Chapter 6: Housing Alternatives – Independent Living Options for Aging in Place

Chapter 6 provides a detailed discussion of independent living options you can enjoy in retirement.

6-1 Introduction.

Diagram 6-1 provides a visual representation of the continuum of housing and care options available to you. As you move from the top left to the bottom right of the diagram, you move from independent aging in place with no need for care, through various combinations of living arrangements and the use of care providers. In the bottom right-hand corner is the skilled nursing option where you have assistance with all your instrumental and basic ADLs, as needed. Refer to this chart as we progress through chapters 6 and 7, which discuss every option shown.

    

Independent living is ideal for individuals who can still perform most activities of daily living on their own, but to the extent they need assistance are able to access it from family members, friends, or third party home care and home healthcare providers. Independent living may involve living alone, sharing a residence, or residing in a community where the residents maintain their own homes but interact and provide companionship and support to each other. The type of home or independent living community is a choice driven by how and where you want to live; it is a “wants-driven” choice.
                        
In contrast, semi-independent living, assisted living, and skilled nursing facilities are for individuals who have difficulty with instrumental and/or basic activities of daily living (ADLs) at home, and are unable to access needed support from family members, friends, or third party home care and home healthcare providers. The type of facility in which you live is driven by the extent to which you require assistance, and the nature of that assistance; it is a “needs-driven” choice.
    

Housing Continuum 1000 8

Residents at semi-independent living and assisted living communities are free to live a partially independent lifestyle, but also receive regular support for daily living activities ranging from cleaning, to meal preparation, to prescription management. Housekeeping and maintenance services are often included in the monthly rental of an apartment, along with laundry services, utilities, transportation and meals. As needs grow more intensive, skilled nursing facilities are the next step, providing 24/7 medical care in addition to assistance with all other ADLS. Continuing Care Retirement Communities (CCRCs) are a hybrid, offering accommodations for at least three levels of care: independent living, assisted living, and skilled nursing.


6-2 Temporary Living Before You Settle In.
In reaching your choice of an independent or an assisted living option, you may want to try out various options first. The home in which you choose to age independently in the future does not have to be the one in which you currently reside.

6-2-1 Rent Out Your Current Home and Sample Other Locations.
Choosing where to live involves fact-finding and checking out locations.

The solution could be to rent out your current home and enter into a series of non-ownership residency situations over a predefined timeframe.

6-2-2 Try Different Types of Structures.
You may also want to try various types of structures and living accommodations.

6-3 Aging In Place.
Aging in place means living in a residence of your choice for as long as you are able to do so as you grow older. This may entail hiring home care or home healthcare providers or other support workers to come to your home to assist you as your needs change.

6-3-1 Home Healthcare Providers and Home Care Providers.
At some point as you age in place, you may need home care, home healthcare, or both services.

Home healthcare is provided by registered nurses, occupational therapists, physical therapists, or other skilled medical professionals. They provide skilled medical care and support services for those who are recovering from a hospital stay, are disabled, chronically or terminally ill, or who need medical, nursing, social, or therapeutic treatment and/or assistance with the essential activities of daily living. Home healthcare is usually less expensive, more convenient, and can be just as effective as care you receive in a hospital or skilled nursing facility. Read More…

Home care, on the other hand, is provided by caregivers not trained or licensed as medical professionals. They are usually called home care aides who are trained in the nuances of senior care . Home care is classified as personal care or companion care and is considered “unskilled” or “non-clinical.” Home care aides provide “supportive” services, helping you to sustain and maintain your quality of life in your home as you start to lose functionality and mobility – keeping you safe and comfortable, while offering friendly companionship. Read More…

Home Healthcare Services

  1. Skilled Nursing:
    1. Skilled nursing services
    2. Administration of medication
    3. IV therapy, injections
    4. Performing medical tests and monitoring health status
    5. Providing medication reminders
    6. Pain management
    7. Caring for wounds
  2. Therapy:
    1. Physical therapy
    2. Occupational therapy
    3. Speech therapy

Doctor Holding Hand of Elderly Woman Patient

Home Care Services
  1. Meal preparation or delivery
  2. House cleaning
  3. Assisting with personal grooming such as bathing, washing hair, or getting dressed
  4. Helping you to move around and/or get in and out of your bed/shower
  5. Providing medication reminders
  6. Helping you or your spouse / partner to cope with Alzheimer’s or dementia by grounding and orienting you or them
  7. Running errands like grocery shopping, sending packages, and picking up prescriptions
  8. Providing transportation
  9. Helping with bill paying
  10. Incontinence care
  11. Toileting help
  12. Companionship


Home Care


6-3-2 Selecting In-Home Care Providers.
Your first step is to determine whether the level of care you need is home healthcare, or homecare, or both. Once you know this, you will need to contact companies and devise a care plan. Only after doing so will you be able to come to a reasonable determination of what costs will be.

6-4 Multi-generational Living.

6-4-1 Multiple Generation Housing.
Multigenerational households include people from two or more adult generations — say, Baby Boomers, their parents, and their adult children. The share of households with multiple adult generations has been growing since a 1980 low of 12 percent.

6-4-2 Accessory Dwelling Units.

An accessory dwelling unit (ADU) is a variation on multigenerational housing whereby you have a second small dwelling on the same grounds as or attached to your regular single-family house, such as:

• An apartment over the garage
• A basement apartment
• A tiny house (on a foundation) in the backyard

6-5 Manufactured Home (MH) Communities.
Depending on where you want to locate, a manufactured home community might be a good choice for you. Many different options and communities exist to suit your interests and budget.

6-5-1 Manufactured Homes.
The definition of the term manufactured home (“MH”) is governed by law. The HUD code governing MH construction went into effect June 15, 1976. Manufactured homes are built as dwelling units of at least 320 square feet in size with a permanent chassis to assure the initial and continued transportability of the home. Manufactured homes may be single-section (entire home contained within one compartment) or multi-section (two or more sections are pieced together at the home site to comprise the whole). They are often referred to as single-wide, double-wide, or triple-wide, depending on the number of sections they have.

6-5-2 Restrictions on Placement of Manufactured Homes.
Placement of new MH units is generally subject to zoning restrictions. These restrictions include limitations on the number and density of homes permitted on any given site, minimum size requirements, limitations on exterior colors and finishes, and foundation mandates. Many jurisdictions do not allow the placement of any additional manufactured homes, while others have strongly limited or forbidden single-wide models, which tend to depreciate in value more rapidly than modern double-wide models.

6-5-3 Avoiding Potential Pitfalls.
Older MH units are generally not energy efficient. MH is considered to be affordable housing, but older models can be expensive to heat and cool due to energy inefficiency. Newer high-performance MH units use less energy, increasing affordability by decreasing operating costs.

6-5-4 How to Search for a MH Community.
Putting aside the likelihood that you have a resident-owned community in your area, here are some MH community house-hunting tips.

6-6 Cohousing Communities.
Cohousing is a form of independent living that involves an intentional community. Residents live in private homes clustered around shared space. They earn independent incomes and lead private lives, but are actively involved in community design and operation and share common facilities. Their intent is to be more connected with neighbors.

6-7 Naturally Occurring Retirement Communities (NORCs).
A Nationally Occurring Retirement Community (NORC) is a type of community that was not originally built for seniors, but now is home to a significant proportion (40 percent or more) of older residents.

6-8 Villages – Neighborhood Networks of Like-Minded People Sharing Specialized Services.
A Village is a group of seniors living independently in a neighborhood who have banded together by creating a formal “Village” organization whose goal is to coordinate access to affordable services from vetted, discounted providers that allow the seniors to more readily age in place. To gain access to Village services, you have to join and become a dues-paying member. The Village organization is run by volunteers and paid staff and operates in a very consumer-driven mode.

6-9 Active Adult Communities.
Active Adult Communities (AACs) are housing developments geared predominantly towards older adults who are still capable of leading active lifestyles, and who want to do so. Each AAC strongly promotes the type of lifestyle that its residents can enjoy, and the wide range of amenities the AAC has available to facilitate that lifestyle. Prospective residents should consider these primary factors when choosing one AAC over another.

6-9-1 Pros and Cons of Active Adult Communities.
People have differing views on AACs. Some are very attracted to the idea, and some are not. You should consider the pros and cons of these communities in general, and specifically with regard to any community you consider.

6-9-2 Questionnaire to Complete for Each Active Adult Community That You are Considering.
Downloadable Template 6-2 is a questionnaire that you should complete for each active adult community you are considering. Do not wait until after you buy to learn the answers to these questions. At that point, you will no longer have the luxury of time to recover from a bad choice, so do the research before you sign on the dotted line.

6-10 Bibliography for Chapter 6.

Appendix 6-1: Selecting a Home Care Provider and a Home Healthcare Provider.
Your goal in selecting a home care and home healthcare provider is to find the best provider of the specific care services you need at the most competitive price. You will need to interview and provide information to several prospective providers. Each will prepare a care plan for your consideration.