What are My Long-Term Care Options for Elderly Parents? Assisted Living to Nursing Homes Explained
As our parents and family members age, finding the right long-term care solution can be an emotional and daunting task. At Mana, we understand the challenges families face during this transition, as many of our team members have gone through similar experiences with their own parents.
Through our collective journeys, we've learned that understanding the diverse range of long-term care options is crucial. From independent living communities and assisted living facilities to skilled nursing homes and memory care units, the choices can feel overwhelming.
To help guide you, let's first explore the 8 main types of senior care available:
1. Independent Living Communities: Also known as retirement homes, senior housing, or continuing care communities, these facilities are ideal for fully independent seniors seeking an active, social and amenity-rich lifestyle. Apartment complexes, condos, and planned communities typically offer resort-like dining, activities, and amenities. A large entry fee plus monthly fees are required, but this often guarantees lifetime housing and access to future higher levels of care, if needed.
2. Assisted Living: Assisted living allows residents to maintain privacy and independence in their own apartments or rooms, while receiving assistance with activities of daily living (ADLs) like bathing, dressing, medication management and more. Social engagement through communal dining, activities, and outings is a major benefit. The range of services varies and the cost is typically higher than Independent Living options, so be sure to thoroughly evaluate the choices available and make sure they are suited to your family’s specific needs.
3. Skilled Nursing Facilities (SNFs): For seniors requiring 24/7 skilled nursing care and extensive assistance with basic needs like bathing, dressing, eating, and mobility. Typically, individuals entering SNF must have a detailed plan established by their medical team beforehand. Care at the SNF is provided in private or semi-private hospital-like rooms, under a doctor's supervision.
4. Memory Care: Specialized, secure care dedicated to those with Alzheimer's, dementia or other cognitive impairments. Memory care can be a separate wing or floor in an assisted living facility, or stand-alone communities. Care is personalized with structured activities to gently support cognitive challenges. These facilities can vary greatly in terms of cost and amenities. We think it’s important to shop around before your loved one’s cognitive impairment reaches the point of needing 24/7 help, so that you can be adequately prepared to choose the best options for your circumstances. Also note- if you have a family history of Alzheimer’s or genetic risk for memory issues late in life, it may even be a good idea to get familiar with your options before age 65, so you can document your own preferences.
5. Board and Care Homes: Smaller residential homes with live-in caretakers providing care for just 4-6 residents. A cozier, homier alternative to larger facilities at a lower cost. Services vary but typically include ADL assistance and basic activities.
6. Home Health Care: Skilled care brought directly to the patient's home, from part-time help with ADLs to full-time nursing care. This allows aging in place, but requires extensive home modifications and can become extremely costly as care needs increase over time.
7. Respite Care: Short-term stays of days or weeks, either at an assisted living community or adult day program. Ideal for trial periods or giving in-home caregivers a break.
8. Hospice Care: For those nearing the end of terminal illness, hospice provides compassionate comfort care focused on improving quality of life, not finding a cure.
Whichever type of care fits your family's needs, creating a solid plan to finance the high costs is essential. Traditional resources families rely on include:
Medicare: Covers limited nursing home stays and hospice care, but not long-term assisted living costs. Understanding what is and isn't covered is crucial for budgeting.
Long-Term Care Insurance: If your parents were fortunate to purchase a long-term care policy decades ago, it can offset many costs of nursing homes, assisted living, and in-home care. Coverage varies by policy.
Retirement Savings: Qualified accounts like 401(k)s and IRAs are often earmarked for long-term care spending. Carefully calculate sustainable withdrawal rates with a financial advisor.
Non-Retirement Savings: Any taxable investment accounts or cash savings are other pools of money families tap.
Home Equity: Reverse mortgages, downsizing, or taking out a home equity loan can unlock funds from your parents' home equity to pay for care.
Medicaid: For those who exhaust their own resources, Medicaid can cover limited types of long-term care for those meeting strict income and asset requirements.
When investigating specific long-term care options, be sure to ask detailed questions to understand all current and potential future costs. Here are some starters for these conversations:
What is included in the base monthly rate? Which services incur extra fees?
What has the historical rate increase been annually? Future projected increases?
Does the facility limit services in any way, like the number of staff visits?
For memory care, what separates it from general assisted living areas, if costlier?
How is transportation provided for medical appointments, activities, etc.?
If an "all-inclusive" rate is advertised, get complete details on what it covers.
In addition to ensuring your parents' care will be affordable, cultivating awareness of their current stage of aging is vital. Check in frequently to honestly assess if they are still able to perform essential activities of daily living (ADLs) independently:
Personal care: Bathing, dressing, using the restroom, transferring in/out of bed
Basic mobility: Walking, getting up from chairs
Eating: Preparing meals, feeding themselves
Continence and cognition: Managing incontinence, taking medications properly
Signs like leaving the stove on, hygiene issues, unexplained bruising, extreme forgetfulness or confusion may indicate escalating needs. Don't wait for a crisis - start making plans once any ADLs become difficult.
Other potential red flags are social withdrawal, poor nutrition, missed medications, and an unkempt home environment. Take note if your parent seems depressed, accounts are mismanaged, or they've stopped participating in hobbies and activities they once enjoyed.
Observing these changes can be heartbreaking, but being proactive allows more time to find the ideal long-term care solution. Involve your parents in decisions to understand their wishes - would they prefer in-home care for as long as possible or are they open to moving to a community?
The path is different for every family, but open communication and starting the research process early are key to a smoother transition. At Mana, we've supported many families through this emotional journey, helping them understand their options, plan for costs, and select high-quality care aligned with their parents' needs and wishes.
No matter which long-term care route you choose, the goal is ensuring your loved ones can age with dignity. From maintaining independence in an active retirement community to receiving comprehensive care in a skilled nursing facility, the perfect solution helps your parents live life to the fullest while providing you peace of mind.
Finding the right long-term care solution is undoubtedly one of the most difficult responsibilities we face as our parents age. But by being informed and prepared, you can make this emotional transition easier for your whole family. With knowledge, resources and an open heart, you can feel confident your parents will receive the care, comfort and respect they deserve in their golden years.
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Stephanie Bucko and Cristina Livadary are fee-only financial planners based in Los Angeles, California. Stephanie is the Chief Investment Officer and Cristina is the Chief Executive Officer at Mana Financial Life Design (FLD). Mana FLD provides comprehensive financial planning and investment management services to help clients grow and protect their wealth throughout life’s journey. Mana FLD specializes in advising ambitious professionals who seek financial knowledge and want to implement creative budgeting, savings, proactive planning and powerful investment strategies. As fee-only fiduciaries and independent financial advisors, Stephanie and Cristina never receive commission of any kind. Stephanie and Cristina are legally bound by their certifications to provide unbiased and trustworthy financial advice.