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By Gail Glockhoff-Long
GolderCare Solutions
Benefits Advocate

You Can’t Have it All – What are Your Priorities?

Appropriate housing as we age can be complicated.  We must consider location, level of care, cost and payment methods accepted.  This is true whether you are 75 and still doing your own cooking and cleaning or if you are 63 with advanced Alzheimer’s or 90 and confined to a wheel chair.

Location, care, cost – pick 2 out of 3.  You can’t have it all.

Let’s look at location.  This includes the physical location of the building but also what the building looks like.  A shiny new facility is impressive with landscaping, wider hallways, bright natural light, and big common areas for meals and activities. We call it the chandelier effect.  When you are touring, keep in mind that like a house, a new building with all the new amenities will cost more than an older building.  We have found some of the best care in a couple of the older facilities in the area.

To talk about care, you need to understand the alphabet.

• HUD – Housing and Urban Development is Government subsidized housing for seniors and disabled based on income – there are usually age and income restrictions – No care or amenities provided – may include one Meals on Wheels meal daily.
• CONDO – You are responsible for everything inside your unit with No care or amenities provided – outside yard/snow/upkeep is usually provided included in monthly fees.  This is private pay.
• CCRC – Continuing Care Retirement Community provides multiple levels of care.  They are designed to move in when you are independent and move through their different levels of care until you pass away.  They generally have the best food because they want to entice healthy seniors to move in.  Housekeeping, cable, maintenance, and a meal plan are usually included.  Cost is based on the care level you are in.
• IL – Independent Living – Congregate living where you are responsible for everything inside your unit with No care or amenities provided – May include some meals per month depending on the complex.  There may be planned activities available.  This is private pay.
• AL – Assisted Living – Congregate living that includes 3 meals per day, housekeeping, oversight of medications, and assistance with activities of daily living.  Residents must need the care or oversight assistance.  There are usually planned activities.  This is generally private pay but could take advantage of Long-Term Care Insurance (LTCI) or Veteran’s Aid & Attendance (VA A&A) to help pay.   
• SLF – Supportive Living Facility – This is a special type of AL with an age minimum and qualifies for use of Medicaid.  Apartments tend to be smaller than normal AL’s and with fewer amenities.
• Memory Care Units – Memory care is generally a locked wing of a facility.  Dementia residents can be found in almost any level of care.  A specific memory care placement is generally for the safety of a locked unit where the resident is protected from wondering off.  Some memory care units have special activities designed to keep brains active.  The staff is generally more highly trained to deal with dementia behaviors.  Memory care is generally private pay – and more expensive than a regular AL.  This type of housing would be eligible to use LTCI and VA A&A.  Medicaid is generally not available.
• NH – Nursing Home level provides the highest level of care and correspondingly the highest cost.  The unit may or may not have doors requiring a code to exit.  Assistance is provided for activities of daily living.  Planned activities may be provided for residents that are able to participate.  Housing is in rooms instead of apartments.  Most facilities have 2 residents per room.  Most accept Medicaid as well as LTCI and private pay for payment methods.

Every facility within each level of care has a different personality and appeal.  You can find an AL that is huge with lots of activity and choices or you can find a smaller AL that is quiet and cozy.

What is important to you?  Think through your priorities and rate them.  Is it most important to have your husband at a facility down the street so you can easily visit?  Or does it need to look like a resort?  Or do you want a place that specializes in working with Alzheimer’s patients?  Or is a facility that has a Medicaid bed the top priority?  Is an affordable private pay cost the priority?  Or are there behavioral issues that need a special placement?

You can’t have it all.  The chandelier locked unit memory care AL paid by Medicaid does not exist in the QC area.  So, which part of that is most important to you and what can you let go?  Cost?  Care?  Location?  Ambience?  As in all things in life, it is a balancing act.  You need a professional advocate or coach for a decision this big and this complicated.  We help people with this balancing act all the time.

GolderCare Solutions is an independent advocacy group for seniors, the disabled and those that care for them. GolderCare has offices in Moline and Bettendorf. You can reach GolderCare at (309) 764-2273 or learn more at www.goldercare.com.