Are your parents thriving?
Do they have interests that keep them engaged, get out often to see friends, stay fit, eat well, and seem genuinely interested in what tomorrow may bring? Might they benefit from increased care or a new living situation?

Helping your parents take charge of their future can seem daunting if you don't know where to begin. We're here to help. Use this website to find answers to many common questions that may arise as you begin this process. Get Started  

The 40,000 Foot View
Discovering how best to assure that an aging family member with increased support needs will continue to thrive can certainly be a complex process. This guide will help you understand the strengths and limitations of different housing and care options, from home health care, to assisted living to CCRCs with LifeCare.

Overview of Independent Living
Well-designed Independent Living communities offer a rich variety of lifestyle options for older adults who generally require little assistance with activities of daily living (bathing, dressing, preparing meals). Dining options, greater security and freedom from home maintenance are the mainstays of these congregate senior communities, but just as important to the creation of an enhanced sense of resident well-being are a wide variety of planned social, educational and recreational programs, as well as the daily opportunities for socialization with peers.

Independent Living housing ranges from Villas or Casitas to studio apartments and these residences are often situated on campuses of significant size with wellness and fitness centers, pools and spas, beauty salons and barber shops, a variety of dining venues, computer and meeting centers, libraries, guest accommodations and outdoor amenities such as gardens and nature trails as well as transportation services.

Paying for Independent Living
Independent Living is most often paid for with private funds. Some Independent Living communities require an entrance fee and may or may not involve condominium ownership. Some communities are rental. Supplemental health services may be paid for with long-term care insurance, if the policy allows. Supplemental private insurance will not pay for Independent Living.

Overview of Assisted Living
Assisted Living, sometimes called Personal Care, is a type of care that supports individuals with their basic Activities of Daily Living (ADLs), including bathing, dressing, preparing meals, and, in some cases, medication assistance or reminders. Residents of Assisted Living communities, whether stand-alone or part of Continuing Care Retirement Community (CCRC), benefit from the community's planned social, educational and recreational programs, as well as the daily opportunities for socialization with peers. Three daily meals are generally provided.

Assisted Living housing tends to be more intimate, offering an enhanced home-like atmosphere. Apartments are generally studio or one-bedroom, with kitchenettes. Safety features such as call systems and handrails are standard.

Paying for Assisted Living
Assisted Living can be paid for from private funds or with a mixture of private funds and long-term care insurance. Supplemental private insurance will not pay for Assisted Living.

Overview of Memory Care
Memory Care is designed to support the specific needs of residents with Alzheimer's disease, memory loss and dementia. Many Memory Care centers develop innovative educational and social programs that engage residents in the daily activities that slow memory loss and provide continuity through structured support. Some Memory Care centers have distinct locations for programs that address the wide range of resident memory loss. Although Memory Care centers should be secure in order to prevent residents from wandering, part of the secured area may be a landscaped courtyard or garden so that residents have access to the outdoors.

Paying for Memory Care
Private funds supplemented by long-term care insurance policies is the most common way to pay for Memory Care, but Medicare and private supplemental insurance may pay for the short-term skilled nursing and rehab care that may be required at times.

Overview of Nursing Care
Often called skilled nursing and rehab centers or nursing homes, Nursing Care communities offer both long-term skilled nursing care and short-term skilled nursing and rehabilitation services. While supporting individuals with their basic Activities of Daily Living (ADLs), including bathing, dressing, preparing meals, Nursing Care communities also provide complex medical care using the services of licensed nurses and therapists (physical, occupational, nutritional and speech). Nursing Care services are often utilized by individuals requiring short-term medical support after an injury, surgery or illness-related hospital stay. Nursing Care communities generally have 24-hour licensed care staffing.

Nursing Care housing is generally a private suite or shared accommodations. Well-designed Nursing Care communities enhance recovery and healing with planned social, educational and recuperative programs, as well as with an emphasis on home-like comforts.

Paying for Nursing Care
Reimbursement for Nursing Care community patients and residents depends largely on length of stay. Different funding sources kick in at different intervals. Short-term rehabilitation stays are often covered by Medicare and/or private insurance, including long-term care insurance. (Certain criteria in terms of length of hospital stay and care requirements while in the Nursing Care community have to be met to receive Medicare payments and it is worthwhile to discuss these with a discharge coordinator at the hospital.) For long-term care residents, private funds, Medicaid, and long-term care insurance are the typical methods of payment.

Overview of Continuing Care Retirement Communities
Continuing Care Retirement Communities (CCRC) are designed to let residents "age in place," with flexible accommodations designed to meet residents' changing health and housing requirements. CCRCs generally offer Independent Living, Assisted Living, Memory Care and Nursing Care on a single campus. Because residents do not have to move as their life situations may change, CCRCs provide a significant sense of community. Residents often enter the community through its Independent Living component. CCRCs are recognized for their robust planned social, educational and recreational programs, as well as resident camaraderie.

CCRC housing ranges from Villas or Casitas to studio apartments. In some CCRCs it is not necessary to move in order to receive a different type of care. These residences are often situated on campuses of significant size with wellness and fitness centers, pools and spas, a variety of dining venues, beauty salons and barber shops, computer and meeting centers, libraries, guest accommodations and outdoor amenities such as gardens and nature trails as well as transportation services.

Some CCRCs offer a LifeCare contract. With LifeCare, residents pay an entrance fee plus a monthly service fee. The contract provides for future costs of health care, including assisted living, memory care, skilled nursing, rehabilitation or even long term care on site at a predictable rate.

Paying for a CCRC
CCRCs generally require an entrance fee, which can be refundable to an individual or estate. Residents also pay a monthly service fee, based both on the services utilized and the nature of the contract they may have signed when entering the CCRC. CCRCs can be paid for from private funds or with a mixture of private funds and long-term care insurance, depending on the level of care. Most CCRCs have a short-term rehab program that is Medicare certified.

Overview of Home Health Care
Home Health Care provides services from certified nurses, often in combination with occupational, physical and speech therapies. Certified Social Workers and Registered Dieticians may also provide support. Home Health Care is delivered in a residence, including some congregate senior communities.

Home Health Care may also offer a full range of personal care and companionship services, that include assistance with Activities of Daily Living (ADLs) such as bathing, dressing, preparing meals, as well as shopping, light housekeeping, and errands. Care is usually provided under the supervision of a Registered Nurse.

Home Health Care has two main components. The first is the orchestration of comprehensive medical assessments and treatments, including effective symptom control, to reach immediate and short term clinical goals after illness, hospitalization or surgery. The second is the education and training that allows patients to integrate new self-management skills into their daily lifestyle. Both are important in the recovery of optimal wellness and vitality.

Paying for Home Health Care Services
Home Health Care can be paid for in a number of ways. If the Home Health Agency is certified for it, Medicare pays for care with the primary goal of improving the patient's current health condition so that the patient can live independently again. Specific conditions must be met. If a patient does not qualify for Medicare, especially if services rendered are not medical, then expenses may be paid by private long-term care insurance or private funds.

Overview
As complex as it can be to sort out which type of care best suits a parent, it can be just as complex figuring out which financial resources may be used to pay for that care, and, largely because of this complexity, it pays rich dividends to do some thorough research.

Basically eldercare may be paid for using private monetized resources, private insurance plans and government plans such as Medicare, Medicaid (called by different names in different states) and Veterans benefits. As with the care itself, it is possible to supplement one type of payment with others.

Just as important as it is to do initial research, it is a good idea to keep up with the changing aspects of a parent's care as well as new options for paying for it. Often, new sources of payment and reimbursement arise as an elder's health care requirements change. For instance, Medicare Supplemental Insurance will "kick in" when someone who has been receiving memory care support additionally requires short-term skilled nursing care. Similarly an elder who lives in a Continuing Care Retirement Community (CCRC) will have the benefit of Medicare in the event skilled nursing is required. (See our Elder Care Reimbursement table.)

Paying for Independent Living
Independent Living is most often paid for with private funds. While some Independent Living communities require an entrance fee and may or may not involve condominium ownership, some communities are rental and require only a small fee upon entrance and monthly fees. Some supplemental health services may be paid for with long-term care insurance while the elder lives in Independent Living, if the policy allows. Supplemental private insurance, also known as Managed Care or Medicare Supplemental Insurance, will not pay for Independent Living.

Paying for Assisted Living
Assisted Living is generally paid for from private funds or with a mixture of private funds and long-term care insurance, which will pay for certain services depending upon the policy. Supplemental private insurance will not pay for Assisted Living.

Paying for Memory Care
Private funds supplemented by long-term care insurance policies is the most common way to pay for Memory Care, but Veterans' Benefits pays for certain aspects of Memory Care, and Medicare, private supplemental insurance and may pay for the short-term skilled nursing and rehab care that may be required at times.

Paying for Nursing Care
Reimbursement for Nursing Care community patients and residents depends largely on length of stay. Different funding sources become viable at different intervals. Short-term rehabilitation stays are often covered by Medicare and/or private insurance, including long-term care insurance. (Certain criteria in terms of length of hospital stay and care requirements while in the Nursing Care community have to be met to receive Medicare payments and it is worthwhile to discuss these with a discharge coordinator at the hospital.) For long-term care residents, private funds, Medicaid, and long-term care insurance are the typical methods of payment.

Paying for a CCRC
CCRCs generally require an entrance fee, which can be refundable to an individual or estate. Residents also pay a monthly service fee, based both on the services utilized and the nature of the contract they may have signed when entering the CCRC. CCRCs can be paid for from private funds or with a mixture of private funds and long-term care insurance, depending on the level of care. Most CCRCs have a short-term rehab program that is Medicare certified.

Paying for Home Health Care Services
Home Health Care can be paid for in a number of ways. If the Home Health Agency is certified for it, Medicare pays for care with the primary goal of improving the patient's current health condition so that the patient can live independently again. Specific conditions must be met. If a patient does not qualify for Medicare, especially if services rendered are not medical, then expenses may be paid by private long-term care insurance or private funds.

What is Medigap?
A Medigap policy is health insurance that fills the gaps left in Original Medicare Plan coverage for eldercare. The plans, sometimes called Medicare Supplemental Insurance, are sold by private companies but regulated by the federal government and must conform to one of several standardized Medigap policy types. The Original Medicare Plan and the supplemental plans are designed to dovetail, each paying for a portion of the covered health care costs.

Depending upon which state an elder lives in, he or she may choose from up to 12 policies, and each plan, designated A - L, has a different set of basic and extra benefits. Generally, elders must have Medicare Part A and Part B to begin with and then supplement with the additional coverage. Although the specific benefits of any provider's Medigap Plan A through L will be the same, costs can vary, and, additionally, not all companies providing this coverage sell all available policies. It pays to shop around.

Spouses are not covered by each other's policies.

When to Get Started

Now, of course! Knowing that your parent may benefit from additional support can become clear suddenly, perhaps as the result of a specific event, or may be a gradual realization, as the subtle clues of diminished life pleasure and fragile health add up. But it cannot hurt to be prepared. You will have some of the groundwork laid and know how your parent feels about many potentially tricky issues that would be better not tackled in a rush.

So, talk early, and talk often.

Here are some of the basic signs that a parent may need increased support:

• A home and yard not as tidy as you would expect
• Unkempt personal appearance
• Scarcity of food items or unhealthy foods
• Missed appointments
• Bills unpaid
• Rash monetary decisions
• Loss of interest in traditional hobbies and no new ones
• No interest in friendships or other social connections

Start with Possibilities

Aging creates opportunities. There's little need to begin a discussion about senior living options with the premise that a change in an elder's living situation must involve loss and limitation, as much as a loss may very well be the precipitating factor in the changed circumstances. Researching senior care options and understanding their relative strengths and limitations, as well as how various aspects of each may be blended for optimal results, means that discussion about change may begin as a discussion about choice.

Don't hesitate to get outside support

This is a time of significant change and seeking the counsel of someone who has personal or professional experience with senior living opportunities may be of great help in making decisions and avoiding common mistakes. You may want to confer with an outside expert on your own before starting the dialog with your parent or ask your parent if it would be ok to include that person in your discussions. Having someone from the 'outside' also may diffuse some of the tension that can accompany discussions about upcoming change.

Pick the Right Moment

As pressing as it may seem to begin discussions about the future with a parent after you have become aware of some triggering event or pattern, be sure to pick a moment that will not add additional stress. Do not blind side them. A large family gathering is probably not the place. Consider scheduling a special time to talk; let them know that there is something important you would like to discuss. Ask them when and where would be good for them. Remember, this is a decision you will be making together and their continuing input is just as vital for its success as yours is. It might be useful to set up a recurring time to talk about upcoming decisions and let the rest of your time together be free of the topic.

Make it a Dialog

It is unlikely that your parent will not have noticed the changes in their behavior and lifestyle that you have begun to notice, even if they do not want to acknowledge them. Make sure to ask questions that will help you realize how they have been experiencing and perceiving their own process of aging. Be willing to follow their lead. There will likely be some surprises for you that will help you be a good partner throughout this time of change. Listen.

Sample Questions

You no doubt know your parent better than anyone and realize how best to start this dialog, but here are some questions that we have found helpful in getting the process not only started but moving towards solutions.

Is there anything you would like to have in your every day life that you don't have now?

Can you imagine feeling more secure every day? What would help with that?

Would you enjoy more companionship of people your age or would that feel limiting?

Would you like to have a program of regular activities and events? Would you enjoy group outings to your city's cultural events?

What is your optimal way to manage your meals? Would you like having someone cook for you?

What is the best size of living space for you? What does it look like? What's in it?