Whether retirement is just around the corner, or that landmark passed years before, there are lots of options for senior citizens who are trying to decide where to live. Even people whose health is failing may not be as limited in their options as they or their families believe.
"The average individual doesn't know all the different services that are available," said Brooks Major, executive director of Keswick, a comprehensive care nursing facility which also offers independent living, assisted living and adult day care.
"People think that they either have to keep their elderly family members at home and devote their lives to their care, or put them into an institution," Mr. Major said. "But there is an in-between. Many people are not using the least intensive level of care they need. People are going into nursing homes who don't need to be there."
To help people determine what their needs are and how those needs can best be met, Keswick offers a geriatric evaluation service for $150. A medical team conducts the evaluation and then refers the patient to a facility that offers appropriate services.
There are assistance programs ranging from adult day care to home health care which help people to stay in their own or a family member's home as long as possible. Adult day care at Keswick costs $53 per day including transportation, Mr. Major said.
Home health care can cost from from $6 to $13 an hour for a health aide, and $14 to $35 an hour for an LPN or an RN, according to Beverly Erdman, a registered nurse who works in the home care field. Such care may cost as much as a nursing home, but may be affordable when a patient only needs a health professional a few hours or one shift daily, she added. Family members provide care the rest of the day.
Mrs. Erdman also is the owner of Helping Hands Health Care Professionals, a consulting firm which evaluates patients to determine whether it is safe for them to live at home. She then works with the family to develop a plan for keeping the person at home and, when necessary, assists in nursing home placement.
When independence as well as help are desired, senior-assisted housing, group homes or retirement communities may be the answer.
"Baltimore had the first senior-assisted housing program in the country," said Ilene Rosenthal, chief of housing and continuing care for the Maryland Office on Aging. "The program combines housing with services, addressing the needs of seniors who are between independent living and a nursing home. Senior-assisted housing projects provide meals, housekeeping and personal services to help delay or eliminate the need for nursing home care."
Call the Office on Aging at 225-1100 for information about the 46 senior-assisted housing units in the state which were established to meet the needs of people in low and moderate income brackets.
For people with considerable equity in a home -- in addition to income from pensions, social security, savings and investments -- continuing care retirement communities offer not only independence and services, but also the promise of a continuum of future health care.
Barbara Coleman White is an independent Baltimore consultant who helps seniors to make decisions about housing and then assists them with the details of moving and settling into their new living quarters.
"These are the most difficult decisions that people have to make," Mrs. White said. "I can help them to objectively think about what their options are and how they would like to approach the problems."
Continuing Care Retirement Communities
Charlestown is the second largest continuing care retirement community in the country. Open since 1983, it has been expanded three times and now has 985 apartments on its grounds in Catonsville, where seniors can live independently. When more supervision is needed, there are assisted living apartments as well as a nursing home for those who require full-time care.
"We make life care affordable," said Michael Erickson, director of marketing. Entrance fees range from $56,000 to $93,000 and are 100 percent refundable when an apartment is rented again. Monthly fees of $684 to $1,323 cover the cost of the apartment as well as utilities, some activities and one meal per day, but not health care or housekeeping.
"Most people are not interested in making huge capitaexpenditures to get into continuing care," said John Erickson, president and founder of Charlestown. "People can transfer their home equity to us and still give it to their kids when they move or die."
Charlestown is what is known as a "fee for service" facility, where residents pay for services, including nursing, as they use them.
Broadmead, on the other hand is a "life care" community with an extensive contract, where all services are included in the entrance and monthly fees -- right down to the handling of insurance claims. Entrance fees are between $52,000 and $145,000, with monthly fees from $1,220 to $2,684.