Housing

The good news? There are many options for senior housing today, including living alone, with family, in a retirement community or senior apartment complex, among others. The bad news? Each senior community, facility, service provision and care option carries with it tremendous variation in terms of costs and services, making it quite difficult to make decisions that provide a good fit for your lifestyle needs and care considerations.
Early Planning for Senior Housing is Essential

It’s never too early to start thinking about where you or your loved ones should retire or move, given health, mobility and lifestyle considerations and concerns. If experts agree that retirement planning should begin in your twenties as you launch your career, thinking about senior housing and housing options should be something to put on your “to do list” in your fifties and, certainly, no later than your sixties.

Why don’t folks like to begin early? It’s simple: few of us feel like thinking about senior housing and care needs when we’re still raising our children or at a time when careers are in full swing. But, you should at least become familiar with the senior housing market way in advance of when you will actually make these decisions for yourself or your loved ones.

Waiting too long can also present barriers to making appropriate housing decisions. The elderly often fear losing their independence. As a result, they believe that seeking help and resources from their local communities, agencies and institutions may result in their institutionalization. These resources may include appropriate housing and service provision.

ABCs of Senior Housing and Residential Care

In 2008, the American Senior Housing Association’s national survey of senior homeowners (over the age of 75) found that 75% of the nation’s seniors owned their homes free and clear of a mortgage and had, on average, 24 years of equity in their homes. This means that a substantial number of seniors in the US have opted to “age in place” instead of seek other housing. For others, this may not be an appropriate choice and more difficult decisions must be made, given a senior’s health and mobility considerations.

Today, there’s a wide range of options for senior housing. These options include:

Staying at home (“Aging in Place”)
Living with loved ones, caregivers, others
Independent living facilities
Assisted living facilities
Nursing and rehabilitation centers
Skilled nursing care facilities
Over 55 communities
Retirement communities
Senior apartments
Personal care homes
Continuing Care Retirement Communities (CCRCs)
Congregate Housing*

*See US Housing amp; Urban Development (HUD)

Each of these senior housing options carries a different meaning and definitition. Costs also vary for each option, depending upon the location of the housing, size of the residence, services provided onsite, amenities such as health clubs, social activities, and educational programs, additional services, such as laundry, cleaning, shopping and transportation, meals, and medical care.

Government Programs for Senior Housing, including Medicaid

Many seniors opt to stay in the home and, consequently, may need additional help as they age or become sick or infirmed. Some of these services include government programs that may provide for or address the costs of:

Housing
Transportation
Utilities
Meals
Home Maintenance
Medical Care
Custodial Care

Check with your local Office on Aging, state or county government for more information on senior programs in your area. Also, you or your loved one may be eligible for Medicaid benefits.

Medicaid and Senior Housing and Residential Care Facilities

Seniors who are experiencing issues of mobility, illness or injury often require additional care and services, but the funding sources for these are somewhat confusing. Private health insurance usually provides offsets for medical care, durable medical devices and, sometimes, prescription drugs. Private health insurance usually does not cover what they call “custodial care” like assistance with bathing, getting dressed, groceries, or transfers from bed to chairs and other rooms. Long term care insurance and Medicaid may offset these custodial care services, but many not provide for medical assistance. There may also be limitations and restrictions on the coverage Medicaid provides.

When it comes to housing, you will need to think about pooling assets and money from several sources. Possible sources of income or revenue to offset senior housing costs include

Personal wealth, assets and money (e.g. savings accounts, stocks and bonds, and other investments)
Family wealth, assets and money (e.g. savings accounts, stocks and bonds, and other investments)
Defined benefit or contribution pension plans
Social security retirement benefits
401(k) and other retirement savings vehicles
Supplemental Security Income (SSI), for seniors and disabled persons, used for rent and mortgage payments
Reverse mortgages, for seniors wanting to stay in their homes or pay for nursing care
Long term care insurance, for seniors to pay for nursing home care, care at home or elsewhere
Medicaid, for persons of limited assets and income, providing health insurance for the cost of hospitalization, rehabilitation, medicine, some custodial care, and long term care in a nursing facility

Medicaid’s Limited Role in Senior Housing

Medicaid is a federal medical insurance program that’s administered by the states that offers medical coverage and some assisted living services for low income, low asset seniors. To qualify for Medicaid services, individuals and couples have to “spend down” their savings and other assets. Eligibility for Medicaid varies by state. It’s possible to retain ownership of your home and car and, at the same time, qualify for Medicaid. It may be possible to qualify for Medicaid if you’re over the income limit by paying “share of cost,” which is a monthly deductible. For example, if the income limit is $750 per month and your income is $850, you may be able to spend $100 on medical costs and Medicaid may underwrite your medical coverage for the rest of the month.

Medicaid also provides some custodial care, but it’s limited. This can include:

Custodial care in your home
Custodial care in an assisted living facility
Long-term care in a nursing home

Red Flags and Restrictions with Medicaid and Senior Housing

Of course, you need to be aware of some red flags when it comes to Medicaid and senior housing. If a senior requires round the clock custodial care, they will probably be directed to a nursing facility. But, some nursing homes have few or no beds designated for Medicaid patients, so there may be a wait or limited choices in your area. Some doctors and medical clinics do not accept Medicaid for payment for services. Finally, and most important, while Medicaid will pay for long-term care after a senior has exhausted his/her assets, there are huge penalties if the individual is found to have hidden their assets or quickly transferred them to their sons, daughters and other family members. Consult your legal advisor or local Office on Aging on these and other issues of senior housing today.