16 What About Assisted Living?
Reginald definitely had mixed feelings about his next move into an assisted living facility, one that included a nursing home. Reginald had managed his retirement years well. He’d enjoyed more than a decade of independent living in his long-term residence, without any substantial services or support. But then, Reginald had a fall, fracturing his hip and requiring a hip replacement. He hoped and expected to return home. Yet as his rehabilitation facility stay ended, Reginald and his care team recognized that his returning home wasn’t possible. His home just wasn’t suited for Reginald’s limited strength and mobility. So, Reginald was headed for assisted living, grateful for the care but already missing his old home.
Assistance
As a prior chapter suggested, retirement years in a sense end with assisted living. When a retiree moves from the retiree’s own home, where the retiree lived independently and actively, into assisted living, the retiree’s focus subtly or starkly turns from enjoying retirement activities toward managing a final decline. Individuals in assisted living can lead long, rich, and enjoyable lives. They can receive the visits of family members and friends, and may occasionally get out for visits and other activities. But the focus of assisted living isn’t outside activities. The focus is instead facility care. The whole premise for assisted living is to bring into the facility the goods and services that an individual might previously have gone out to find. The subsidiary premise is that assisted living can simultaneously supply an enjoyable experience of quiet activity and society within a closed community. Thus, assisted living isn’t a vision for retirement. It is instead a vision for a safe, secure, and comforting passage into the great beyond, one that might in the best case extend a relatively ordinary life by a few more blessed years. Recognizing the difference between retirement years and assisted living can go a long way toward relieving the questions and challenges over the transition. This chapter addresses that transition.
Reasons
As a prior chapter addressed, disability is the primary and obvious reason to move from your own retirement home into assisted living or a nursing home. Disabilities can be mental, physical, or medical. Your mental incompetence may, for instance, require locked doors against wandering and round-the-clock monitoring. Your restriction to a wheelchair or bed, for another example, may require 24/7 nursing care. Or your medical condition, such as with frequent seizures, dizziness, and severe shortness of breath, may require continuous monitoring and frequent prompt intervention. But disability isn’t the only reason for assisted living or nursing-home care. Some retirees move into assisted living to relieve severe isolation or for better meals and nutrition, better access to medical care, and safety, security, convenience, activities, and social and mental stimulation. Investigate local assisted living facilities. You may find that they do not require a certain level of disability and associated needs. You may also find that assisted living is, for you, more conducive to an enjoyable retirement lifestyle.
Benefits
The prior paragraph already suggests some of the several benefits of assisted living facilities, whether or not they also include a nursing home. Those benefits can include a safer and more-secure physical layout and residential design. Limited facility access may lower risks of theft, assault, and other crime. A one-level, no-steps and no-curbs design may reduce fall risks. Wider doorways may facilitate wheelchair access. Alert, monitoring, and surveillance systems may ensure prompt attention in case of a medical event or fall. And the list goes on. Assisted living can also provide meals, social activities, and medical care on site, in a community center. Assisted living units may be closer together, even practically shared, facilitating greater social interaction. Transportation to off-site medical facilities and entertainment events may also be available. A resident’s maintenance and repair responsibilities would also be zero. For some retirees, assisted living can be the cherry atop the retirement sundae.
Forms
Assisted living can be a broad category for two basic forms. The first form would be like that described in the prior paragraph, a sort of glorified condominium arrangement, with each resident having the resident’s own full living quarters, kitchen included, but with substantial communal facilities, often including dining. An assisted living facility may even be indistinguishable on the outside from condominium grounds. Indeed, residents may in some facilities purchase assisted-living rights in condominium form, in what developers call a buy-in or life-care community. Leasing, rather than buying, assisted-living units is the more-common arrangement. An outright nursing home would be the other basic form of assisted living, although some would apply the assisted living nomenclature only to the first form and would treat nursing homes as their own next residential form. The general progression, though, is from one’s own retirement home into assisted living and from there into a nursing home, although many retirees would skip the middle or last stage, or avoid any form of assisted living, depending on their own peculiar progression. Just recognize that assisted living can take two forms, one transitional, the other final or complete.
Resources
If your time for investigating local assisted living facilities is now (and when you are retired anytime can be a good time to do so), then you should find plenty of resources to help you do so. Your medical care providers, financial advisor, lawyer, social worker, or other members of your retirement team can be a great source for insight and recommendations on assisted living and preferred facilities. Online, you’ll not only find assisted-living locators but also abundant information, comparisons, and reviews. Word of mouth among friends and acquaintances can be another good source for identifying and distinguishing candidate facilities, while learning their advantages and disadvantages. Of course, visit candidate facilities, preparing in advance a list of concerns, interests, and questions. Take a trusted family member or close friend with you on visits, to help you listen, process, inquire, and evaluate. If your investigation leaves you unsure, consider retaining a social worker or geriatrics specialist to advise you. Indeed, hesitate to make any commitment to assisted living without a qualified expert’s evaluation of your needs. Assisted living is a big commitment. Make the right commitment at the right time.
Factors
You likely have one or more factors driving your need for or interest in assisted living. As far as you are able, identify those factors, and then seek a facility that best satisfies them. Assisted living facilities can vary relatively widely in their features. Consider which of the following factors is most important to you: (1) your physical comfort and safety in the facility’s layout, design, and furnishing; (2) your access to your unit and the facility’s other amenities with your current or anticipated disabilities; (3) the facility’s security from threat of assault, theft, or other crime or disturbance; (4) meals and nutrition that the facility is able to provide on site; (5) social engagement and community activities that the facility offers residents; (6) medical evaluation and care on site; (7) transportation from the facility to off-site medical facilities and other off-site services and events; (8) the facility’s professional management, staff, staff culture, and staff stability and morale; (9) the facility’s licensure as a qualified assisted-living provider; (10) the facility’s cost within your financial resources including your ability to qualify for public-program financial support; and (11) the availability of a unit for your occupancy on your needed or desired schedule.
Location
The location of your assisted living facility can be another significant factor in the quality of your experience there. Facility location in an urban, suburban, or rural setting, and in various regions with different populations, cultures, and economics, can affect the quality of the facility, its operation, its efficiency, and its staff including staff morale, commitment, and loyalty. If one factor may affect your assisted living experience more than anything else, that factor may be the staffing, specifically its skill, commitment, and morale. If you can, choose a facility in a locale with a stable, friendly, and morally and culturally sound population, one with which you share affinities. Also, if you can, choose a location nearer family members and friends who are most likely to visit you. That choice may mean moving to the distant location where your closest adult child or another family member who most cares for you resides. Find the best location for your assisted living, not just as to the specific facility but also as to the general locale.
Costs
The cost of assisted living can be substantial and may be a significant factor in your ability and choice to pursue it as a preferred housing option. Your personal funds may be the primary source on which you must draw to finance assisted living. You may draw from your retirement savings, or you may sell your retirement home and apply the proceeds toward assisted living costs. You may alternatively have purchased long-term care insurance, a feature of which is to pay all or a part of the cost of assisted living. You may alternatively have veterans benefits or qualify for Medicaid support, the latter generally dependent on financial need and requiring your expenditure of other assets first. You should be able to find free benefits calculators online to help you determine public or other funding that may be available to you to pay for assisted living. Also rely on your professional retirement team to help you confirm the costs and sources for paying for those costs. The director or staff members of the facility that you wish to join may also be able to provide substantial assistance investigating and qualifying for support programs.
Transition
The timing, terms, and conditions of your transition into assisted living can go a long way toward making that transition a failure or success. Move into assisted living too early, and you may miss months or years that you could have continued to enjoy your retirement home. Move into assisted living too late, and you may struggle unduly and unnecessarily in your retirement home. Your challenge in that timing isn’t necessarily knowing when to move. It may instead be in ensuring that an assisted living unit is available when you want or need to move, and then in coordinating the full and complex transition. You may need to list, sell, and vacate your retirement home, in the process liquidating substantial personal property. You may also need to liquidate financial investments, obtain your home sale’s proceeds, and qualify for public support, all to finance your assisted living move. You may also need substantial assistance with sorting, packing, transporting, and unpacking the personal property that you wish to accompany you into assisted living. Expect to recruit substantial assistance from family members, friends, professionals, and commercial or professional services in that transition. And expect some bumps, twists, and turns along the way.
Issues
While assisted living can be a great solution to growing and pressing problems living independently, assisted living generally, and nursing homes in particular, can have their own issues. Don’t expect a bed of roses in assisted living. Life doesn’t work that way. In an assisted living setting, issues can arise with missing, inconsistent, or incompetent services, or with unit or facility maintenance and repair issues. You may also face hidden costs or cost escalation. In nursing home settings, you may risk or witness disturbing abuse or neglect. The poor condition of other residents may upset and burden you. You may find the physical setting to be unfamiliar or alienating, entirely unlike the warmth of your former retirement home. You may even feel greater isolation and loneliness in a nursing facility than you did at home, depending on the mood, morale, and turnover of the staff and of the residents. These and other risks, factors, and conditions are why retirees generally try to hang on in their own homes as long as reasonably possible before accepting assisted living.
Reflection
How close do you think you may be to needing or wanting assisted living? How many years longer do you hope to remain in your own home? Have you identified a local assisted living facility in which you would like to reside? What medical conditions or disabilities may be pushing you toward assisted living? Can you address those conditions to slow their progress and preserve your independent living? Are you considering a nursing home or instead an assisted living facility offering a residential experience? If the latter, will you soon need to transition into a nursing facility? And if so, does the assisted living facility that you are considering have its own nursing facility, to ease your next transition? What are your greatest needs and interests for assisted living? Does the facility that you’re considering meet those needs and interests? Do you know the full costs of the facility that you are considering? How are you planning to meet those costs? Will you need to sell your home? Do you have the equity in your home, after sale expenses, to finance assisted living? Will you need to qualify for public programs to do so?
Key Points
A retiree’s need to move into assisted living marks retirement’s end.
Mental, physical, and medical disability are reasons for assisted living.
Assisted living offers safe and secure supportive services and setting.
Assisted living may be residential style or a full-on nursing facility.
Seek referrals, online resources, and word of mouth to find facilities.
Weigh your greatest needs and interests in seeking assisted living.
Consider an assisted living location where family and friends visit.
Use savings, home equity, and public programs to fund assisted living.
Get family and professional help transitioning into assisted living.
Assisted living residents can face their own issues with services.
Read Chapter 17.