Senior Living Options Explained- Nursing Homes Might Not Be What You Think They Are

In years past, most people referred to senior living collectively as nursing homes. There was no distinction between types of facilities and care needs. Seniors and their families had fewer options for varying requirements and preferences.  While the world of senior living has changed significantly in recent years, there are still many people who remember the stigmas associated with nursing homes of old and are hesitant to consider senior living communities for themselves or a loved one.

Understanding of geriatric needs has improved over the years and with it have come many options for seniors, when staying at home is no longer an option or desire. Senior living communities in South Carolina typically fall into the following categories:

• Independent Living
• Assisted Living
• Memory Care
• Skilled Nursing Facility or SNF
• Residential Care Facility
• Continuing Care Retirement Community

This blog is designed to increase understanding of the various types of senior living options available and help South Carolina’s aging population make better decisions about what is right for them.

Independent living communities were designed years ago for seniors who are living independently and want to continue to do so. These seniors often are still driving and don’t require help with activities of daily living (ADL). Over time, as the age of seniors choosing IL has increased, there’s a higher prevalence of walkers and wheelchairs in independent living communities and some people opt for independent living with a few in-home care services factored in.

The reasons to choose this option rather than staying at home include:

• Simplicity and Freedom: Seniors don't have to deal with home maintenance or lawn upkeep. Cooking is optional; as many independent living communities offer meal plans or meal plans come standard with monthly rent.
• Staying Active: Most independent living communities offer multiple daily programs designed with holistic needs in mind: spiritual, physical, intellectual, and social. 
• Socialization: The effects of social isolation on the elderly can be devastating but independent living communities combine the benefits of private dwelling with better access to people of your own age for activities, meals, and other connection opportunities.

Most independent living communities will require an upfront deposit, some more significant than others, depending on the type of housing and plan chosen. Some have buy-in amounts for real-estate but most do not. Most payment plans are monthly rent which can cover housing, meal plans, monthly maintenance and lawn upkeep. These items depend on the structure of the community and the needs of the resident. 

Assisted living communities are a great option for seniors who need help with ADL or other assistance to live life to the fullest. Many people choose assisted living after a health care provider has advised that staying at home is not the best solution for them. Others realize that they are isolated and simply need a little help with day-to-day activities. Just as each senior’s needs are different, so are assisted living communities. Here are a few points to note about assisted living communities in South Carolina:

• AL communities in the state are under the oversight of the SC Department of Health & Environmental Control or DHEC which performs regular visits and inspections and has parameters in place regarding employee-to-resident ratios, types of care allowed by staff, employment guidelines and testing, and more. Per DHEC guidelines, there are a few medical issues that would exclude someone from assisted living eligibility. We will discuss this more, further in the blog. 
• Not factoring in the DHEC exclusions, assisted living communities are equipped to assist with a wide spectrum of care needs. One of the first steps when moving is a review of the senior’s medical history, a non-invasive medical assessment, and meeting with staff to determine a care plan. Some need assistance with only a few things like medication management or bathing; while others may need more hours dedicated to helping them. The beauty of today’s assisted living is that the communities are not “one size fits all” but are able to adapt and plan for individualized needs.
• Assisted living communities, like their independent living cousins, are designed to maintain a senior’s independence and address issues of mind, body and spirit with multiple activities and socialization options. Assisted living communities can do most of what a nursing home can do at a fraction of the cost.
• Most assisted living community rooms and apartments are not clinical in appearance or nature. Seniors are encouraged to decorate to their tastes and bring personal items to make the space their home. Most communities offer studio apartments and some buildings have 1 or 2-bedroom options. There are also many common areas in each facility such as dens, game rooms, exercise rooms, porches, movie rooms, etc.
• Meals and snacks are often included in the monthly rent and most communities include regular laundry service and cleaning, as well.  Rooms with microwaves and refrigerators vary by building.
• Many assisted living communities today also offer the added benefits of an in-house primary care physician through contracts with outside providers. This is an optional amenity that allows residents the convenience of seeing a doctor for routine visits or common colds without leaving the community. Rehabilitation therapies are offered at many communities through the same process of contracting with outside providers. Again, this is an optional amenity that may be convenient for a senior who has medically authorized post-hospitalization therapy by eliminating the need for daily trips to a separate facility.
• Common amenities offered at assisted living communities include: in-house beauty/barber shop, private dining rooms which can be reserved for family dinners & special occasions, library, Wi-Fi, and many allow pets.

Usually, assisted living communities will require a nominal up-front, community fee which goes to building maintenance, and to offset re-modeling between each resident with new paint, repairs, and flooring. Most communities are designed to either private-pay or accept Medicaid residents, not both.

Memory care communities are designed for people with dementia and cognitive issues who may need specialized care or have a history of exit-seeking. Everyone who has dementia does not necessarily need a memory care community; some dementia patients do well with the care provided by an Assisted Living community. In a nutshell, memory care communities are basically restricted access assisted living communities.

Key points about memory care communities include:

• Memory care communities have the same look & feel of assisted living communities in regard to room design and amenities. The biggest variance is that these communities have locked doors and secure outside areas to ensure the safety of residents who are prone to wander.
• Many memory care communities are units and wings within a larger community which includes assisted living communities and sometimes independent living facilities. There are also memory care communities dedicated solely to dementia needs.
• Activities are tailored to the special needs of this population to strengthen cognitive and motor skills, while promoting socialization and interaction.
• Memory care is usually more expensive than assisted living but more likely to have care costs included in the price.

Typically, memory care communities will require a nominal up-front, community fee which goes to building maintenance and to offset re-modeling between each resident with new paint, repairs, and flooring. The exception might be if a resident transfers from assisted living to memory care within the same community which is determined by that community’s processes. Most communities are designed to either accept private-pay or accept Medicaid residents, not both.

Skilled nursing facilities are more clinical in nature than assisted living and memory care communities and provide round-the-clock care for people whose care needs are beyond the scope of other communities. Sometimes a stay at a skilled nursing facility is temporary and part of a physician ordered rehabilitation which is covered under Medicare and most other insurance policies. In other instances, someone may need physician directed care long-term and are recommended to skilled nursing facility for permanent placement. 

• Because of the nature of care and volume of medical staff at a skilled nursing facility, the cost can be double that of other communities and permanent stays at skilled nursing facilities are not covered by Medicare and most insurance companies. Options for financing are either private pay or Medicaid programs designed especially for this need.
• As discussed in an earlier section, people who have permanent catheters, staged wounds that need higher-level medical attention, require the assistance of a hoyer lift for transferring, are unable to feed themselves are precluded from assisted living and memory care programs per SC DHEC guidelines. Regulations in other states may vary.
• Skilled nursing care communities have residents of all ages because they offer care for both elderly and disabled individuals.
• Many skilled nursing facility rooms have the look and feel of a hospital and often are shared between two people.

There are two other community types in SC worth noting:

• Residential care facilities are small private facilities that are staffed round the clock. They deliver non-institutionalized home-based services for people who do not need a skilled nursing facility. Many residential care facilities were once single-family private residences. Rooms may be private or shared with most bathroom facilities being shared. In SC, the majority of residential care facilities accept Medicaid but also offer a private pay option.
• Continuing care retirement communities house all four of the above-named communities under one umbrella: independent living, assisted living, memory care and skilled nursing facilities. Their primary benefit is the assurance of a continuum of care throughout the aging process. Most people become residents in independent living facilities and have the option of staying at the same community if they need to transition to areas that offer higher levels of care as they age. Continuing care retirement communities often have a more stringent application and financial background check policy than do other communities. Buy-in fees are also often higher and can range into six figures if real estate is being purchased.

As you can see, the options for senior living have changed and expanded over the years. There are a multitude of choices which can be catered to individual needs and tastes. Navigating this landscape can be time-consuming and overwhelming for family members who are juggling the demands of caregiving and seniors who have limited knowledge and access to technology. CarePatrol of SC is a knowledgeable team of senior living experts who can take the stress out of the process. We are as hands-on as our clients wish and take time to get to know you so that we can offer the best advice on community options in regard to lifestyle, finances, care needs and other issues. We will help with tours and the onboarding process as well.  Our services are always free to seniors and their family members.