Seniors and people with disabilities often need supportive living options. When the time comes to start considering your options for assisted living, it’s easy to become overwhelmed by the sheer number of housing options. Not only are there different categories of assisted living to choose from, there are also a plethora of homes from which to choose. The right choice depends on a number of factors, including support needs, expense, and personal preference.
Once a home is chosen, there’s still a significant barrier to overcome: figuring out how to pay for it. There are a number of different options, but it’s important to choose the option that will allow for comfortable living now, while also ensuring your resources aren’t used up too quickly.
This guide helps those searching for assisted living homes overcome the two main barriers: choosing a home and figuring out how to pay for it. In this guide, you will learn about the different types of assisted living homes, how to choose the right home for you, how to pay for that home, and state-specific resources to assist you in your search.
Care Options for Seniors and People With Disabilities
There are three levels of assisted living: assisted living communities, independent living communities, and home care. Home care brings assistance with daily living to the home, independent living offers a community with convenient amenities, and assisted living combines a community that offers convenient amenities with support for daily living tasks.
Assisted living is a residential community for people who need help with everyday activities, such as bathing and dressing. Since residents usually live in their own private or semi-private apartments, these communities are able to offer a supportive atmosphere that is still independent. Residents can typically tailor the support services to match their needs, so they can perform more of less of their own daily tasks according to their current abilities.
Who it’s for: Assisted living communities are a good choice for seniors and people with physical disabilities who need help with tasks such as bathing, dressing, eating, taking medications, and using the restroom.
Who it’s not for: Assisted living is not a good choice for people who are still able to live independently, as the unneeded services may result in a higher cost than independent living facilities. However, it can still be a good choice for those who are mostly independent now, but will need support for daily living in the not-too-distant future, since many have programs and services designed to help seniors transition from a low level of care to a more comprehensive care plan.
What’s available: Assisted living communities are similar to independent living communities, with services including meals, transportation, and social activities. However, assisted living communities also have support services for activities of daily life, including hygiene, fall prevention, and housekeeping. Often, assisted living communities provide additional medical care as residents’ needs increase as they age. Some contract with local health care providers that can come in to offer medical care as needs increase.
What it costs: According to the Genworth 2017 Cost of Care Survey, you can expect assisted living to cost about $3,750 per month.
Independent living offers a home or apartment in a community designed for seniors and people with disabilities. Residents live in private apartments or homes with access to common areas. It offers convenience and a low-maintenance lifestyle, but does not have the same level of support as assisted living.
Who it’s for: Typically, people who choose independent living are able to live on their own, but prefer the convenience of having services available to minimize their daily tasks. Independent living is a good choice for seniors and people with disabilities who do not need assistance with daily living and want to join a community with social and entertainment opportunities.
Who it’s not for: Since independent living does not offer full time health care or help with daily living activities such as bathing, dressing, eating, or taking medication, it’s not a good choice for people who need these support services, or those who may need them in the near future.
What’s available: In an independent living community, residents get convenient access to services that are designed to minimize daily responsibilities, such as laundry, housekeeping, on-site dining, transportation, and security. Activities, events, and entertainment are typically available with the community. Amenities may include on-site gyms, beauty salons, and pools. Some have periodic access to medical care, but independent living communities typically do not have full time staff dedicated to medical care.
What it costs: The cost of independent living is typically either similar to, or slightly more than, the local cost of similar housing options, such as an apartment or townhome that’s not in an independent living community. Generally, independent living costs between $1,500 to $3,500 a month for a one-bedroom apartment.
Home care is in-home personal and medical support for people with disabilities or who are otherwise unable to manage the tasks of daily life. With home care, individuals can age in place in a private, comfortable environment with which they are familiar. While this type of assisted living offers independence and the ability to control schedules and routines, it may be cost prohibitive, and care may not be available around the clock.
Who it’s for: Home care is a good option for seniors or people with disabilities who have been recently hospitalized and are healing at home. This service can help these individuals transition back to independence. Home care can also be a good choice for individuals who have experienced a decline in function and are unable to manage the tasks of daily life independently, but prefer to stay at home.
Who it’s not for: Home care is not optimal for those who need care around the clock. It’s also not a great long-term option for those without significant income or savings.
What’s available: Home care services include both personal and medical support. The personal services offered typically include hygiene, home chores, and other assistance, such as:
- Getting dressed
- Appointment escorting
- Meal preparation and delivery
- Fall prevention (including assistance in moving)
Those who need medical care typically have access to services such as:
- Wound care
- Injections or administration of important medications
- Managing illness and chronic conditions
- Monitoring vitals such as blood pressure, temperature, heart rate, and breathing
- Assistance with taking the correct medications on time
What it costs: According to the Genworth 2017 Cost of Care Survey, homemaker services cost about $3,994 per month, and a home health aide costs about $4,099 monthly.
Financial Support Options
Long-term care can be expensive, and cost is one the main challenges to overcome. Although some families are able to pay out of pocket for residential and care expenses, many are not able to afford it on their own. For those individuals, there are financial support options including Medicare, Medicaid, Social Security and HUD programs.
Medicaid offers health coverage for some low-income families, including the elderly and people with disabilities. You may qualify for Medicaid based on your income and family size.
Although state Medicaid programs vary, residents with Medicaid will have at least some assisted living costs covered in most states. Some states use different terms to refer to assisted living coverage, such as residential care, adult foster care, personal care homes, or supported living. Home health services are one of the mandatory benefits available for those with Medicaid.
Coverage varies depending on the state, and may include medication administration, chores, homemaker services, and recreational activities. Medicaid does not pay for room and board in any state. However, it may cover meal preparation and serving, just not the cost of food itself.
Medicare is a national health insurance program generally available to seniors 65 and older, or younger people with disabilities or permanent kidney failure requiring dialysis or a transplant.
Home health services are typically covered by Medicare for those who are eligible. To become eligible, a doctor must certify that you are homebound, or that you need intermittent skilled nursing care, specific physical therapy, speech-language pathology, or continued occupational therapy services.
Medicare does not cover long term care such as assisted living, 24-hour care, meal deliveries, homemaker services like laundry, or personal care like bathing or dressing.
Social Security offers financial benefits for people who are disabled, or those who are 62 or older. Along with retirement income for seniors, Social Security provides two other means of financial support. The first is Supplemental Security Income (SSI), which is available for people with limited income and assets. The second program provides state-based benefits that can offer financial support for assisted living. This program is either called Optional State Supplements (OSS) or State Supplementary Payments.
People who are financially eligible can get assistance paying for room and board at an assisted living facility using OSS. This is in addition to Social Security Income payments and is paid directly to the community. The amount of OSS given to the resident is based on his or her income and can range from a few dollars to nearly $1,000 per month depending on income and state policies.
Some states cap the amount assisted living communities that accept Medicaid can charge for room and board. This limit is usually equivalent to the federal Social Security Income benefit, or the Social Security Income benefit plus the OSS payment.
The U.S. Department of Housing and Urban Development, commonly known as HUD, offers a number of programs designed to help seniors and disabled individuals with housing expenses. These programs offer rent subsidies, income-based housing, vouchers, and homeownership opportunities.
Programs typically have high demand, and applicants may face long waiting periods of two years or more. If you’re interested in a HUD program, it’s a good idea to start the application process as early as possible.
Subsidized housing programs
Subsidized housing programs offer income-based housing that’s designed to be affordable. Some programs offer rent assistance in facilities that offer support and activities for seniors and people with disabilities. HUD offers a state-based inventory of units for the elderly and persons with disabilities, which you can use to identify facilities that offer subsidized housing.
Under the Section 202 program, HUD finances the development of supportive housing for the elderly. These facilities offer residential options with support activities including cleaning, cooking, and transportation. The program includes rental assistance funds, which are designed to make up the difference between HUD-approved operating costs and tenant rent contributions. Section 202 occupancy is available for very low-income households with at least one member who is 62 years of age or older.
The section 811 program is similar to the Section 202 program, offering funding for the development and subsidizing of rental housing with support services for very low-income adults with disabilities. Like Section 202, Section 811 provides funding for development of supportive housing as well as rental assistance. Residents typically pay 30 percent of adjusted income.
HUD public housing offers rental housing to eligible low-income families, the elderly, and people with disabilities. Rent in public housing is limited to the highest of 30 percent of monthly adjusted income, 10 percent of monthly income, welfare rent (if applicable), or a minimum rent of $25 to $50 which is set by a local housing agency. Under HUD regulations, housing agencies can exclude $400 of income for elderly families or a person with a disability, as well as some medical deductions for families whose head of household is an elderly person or a person with disabilities.
HUD’s housing choice voucher program helps elderly, disabled, and very low-income families pay for private-market housing. Eligibility is typically limited to those with a household income of 50 percent or less than the median income for the county or metropolitan area in which they live. Housing voucher recipients can use their benefits to find housing, such as assisted living, and are not limited to living in subsidized housing projects. Housing choice vouchers are available locally through public housing agencies, known as PHAs, which receive federal funds to administer the program. The PHA pays housing subsidies directly to landlords on behalf of the individual or family.
Reverse mortgages are an option for seniors who have equity in their homes. With a reverse mortgage, senior homeowners are able to draw on home equity to pay for living expenses such as home health care. HUD’s Home Equity Conversion Mortgages, also known as HECMs, are reverse mortgages insured by the federal government available through Federal Housing Administration approved lenders.
First-time home buyers can get help with monthly mortgage and homeownership expenses from the Homeownership Voucher Program. This program can reduce the total monthly payment to 30 percent of the family’s adjusted monthly income. There are certain eligibility requirements, including employment. However, employment is not required for elderly or disabled families.
State Support Resources
District of Columbia
- Illinois Department of Healthcare and Family Services (Medicaid) (217-782-2570)
- Home and Community-Based Services Waiver
- Montana DPHHS (Medicaid) (800) 362-8312
- Big Sky Waiver Program
- Community First Choice/Personal Assistance Services
- New Hampshire Department of Health and Human Services (Medicaid) (603) 271-4334
- Choices for Independence
- Elderly and Disabled Waiver