicated hospice facilities, and extends support to both the patient and their loved ones during this challenging period.

The key difference between palliative and hospice care lies in their timing and objectives: palliative care can be introduced at any stage of a serious illness and works in conjunction with other treatments, while hospice care is generally reserved for the final six months of life, focusing entirely on comfort and quality of life without pursuing curative measures. 

Embracing the Journey Through Senior Housing Options

Selecting the right senior living arrangement is a significant decision, shaped by individual needs, health conditions, and preferences for quality of life. In this discussion, we've taken a closer look at the various senior living options available, from the autonomy provided by aging in place to the full-spectrum support offered in nursing homes. The journey with my father's care underscored the dynamic nature of these choices and the importance of making well-informed decisions at every juncture.

We've seen that flexibility and a readiness to adapt are essential as health and wellness paths evolve. A clear understanding of the different living environments enables families to effectively prepare for current and future care requirements, striking a harmonious balance between a loved one's independence and the need for professional support.

In our upcoming blog post, we will explore how to use the Katz Index and Lawton-Brody Scale in evaluating care needs, aiding in conversations with facilities and care providers to find an ideal match for services. Subsequently, we'll examine the financial considerations of senior living, focusing on the costs linked with each option and potential funding avenues. Together, this information is vital for making decisions that are both beneficial for loved ones and financially manageable.