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
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
The environment that’s chosen should be the one that will best
foster health and happiness while providing for both current and future
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?
– 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
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.
– 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
- 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
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.
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
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
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
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 www.eldercaring.ca.
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