The What Now Stage
The Basics - Living Arrangements for those Living with Dementia
At a recent support group that we facilitated, a pamphlet was available listing the various medications used to ease the symptoms of Alzheimer’s type dementia. One family member slowly flipped through the pages, looked defeated and raised her hand to ask a question: “This is all fine and good, but I don’t even know the difference between a nursing home and an assisted living facility. I need to learn my options.”
Point well taken. The remainder of the group set down their pamphlets as well, nodding their heads in agreement. They all needed guidance in the “What Now?” stage and they found themselves overwhelmed by medical & technical jargon. They came for support and understanding of some basics before they could move on.
So, let's begin with the facts:
Senior Apartments - are typically one or two bedroom apartments that offer no medical services, however, they do provide for social service assistance with financial, social and in-home care coordination. Some Senior Apartments operate on a federal subsidy program where rents are determined on annual adjusted income, medical expenses and other deductions. Senior Apartment living encourages enhanced socialization, independent driven activity programming and community events.
Assisted Living Facilities (AL) - are private pay only long-term care facilities that offer a variety of services, typically offered as an ala carte menu. The more assistance needed, the higher the cost. Some Assisted Living Facilities offer memory care, others do not. Be mindful of this. In 2017 the average cost of a one bedroom accommodation in an Assisted Living Facility ran about $3750.00 per month, or $45,000 per year. The potential resident in an Assisted Living Facility must use their own funds to participate in this option. Assisted Living Facilities do not accept Medicare or Medicaid.
A few states have been identified as the most expensive in Assisted Living Costs. They include: Delaware and Alaska ($72,000/ year), New Jersey ($69,000/ year), Massachusetts ($67,000/ year) and Rhode Island ($61,000/ year).
The more affordable states that offer Assisted Living include: Missouri ($32,000/ year), Georgia ( $33,000/ year), South Carolina ($34,000/ year), Arkansas and North Dakota ($36,000/ year).
Continuing Care Retirement Communities (CCRCs) - are facilities that offer a multitude of care levels, encouraging the resident to live independently for as long as possible while moving through the various stages of care. CCRCs look to accept an applicant that can live independently with little to no assistance. As age and disease processes progress, nursing assistance (and potentially memory care) is provided as needed. The concept of a CCRC is to have a resident transition through the stages of aging within the same long term community.
CCRCs are private pay only communities and do not accept Medicare or Medicaid as a form of payment. However, depending on the possible need for rehabilitation services due to an acute medical condition, Medicare (and possibly Medicaid)may assist with the cost of some services during that time.
Most CCRCs require an entrance fee that can range from $100,000.00 to $1 million. Monthly fees can range from $3000- $5000/ month. The fee may increase as the care needs increase.
Supportive Living (SLF) - is a modification or bridge lifestyle between Senior Apartments and Assisted Living. Supportive Living provides daily nursing services by a licensed professional, 24-Hour Nursing Assistant Staff, medication monitoring, assistance with up to two activities of daily living (ADL’s: bathing, grooming and/ or dressing), social service support and activity programming. Supportive Living accepts both private pay and Medicaid assistance. Only designated Supportive Living Communities provide memory care, so be mindful to ask. Supportive Living communities are designed to assist residents that can ambulate independently as well as manage any possible incontinence issues.. Once care increases, the appropriateness of a Supportive Living Facility will be discussed with your Service Coordinator.
Memory Care Facilities - can either be part of an Assisted Living Community, Nursing Home Community or a stand alone establishment that specializes in care for those living with various forms of dementia. These facilities or care providers specialize in a safe and structured environment that engage and support through communal meals, activity programming and ADL assistance. Payment for this level of care can be either private funds, Medicaid or a blend of both.
Nursing Homes (NH) - are facilities that offer the highest level of care to a recipient. Nursing Homes accept private pay, Medicaid and (in specific rehabilitation instances) Medicare as well. Nursing homes vary from a single occupancy room to a double/ shared room with a roommate. Licensed nursing professionals and certified nursing assistants are scheduled around the clock and can provide any and all ADL assistance as needed by each particular resident.
~ Written By - Cathy Braxton, Chief Education Officer
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