Couples who want to remain together but require different levels of care always present some very complicated challenges. One person may want to stay in the home, the other may not. A member of a couple may develop health challenges that may necessitate a move to a nursing home due to medical and financial reasons. I always show people the costs of both stay-at-home care and moving to a community. The problem with the latter is that many communities are not set up to accommodate different levels of care. A community’s capacity to handle multiple levels of care depends upon the way its apartments are licensed. Some communities are capable of handling residents who are on the independent level and who need assisted living (standby care and some hands on care with bathing, dressing, eating, toileting, transferring, and walking), often referred to as “swing apartments” because they are licensed to accommodate people at both levels. The situation becomes more complicated when one person needs nursing home care and the other remains at the independent or assisted level. Nursing home care requires yet another level of licensing which doesn’t allow couples to remain together unless their health issues require it. (For example, a person who is independent cannot occupy a nursing home room with his/her spouse unless s/he too needs the care). I recently worked with a couple who needd help sorting through these issues, as exemplified in the following real life story.
REAL LIFE STORY
My clients were the children of parents in the Chicago metro area who were in their early seventies (clients who were much younger than those I normally work with). Their parents were living in a lovely home with an urban setting. Their mother had been suffering from a disease that caused recurring seizures every few years. The latest bout with the disease caused her to be sent home with a full-time, non-medical caregiver who was costing them $350 per day. Their mother needed help with most of her activities of daily living, but could feed herself and walk with a walker. Their father, on the other hand, was independent. The caregiver was also preparing their meals, doing light housekeeping, and running errands. The children hired me because they lived in a suburb more than 20 miles away from their parents and were busy with their own families. They wanted their parents to move to the same suburb. In addition, they were uncomfortable with the existing home care arrangement because they felt there was no ongoing support system in case their mother became more ill. They were not comfortable with the “live in” situation and preferred to order a lesser number of hours if possible. The cost of maintaining the home plus the home care services was becoming prohibitive. The parents had been married for 50 years and wanted to remain together as long as possible. The dad was not social and wanted to “do his own thing.” During rehabilitation, the mom had enjoyed art therapy classes, such as water color painting, and music appreciation classes. I was instructed to find a community that would allow the couple to continue their current living situation, with a continuing care support system, in the kids’ suburb, with opportunities for socializing for their mom. I was able to come up with three options in their requested location.
First, I was able to find a luxury independent living community that contracted with a home care company to provide non-medical catered* living assistance and nursing services to the residents living in the building. The company had an office in the building and offered the flexibility of ordering ala carte services as needed, as well as service packages. Or, the couple had the option of hiring their own services. Therefore, they could age in place as long as their finances allowed. A certain number of meals and housekeeping were included in the rent, eliminating the need for a full-time, live in assistant. The activities my clients’ mom requested were available. The community is operated by an organization that owns a nursing home with both skilled and intermediate care services, less than four miles away. Priority access to the nursing home was guaranteed to the building residents.
The second option offered the couple an opportunity to move to a Continuing Care Retirement Community (CCRC).** If they chose this option, they would be able to move to a sizable apartment in the assisted living area where they could remain together. My clients’ mother would have access to higher level, hands-on assisted living care. However, their father would be given an option to pay a small entrance fee as an independent resident and partake of the community’s Life Care contract.*** Unfortunately, their mother would not be offered this sort of contract since she was already ill. Both of their long-term care needs could be addressed as they aged. The nursing home on the campus is connected to the entire building by an underground tunnel which makes visiting easy if one of them needs to move.
Is there a down side to this option. Yes! Their father would have to make a decision as to whether he would eat his meals in the assisted living area with his wife, an be surrounded by residents who were at a higher level of care than himself. Or, he could opt out of the meal program and eat his meals on his own. Such decisions, while perhaps seemingly minor to some readers, underscored the many changes and sacrifices the couple would be making as they prepared to leave their longtime home. Thus, there were real tears and heart-wrenching moments as we worked together to identify the solution that would be optimal for both husband and wife.
Last, I identified a rental community that offered “swing apartments.” This meant that an independent living apartment was also licensed to handle assisted living residents needing standby assistance and some reasonable hands on care. There would be no need to hire a non-medical agency for the man’s wife, and he could remain independent. Another advantage was that if the father ever needed assisted living, they would not have to change apartments.
The only drawback was that this community did not have a nursing home. If one of them became sick, s/he would have to move. As this was the least expensive option, and they may never need a nursing home, I was obligated to show them this alternative.
Perhaps I have made an excessively complicated task sound easy. This is only because as a senior living advisor I have knowledge of the communities that have flexibility to deal with these issues and deliver good quality care in a preferred location. Let me help you and your loved ones too!
*Catered living is a description that is basically synonymous with assisted living where assistance with activities of daily living, meaning bathing, dressing, walking, eating, toileting, and transferring are provided.
**A Continuing Care Retirement Community (CCRC) is a long term care community that offers independent living, assisted living, and nursing home care on one campus. The resident moves from one level of care to another without having to leave the community since all levels of care are provided. Some CCRCs require an entrance fee upon admission. Others charge a fee for service. Some offer hybrids of the various contracts.
***A Life Care Contract generally means certain types of care are included in the CCRC’s contract for certain individuals. The monthly fee that is charged in addition to the entrance fee doesn’t increase as a result of a person moving from independent living to the nursing home or assisted living. You have to be reasonably healthy to be offered this sort of contract (called a Type A contract). There are some contracts that will offer a certain number of days in the assisted living or nursing home area, and are accompanied by an increase in monthly fees (called a Type B contract). Some places offer a fee for service (Type C).