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The Journey, Part 3: Options, Options and More Options

Congratulations on coming to the conclusion that your loved one does, indeed, needs a higher level of care than he/she is currently getting. The road to get to this point may have been a rough one (see part 1 and part 2 of this series), and the decision on which direction to walk towards from this point may also be just as challenging. Fear not -- below you will find the various options that are available to you and your loved one.

Each option should be considered carefully, especially since each one comes with their own set of pros and cons. There may not be an option that is 100% perfect, but in reviewing these choices and discussing them with your loved one, you may be able to find an option that comes pretty close. Again, keeping in mind that overall quality of life and peace of mind (both for you and your aging loved one) is the end goal.


In-home care


Let’s face it – most people want to grow old in their own homes. This is called “aging in place” and in order to be able to do so while also receiving some additional assistance for daily tasks or activities of daily living (ADLs), a private caregiver must be hired.

For seniors who are on Medi-Cal, the state of California offers a program called “in-home supportive services” (IHSS) which pays for a certain number of hours for a personal care aide for various tasks every month. The types of services which can be authorized through IHSS are housecleaning, meal preparation, laundry, grocery shopping, personal care services (such as bowel and bladder care, bathing and grooming), accompaniment to medical appointments, and protective supervision for the mentally impaired.

If a senior is not eligible for this type of program, there are a number of caregiver agencies that can provide a trained caregiver to come to the house for a designated amount of hours. The average rate for a caregiver can range from $15-$30 per hour, with potentially higher rates for the evening shift. Having a caregiver come for a few hours a day can be helpful and used to prolong a senior’s ability to stay in their home and maintain their independence. However, as the care needs change, more caregiver hours may need to be added which can certainly add up very quickly. Should your loved one require 24-care at $15 per hour, that’s easily $10,800 per month! Not to mention the costs of maintaining the house, utility bills, food, etc.

Remaining at home is right for your loved one if:

  • They have no desire to be anywhere else but need assistance with ADLs.

  • The neighborhood is safe and family and friends are nearby.

  • They can afford and feel comfortable with home-care aids around the clock or as often as needed.

Independent Living

Independent Living, which is also also known as “retirement homes”, “senior housing” or “senior apartments” are living arrangements that can either be apartment complexes, condominiums or free-standing homes. Some offer a wide range of social amenities and others simply provide a community for people in the same age demographic. This is a non-medical type of living arrangement.

This type of living arrangement works best for those who are:

  • Fully independent, aside from a few minor medical needs.

  • Interested in being able to socialize with other seniors.

  • Would enjoy a wide variety of amenities included in the monthly rent. (Utilities, emergency call-for-aid systems, a-la-carte meals and access to a wellness center and library, etc.)

  • Looking to downsize from the family home but not quite ready for assisted living.

Assisted Living

Assisted living communities allow residents to live in private apartments, private rooms or share with a roommate while having access to assistance with activities of daily living. Most have communal dining, recreational programs, transportation services and a variety of housekeeping, laundry and maintenance services; some facilities are modest while others are lavishly designed. “Assisted Living Communities” can be large places, accommodating over 100 beds and some are smaller residential homes that house six or less seniors (more on this type of congregate living later). Some assisted living communities also offer a memory care unit for those suffering with dementia and Alzheimer’s. This is a non-medical type of living arrangement.

This type of living arrangement is right for your loved one if:

  • He/she is no longer able to live at home safely but does not require a high level of care.

  • Cooking is becoming too difficult to manage.

  • He/she would feel safer with 24-hour emergency response, just in case.

  • He/she is unable to drive anymore. Most assisted living communities offer transportation to doctors' appointments or errands, as well housekeeping and laundry services.

  • He/she is interested in social activities, such as lunch outings, bowling leagues, gardening clubs, and fitness programs.

  • He/she needs more personal care services (assistance with personal hygiene and dressing, medication management, escorts, and help managing incontinence

Residential Care Facility for the Elderly

A residential care facility for the elderly (RCFE) is also known as a board and care. These facilities offer a home-like setting and has a better caregiver-to-resident ratio than the bigger assisted living places. The homes are typically licensed to care for up to six residents at a time and can provide a good balance between high level care and supervision and also socialization. Memory care is also available at an RCFE. This is a non-medical type of living arrangement. Grace Living falls under this category and we pride ourself as being able to offer the highest form of person-centered care in a loving and safe environment.

This type of living arrangement is right for your loved one if:

  • He/she wants the feel of a home-like setting and needs assistance with activities of daily living/ADLs (bathing, toileting, grooming, etc.).

  • Wants access to a personal caregiver for assistance and companionship. The bigger places do not usually have a 1:3 caregiver-to-resident ratio and charge an extra fee if you want/need a caregiver to be solely dedicated to you.

  • He/she wants a more private setting than is available in other settings.

  • Wants the flexibility to have more personalized care and food options.

  • Needs to have his/her medication managed and administered.

  • Does not need or want all the social activities and amenities offered at the bigger places and feels overwhelmed by the thought of being in such a large setting.

Nursing Home

Also known as Convalescent Care or Skilled Nursing, this type of facility accommodates the highest level of care in either a private room or shared room. Scheduled activities are available and meals are served in a central dining area or in the resident’s room.

Unlike the living arrangements previously mentioned above, this type of facility offers 24-hour medical care with access to nurses, doctors and other licensed care providers. Think of it like a long-term hospital-type setting.

This type of living arrangement is right for your loved one, if:

  • He/she is a frail elderly or disabled person who requires 24-hour skilled medical assistance with things like feeding and lifts in and out of bed. (Gastrostomy tube management, ventilator support, etc.)

  • He/she requires short-term rehabilitative care (recovering from surgery or illness). This care may include: Surgical & Medical Recovery, Orthopedics/Joint Replacement, Cardiac & Pulmonary Care, Respiratory Rehab, IV Therapy and Palliative Rehab.

While some of the bigger places may seem more attractive at first, there can also be extra costs involved for things that come standard for the smaller places (i.e. caregiver ratio).

As you can see, there are a lot of options available to you and your loved ones. Take the time to explore each one and make sure to ask what services are included with the monthly rate and what services are additional charges. While some of the bigger places may seem more attractive at first, there can also be extra costs involved for things that come standard for the smaller places (i.e. caregiver ratio). Or the smaller places may charge less than the bigger places, but they also aren’t able to offer as many social events or activities as the bigger places. Regardless, don’t be afraid to ask questions and do some research. Being able to speak with current or past families who have had a loved one in a particular living arrangement is also a great way to learn more about a potential option for your loved one. Click here for some pertinent questions you can ask when touring various senior communities.


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