Lisa Sanders
Lisa Sanders, director of media relations for LeadingAge, the professional association that represents not-for-profit senior living communities in the United States.
The senior housing sector is made of more than nursing homes: It offers a continuum of services that can provide everything from a little help with housekeeping to 24/7 medical care. By familiarizing yourself with the many options, you can begin to plan what may work best for you or a loved one.
Many people prize staying in their own homes as they age, and a variety of senior services can help address the medical and psychosocial needs that can make that challenging. In adult day programs, for example, seniors who need assistance spend an average of eight to 12 hours in a community setting, where they have access to health, social, functional, and therapeutic activities. They may receive help with transportation to activities and appointments as well as assistance with activities of daily living (ADLs), such as eating, bathing, and dressing.
Coverage: These programs may be paid for by Medicaid, some Medicare Advantage plans (but not traditional Medicare), and private funds.
Cost: The national average for adult day care is $80 per day, according to the 2021 Genworth Cost of Care Survey, but prices vary widely by location. For example, if a person attends five days per week, the monthly cost averages $620 in Alabama but $2,900 in Alaska.
Programs for All-Inclusive Care of the Elderly, which are available in 30 states, offer preventive, acute, and long-term services to Medicaid-eligible seniors who can safely live in their communities. (About 5 percent of PACE participants live in nursing homes.) Programs are available in Alabama, Arkansas, California, Colorado, Delaware, Florida, Iowa, Indiana, Kansas, Louisiana, Massachusetts, Maryland, Michigan, North Carolina, North Dakota, Nebraska, New Jersey, New Mexico, New York, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Virginia, Washington, and Wisconsin.
Coverage: PACE programs are covered fully for people who are enrolled in both Medicaid and Medicare. People who are not eligible for Medicaid can pay privately.
Cost: $0 for Medicaid-eligible seniors; $4,000 to $5,000 per month if paying privately.
When a person transitions from a hospital to home, a physician may order a range of services, such as nursing care, wound care, and occupational and physical therapy. People may also use companion care services that include help with meal preparation, shopping, transportation, laundry, dressing, and bathing.
Coverage: Medicare covers medically necessary services that have been prescribed by a physician, but not companion care services. Medicaid coverage depends upon the state.
Cost: Without Medicare or Medicaid coverage, the average cost of home health care is $5,148 a month. Nonmedical care averages $4,957 a month, with a low of $3,623 in Louisiana and a high of $6,547 in Washington, according to Genworth.
People with a terminal illness and an expected lifespan of less than six months can receive hospice services at home usually at no charge. These services include care that is focused on reducing pain and suffering, while attending to patients’ emotional and spiritual needs.
Coverage: Medicare covers most or all of the cost of hospice. Medicaid coverage depends upon the state.
Cost: $0
There are also a variety of options for people who want or need to move to a new setting. Affordable senior housing allows older adults with low incomes to live independently in cost-controlled apartments. In about half of these communities, professional service coordinators can help residents locate local services and support. These programs are funded by the Department of Housing and Urban Development (HUD), the U.S. Department of Agriculture’s Rural Housing Service, and the Low-Income Housing Tax Credit program. These programs are extremely limited, however, and there are far more applicants than available homes.
Coverage: Limited availability through federal programs.
Cost: Resident rents vary by federal program. In most HUD programs, called Section 202, for example, residents pay about 30 percent of their incomes for rent.
People who need a little more assistance with activities of daily living and medical care, but don’t require a nursing home, may choose an assisted living facility. There, they have the privacy of living in their own apartment or suite, but also have access to medical care, medication management, meals, help with personal care, housekeeping, and recreational activities. Assisted living facilities are regulated by the state, not the federal government, so there can be significant differences in cost, services, and quality of care between states.
Coverage: Most assisted living is private pay. Some states offer assisted living coverage through Medicaid waivers, but demand outstrips supply.
Cost: The national median cost of assisted living facilities in 2021 was $4,500 per month with a range from $3,000 per month in Missouri to $6,978 in Washington, D.C.
Nursing homes provide the highest level of medical care around-the-clock. Unlike assisted living facilities, nursing homes are federally regulated, so the care and services provided are more consistent state-to-state. You can review information on all Medicare-approved nursing homes through Medicare’s Nursing Home Compare website (https://www.medicare.gov/care-compare/).
Coverage: Most, but not all, nursing homes accept Medicaid. Medicare does not cover long-term nursing home care, but it may cover short-term stays in skilled nursing facilities for people who need rehabilitation care. Most nursing home care, then, is paid for privately.
Cost: The average cost is $7,900 per month for a shared room and $9,034 for a private room, but prices vary by state. Texas has an average cost of $5,125 compared with $13,764 in Connecticut.
LPCs cover the spectrum of care, so people can transition to higher or lower levels as needed. An LPC will often have independent living, assisted living, memory care, and nursing home residential areas, and some offer home-based care services.
Coverage: Most LPCs are private pay. Some require that you agree to apply for Medicaid if you run out of funding, and you may have some medical bills processed through Medicare.
Cost: Most LPCs have two costs to consider: entrance fees and monthly fees. An entrance fee could be as low as $20,000 if you will be renting your home or hundreds of thousands of dollars if you are buying it. The monthly fees also vary widely and depend upon what they cover. As the level of medical care that you need rises, so do the fees.
The costs also vary depending on your contract type:
An extensive contracts provide a lifetime guarantee of housing and all the care that you need.
Modified contracts are cheaper, but they limit care coverage. When you exceed that care, you will be charged for additional services.
Fee-for-service contracts allow you to pay only for the services that you use. While these may cost the least initially, it is best to budget for unexpected and additional expenses, since health care and other needs can change as you age but can lead to surprise bills.
When investigating communities, be sure to ask about their policies if you spend all of your assets and still require care.
