Part 5A: Independent and Assisted Living
By CarePatrol of Northern DE & South Chester County
Independent Living is not entirely what the name implies because you do get some services. These private-pay communities handle things like weekly housekeeping, meal preparation, activities, and property maintenance. Note that ADLs are not included on that list. If you do need help with some ADLs, you can bring them in home-aides. Some communities even have home aides on staff, which saves money by allowing you to use them in increments of 60, 30, or even 15 minutes as opposed to the 3-hour minimum that can mean $75 or so to a minimum per visit.
Seniors are doing their own thing in IL. The apartments are often beautifully appointed and spacious and there are lots of trips, outings, activities and other amenities. Cars are allowed for residents along with small pets (cats, dogs) provided you can care for them yourself and subject to size limits (important questions to ask). The best part is that these communities must attract you so they are in fierce competition for your business and that works to your benefit.
Often, IL communities allow for a smooth transition to increasing levels of assistance without physically moving the senior - aging in place. Staff are trained that when they come to work, they are entering the homes of the residents and need to act accordingly. Chef-prepared meals offer plenty of variety with outstanding quality and many communities specialize in particular programs or activities: an expansive art studio here, bocce courts over there. It pays to look around.
Ironically, many seniors say they're "not ready" to move to an "Old Folks Home" or "be around a bunch of old people" but the fact is that making the move often allows seniors to thrive. Their quality of life often improves since they are safer, have fewer worries, are more socially connected and are more easily, and effectively monitored medically than they would be living at home. Organized games, events, outings, activities, therapies & exercise and more enables residents to make new friends and consistently be healthier physically, mentally, emotionally, and spiritually. It can be a virtual rebirth.
A few IL communities are standalone, meaning you would have to move if your care needs became too great, but most are part of a larger community that includes AL and possibly Memory Care sections. Some even have all levels of care right on their campus: Independent, Assisted, Memory Care, and a Skilled Nursing unit.
There is an oh-so-true adage in the LTCC business:
“No one moves to AL because they want to; they move because they have to.”
Whether needing help with ADLs or medical care needs, AL is not a place any of us wish to end up - except when we compare it to nearly all of the alternatives. That is not to suggest that AL’s are any less nice or less welcoming or less active than IL communities. AL is a broad term that covers a wide swath of conditions and situations between living independently and needing a SNF.
AL communities become the choice when a senior needs more assistance than an IL community can provide. Who determines that? Medical professionals. Prior to move-in (and periodically afterwards), the Director of Nursing at the LTCC will do an assessment that includes a separate doctor’s assessment of medical care needs and a detailed in-person interview with the potential resident that includes questions and observations concerning their ADL needs. In many states, a point system is used to assign the level of care.
Some communities offer a base rent and add services a la carte. Most assess and assign the level of care and charge more (or less) as certain thresholds are crossed. Those models are designed to allow for aging in place. Palliative and even hospice care can be brought in when needed. Only when medical needs exceed the community’s capabilities is a SNF considered.
In the living quarters, the biggest differences between IL and AL is probably the kitchen. Many AL communities restrict what appliances are allowed. The stove may be removed entirely while microwaves and induction cook top units are allowed. For those seniors in AL who love and miss cooking, there are communities that encourage residents to submit recipes and be involved by supervising or even assisting the chef as he or she prepares the dish.
AL communities have more staff and higher level medical professionals than IL communities. They will manage medications and often have several house doctors (PCP, Podiatrist, dentist, etc.) who visit periodically. While a senior may keep their own PCP, switching to the house doctor means doctor’s appointments are done right where they live - even in their own rooms in many cases.
Although ALs strongly encourage and facilitate socialization, seniors are free to not participate. In most communities there is an Activities Director who solicits ideas and suggestions from the residents. Some seniors in AL may be less mobile than they would like but that doesn’t mean they don’t enjoy and benefit from activities, outings, clubs and simple acts of socializing like enjoying a meal with friends.
ALs are private pay but depending on the state you live in, there may be the possibility of Medicaid paying for some or all of your monthly cost. Like IL, communities must compete for your business so if you don’t like living there, you can move to another AL.
Refusal to move to AL when the need is clear can have terrible consequences for the senior and their family. A broken hip or head injury can eliminate all choice. They will be sent to the nursing home that can handle their care needs and has an open bed, period. Those events are less likely to happen in a LTCC and if/when they do happen, help will be there sooner, perhaps much sooner, and that can make a world of difference.
Next: LTCC options - Memory Care and Skilled Nursing.