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Alternatives to Assisted Living

An assisted living facility is a senior housing option for those who require assistance in their daily lives but do not need 24-hour-a-day skilled nursing care. However, not everyone will need an Assisted Living, no matter how long they live, but may end up there by default, not knowing there are alternatives.

To put the following information into perspective, the basic cost of Assisted Living in the US ranges between $31,200 and $45,600 annually, and this is before any additional service fees (for bathing, dressing, medication management, etc.) are factored in.

The fact is, there are less expensive alternatives that will provide the degree of assistance and support needed while also conserving both the senior’s independence and finances while simultaneously benefiting the people caring for them.

Depending on various factors, including the senior’s physical, mental and emotional health, the strength of their support network, and their own personal preference as to their living circumstances, there are five options that can be tailored to the need of the loved one and their caregivers. This article will explore the key elements of each of these alternatives.

5 Alternatives to Assisted Living

These are the five alternatives, which are listed in the order of least to most expensive. They are:

  • Medical Alert Systems
  • In-home Care
  • Adult Day Care
  • Adult Care Homes
  • Respite Care

Medical Alert Systems

A medical alert system (aka Personal Emergency Response System, Medical Emergency Response System, or fall monitor) is the least expensive route for those who would like assurance that help is a button push away if needed. The benefits of a medical alert device are:

  • Allows the senior to continue to live in their own home with assistance just a button press away. The right system will also protect a senior who is away from home, wherever they may be with a GPS connection.
  • Relieves the minds of family and friends, who, along with doctors and any other caregivers, can be kept in the loop as to the senior’s status.
  • A medical alert system can cost as little as $200 a year, depending on how elaborate a system one needs.
  • A medical alert can work regardless of a landline in the home, many companies offer a cellular in-home alert option.
  • There are many medical alert devices available and should be chosen based on the wearer’s needs and preference. Devices include buttons that can be worn around the neck, the wrist, handheld cellular units, and even voice-activated wall buttons. Since many otherwise healthy seniors are prone to loss of balance, many alert companies offer a fall-detection medical alert, for an extra charge, that will automatically detect and report a fall, without the user’s having to press a button.
  • Systems range from the most basic (connecting a user to trained monitoring personnel) to registering vital statistics like heart rate and blood pressure. Some mobile units include a GPS function, can track activity, and serve as a communication device with caregivers.

In-Home Care

In-home care is for seniors who are still able to age-in-place but may need some assistance with day-to-day activities or simply require someone to check in on them.
Such “custodial care” (versus medical care) does not require a trained professional.

  • Depending on the senior’s needs, the caregiver could be a family member or even a “virtual” caregiver who visits with the senior via the internet or telehealth technology.
  • The costs of modifying a senior’s home to aid in caring for them may be tax deductible. Additionally, most, if not all, states offer loans and grants to finance such modifications.

*Note that In-home Care is not the same as Home Health Care

Adult Day Care (aka Day Program)

No matter how close the caregiver and senior are, tensions can arise over time. An Adult Day Care (ADC) facility is a relatively inexpensive way to not only give the senior a change of scenery and a chance to socialize but also grant the caregiver the opportunity to relax or to get other, non-caregiver tasks done.

  • Adult day care facilities provide day-only, supervised care for those who have physical or mental issues (including Alzheimer’s) and should not be left on their own. They supply social interaction, suitable activities, meals, and general supervision.
  • Adult day care facilities required to have a license and can be inspected without notice.
  • Adult day care can provide a needed break for both the senior and their daily caregiver(s), allowing the senior a fuller social life, and the caregiver a chance to relax or to accomplish tasks not related to caregiving.
  • Note that this facility type differs from Adult Day Health Care (ADHC) in that the latter is meant for those with more pressing health issues, requiring the presence of staff trained in the appropriate health issues of their clientele.
  • According to Paying forSeniorCare.com, the average daily rate across the US is $70, though that rate can vary dramatically from state to state and depending on the group sponsoring the facility.
  • Medicare, Medicaid, Veterans benefits, among other financial sources, may help defray adult day care costs. Failing that, such expenses are nearly always tax deductible.
  • A percentage of the cost may be tax deductible, either for the senior or for the caregiver. Contact a tax expert for more information.

Adult Care Homes (aka Adult Foster Care or Adult Family Homes)

Adult Care Homes are small (5-10 residents) residential-style homes where care is provided to a small group of people.

  • Adult care homes could be an excellent alternative to the larger, more expensive senior housing options such as assisted living communities or nursing homes.
  • Adult care home residents may have mental, physical, or emotional disabilities. Typically, residents do need assistance with some daily tasks, such as transfers, toileting, dressing/ grooming, medication management, or meal preparation.
  • Unlike Day Programs, the senior in an adult care home is a full-time resident in a home-like setting. And, unlike typical nursing homes, there are usually no more than five-10 residents in the home, allowing one-on-one attention from staff and a pleasantly low-key, homelike atmosphere.
  • The level of care provided varies. Some Adult Care Homes are staffed to deal with more advanced health issues than others.
  • Most fundamentally, the owner of the adult care home is required to provide room and board, daily meals and snacks, and laundry services. The cost for these services is typically referred to as a “base rate”.
  • Among the numerous potential financial sources to cover all or part of the costs of adult care home services are Medicare, Medicaid, private pay, and some state-based programs. Veterans may also be eligible for special funding. Long-term or life insurance policies are another possible source.
  • The additional services offered (beyond the basic services like room and board), similar to an Assisted Living or a Nursing Home, are an additional fee and may cover anything from assisting with dressing or bathing to highly sophisticated medical or psychological support.
  • Regardless of the level of care provided, adult care homes must be licensed and are highly regulated by individual state governing agencies while subject to random, yearly inspections.
  • Though the owner of an adult care home may not live on-site, they are legally required to obtain sufficiently experienced staff to maintain full-time quality care.
  • Continuing education, to keep owner and staff abreast of current trends and laws, is also required.
  • If any issues arise with the facility and resolution seems impossible, the Long Term Care Ombudsmen Program, a nationwide program, is an excellent resource.

Respite Care

Respite care serves to give the everyday caregiver(s) a temporary break from the stress of caring for their family member. Doing so should not only contribute to improving the quality of life for all involved but reduce the likelihood of caregiving mistakes because of fatigue and stress. Respite Care, depending on the method chosen, could last anywhere from a few hours to several weeks.

  • Respite care takes several forms such as bringing a new caregiver into the loved one’s home to share caregiving responsibilities; enrolling the senior in a social day group or adult day care, or relying on emergency respite care.
  • Many Assisted Living Facilities offer respite care. Taking advantage of this option would give the senior an opportunity to learn about the facility, in case it is eventually determined that an ALF would be suitable.
  • Per Investopedia.com, the average cost of having a home care aide come into the senior’s home is $21 per hour while, on average, a housekeeper’s pay would be $19 per hour. Longer-term care, eight hours a day and five days a week, would average about $67 per day. Health insurance may cover these costs. If not, depending on the senior’s health situation, there may be a special interest group (the Alzheimer’s Association, e.g.) or a governmental organization offering grants or loans to cover respite care costs.
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