Type of Care
Accessory Dwelling Units (ADUs): If you or a loved one owns a single-family home, adding an accessory dwelling unit (ADU) to an existing home may help you keep your independence. An ADU, sometimes called an “in-law apartment,” an “accessory apartment,” or a “second unit,” is a second living space within a home or on a lot. It has a separate living and sleeping area, a place to cook, and a bathroom. Space such as an upper floor, basement, attic, or space over a garage may be turned into an ADU. Family members might be interested in living in an ADU in your home, or, you may want to build a separate living space at your family member’s home.
Check with your local zoning office to be sure ADUs are allowed in your area, and if there are special rules. The cost for an ADU can vary widely depending on how big it is and how much it costs for building materials and workers.
Subsidized Senior Housing: There are Federal and state programs that help pay for housing for some older people with low to moderate incomes. Some of these housing programs also offer help with meals and other activities like housekeeping, shopping, and doing the laundry. Residents usually live in their own apartments within an apartment building. Rent payments are usually a percentage of your income (based on a sliding scale).
Board and Care Homes: Board and care homes are group living arrangements designed to meet the needs of people who can’t live independently but don’t need nursing home services. Most board and care homes provide help with some of the activities of daily living such as bathing, dressing, and using the bathroom. Board and care homes are sometimes called “group homes.” Many of these homes aren’t paid for by Medicare or Medicaid. The monthly charge is usually a percentage of your income (based on a sliding scale) that covers the cost of rent, meals and other basic shared services.
Assisted Living Facilities: These facilities provide help with activities of daily living like bathing, dressing, and using the bathroom. They may also help with care most people do themselves like taking medicine or using eye drops and additional services like getting to appointments or preparing meals.
Residents often live in their own room or apartment within a building or group of buildings and have some or all of their meals together. Social and recreational activities are usually provided. Some of these facilities have health services on site.
In most cases, assisted living residents pay a regular monthly rent, and then pay additional fees for the services they get. Assisted living facilities aren’t paid for by Medicare. The term “assisted living” may mean different things in different facilities. Not all assisted living facilities provide the same services. It is important that you contact the facility and make sure they can meet your needs.
Continuing Care Retirement Communities (CCRCs): CCRCs are retirement communities that offer more than one kind of housing and different levels of care. In the same community, there may be individual homes or apartments for residents who still live on their own, an assisted living facility for people who need some help with daily care, and a nursing home for those who require higher levels of care.
Residents move from one level to another based on their individual needs, but usually stay within the CCRC. If you are considering a CCRC, be sure to check the quality information (see pages 17–25) and inspection report (posted in the facility) of its nursing home. Your CCRC contract usually requires you to use the CCRC’s nursing home if you need nursing home care. Some CCRC’s will only admit people into their nursing home if they are living in another section of the retirement community.
Many CCRCs generally require a large payment before you move in (called an entry fee) and charge monthly fees. Find out if a CCRC is accredited and get advice on selecting this type of community from the Commission on Accreditation of Rehabilitation Facilities and the Continuing Care Accreditation Commission (CARF-CCAC) by calling 1-202-587-5001. You can also visit www.carf.org.
Hospice Care: Hospice is a special way of caring for people who are terminally ill (with 6 months or less to live) and for their families. Hospice care includes physical care and counseling. The goal of hospice is to provide comfort for terminal patients and their families, not to cure the illness.
If you qualify for hospice care, you can get medical and support services, including nursing care, medical social services, doctor services, counseling, homemaker services, and other types of services. As part of hospice care, you will have a team of doctors, nurses, home health aides, social workers, counselors, and trained volunteers to help you and your family cope with your illness. In many cases, you and your family can stay together in your home.
Medicare covers hospice care if you qualify. Depending on your condition, you may get hospice care at home, in a hospice facility, hospital, or nursing home. Room and board aren’t covered by Medicare if you get general hospice services while you are a resident of a nursing home or a hospice’s residential facility. Medicare doesn’t pay for 24-hour assistance if you get hospice services at home.
Respite Care: Some nursing homes and hospice care facilities provide respite care. Respite care is a very short inpatient stay given to a hospice patient so that the usual caregiver can rest. Medicare covers respite care for up to 5 days if you are getting covered hospice care. Room and board are covered for inpatient respite care and during short-term hospital stays.
Programs of All-inclusive Care for the Elderly (PACE): PACE is a Medicare and Medicaid program that manages all of the medical, social, and long-term care services for frail people to remain in their homes and maintain their quality of life. PACE is available only in states that have chosen to offer it under Medicaid. The goal of PACE is to help people stay independent and living in their community as long as possible, while getting the high quality care they need. To be eligible for PACE, you must be age 55 or older, live in the service area of a PACE program, be certified as eligible for nursing home care by the appropriate state agency, and be able to live safely in the community.
