Independent Living
Independent living communities or independent retirement communities are housing designed for adults age 55 and older.
These communities commonly provide apartments, but some also offer cottages, condominiums, and single-family homes. Residents include older individuals who do not require assistance with daily activities or 24/7 skilled nursing, but may benefit from convenient services, age-friendly surroundings, and increased social opportunities that independent senior living communities offer.
Many independent living communities offer dining services, basic housekeeping and laundry services, transportation to appointments and errands, activities, social programs, and access to exercise equipment. Some also offer emergency alert systems, live-in managers, and amenities like pools, spas, clubhouses, and on-site beauty and barber salons.
Independent living properties do not provide health care or assistance with activities of daily living (ADLs) such as medication, bathing, eating, dressing, toileting and more. Independent senior living differs from continuing care communities, which offer independent living along with multiple other levels of care, such as assisted living and skilled nursing, in one single residence.
Independent living residents are permitted to use third-party home health care services to meet additional needs.
To search for Independent housing visit:
Assisted Living
Assisted living facilities—also known as congregate housing, residential care, adult congregate care, boarding home, or domiciliary care—are suitable for individuals who need minimal daily care. In terms of medical needs, minimal care might be considered assistance with medication or intermittent skilled nursing care.
Currently, nearly 1.2 million individuals live in the nearly 30,000 assisted living facilities in the US. In general, the average resident of an assisted living facility is an 80-year-old mobile female who has moved from a private living arrangement to the facility and has an average annual income of approximately $30,000. Individuals who require a wheelchair for locomotion, have a severe cognitive impairment, or show behavioral symptoms such as wandering are discouraged from becoming residents of an assisted living facility.
The typical resident lives in assisted living for two to three years, and many then move to nursing homes. Other reasons that a facility discharges an individual include:
- To return home
- For a hospital stay
- Financial problems
- To move to another assisted living facility.
Living Arrangements and Services
Assisted living residents usually live in their own semiprivate or private apartments, which include a furnished or unfurnished bedroom, kitchen area, and bathroom. Various types of apartments are available such as private studio apartments, one-bedroom private apartments, one-bedroom shared apartments, and dormitory-style bedroom arrangements.
Although assisted living facilities differ by state, services offered can include:
- Assistance with daily living activities (bathing, dressing, eating, toileting, etc.)
- Central dining programs that include three meals a day
- Educational activities
- Emergency call systems in private and common areas
- Exercise activities
- Health services and medication administration
- Housekeeping and maintenance
- Organized recreational activities
- Personal and/or nonpersonal laundry services
- Social services and religious activities
- Transportation arrangements
- Wellness programs
- 24-hour security
The majority of assisted living facilities also contract with home health agencies to provide skilled nursing care and with hospice providers for hospice services.
Regardless, the resident and his or her family should receive an initial orientation of the services provided. Additionally, an assisted living service coordinator should make an initial evaluation to determine which services are needed. Assisted living residents should also be reevaluated on a regular basis and modifications should be made to his or her service program to reflect any services no longer needed or any additional services required. The resident should have access to these evaluations at all times and should be given a copy of each evaluation for his or her own records.
Finding the Right Facility
Those interested in assisted living opportunities should contact a case manager, clergy member, financial planner, hospital discharge planner, physician, or social worker to inquire about facilities in the area.
When visiting an assisted living facility be sure to ask the following questions:
- What is the entire range of services offered at this facility?
- How is the payment plan set up?
- Which services are included in the base monthly plan?
- How do you identify which care services I may need, and how often will I be reevaluated?
- Who conducts these evaluations?
- What is your policy regarding use of outside services?
- Is there a deposit, and is it refundable if I need to move?
- If my needs increase or decrease, will the fees reflect these changes?
- How much notice will I be given if or when fees change?
- Can my fees increase even if my needs do not?
Fees and Payment
Most assisted living services are included in the facility’s basic service costs, but some may be offered for additional fees. Generally, fees charged for an assisted living facility pay for the facility and some services. Because specific assisted living facilities differ greatly, the fees also differ between facilities and may be offered as an all-inclusive monthly price, tiered pricing based on required services, pricing based on individual services requested by the resident, or some combination of these.
Most residents pay for assisted living without assistance, although some states provide public assistance with payment in the form of Medicaid, Supplementary Security Income, or Social Services Block Grant programs. Private long-term care insurance and some managed care programs may also assist with costs incurred while living in this type of facility. Medicare does not cover assisted living facility expenses.
Resident Rights
Assisted living facilities allow individuals to remain independent as long as possible in an environment that maximizes the person’s autonomy, dignity, privacy, and safety, as well as emphasizes family and community involvement. This means that in cases of temporary incapacity, the residents should be allowed to remain in the facility or should be readmitted after needed outside services have been provided. Even when death is imminent, the facility often allows the resident to remain as long as the facility can provide any necessary services. In general, resident rights in assisted living facilities include:
- Being treated with dignity and respect
- Continued practice of or abstinence from religion
- Freedom from neglect or abuse
- Freedom to interact with individuals inside and outside of the facility
- Privacy
- Receipt of all evaluations of medical needs and health-related services
- Representation in residential councils
- Retention and use of personal possessions
- Self-control of personal finances
Additionally, most assisted living facilities continue to allow residents to use tobacco and consume alcohol, to keep small pets or to interact with facility-owned pets, to allow visitors at any time during the day, and to allow overnight guests at the discretion of the resident.
To find assisted living facilities in NY, visit the Department of Health's website.
Skilled Nursing
Skilled nursing facilities or nursing homes are for people who require significant medical care, such as a specialized line for IV medications, a ventilator, respiratory therapy, or have a stage 3-4 pressure ulcer (bed sore). Essentially, any older adult who needs medical treatment from a registered nurse 24/7 or daily therapy services will need a skilled care setting.
A stay in a skilled nursing facility is akin to a hospital stay. It is often temporary, with the goal of rehabilitation, so the person can then return to assisted living or back home. An individual with significant physical or medical needs may require permanent placement in a nursing home.
Skilled nursing home care frequently begins with an on-site assessment at the hospital and continues through an initial conference and discharge planning. Many skilled nursing centers accept Medicare.
Here are a few examples of when skilled nursing care is needed:
- Rehabilitation care due to fractures or joint replacements
- General wound care
- Acute medical conditions
- Interim medical care following a hospital stay
- Respiratory care
- Parkinson’s care
- Terminal illness care (in cooperation with hospice)
- Stroke recovery
- General rehabilitation due to weakness or physical decline
- Diabetic rehabilitation
Medicare will pay for a stay in a skilled nursing facility if the enrollee was admitted as a hospital inpatient for at least three nights prior to the stay in the skilled nursing facility (a subsequent skilled nursing facility claim can be covered without another hospital stay, as long as it occurs within 30 days of the first skilled nursing facility stay).
Cost
Long term care is very expensive. Most people cannot afford to privately pay for long term care services for very long. The monthly cost associated with skilled nursing care can run from anywhere between $4,258 and $23,451 per month for a semi-private room and between $5,019 and $23,451 per month. It is estimated that people in nursing homes stay for less than 2.5 years on average.
For More Information:
To research or assess skilled nursing facilities, visit Medicare.gov.
To find quality and safety information on New York's nursing homes, visit the New York State Department of Health's website.
To file a complaint about an assisted living or nursing home in New York State, fill out a complaint form.