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When Staying At Home Is No Longer An Option – Make sure you plan the right move

Contributor: Audrey Miller MSW, RSW, CCRC, CCLCP

Let’s face it, most people don’t like to move, and for older individuals it can be even harder to leave the family home and move into a more supported environment. From leaving a lifetime of memories to the overwhelming thought of emptying cupboards, basements and bedrooms, it can be a decision that gets put off until it becomes an urgent necessity.

Where possible, I would advise seniors to consider and plan a move while they are well enough to adjust to a new setting. Without this kind of planning, a move can be necessitated by other factors such as difficulty managing ongoing home maintenance, the death of a spouse, mobility issues, or the overall determination that ‘the home is no longer safe' as a primary living environment.

Regardless of how the decision is made, once a move has been deemed necessary, it’s important to be aware of and consider all factors of the options available. Most of us have negative images in our heads of "old folks’ homes" – but may not be aware that there are several potential options available in today’s marketplace. These include: condominiums, life lease apartments, senior’s apartment buildings, supportive housing, retirement residences, and long term care facilities.

The environment that’s chosen should be the one that will best foster health and happiness while providing for both current and future care needs.

I’m often asked by seniors and their families to help them understand the differences between retirement settings and long term care facilities and how to choose the best one.

My advice is to start by considering The 3 ‘C’sTM:

My first ‘C’: CARE

  • What amount and type of care does the person require?
  • What is the medical condition and is it chronic, temporary, progressive or palliative?
  • How is the condition being treated medically and what course of treatment and outcome can be expected?
  • Will the care needs increase over time?
TIP – Don’t forget to consider future care needs: So often when families don’t plan ahead a move is made based on immediate requirements rather than an assessment of what needs will be tomorrow. Many retirement residences are not equipped to deal with complex medical needs from either a physical or cognitive perspective. Make sure that when you are thinking about care to think beyond immediate needs and towards what the likely need will be in one, two or five years.

My second ‘C’: COST

  • What is the cost of hiring care?
  • What will be the total monthly cost?
  • Do you know all of your current monthly costs? Remember that food and lodging are usually included in the retirement residence cost while care is often available on an incremental cost basis.
  • What is the cost of the care component by itself? Consider costs for nursing, the services of a personal support worker, other therapies, medication monitoring and administration, and any special equipment that may be needed.
TIP – Make sure you know all the costs. Fully document all current monthly expenses so that costs can be compared in a meaningful way with other options being considered.

My third ‘C’: CHOICE

  • Is there a preferred geographic location?
  • How important is it to be close to family, friends, religious organization, doctors?
  • How important is it to be close to public transportation?
  • Are pets welcome?
  • Are there other personal preferences that should be considered, such as special diets or a sense of religious or cultural community?
  • What amenities are available?

TIP – Don’t make a hasty decision: The expression ‘don’t judge a book by its cover’ holds true for retirement and long term care settings as well. Care, staff and service are often more important than new walls or furnishings. Take time to talk to other families about their experience.

Once a few places have been selected, I always encourage families to tour, ask questions, have a meal (most will happily invite you for lunch) and spend a little time at a community event that the facility is hosting. Trial stays for a few weeks or a month are also an excellent way to try before you buy.

Now let’s look at the benefits and drawbacks of the various potential living options.

Purchasing or renting a condominium might be a good fit for someone who wants to maintain complete independence but is finding the outside maintenance of their home to be a challenge. Most don’t offer any added services, but many have a door person or concierge who can provide some level of security and assistance. These buildings can also allow the senior to stay in a community with people of varying ages. Seniors living in condominiums still need to prepare their own meals and take care of their own household chores. Perhaps the largest drawback to this option is that it is likely that a senior may have to move again if their care needs increase, unless there is space and interest in hiring private home support assistance and/or a live in caregiver.

Life Lease Apartment
A life lease apartment is much like a condo – but includes access to all the services of the retirement home. These facilities may be within a retirement residence or a separate facility. The benefit to these types of apartments is that the resident maintains a bit of home equity –they own their apartment and when they pass away, the money from the sale of the apartment will act as an inheritance or be available to pay off any remaining debt. If a retirement residence has life lease suites along with apartments, assisted living programs and long term care, the senior could move once and not need to move to another facility in the future. Rather, they would move within the facility as the need arose for higher levels of care.

Senior’s Apartment Building
A senior’s apartment building is a rental option for seniors who, much like those who opt for a condominium, find outside maintenance of their homes to be difficult to manage but in every other way would like to maintain complete independence. These apartment buildings have an age requirement and do not allow children or younger families to rent. Seniors who chose a facility like this to call home may find that they meet more people who share similar interests and activities. Like the condominium, however, the largest drawback to this type of facility is the potential need to move again to a residential option with a higher level of care, when health begins to decline and the need for assistance with tasks of daily living increase (unless there is space and interest in hiring private home support assistance and/or a live in caregiver).

Supportive Housing
Supportive housing provides affordable housing designed to help seniors re-establish connections to the community. The housing is linked to voluntary and flexible support services designed to meet the senior's needs and preferences. It is designed for people who only need minimal to moderate care, such as homemaking or personal care and support, to live independently. The level of support may vary, and some support services are provided by on-site staff, while in other instances may be delivered on an outreach basis. This may include adult day programs or medical/physiotherapy clinics coming into the apartment building. Staff working in these facilities try to help seniors in their building get linked into other services offered out in their community, such as senior’s centres. These staff, however are not medically trained. Some are Personal Support Workers, while others have certifications in recreation planning. In many facilities, no one is on staff during the night in case of emergency. Supportive housing buildings are owned and operated by municipal governments or non-profit groups including faith groups, seniors' organizations, service clubs, and cultural groups. Accommodations, on-site services, costs, and the availability of government subsidies vary with each building. 

Accommodation costs are often based on market rent for similar apartments. Seniors wishing to live in this environment need not have a certain income level however subsidies may be available for seniors with limited financial means.

Retirement Residence
A retirement residence is another preferred option. Many are geared to modestly healthy and independent seniors. These rental facilities can range in price and service delivery. They typically offer dining room settings with a selection of meals provided, exercise rooms, supervised outings and bus services. Monthly rates may also include housekeeping, linen change and laundry. Some may also have medication monitoring and emergency response units, included in the monthly rate. Alternately, medication monitoring, as well as others services may be available à la carte. Units can range from bachelor to one or two bedrooms with some having kitchenettes that may allow residents to opt out of the meal program. Retirement residences have the benefit of having staff (typically Personal Support Workers) available to residents as well as nursing and recreation planning staff. This provides the senior and their family a feeling of security in knowing that there is always someone close by in case of emergency. These facilities often become a community unto themselves, with meals offered and activities and events pre-organized by the staff. Many even have visiting physicians and other health practitioners, and can arrange for medications to be delivered right to the resident’s door. 

Within many retirement communities varying levels of assistance for personal care are available and can be purchased as needed for an additional fee. Additional levels of care may be referred to as ‘assisted living’ which includes some hands on assistance from a Personal Support Worker for bathing and/or dressing and may include medication monitoring. If the individual requires more assistance during the day and evening, or is dealing with significant cognitive issues that result in the need for full time supervision (or a secured floor), some facilities may be able to accommodate while others would deem the senior ready to move to long term care or to require extra help from private service providers. 

One of the major drawbacks to moving to a retirement setting is the need to adjust to a communal setting. In these facilities there is a set menu, a set meal time and bus trips and outings are set according to a pre planned schedule. Discussing what to expect and arranging tours of potential residences will help make the decision as to whether the facility will be the right fit. Some locations will offer trial stays so that seniors can see what daily life will be like, get to taste the food and meet other people who live there. Respite and convalescent care is also offered in many retirement residences and may be another good way to introduce an alternate setting.

Long Term Care Facility
A long term care facility is available for those who require more assistance than what is offered by a retirement residence. These facilities are funded by the government so that no person who requires this level of care will be turned away for lack of funds. 

These facilities have 24 hour nursing care with residents receiving help with all activities of daily living (including eating, dressing, bathing and grooming), and also have provision for laundry and housekeeping. 

When staying at home is no longer ideal, consider the wide range of options that are available, and whatever option you end up choosing, in order to ensure you make an informed choice, it’s always a good idea to book a tour of each facility, enjoy a lunch or dinner and speak with other residents and family members prior to making any decisions.  

And remember, home is where you hang your hat, whether it’s the family home of 50 years or your new suite at a retirement residence.

Audrey Miller MSW, RSW, CCRC, CCLCP is the founder and managing director of Elder Caring Inc., a national consulting company dedicated to delivering comprehensive health and wellness solutions to Canadian families with elder care and health concerns. As a Registered Social Worker, a Canadian Certified Rehabilitation Counsellor, and a Canadian Certified Life Care Planner, Audrey counsels families, employers, financial institutions, law firms and insurance companies on aging issues. Learn more at

Royal Bank of Canada and its subsidiaries are not responsible for products or services, advice or information provided to you by Elder Caring Inc. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by Royal Bank of Canada or any of its subsidiaries.

Topics: Senior care | Caregiving

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