• Age Restricted "Retirement Communities" [CLICK FOR MORE INFO]

  A senior community can be like any other neighborhood or community except restricted to people usually 55 or over, or 62 and over. Differences in minimum age is usually established when the original community entitlement and funding is obtained. Those with a 55+ restriction require one resident to be 55+. Other residents must be over 18, but are permitted to be younger than 55. In a 62+ community all residents must meet the age requirement. HUD regulations used to require amenities, activities and services that cater to seniors to be provided or available. Although no longer required by law, to be competitive and attractive to a retirement lifestyle, age restricted communities are continuing to offer amenities, activities and services that cater to residents.

  Retirement Communities are oriented toward an active lifestyle, or "younger thinking" seniors. They might offer golf, tennis, swimming pool and spa, exercise rooms and a variety of clubs and interest groups.

• "Seniors Only" Apartments [CLICK FOR MORE INFO]

  Some older seniors sell their homes of many years and move to an apartment. This frees up equity that can then supplement income through interest or dividends earned through investment of the capital. The move also frees seniors from home maintenance and grounds-keeper chores. For others living in a large complex of all seniors also affords a greater sense of security than living in a private home.

• Modular Home Communities [CLICK FOR MORE INFO]

  Modular Home Communities have full time residents or ones who reside only part of the year with them. Part time residents may be "snowbirds" coming for three months or a bit longer. The lots and the mobile units (which are not really very mobile) may be leased to, or owned by, the residents.

• ECHO Housing (Elder Cottage Housing Opportunity) [CLICK FOR MORE INFO]

  Elder Cottage Housing Opportunity, Accessory Units, Granny Flats refer to a housing opportunity where seniors occupy a second family living unit or apartment with a separate entrance, on a single family lot, with another family. Generally they are permitted by the jurisdiction to foster affordable housing, or aid families with elderly parents unable to live completely alone. The owner of the home and lot may be a senior, or the "renting" party may be seniors.

• Shared Housing [CLICK FOR MORE INFO]

  Seniors can share their home, or share the home of another. The roommate need not also be a senior. Professional organizations which specialize in these arrangements match the two parties based on needs on one side with abilities to provide on the other side. They screen before matching and follow up afterwards to help the match work out. Most organizations who do this are non-profit and supported from sources other than those seeking their help.

  Seniors who share their home, are Aging In Place , and should understand the planning that will help to do it successfully.

• Continuing Care Retirement Communities (CCRCs) [CLICK FOR MORE INFO]

  Continuing Care Retirement Communities (CCRCs) or communities offering Life Care are designed to offer active seniors an independent lifestyle and a private home from which to enjoy it, regardless of future medical needs. They may require buy-in, or an up-front annuity purchase followed by monthly payments covering services, amenities and needed medical. The buy-in may be refundable in part, or not at all.

  They provide the availability of multiple levels of care, without the uncertainty of wondering where you will live.

• Congregate Housing [CLICK FOR MORE INFO]

  Congregate communities offer independent living in private separate apartments, and the opportunity to share activities of daily living with other residents as one chooses. They may offer rental or ownership units.

• Assisted Living  [CLICK FOR MORE INFO]

  Assisted Living (or Residential Care For the Elderly/RCFE) offers help with non-medical aspects of daily activities in an atmosphere of separate, private living units. It can be likened to Congregate living for residents less able to function independently in all aspects of their daily lives. In some states licensing is required.

• Board and Care, Residential Care or Foster Care [CLICK FOR MORE INFO]

  Board and Care is usually offered in what may appear as a converted home. It provides a homelike setting with supervision and care for 4-10 residents (Foster care, available in some states is limited to 2 residents).

• Skilled Nursing Facilities [CLICK FOR MORE INFO]

  Skilled Nursing Facilities may be freestanding, or part of a seniors community offering any or all of the following:

• Congregate

• Assisted Living

• Continuum of Care

It may specialize in Short Term or acute nursing care, intermediate or long term skilled nursing care.

More than 50% of active adult community buyers continue to purchase their home for cash using a portion of the proceeds received from the sale of a previous home. They also tend to set a portion of the sale proceeds aside in an investment to generate additional income to supplement their annual cash flow or to use for an emergency, should it be needed. Focus groups indicate that on average, 2/3 of the cash from the sale of a home goes into the purchase of a retirement home.

The incorporation of amenities and shared facilities means senior communities have a Community Association. Considering a Retirement Community may be your first introduction to a Community Association. To better understand the costs involved, compare the Community Association fees to your present home costs:

• Home Maintenance and Repair

• Gardening Service

• Landscaping costs including watering

• Pool and spa costs including maintenance and repairs

• Fire and theft insurance

• Country Club membership and privileges

• Golf and tennis fees

• Snow plow, trash, and other local services

• Cable access

• Other home utilites -i.e.water, if included in C/A fee

• Security services

• Costs to retrofit or remodel to accommodate aging

• Cost to commute to clubs and activities

• Cost to get together with friends

• Cost for home security

You should also be aware that a Community Association has Conditions, Convenants and Restrictions ('CC&Rs) that may control or affect what you can do with your property. Although many work well to protect your property values, become familiar with the regulations before you sign on the dotted line. To learn more about possible cautions and pitfalls visit  Homeowners Associations Free Consulting. Then buy into a senior community with your eyes opened.
 

Categories of Senior Apartments

The three pricing categories of apartments (although all may not be available in any one market) are:

• Market rate
   

• Above market rate, luxury rentals
   

• Affordable
   

Market rate are just that. They offer unit size and numbers of bedrooms and baths as non-age-restricted rentals in the area at a competitive monthly rate, or occasionally 10-15% under general age-occupancy market-rate rents. The senior orientation of the age restricted community may however offer different amenities and other advantages geared to the needs and preferences of seniors.

Above market rate, luxury rentals are a relatively new phenomenon for the age-restricted market. We see them appealing to the affluent senior wanting a "home" in a second city, or wanting to be free of maintenance without giving up luxuries. Some high end age-restricted properties definitely offer "snob" appeal.

Affordable apartments for seniors (sometimes 55+, more often 62+) are in high demand and short supply. Social, cultural and medical changes have certainly contributed to the need.

Contributing factors are:

• Predominance of women among the 65+ population and their lower retirement income
   

• High divorce rates among women now 55-80
   

• Out-living husbands resulting in lowered retirement income
   

• Unplanned longevity leading to out-living ones financial resources
   

Affordable apartments have been created by government programs since the 1930s. What is defined as affordable in one community may not match the definition of affordable in another community. Housing is "affordable" if one pay no more than 30 percent of their monthly income for rent and utilities. To provide housing that is "affordable" government relates affordability to the county median income.

Housing labeled "affordable", indicates someone who earns (or receives) the median income in that county must not have to spend more than 30 percent of that income to pay their rent and utilities.

Programs that provide opportunities for affordable housing are structured or defined by regulations from federal, county or city government legislation.

• "Vouchers" enable a qualified recipient to rent a market-rate home or apartment and the voucher assures the landlord that the renter will pay 30 percent of his or her monthly income toward the rent and the difference between that portion and the market-rate rent will come from the government entity granting the voucher.
   

• Bonds may be through city or county redevelopment programs, and use the money raised from the bond sale to fund and subsidize specific development of housing for "lower" income people. Bonds may specify what percent of the median income someone must have to qualify to rent in their building. i.e. You may be restricted to make no more than 50 percent of the median income in the county. Perhaps the funding of the complex specifies that you can make no more than 120 percent of median income. The funding is specifically tied to the complex, or specific units that are "affordable".
   

• Funding can also come from grants, community, government or federally based. The grant money functions similarly to bond money, designating percent of county median income at the time of the grant.
   

• Tax credits are another way that the federal government may encourage development of affordable housing. By awarding tax credits (money deducted from a company's federal tax obligation) in exchange for developing apartments within restrictive guidelines. In the past many years we see properties developed to offer affordable apartments that combine tax credits, grants and bond measures.

The most commonly-known rental vouchers are Section 8 vouchers which can provide renter-based benefits to a qualified renter. They provide rent subsidies so tenants who hold them do not pay more than 30 percent of their adjusted gross income for rent.

To find out about affordable housing opportunities in an area , contact city or county housing agencies. Local senior centers and Area Agencies on Aging may also be able to identify affordable housing or even outline the steps for getting onto waiting lists. Because of undersupply, waiting lists prevail in almost all regions for affordable rentals.

Congregate Housing and multi-level campuses offer what they call Independent Living. They offer services for those in their own "apartment". These services may be optional and charged separately above rent. Shared meals, transportation and housekeeping are among the most common services provided. This housing type differs from the conventional notion of an apartment and therefore is defined separately with Congregate Housing or Assisted Living since that is the one common element for multi-level offerings. The Independent Living offering is most appropriate for those not able or willing to continue living alone. Recently we have seen senior apartment buildings add services to retain their frail and aging residents. We considered them apartments with added congregate services.

Things to Consider When Apartment Shopping

• Parking convenience to the living unit.

• Lighting and security around parking.

• Storage
   

  • Are there a lot of closets and cupboards?
     

  • Is their common storage for an additional fee?

• Stairs.

  • They may be a deterrent or a means of staying fit.

• Distance to shopping - walking or riding.

• Public transportation availability and convenience.

• Distance to medical facilities and doctors.

• Security.

  • Total complex access from external streets.

  • Individual apartments

    • Intercom to front door, apartment entry and front desk.

    • Safety pull cord in unit.

• Grab bars in bathroom and tub area.

• Cabinet and counter height.

• Shower and/or tub arrangements to meet your present and future needs.

• Management quality and experience.

• Amenities on site:

  • Pool.

  • Spa.

  • Clubhouse.

  • Laundry availability.

• Services and activities available or provided.

• Distance to relatives.

• Greater community cultural activities.

• If you are eligible for subsidies, do they accept rent vouchers?

From the zoning regulations you know lot setbacks - front- back- and side-yard footage requirements - minimum unit size, roof line height limits and if the "apartment" can be a permanent addition to the lot, or only temporary. If it must be removable when its useful life in your family is over, then it will be a mobile or modular unit, and the division of rooms and amenities may be predetermined by the company that manufactures or provides the modular unit.

Either way, it is important to address the function to assure that the finished "apartment" will meet the needs for which it's intended.

• What is the age of the expected occupant(s)
   

• Are stairs expected to be a problem over time?
   

• If there must be stairs to get to it and the unit just must be over the garage, can a stair rail elevator work with your plan?
   

• How many people will live in the "apartment"?
   

• Will the minimum permitted square feet provide enough space, or will you need to build a bigger unit?
   

• If for a couple, will they sleep in twin beds? Two beds require a longer "headboard" wall span than does a double, queen or king bed.
   

• How many rooms will the occupant(s) need?
   

• Will they need room to eat in the kitchen?
   

• Will they need a separate living, or sitting room?
   

• Will a studio "apartment" layout work?
   

• Based upon zoning regulations will there be a stove with an oven, or a cooktop and microwave?
   

• Based upon the lifestyle of the occupants will these criteria work?
   

• Will the apartment occupants and you want privacy in coming and going, so that the exit door should face away from the main house?
   

• Should it face away from the yard of the main house?
   

• Will the occupants lend a hand with caring for children, so that a view of your yard from the unit is desirable?
   

• How much storage will be needed?
   

• Will extra parking be needed on site to be provided for the "apartment", or is there sufficient on-street parking, and is it permitted on your street?
   

• To find enough square feet on the lot does the "apartment" have to be attached to the main house?
  
  If the "apartment" is attached, can it share space with the main house, like a bathroom?

  With a rough size and tentative location for the ECHO unit you are ready to locate a contractor or architect to produce plans for the unit and the site placement. These are what the construction contractor will work from.

  If the unit is to be modular or mobile you will need to contract with a company that handles such units. Whom ever you contract with, should be chosen with the same care you would select anyone who will work in your home. Check them out with the Better Business Bureau. Check out contractors with the state contractors license board to verify they are licensed to perform the type of work you need. Find out if there have been complaints against them. Be sure they have liability insurance and workmen's compensation to protect you and your home. Do they have experience in ECHO, or accessory unit, housing? Ask for references and call at least three of them. You might even want to visit the completed jobs to see for yourself. They may be satisfied, but.... Their insights may or may not be of concern to you.

  Questions you might want to ask are:
  Are past clients happy with the finished product?
  Was it completed in a timely fashion?
  Were workmen courteous and neat?
  Were change orders handled efficiently, and in a cost-effective manner?

  To find a licensed contractor you might check with local architects for referrals, and check with your bank or savings and loan - they often have a list of reputable contractors their clients have dealt with in the past. Always use a licensed contractor. Any money you think you might save using someone who is unlicensed is risked because you do not have the same legal rights against an unlicensed contractor.

  ECHO HOUSING - A MULTI-GENERATIONAL SOLUTION, October 2000

  If you are going to pay cash for ECHO or second unit, or pay for it as a monthly rental, (only applicable to modular units delivered in a completed state, and removable when your need for the unit is over) then you won't need to shop for financing. If not, than you need to decide how best to finance the project. Don't wait until too late in your planning process to shop for financing. Funding limits may have an influence on your finished product, or if you can proceed at all.

  Among your financing options are:
  Refinance of the present mortgage.
  A home equity loan.
  A second mortgage.
  A home equity line of credit.

  In shopping for financing, remember that some funding options tied to your home mortgage may be income tax deductible.

  Incremental draws against the loan amount, for payment to the contractor are the norm, as is a hold back of 5-10% on each increment of work that triggers payment to the contractor. Your goal should be to retain sufficient money against the work still to be performed, not to be caught short of money should there be a problem with the contractor and job completion.

  If your funding is from your bank they will be able to help you structure your loan draw and contractor payments to protect you from making payments that put you ahead of the work performed.

Federal regulations require any long-term care home or facility to provide 30 days written notice and an appropriate discharge plan if they determine a patient is inappropriate to remain with them. They may not just tell you verbally you have to relocate a loved one!

Foster care is sometimes limited to only 2 residents. Most designated converted homes offering care are allowed only 5 or 6 residents. Those that appear to be converted homes, but offer more beds are usually licensed as Assisted Living residences.

A Board and Care, Residential Care or Foster Care home may be able to provide residents the services found in an assisted living facility, a skilled nursing home or in some cases, an Alzheimer facility, depending on the goal and licensing of the individual facility. Many Board and Care Facilities have their own specialty or emphasis and the intensity or type of care needed by residents within a home may be similar. For instance, some specialize in care of seniors in the middle stages of Alzheimer's. Another may only take early stage Alzheimer's. Another home may only be licensed to accept those mildly impaired mentally, or needing "custodial" help (reminding, meal service, laundry, housekeeping help and driving services). In many states they would need to be licensed to hand out medications, assist with bathing or care for a patient who cannot turn themselves in bed.

Because there are so many Board and Care Homes, hundreds in a populated county, it is also unrealistic to think that licensing can monitor them all. Therefore, decisions should be made regarding placing a loved one in such a home after:

• Getting referrals
   

• Checking of referrals
   

• Unscheduled, unannounced visits at different hours
   

• Checking with the State Licensing Agency

What to Look For In a Skilled Nursing Facility

There is no substitute for visiting the home in person!

Your Nursing Home Check List

After placing someone in a nursing home, remember "the squeaky wheel gets the oil". By trying to be an ally of the staff, advocate for the needs of your loved one. Show up often, not necessarily on "schedule". Catch staff unexpectedly - hopefully doing their job well. Remember the cute sweet girl in grammar school who was always teachers pet? Well it works the same when we are elderly - the sweet, charming patients are better candidates to be well liked by staff.
br /> "My father was angry and disruptive when a child in school, and again as an Alzheimer's patient of 83. Someone from the outside needed to be his advocate, show up often and assure that he got the care he needed when family could not be there to provide care."
 

• Nursing Home Reports provides ratings on nursing homes across the country and offers a book of the same for sale. Web site includes related articles of interest.
   

• CareScout offers ratings for Nursing homes throughout the USA. Registration and a fee are required for specific home rating reports.
   

• MyZiva.Net - The Complete Nursing Home Guide - is a completely free , objective resource for healthcare professionals, caregivers and prospective residents and their loved ones to find, evaluate and compare Nursing Homes across the nation. Search results contain government Survey (inspection) reports, Quality Measure rankings and Nurse Staffing Level ratios (including County averages). The unique MyZiva Comparison Tool also empowers users to easily create and print a comparison chart containing selected facilities.
   

NOTE: Alzheimer's Facilities or Units in multi-level retirement campuses may take Assisted Living level patients, or they may be geared to late stages of Alzheimer's and offer nursing home level of care. Costs are comparably different between the two levels, as between Assisted Living homes and Nursing Home costs. An Alzheimer's Nursing Home offers care more geared to the needs of Alzheimer's patients.

What should you do if loss of memory or confusion is evident, and dementia or Alzheimer's is suspected?

The Alzheimer's Association can help with...

Progressive manifestations of the disease

If you choose a home care option

In considering placement options the environment should...

Components of a special care unit to consider when selecting a facility

Alzheimer?s, Dementia & Driving

Additional information resources
 

What should you do if loss of memory or confusion is evident, and dementia or Alzheimer's is suspected in you, or a family member?

Know the 10 Warning Signs of Alzheimer's Disease, as identified by the Alzheimer's Association, so you avoid jumping to conclusions, or denying that there is a possibility of Alzheimer's that should be professionally evaluated.

• Memory loss

• Difficulty performing familiar tasks

• Problems with language

• Time and place disorientation

• Poor or decreased judgment

• Problems with abstract thinking

• Misplacing things

• Changes in mood or behavior

• Changes in personality

• Loss of initiative

Contact the local Alzheimer's Association Chapter for guidance and help with diagnosis. Your Chapter can be found from National Alzheimer's Association on the internet or at 1.800.271.3900.

The Alzheimer's Association can help with:

• How to select a physician and other professionals involved in diagnosis and treatment of Alzheimer's/dementia.

• Ideas for environmental adaptations that can assist patients to function better in non-institutional environments.

• The family's need to inquire about long term care options early in the disease process.

• Ideas for types of respite care options for caregivers.

• Information regarding caregiver support groups in your area.

• Information regarding research programs that might be available in your area.

• Information regarding different types of Alzheimer's patient support groups.

  • Ones in which patients talk openly about having the disease and take a pro-active approach, for as long as they are able.

  • Those in which patients concentrate on brain stimulus and hand/eye coordination activities, and offer social interaction.

• Information regarding private research groups in your area that may be working with Alzheimer's.

Progressive manifestations of the disease

• Loss in short term memory.

• Wandering

• Episodes of agitation

• Depression

• Disorientation and confusion

• Incontinence

• Loss of weight

• Sleeplessness

• Forgetfulness regarding functions of daily living

If you choose a home care option:

• Can you make the environment secure and safe?

• Can you hire services to come into your home to help care for the patient and provide you with respite?

  • Nurses?

  • Home health aides?

  • Homemakers?

  • Companions?

• Is there a senior adult day care facility available?

• Are there opportunities for social interaction, mental stimulation and recreation for the Alzheimer patient?

• Can the caregiver get respite care?

In considering placement options the environment should:

• Be designed for dementia and Alzheimer's patients.

• Encourage way finding through patterns, colors and cues.

• Provide for safe wandering indoors and outdoors.

• Provide furniture groupings encouraging human interaction.

• Provide overall even lighting.

• Include areas of privacy for residents.

• Include identified and accessible safe bathrooms.

• Private areas for families to interact.

• Offer opportunities for nurturing and comfort.

Components of a special care unit to consider when shopping for a community:

• Is the facility dedicated to dementia and Alzheimer's care?

• If not, do they have a separate wing?

• Do they offer specialized Alzheimer/dementia care?

• Is the facility location convenient for you, the caregiver?

• Is the environment calm and pleasurable?

• Is there secure outside space for use by the residents?

• Is private space personalized and respected?

• Does the mission statement include benefits for your family member?

• What licenses does the facility have?

  • State licenses?

  • Medicare certification?

  • Medicaid certification?

  • Private accreditation?

• Are other residents' functional capabilities similar to your family member's?

• Is patient assessment done by an interdisciplinary staff to determine individual needs?

• Will re-assessment be done at regular intervals?

• Do you feel you can establish a caregiver partnership with facility staff?

• Are residents' rights addressed?

• Is respect shown for resident's dignity in physical psychosocial, spiritual and emotional areas?

• Does medical care and supervision seem sufficient?

• Are behaviors accommodated without the use of restraints?

• Are fees and charges competitive with nearby comparable facilities?

• Will staff honor advance directives such as Durable powers of attorney?

• Are nutrition and eating needs of residents accommodated?

• Is there a full daily schedule of therapeutic activities?

• Are residents active and engaged in activities?

• Will diminished abilities and disease progression result in transfer or discharge from the facility?

• Is late stage care and illness addressed maximizing functional abilities?

• Are research opportunities explained?

Alzheimer?s, Dementia & Driving

Driving represents independence, competence and control. It's a means to buy necessities, be productive, stay connected to family, friends and the community and to access healthcare. Concerns about driving often surface during the early stages of dementia when individuals are still independent and able to manage daily activities.

Alzheimer's is not like other "changes" in later life that affect driving, such as eyesight problems and slow reaction times. Many older adults who don't have dementia can assess their driving changes without family intervention and do make gradual changes to the way they drive. Many are able to continue driving safely throughout their life. With dementia, an individual's capacity to assess his or her driving ability diminishes. They are especially likely to minimize the complexity of driving and overestimate their abilities. They may make excuses for their high-risk driving.

Those with Alzheimer's Disease and other dementias experience gradual and somewhat unpredictable progression in function loss. Cognitive functions critical to driving, decline; such as judgment, reaction time and problem-solving abilities. Other areas of decline are physical and sensory and they also increase driving risks.

As driving and assessment skills decline, the risk of serious loss or injury increases. Caregivers must assume the responsibility for monitoring and regulating the driving of the person with dementia. They need to realize that if there has been a diagnosis of Alzheimer's or dementia, a victim of an accident they cause will not stop their suit at the liability limit of the auto insurance. If negligence or a prior knowledge of incompetence can be found they can sue for all a person possesses. Auto insurance will indicate you did not tell them of the medical diagnosis, and you could be on your own to pay the claim.

Fortunately, in many cases, people with dementia begin limiting where and when they drive. The following signs indicate that a person with dementia is modifying his or her driving behavior:

• Driving shorter distances.
   

• Driving on familiar roads.
   

• Avoiding difficult unprotected left-hand turns.
   

• Avoiding driving at night, in heavy traffic, on heavily traveled roads or during bad weather.
   

Resolving the driving issue involves not only substituting other drivers or modes of transportation, but also addressing the reasons people want to go places. Caregivers can look for ways that others can help meet the physical needs of the person with dementia, such as:

• Arrange to have prescription medicines, groceries and meals delivered, reducing the need to go shopping.
   

• Have hairdressers make home visits.
   

• Schedule people to visit regularly, either as volunteers or for pay.
   

• Arrange for friends to take the person with mild dementia on errands or to social or religious events.
   

While caregivers consider ways to reduce the need to drive, it's also important to remember the social benefits the person with dementia derives from interacting with others. As one person reflected: "When I went to the bank or drug store, I would stop at the local bakery for some pastries. Sometimes it would take most of the morning because I could take my time and chat with different friends along the way." If caregivers consider the social needs that were met through driving, the transition to not driving will be more successful.

When possible, include the person with dementia in the planning process. People are better able to respond to appeals to safety during the early stages of Alzheimer?s Disease or other kinds of dementia.

Caregivers need to remember that family members follow long-established patterns for making decisions. It is unrealistic to think that patterns will change when handling a difficult issue like driving safety. Caregivers can work to minimize friction by listening to different opinions and appreciating what each person can contribute, even if it differs from their point of view. Disagreements in families often result when individuals do not have the same opportunities to assess driving abilities. Having factual information about driving behavior does not guarantee families will reach consensus on when to limit driving. However, frequent, open communication about specific, observed behaviors and concerns may help to lessen differences. Everyone involved in caring for the person with dementia can help by focusing on the key issues; the self-respect of the person with dementia and the safety of everyone on the road.

Additional information resources

National Alzheimer's Association or toll free at 1.800.621.0370. They can lead you to the closest affiliated local chapter.
 

The Alzheimer's Research Foundation since 1988, an independent group of professionals that volunteer to help Alzheimer's patients and caregivers. Feel free to ask them about caregiver problems, alternative medications (herbals, vitamins) and offer your suggestions for others. They prefer to focus on problems and solutions for care of patients in the home.
 

ALZwell Caregiver Support Dedicated to helping dementia caregivers find understanding, wisdom and support through the caregiving journey.
 

CareScout provides ratings of Alzheimer's Communities throughout the USA. For a report fee, and registration you can check a rating for a community you are considering for a loved one.

 

Adult Day Care and Adult Day Health Care This is a service for frail, physically or cognitively impaired, seniors and their caregivers. Stand alone facilities offering adult day care and adult day health care are cropping up in urban and suburban areas. Congregate, assisted living, or nursing care communities may offer day care as an "outpatient" service to the neighboring population. Those that do, may also offer respite care for a weekend, or a week. Senior centers may also offer senior day care. Senior day care and senior adult day care enables caregivers to: Retain a job outside of their home Have help with the physical part of caring for a loved one Avoid the guilt of putting a parent in a "home" Obtain respite from what can be a 24 hour responsibility

Distinguishing Features Between Day Care and Day Health Care Centers

There are three types of Senior Day Care. The lines between may overlap in practice. In shopping for a day care facility, pre-determine (perhaps with the help of a professional, and specially trained social worker, what are the needs of the senior and the goals of the caregiver.

The three types of adult or senior day care can be broken down to meet the need for:

• Social interaction in a safe environment.

• Medical care, therapy and socialization.

• Alzheimer's or dementia care with all aspects of related attention.

The inclusion of "health" in the type of day care a center provides should indicate that they provide elements of health care, and are not just a model for socialization and baby-sitting of seniors. The designation of Adult Day Health Care (ADHC) in many states is reserved for those centers that have been licensed by their state to provide health and medical-related care, similar to what might be provided by a state licensed assisted living community or by a state licensed nursing home. A senior or adult day care center that is not an ADHC, in most states will not be licensed to include, or have available on site, psychological evaluations, licensed social workers, administration of medications, assistance with bathing and hair washing, dressing of wounds and assistance with feeding. Their costs will also not be reimbursed by Medicaid (Medical in California).

Most states require a licensing process for ADHC and a state licensing process to be approved for Medicare reimbursement and/or Medicaid (Medical in California) reimbursement. In some states the legislature has recognized the cost savings between supporting an indigent person in assisted living at $2,500 - $5,000 per month or in a nursing home at $3,500 -$6,000 per month and supporting them in an ADHC where they return home each night to live with family.

Medicare does not cover day care costs, but in a licensed medical or Alzheimer's environment Medicaid may pay all of the costs if the senior qualifies financially. Some day care centers offer need-based scholarships. Private medical insurance policies sometimes cover a portion of day care costs when registered, licensed medical people are involved with the care. Long Term Care Insurance policies can cover day care.

There are limited spaces for Medicaid provided ADHC, as there are limited spaces for Adult Day Care as a social model, so waiting lists may prevail in both urban and suburban settings.

Adult day care and adult day health care offers seniors:

• The chance to live with family and not be a 24 hour burden

• Opportunities for social interaction with peers

• A program of stimulating activities

• Physical, occupational or speech therapy in a non-medical environment

• Help with activities of daily living with dignity

When shopping for adult day care, look for:

• Round trip transportation

• Facilities for bathing and hair washing

• Licensing for administering medicine and medical procedures

• Professional qualifications of staff

• Schedule of activities

  • Trips, if appropriate for seniors' profile

  • Arts, crafts and other disguised therapy

• Nutritional meals prepared on site or by a qualified outside source

• Menus that meet the needs of seniors

• Compare prices for services offered, if you have a choice

• Compare prices with in home services but be aware:

  • Group environments are more stimulating

  • We are all social beings

  • A full activity schedule provides more stimulus

  • A good center responds quickly to changing needs

• Does the center also provide respite care.

A pamphlet resulting from the United States Senate Special Committee on Aging Report, based on allowed deductions on income tax filing is available by calling 800.829.3676 and asking for IRS publication covering dependent care.

"If a dependent spends at least 8 hours a day living in your home, expenditures made for out of home, no institutional care are eligible for Dependent Care Tax Credits." The Dependent Care Center must be in compliance with all state and local regulations for expenditures to qualify.

Senior Short Term Vacations (Travel Vacations, Snowbirding, Respite Care) Try Before You Buy Respite Care and Short Vacations With Care (Includes link for care vacations abroad!) Hotel Federal Handicapped Regulations Medicare and Senior Travel

Senior Housing "Try Before You Buy"

New, just selling, Active Senior Communities often offer 2 or 3 day a vacations at reasonable rates to try out the community and the offered amenities.

• Contact the sales departments of larger retirement communities to find out if they have a "try before you buy" program.

Congregate, Assisted Living or CCRC communities offer opportunities for vacation stays for:

• Short term visits.

• Snowbird vacations.

• Trying out an area before relocating.

• Trying a local care home as a possibility for longer term care and housing later on.

  • For parents to try a place near their family.

  • For parents to try places near each of their children during a the decisions making process.

• Frail seniors to attend a family gathering in a distant city and be cared for between get-togethers.

They:

• Are less costly than a hotel stay, with restaurant meals.

• Offer meals, housekeeping, transportation and planned activities, plus the chance to socialize.

• Offer more than what one gets with a furnished apartment rental.

• Provide assistance with activities of daily living within the scope of services the Congregate or Assisted Living Community offers to its regular long term residents.

Respite Care

Respite Care and/or short term vacation opportunities are available in some Active Retirement, Independent, Congregate, Assisted Living, CCRC Communities and Alzheimer's communities. In addition to the usual reservations made ahead for any vacation stay, special medical arrangements must be made in advance when care is required.
 

Respite care is also available in places that specialize in Respite Care and in conjunction with Senior Day Care providers. Special care-related arrangements must be made in advance.

Special care-related arrangements include:

• A doctor's letter sent to the Community with:

  • Medical status assessment or diagnosis

  • Medications and treatments etc.

• Review by the Community Administration to determine if they can meet the senior's or proposed guest's needs.

Check with the communities that are appropriate and close by well in advance of the date. That way, necessary paperwork can be done in time for the planned visit.
 

Hotel Federal Handicapped Regulations

Federal laws require new hotels to accommodate the handicapped. The degree to which they do so varies. Check with individual hotels to see what handicapped facilities they offer. An elevator may not be enough to meet someone's needs.

• Will bathrooms accommodate a walker or wheelchair?

• Do they have shower chairs available?

• Do they have a low threshold stall shower with a shower seat?

• Are there grab bars in the tub or shower and by the commode?

• Are light switches and shaving plugs reachable from a wheelchair?

• Are there levered faucets and door handles?

• Do sinks and tubs have mixers on their faucets?

Medicare and Senior Travel

Medicare may not pay medical expenses incurred outside the United States or Canada. Being abroad may also affect supplemental coverage. Check what is and is not covered before you travel abroad. Supplemental travel insurance may be an affordable option.

Be prepared for medical emergencies while traveling!
Health Worldwide offers health services for travelers. With information for 550 cities worldwide: emergency numbers, hospitals, pharmacies and health systems. Visit before you travel. For a $19 registration fee they offer access to drug translation guides, providers, doctors and online appointment scheduling.