What Are the Best Assisted Living Alternatives?

Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

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As our population ages, older adults are looking for alternatives to the traditional model of assisted living. These other housing choices are sometimes less expensive, and more flexible. Financial considerations and a desire for greater choice have driven the senior housing market in new and creative ways.

But for many people, assisted living can be a viable choice as they age. Assisted living provides nursing, aide service, housekeeping, transportation, and activities. Others may find the cost of assisted living less appealing and not the right choice. In addition, residents do not get to choose their neighbors, as the social makeup is predetermined.

Below, we'll explain common alternatives to assisted living, who they're right for, and more.

1. In-Home Care

As an alternative to assisted living, in-home care can be a viable option for people who want to stay at home for as long as possible. Survey after survey shows that most people say they prefer to age in place. In-home care makes that possible if you can afford it. But of course, with any senior living option, in-home care has its advantages and disadvantages.

Unless you have long term care insurance or Medicaid, in-home care is an out-of-pocket cost. That hourly cost can vary by agency as well as the state you live in. The national monthly average in 2019 for homemaker services was $4,290. The average will vary depending on the number of hours per day and per week requested. As this cost climbs, it can easily exceed the cost of staying in assisted living.

In-home care is very flexible. Caregivers adjust their hours based on what the client needs. For example, you may have a family member that has recently returned home from a rehab stay due to an accident or illness. The initial hours required might be greater in the beginning until your family member is stronger and able to function more independently.

Caregiver turnover in the home care industry is estimated at 82 percent. What does this mean for you? Sadly, if you find a caregiver you really like, they may leave. High caregiver turnover can be disruptive to your loved one and frustrating for you.

Although an agency will manage caregivers in the home, you will still need to monitor your loved one’s care. A proactive approach will make certain that the plan of care is followed and that you and your family member are happy with the care staff.

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2. Independent Senior Living

Independent senior living can appeal to older adults thanks to the opportunities for community and socialization. For many older adults, living in their own home is isolating and lonely. They want and need other people while remaining independent.  

  • Independent senior living can be a congregate setting with multiple apartments. This could be a high rise or even smaller single homes in a group setting. 
  • Independent senior living apartments can also be part of a “continuum of care.” An example would be a community that has independent, assisted, and memory care apartments all in one building or on the same campus. They may also have support groups for aging adults as well.
  • Independent usually means that there is no help from aides for tasks such as bathing, grooming, and transfers. Nursing is not available although in some communities on-site physician services can be arranged. If someone wants to stay in independent living but needs help, they can hire private caregivers through an agency.
  • Medications are not managed or dispensed. Taking medications is the responsibility of the resident.
  • Amenities can include weekly housekeeping, laundry, transportation to medical appointments, and all meals and snacks. Daily activities are also included.
  • Independent senior living eliminates the headaches of homeownership such as yard care and home maintenance 
  • Pets of a certain size are allowed in most independent living as long as the resident can care for that pet.
  • Just as with in-home care, the cost depends on the state where you live. Costs may also vary within a state depending upon whether you are in an urban or rural area. You can look up what the average costs are for all senior care options across the country.

3. Cohousing

Independent living may also encompass community formats like cohousing. Cohousing is similar to independent senior living, but it features several residences on one piece of property where common space is shared.

Although this model appeals to seniors, some cohousing communities may be multi-generational and others may be for seniors only. Features of cohousing can include the following:

  • With cohousing, you buy your property, but also requires you to have equity in the home you live in so you can buy within a co-housing community. 
  • Cohousing communities are independent. Some are in cities, but many are in more rural locations.
  • Cohousing is similar to a homeowner’s association. Decisions are made as a group and follow a consensus model of governance.
  • There is an emphasis on the sharing of chores, responsibilities, and activities.  Cohousing residents are expected to be active participants in the community. There are no support services available except for those that you arrange.
  •  In multigenerational co-housing developments, there is an opportunity for seniors to be around children and families.

4. Continuing Care Retirement Communities (CCRC)

Continuing Care Retirement Communities (CCRC) offer peace of mind and security for many people. CCRCs give seniors the option of living within the same community throughout the rest of their lives. The appeal is pretty straightforward.

With a CCRC, you can opt in not having to worry about where to go if you need more care. They include independent, assisted living, memory care, and skilled nursing all in one location. Some may have individual homes, condominiums, or apartments with assisted living and nursing care on the same campus. Most people move to CCRCs when they are independent.

Many CCRCs vary in terms of their structure and buy-in options. They can be costly, as CCRCs require a significant upfront investment. By contrast, most traditional independent, assisted living, and memory care communities are paid for month to month, and you can cancel with advance notice. 

Do your due diligence and make sure you understand the long-term consequences of the investment you are making. You may want to consider meeting with a financial advisor to do an estate plan.

People who choose CCRCs say they like not having to worry about where they will go when more care is needed. Although the upfront investment takes care of you all the way through nursing home care, there may also be additional monthly fees. Amenities can be extensive. Some CCRC have pools, pickleball courts, clubs, 

5. Board and Care Homes

Board and care homes go by several different names: residential care home, group home, V.A. foster home program, adult foster home, or senior group home.

Board and care homes can be found in residential neighborhoods, often in someone’s home. Most houses can have anywhere between 2 and 10 residents. Services provided are very similar to assisted living and include meals, help with grooming and hygiene, medication management, and recreation activities. Nursing may be limited.

Some folks like board and care homes because they are smaller and more intimate. This also allows for more oversight by staff since there are fewer residents. Rooms are often shared.

6. Program of All-Inclusive Care for the Elderly (PACE) 

PACE is a program administered by the Center for Medicare and Medicaid Services for frail older adults who live in the community. Most of the recipients are eligible for both Medicare and Medicaid.

The purpose of the program is to provide support services to keep people in their homes, as not everyone can afford other alternatives to assisted living.

In addition to all of the resources available through Medicare and Medicaid, a team of specialists can care for the following tasks:

  • Dietician
  • Driver
  • Home care liaison
  • Nurse
  • Occupational therapist
  • PACE center supervisor
  • Personal care attendants
  • Physical therapist
  • Primary care physician
  • A recreational therapist or activity coordinator
  • Social worker

7. Home Sharing

Home sharing is gaining in popularity and for good reason. It is very affordable. The fact is, more and more people can’t afford traditional assisted living or continuing care retirement communities. Home sharing can be a creative way to address affordability and the need for socialization.

Let’s look at the ways people are making this work for everyone:

  • You own a home and need extra income. Let’s say that a single or married couple find themselves in a home that is too large for their current situation. The kids have grown and gone. More and more people are looking at this as an opportunity to share their space while getting extra income. Especially single or widowed women. 
  • You will likely share a bathroom and kitchen. Also, someone needs to establish lease arrangements and rules of the house.
  • Downsizing may mean moving. Some friends are considering a home purchase together. This way everyone eliminates the need for their single-family home and does a group purchase with room for everyone.
  • All household costs are shared. This includes utilities, maintenance, and taxes.
  • There is ample opportunity for socialization and sharing of activities.
  • A supportive atmosphere where residents can help one another.
  • Living with people provides more security than living alone.
  • Home sharing is not for everyone. The legal arrangements and close quarters are less appealing to people who value their privacy.

Alternatives to Assisted Living: Your Choice, Your Life

As you look to your future or that of an aging parent, you have more choices than ever before. Finding the best fit can take time, but your efforts will yield some ideas you may have never considered. Assisted living is not your only option, and that is as it should be. 


Sources

  1. “Cost of Care Survey.” Genworth. www.genworth.com/aging-and-you/finances/cost-of-care.html
  2. “Home Care Industry Turnover Reaches All-Time High of 82%” Home Healthcare News. homehealthcarenews.com/2019/05/home-care-industry-turnover-reaches-all-time-high-of-82/
  3. “What is Co-Housing?” The Co-housing Association of America. www.cohousing.org/

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