Monday, November 17, 2008

The Future of Elder Care: Part 1: Elder Cohousing

In my work with families who are placing a loved one in a care community, I am often asked about the future of long term care. Many people I talk with are uncomfortable with the concept of long term care for themselves but think it’s adequate for their parents. I have good news and bad news: There is an alternative to long term care options known as Elder cohousing, but don’t expect it to show up in your neighborhood anytime soon.

The cohousing model was adopted from Denmark and migrated to the US in 1988. Initially conceived as multi-generational cohousing, neighbors adopted rules and built structures that allowed them to live supportively with one another, sharing common facilities and incorporating non-hierarchical decision-making, two of the six main characteristics that all cohousing communities share. Now, a similar concept, Elder cohousing, is becoming more popular with the 50 and older crowd in the US. Elder cohousing is an environmentally sustainable alternative to the existing models of housing for boomers and elders alike who yearn for their independence within a supportive community environment.

There are three elder cohousing projects that have been completed in the US. The three lucky states are Virginia, California, and Colorado. To date, there are eight elder cohousing projects actively underway according to Some communities are spearheaded by a group of friends or neighbors; others are formed by a few members who then recruit other future “neighbors” for investment and participation.

Studies suggest that people remain healthier and may live more independently if they have strong community ties. Cohousing fits this prescription perfectly as each member of a cohousing project has duties and contributions they are expected to provide. In one cohousing community, members’ professions included the following:
* Architect and Project Manager
* Technical illustrator/painter/sculptor
* Librarian
* Builder/Developer
* Teacher
* Retired English professor
* Financial planner
* Ombudsman
* Psychotherapist
* Retired businessman
* Social services for youth in prison.

If a member of an elder cohousing project needs care at some point in their journey, they continue to live at the site for as long as possible. Members are expected to help provide for one another; some will hire in-home care or employ caregivers for those who are in need. In the event that a member needs to live in a long term care community, members of the elder cooperative will continue to remain a part of the member’s life. This allows members to age in place for as long as possible, decreasing the financial, psychosocial, and health burden of the individual.

If you would like to learn more about elder cohousing, or how to form your own cohousing project, visit

Amie Clark, Founder, The Senior List

Wednesday, June 4, 2008

Assisted Living- The Good, Bad and the Ugly

There are almost 35,000 Assisted Living Facilities licensed and operating in the US today. These communities range widely in size, price and amenities and are all fiercely competing for your businesses. The real trick is finding the one the suites your needs, life-style, and pocketbook.
What is Assisted Living?

The typical Assisted Living model is based on apartment style living with care services built in. This model encourages independence and autonomy while providing supervision and daily assistance with care needs. Meals are typically served in a main dining area with the intent of a social gathering while enjoying meals selected by the residents. Activities will be offered, including outings, scenic bus rides, and trips to the grocery store, bank, and doctors visits on designated days of the week.

What type of care is provided in Assisted Living?

Assisted Living provides custodial care, not medical care.

  • Bathing, Dressing, Toileting, Grooming, Mobility, Medication Management
  • Cooking, Housekeeping, Transportation, Laundry

What can I expect to pay for Assisted Living?

Most Assisted Living facilities structure their costs on an "ala carte" system. You will be quoted a "base cost" or "room and board cost" ranging from $1500-$3000 per month, depending on geography, size of apartment, and amenities offered. Expect to see additional costs added on right away. Based on an assessment of your care needs, the price will increase accordingly. This price can vary from month-to-month, especially if care needs drastically improve or decline over time.

What are the advantages to Assisted Living?
  • Less expensive than nursing home care
  • Private apartments to optimize privacy, autonomy, and independence
  • Three meals a day served in a social dining atmosphere
  • Security and call bell systems
  • Designed with accessibility in mind (roll-in showers, etc)
  • Exercise programs
  • Care Services available- to be used as little or as much as you require
  • Activity programs designed to keep residents active, social, and healthy
  • Most have a beauty parlor on site
What are the limitations of Assisted Living?
  • Despite staff presence and encouragement, some residents can become isolated
  • Most do not allow residents to cook, for safety reasons
  • Assisted Living can not accommodate residents who are wandering or exit seeking
  • Minimal staffing requirements in most states. On average, expect to see 1 caregiver for every 30 residents during peak hours, and much less at night
  • While facilities tout their abilities to care for residents through the end of life, many will ask families to hire private caregivers or transfer to a higher level of care if the residents needs are beyond the scope of their staffing levels
What do I look for in an Assisted Living community?
  • Ask to see the latest survey
  • Invite yourself to lunch (most will happily invite you first). Do you have menu options? Can family or friends join you for a meal? What is the cost for guest meals?
  • Do the other residents interact well with each other? Are the staff friendly and kind? Do they know the residents by name?
  • What is the caregiver-to-resident staffing ratio for each shift?
  • Is a nurse available? What hours is the nurse in the building?
  • Does the facility have a comfortable atmosphere? Is it clean? Are there any noticeable odors? What safety features are available?
  • Is transportation available? Is there an additional cost?
  • How often is the care plan reviewed? Is the resident or responsible party involved in the review? (they should be)
  • What is the turn-over rate for staff? *Note* Most facilities have a high turn-over rate. It's a huge problem. What is the facility doing to keep current staff and attract new quality caregivers?
  • If you have a pet, ask about any fees you will be expected to pay for your pet. Typically, an additional move-in fee and cleaning deposit will be incurred.
  • What cost of living increases can be expected? (we have noticed 3-6% yearly for most communities)
  • If the community can no longer meet your needs, how much notice will you receive and what assistance will be available to relocate to another level of care?
  • Trust your instincts!!!
Who pays for Assisted Living?
  • Private Pay (you)
  • Long Term Care Insurance- Check your policy for coverage, waiting periods, etc...
  • Medicaid- If you already qualify for Medicaid, or will qualify in the near future, make sure the facility you are considering has a Medicaid contract- many do not. You can check with the facility or your local Agency on Aging office for a list of contracted facilities in your area. If a facility does have a contract, chances are they are trying to balance Medicaid v.s. private pay in the building. Some will have a waiting list for Medicaid, so plan ahead. Do not wait until a crisis to start your search!!!

If you are just starting your search for an Assisted Living Community, you may consider working with a geriatric care manager or placement and referral agency to guide you. These professionals will know the communities in your area and save you valuable time and energy.

Amie Clark, Founder of The Senior List