Senior Housing Options and Their Social and Financial Implications
The continuum of senior housing
Match the setting to the person's activities of daily living (ADLs) - bathing, dressing, eating, toileting, transferring and continence.
- Aging in place: home modifications and in-home care; often best emotionally, not always cheapest.
- Active adult / 55+ communities: age-restricted under HOPA - at least 80% of units occupied by someone 55+, published policies, and intent to serve older persons. Typically no care services.
- Independent living: age-targeted rental with meals, transportation and social programs; no medical care.
- Assisted living: 24-hour staff, help with ADLs and medications; not a medical facility.
- Memory care: secured units for dementia.
- Skilled nursing facility: 24-hour nursing and rehabilitation.
- CCRC / life plan community: entry fee plus monthly fee; contract types A (life care), B (modified) and C (fee-for-service); refundability varies - read the contract.
Payment traps: Medicare covers short-term skilled nursing after a qualifying hospital stay, not custodial care in assisted living. Medicaid is the long-term-care payer for those who qualify. Long-term care insurance and VA Aid & Attendance may help.
Other traps: conflating assisted living with skilled nursing; assuming a 55+ community may refuse a service animal (reasonable accommodation applies); assuming a CCRC entry fee is fully refundable.
Rule of thumb: one unmet ADL need with no 24-hour help at home means tour assisted living, not just independent living.