Guide: Senior living

March 10, 2010 

Older adults who need little or no help getting by from day to day are at one end of a spectrum of care. People who need help as they die are at the other.
In between are limitless combinations of places to live and means of getting help in the Triangle — some governmental and some private, some informal and some improvised.

Using governmental or private services, an older person may be able to stay at home if he or she gets help with food preparation, bathing or doctor’s visits.
When people move from being independent to needing more help, they immediately wonder about costs. It’s not good news for people in middle-income ranges. Medicaid will pay for services for those who are eligible because of low incomes. Otherwise, it’s an out-of-pocket expense — which can be a big hit to all but the wealthiest.

For people who need 24-hour supervision that can’t be provided at home, options include adult care homes, also known as assisted-living facilities, rest homes and family group homes. In some cases, Medicaid will pay for someone to stay in a facility when it won’t pay for the person to get help at home.

Nursing homes, with the highest level of medical care, are a step beyond adult care homes. An AARP study found that about 60 percent of Americans over 45 think that Medicare pays for nursing homes, which can total $70,000 annually. It doesn’t, except for limited stays under specific conditions.

At the farthest end of the spectrum is hospice care, which becomes an option for people who are likely to die within six months, whether they are in a nursing home, in a hospital bed or at home. The sooner patients enter hospice care, the more they and family members can benefit from its multidisciplinary approach, say experts in the field.

INDEPENDENT ADULTS

WHO THEY ARE:
Older or disabled people who can still drive or otherwise remain mobile. May have downsized after selling a home in which they raised their children. May need ramps or other renovations to home.

WHERE THEY LIVE:
Many still live in the community in homes not specifically meant for older people. Other options include:

Rental Retirement Communities:
Complexes for people over 62 offer rental apartments, a central dining area and some services for people 62 and older.
Example: Gardens at Wakefield Plantation, Wake Forest.
Cost: About $2,000 monthly, depending on level of services.

Continuing Care Retirement Communities:
Complexes in which residents start in independent living, but can move to assisted-living and nursing-home care on-site if needed
Examples: Springmoor, Raleigh.
Cost: Expensive, but varies based on whether resident rents, pays entrance fee, or buys a unit.
Here are details on cost at each community.

Information:
Phone: 733-5633, extension 249 or 250
Website

Subsidized/affordable housing:
Some housing for rental or sale is available to people below specified income levels.
Example: Capital Towers, North Raleigh
Cost: Based on income.
General information:
Resources for Seniors
Phone: 713-1556

Wake County Supportive Housing program
Phone: 231-5957

Downtown Housing Improvement Corporation (Wake County)
Phone: 981-0060
Availability: Waiting lists of as long as two years

SEMI-INDEPENDENT ADULTS

WHO THEY ARE:
People who need some support to meet basic needs. Can still live outside long-term care, but need help for physical or cognitive reasons. Have problems dealing with activities of daily life, including bathing, eating, dressing and going to the bathroom.

WHERE THEY LIVE: Still may live in private homes and many of the same settings as independent adults.

Emergency and Transitional Housing: Includes halfway houses
Example: The Women’s Center, Raleigh
Information:
Phone: 211 or 888-892-1162 from a cell phone.
Website

Adult Day Care: State-regulated organized settings in which adults are offered various activities. Helpful to caregivers who need a break.
Example: The Glade Adult Day Care Center, Cary
Costs: Vary, the Triangle has a mix of state-subsidized and private pay sites.
Information:
Division of Aging and Adult Services

North Carolina Adult Day Services Association

Adult Day Health: Similar to adult care, but offers health care as well.
Example: Central Orange Adult Day Health, Hillsborough
Information: See adult day care

In-Home Personal Care Services: Brings in help with bathing, eating or carrying out other activities of daily life, when need is based on a medical condition.
Example:
Association for Home & Hospice Care of North Carolina
Phone:848-3450

DEPENDENT ADULTS

WHO THEY ARE: People who need continuous support for basic needs. Cannot live day-to-day without 24-hour supervision. May have chronic diseases such as cancer or cognitive disorders such as Alzheimer’s disease.

WHERE THEY LIVE:

At Home: Some people with dementia or chronic diseases remain at home, but need high levels of care from relatives or paid professionals. Such care can be very expensive if provided on a 24-hour basis by home health agencies or nurses.

Adult Care Homes:
North Carolina’s umbrella term for what used to be called homes for the aged or rest homes. These include assisted-living facilities, which house seven people or more, and family group homes with two to six people. They require a doctor’s order for admission and provide room and board, 24-hour supervision and help with activities of daily life. They are not required to have a registered nurse on duty. Some have special units for people with Alzheimer's.
Cost: $1,800-$4,000 monthly, according to Resources for Seniors. North Carolina’s special assistance program pays for this level of care, but only for low-income people or those who have “spent down” their assets. Apply through county departments of social services.
Information:
Division of Health Service Regulation
Phone: 855-3765
Website

NC Assisted Living Association
Phone: 467-2486

North Carolina Association, Long Term Care Facilities
Phone: 787-3560

Continuing Care Retirement Communities: Also include levels of assisted-living and nursing-home care.

Nursing Homes:
People who are getting over surgery or who have chronic diseases can live in nursing homes, which require a doctor’s order for admission. At the skilled-nursing level, residents are supervised 24 hours a day by registered or licensed nurse. At the intermediate-care level, fewer hours of nursing care is available. Some nursing homes also have secure, locked units for Alzheimer’s patients.
Cost: $5,000 monthly, according to AARP. Medicare pays only for short-term recovery in nursing homes. Medicaid covers cost for low-income people or those who have “spent down” their assets.
Information:
Phone: 1-800-MEDICARE (63342273)
Website

North Carolina Health Care Facilities Association
Phone: 782-3827

Hospice:
Offers help by a team of volunteers and professionals for people with life-threatening illnesses and their families. Includes some residential beds, but also can be provided at home, in long-term care or in a hospital.
Cost: Varies widely based on type of service. Private insurance and Medicare often pay for hospice care.

INFORMATION:
Carolinas Center for Hospice and End of Life Care
Phone: 677-4100

Hospice of Wake County

Phone: 828-0890

Association for Home and Hospice Care of North Carolina
Phone: 848-3450

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