Housing options abound for seniors, and they come with pros and cons

For older adults, deciding where to live can be challenging and overwhelming. Each type of senior housing offers different pros and cons. Plus, recent headlines have highlighted financial struggles at some communities, painting a bleak picture of the options.

But quality choices abound — if you can put in some legwork to find them.

For help, consider working with a geriatric care manager (also called an aging life care professional), said Debra Whitman, the chief public policy officer at AARP.

In most cases, these social workers’ services will not be covered by Medicare or Medicaid and can cost $100 to $250 per hour (plus sometimes additional fees for the initial assessment and travel). But they’re often well worth it, Whitman said.

For her father-in-law, she found a geriatric care manager through a local social services organization. The social worker visited his home and assessed his physical and mental capacities. Afterward, the care manager recommended he relocate to a nearby assisted-living facility, predicting that it would ease his loneliness. He moved and spent his remaining days surrounded by friends and, eventually, a romantic partner.

Along with contacting a geriatric care manager, ask around for recommendations. Then visit facilities and ask a lot of questions.

Once you make a decision, read contracts closely to understand terms and fees and what they include, said Lisa McCracken, head of research and analytics at the National Investment Center for Seniors Housing and Care, a senior housing nonprofit known as NIC.

Here’s an overview of the main senior housing options, in order from least to most care and supervision.

Staying in your own home can be a “great comfort,” McCracken said. Along with privacy, familiarity, community, and control over your surroundings, you can phase in more support as needed. But aging in place can come with downsides.

“As you get older, sometimes your world gets smaller, and there’s a danger in not having the stimulation and the social connections that are built in when you reside in congregated settings,” McCracken said.

A home in a naturally occurring retirement community, like a building or neighborhood with a high concentration of seniors, can help. So can sharing space with a family member or a friend.

“There are more multigenerational households now than in the 1970s,” Whitman said.

People in senior living communities tend to live longer and avoid more hospitalizations, McCracken said, citing research NIC conducted with the University of Chicago. You can address this issue by moving to a one-story home or adapting your surroundings for aging in place.

The cost of aging in place can be prohibitive when you also factor in the expense of care, Molinsky said. Most people will have to bring in help, at least for a short time period, Whitman said. Those expenses can add up quickly. Nonmedical personal care services, like bathing, transportation and cooking, average more than $30 per hour, according to CareScout, a company that helps people find care facilities. In-home skilled medical care services are even pricier.

These older-adult communities can resemble suburban developments or even country clubs. Typically, they include basic services like housekeeping, lawn care, and meals, and sometimes feature activities and amenities like gyms and pools.

Whitman’s grandmother didn’t want to leave her farm in rural Washington state but could no longer drive. She ended up moving to an independent living community at 89. There, she thrived, playing poker with other widows on her floor and shopping for groceries at the store across the street. She remained at the facility until her death at 96.

However, there is a potential downside with independent living: the expense. Industry data suggests monthly costs average $3,000, which doesn’t include hands-on help with personal or health care tasks, according to the AARP Public Policy Institute.

But that is not always the case. The average monthly cost of assisted living is $6,000, according to CareScout. Some services cost extra. Whitman said one of her friends is paying $200,000 annually for their mother’s assisted living with memory care, as well as a surcharge for incontinence care.

Another issue is rules around functional eligibility, which concern the level of care a resident requires. This can change overnight, like after a resident falls or experiences a stroke. Some facilities may discharge residents who require a higher level of care, Whitman said. Others may allow residents to stay but add surcharges. Communities can vary broadly since regulations differ from state to state.

“Read contracts and go into them with your eyes wide open,” Whitman said. “You may think you are buying more than you are, then find out too late they won’t let you stay because your need for care is too high.”

These facilities provide 24-hour supervision and on-site skilled nursing and medical care, often for seniors with disabilities or serious health conditions like dementia. Other than rehabilitation facilities for short-term stays, nursing homes are the only senior housing category covered by Medicaid and are more regulated than independent or assisted living communities, Whitman said.

Each state has different requirements to qualify for Medicaid, but the general rule is seniors must be very low income with virtually no savings, she said. Without Medicaid, the average monthly cost of nursing homes is about $10,000, according to CareScout. For help sorting through the options, review the ratings published by Medicare.

But there are some drawbacks, like the lack of a guarantee that a certain type of housing is available when you need it.

“Maybe your husband just fell and needs to move to the nursing home, and they say, ‘Sorry, those beds are full,’” Whitman said. “That happens. Even if you think you’ve planned, it can come back to bite you.” In those cases, you might need to pay for in-home care services while you wait for a vacancy.

Another con is the substantial financial commitment.

“Often, you need to put a whole bunch of money down,” Whitman said. “Most people have to sell their house to finance the entry fee.”

This can range from the low six figures to $1 million-plus, depending on factors like the area, facility and unit size. If the community goes bankrupt, you could lose some or even all of your deposit, she said.