making decisions
In 2017, baby boomers are between ages 53 and 71. Other key findings reported by the Population Reference Guide are:
  • The number of Americans ages 65 and older is projected to more than double from 46 million today to over 98 million by 2060, and the 65-and-older age group’s share of the total population will rise to nearly 24 percent from 15 percent.
  • The aging of the baby boom generation could fuel a 75 percent increase in the number of Americans ages 65 and older requiring nursing home care, to about 2.3 million in 2030 from 1.3 million in 2010.
  • More than one-fourth (27 percent) of women ages 65 to 74 lived alone in 2014, and this share jumps to 42 percent among women ages 75 to 84, and to 56 percent among women ages 85 and older.
  • Demand for elder care will also be fueled by a steep rise in the number of Americans living with Alzheimer’s disease, which could nearly triple by 2050 to 14 million, from 5 million in 2013.

tough decisions– Staying at home or moving to a facility? According to the Family Caregiving Alliance, every year 34 million family caregivers provide $44 billion in unpaid care-giving. Most caregivers are adult daughters and they generally spend about 20 hours each week caring for their senior loved ones. The average monthly costs for Homemaker services in 2016 was $3,613 and for Home Health Aide services was $3,623. Family caregivers report that the physical and emotional demands of care-giving causes a variety of health conditions in addition to lost earnings/wages/benefits, which can exceed $659,139 in a lifetime. An article accessed on in September 2017 states, “When a senior needs 30 – 40 hours of combined support each week, home care can be a viable short-term solution. When the amount of care exceeds 30-40 hours per week, a senior living community may become a safer, more cost-effective solution.”

creating a safe elderly home

common modificationsestimated costs
Monthly monitoring fees (home systems that track a senior’s every move) $40+
Smart home technology installation $99 – $1500
Grab bars (2 installed) $250
Door widening $800 – $1200 each
Ramps & lifts $2,500- $20,000
Stair glide $3,000 – $12,000
Bathroom renovations $3,500 – $35,000
Accessible master suite addition $35,000 – $100,000
facility types
The main difference between assisted living facilities and nursing homes is the level of care a resident receives and the extent of independence the resident is capable of maintaining. Today, skilled nursing home facilities transition to providing hospital-like services, while assisted living facilities transition to offering nursing home-like services. In the past, it was nursing homes that offered skilled nursing services like wound care, hospice, and rehabilitation. But today, assisted living facilities compete with hospitals and nursing homes. A stay in a skilled nursing facility is usually temporary in nature and is focused on rehabilitation that is intended to prepare the resident to return to their independent homes. Assisted living services are typically long-term facilities, providing assistance with bathing, dressing, grooming, medications, and meal preparation.
assisted living facilities(ALFs) In general, assisted living is an independent option offering protection that includes personal care and support services, if and when needed. Support services may include; fundamental activities of daily living like bathing, grooming, dressing, and going to the toilet. Since each state and not the federal government regulate assisted living facilities, a few states allow medication assistance and reminders. The living quarters of ALFs range from standalone apartments, cottages, studios, or large shared one or two bedroom apartments. It’s more home-like and may offer a kitchenette. Assisted living residents may still drive, cook their meals, come and go freely, have the security of medical supervision, and interact socially with other residents. Nursing home residents generally do not have these options. As the population continues to age and live longer with chronic conditions, some ALFs are gravitating towards offering more complex medical services for chronic or terminal illnesses.
Services Meals, housekeeping services, transportation, health promotion and exercise programs, personal laundry services, planned social interactions and recreational activities may be included. ALFs may also provide access to healthcare services such as emergency monitoring/call systems, bathing, dressing, medication management, assistance with eating and going to the toilet.
Payment ALFs are not covered by health insurance, Medicare or Medicaid. Long-term care insurance may pay for assisted living care, but most people pay out-of-pocket. Costs vary depending on the level of care and services provided.
nursing homes(Skilled Nursing Facilities – SNFs) A nursing home is a place of residence for persons requiring constant nursing care and ongoing medical supervision. Residents are unable to live alone or independently and are treated more like patients in hospitals. They are physically or mentally powerless to leave on their own and and generally experiencing substantial deficiencies with activities of daily living.
Services Major assistance with medical care, personal care, meals, housekeeping and minimal social activities are included. SNFs provide 24-hour skilled nursing care and medical supervision for the more acute (critically ill) patients that are one step below hospital acute care.
Payment SNFs are covered by out-of-pocket private pay, private health insurance or long-term care insurance policies. Medicare or Medicaid may also pay for SNFs under specific circumstances. Cost depends on the level of care and services offered.
home health careHome health care (HHC) is a wide range of health care services that are provided in the patient’s home after an illness or injury. HHC is usually less expensive, more convenient, and may be just as effective as care received in a hospital or SNF. Many families find that utilizing HHC staff is a viable option to address clinical and rehabilitative needs after hospitalization. A HHC aide may also help with personal care-giving and household chores requiring assistance during the patient’s recovery.

care comparison

Services Typically OfferedAssisted LivingNursing HomeHome HealthHome Care
Nursing / Extensive Medical Care
Resident Freedom & Transportation
Medicare Parts A & B coverage
Therapy towards rehabilitation
Administer Medication
Perform Medical Tests
Formally monitor health status
Skilled nursing
Pain management
Wound care
IV Therapy / Injections
Prescription medication management
Reminders to take medicine
Meal preparation / delivery
House cleaning
Bathing, Dressing, Grooming
Incontinence care
Toileting help
Assisted LivingNursing Home
Insurance Coverage Neither Medicare Parts A nor B offer coverage for comprehensive ongoing long-term care. Many states cover some assisted living services under their Medicaid programs; however, these fluctuate widely in terms of eligibility requirements and dollar amounts of coverage. Medicare covers nursing home services for up to 100 days for beneficiaries who require skilled nursing care or rehabilitation services following a hospitalization of at least 3 consecutive days.
Cost Average $3,628 U.S. monthly median for Private one bedroom in 2016 (Texas median is $3,515)

Source – Genworth 2016 Cost of Care Survey, conducted by CareScout®, April 2016
$6,844 U.S. monthly median for 2016 for Semi-private room; Private is $7,698 (Texas median is $4,502 and $5,931)

Source -Genworth 2016 Cost of Care Survey, conducted by CareScout®, April 2016
ADL – activities of daily livingare the tasks a person must be able to do unassisted in order to live independently. The core activities include bathing, dressing, eating, using the bathroom, “transferring” (getting out of bed or up from a chair, etc) and walking.
assisted livingAn assisted living residence is a long-term senior care option that provides personal care support services such as meals, medication management, bathing, dressing and transportation.
type A facilityType A facilities may care for residents who are physically and mentally capable of evacuating the facility unassisted, do not require routine attendance during sleeping hours, and are capable of following directions in an emergency.
type B facilityType B facilities may care for residents who require staff assistance to evacuate, are incapable of following directions under emergency conditions, require staff attendance during nighttime sleeping hours, and require assistance transferring to and from a wheelchair.
type C facilityA Type C facility is a four-bed facility that meets minimum standards for enrollment with DADS as an adult foster care facility.
CAN – certified nurse aideprovides assistance with activities of daily living
RN – registered nurseusually hold an associate degree or a bachelor’s degree in nursing, has passed an exam given by the National Council of State Boards of Nursing and also has satisfied all of the state’s licensing requirements.
CCRCs – continuing care retirement communitiesare similar to assisted-living facilities. They offer a “tiered approach” to the changing needs of aging. For example, a married retired couple may move into a single-family home or apartment within the community. If one spouse passes away or develops serious health issues, that spouse can transition to an assisted-living or nursing-care facility in the same complex. This option provides the peace of mind of knowing that, as long as it’s financially feasible, senior citizens will receive the care they need for the duration of their lives.
personal care servicesInclude assistance with services of activities such as eating, dressing, transferring from a sitting or laying position to standing, bathing, other personal needs or maintenance; general supervision or oversight of the physical and mental well-being of a person who needs assistance to maintain a private and independent residence; or oversight of a person who needs assistance to manage his or her own personal life, regardless of whether a guardian has been appointed for the person.
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