As revealed by the 2020 Census, the American population aged 65-and-older grew by 34% over the past decade. No other age group saw such a significant increase. By 2050, the U.S. Census Bureau projects that 20 percent (83.7 million people) of our population will be over the age of 65.  Meanwhile, the nation's 90-and-older population nearly tripled to 1.9 million people between 1980 and 2010.  This number is expected to quadruple over the next four decades.

As we age, personal care support often becomes necessary. While access to this care is available in various, less-restrictive settings, most elderly Americans are familiar only with nursing home care. As the final destination along the care spectrum, many view nursing home placement as a death sentence. Fortunately, there are some excellent alternatives to nursing home placement once assistance with daily personal care is needed.

Home Care

The most common goal that we hear from our aging clients is the desire to remain in the home as long as possible. As the ability to live independently declines, a great way to extend time at home is via in-home personal care support. In metro Atlanta, unskilled home care typically costs $22 - $24/hour and must be purchased in blocks no less than four hours. For our clients who are able to qualify for the Community Care Services Program, Medicaid typically awards 20-30 hours/week. Here are some common examples of care available in one’s home:

• Bathing/Showering
• Bathroom activity (supporting continence)
• Grooming
• Dressing
• Feeding assistance
• Walking and transferring (ex: moving from bed to wheelchair)
• Communicating regularly with your larger healthcare team
• Activities and social engagement
• Grocery List Planning
• Running errands
• Social outings
• Medication reminders
• Meal Preparation
• Light Housekeeping

Home Health Care

Home health care is health care that is provided in-home by licensed medical professionals (registered and licensed practical nurses, occupational therapists, and physical therapists). This type of care is usually prescribed by a doctor as part of a senior’s care plan after an injury or hospitalization, but can also be part of a maintenance plan for someone with a chronic condition. These types of services include:

• Physical therapy
• Speech therapy
• Occupational therapy
• Wound care
• Catheter care
• Intravenous injections
• Medical tests
• Monitoring of health status

Independent Living Facilities

Independent living facilities can provide peace of mind to seniors who no longer feel comfortable living alone, as well as peace of mind for their families. These facilities are not designed to provide skilled medical care or even unskilled personal care support. Rather, the focus is providing convenience and an opportunity to live a more active and independent lifestyle. Most independent living facilities offer services like housekeeping, laundry, and meals. It is also common to find that an emergency call service is available in each unit. While residents are supposed to be independent upon admission, it is not uncommon for residents to eventually engage the assistance of a home care company for personal support services as a resident’s needs grow. In terms of the base rent, most independent living facilities will fall within $2500 to $5000/month. Neither Medicaid nor the VA will help with the rent in an independent living setting.

Assisted Living Facilities

Some seniors require assistance with day-to-day activities like getting dressed, showering, and using the restroom, but do not need medical assistance. For these residents who lack the ability to live independently, assisted living is a stellar option which provides both safety and an opportunity to enjoy socializing with other residents. For those who suffer from advanced dementia and pose a risk of wandering (along with greater personal care needs), many assisted living facilities offer Memory Care as an enhanced care option. These residents live in an area of the property which is protected with coded keypads which prevent wandering. Seniors who live in assisted living facilities pay rent based on their floorplan as well as a monthly charge for personal care support received. For residents that do not require memory care, assisted living rent usually falls within $3500 to $6500/month. Memory care assisted living rent is higher typically around $5000 to $7500/month. Georgia’s Medicaid program does not currently offer any assistance with assisted living rent. While this is true, those who are able to qualify for the Wartime Pension (Aid & Attendance) can receive financial support from the VA.

Personal Care Homes

Personal care homes provide unskilled personal care comparable to that offered in assisted living facilities, but just on a smaller scale. In Georgia, the state considers care facilities under twenty-five beds to be personal care homes and those with more to be assisted living facilities. In reality, most personal care homes have less than ten beds. While they are typically less fancy than assisted living facilities, personal care homes can offer a less expensive residential setting when the only other option is a nursing home. Moreover, a personal care home can be a better choice for residents with behavioral issues that call for a smaller, less chaotic environment. Most personal care homes fall in the $2000 - $4000/month range, but there are outliers both above and below these amounts. For our clients able to qualify for the Community Care Services Program, Medicaid can help to cover the rent.

Continuing Care Retirement Communities

Continuing Care Retirement Communities (CCRC) have become more and more popular over the past decade. Designed to be a single destination for seniors, they offer housing that extends across the care spectrum from independent living to assisted living to nursing home care all on the same campus. As time passes and needs grow, a resident can simply transition to the next level of care within the CCRC rather than move to another property. Unfortunately, these communities often require a large up-front deposit in addition to requiring ongoing rent that is comparable to rent charged in non-CCRC properties. These upscale communities are generally private pay, so there is no way to get help from Medicaid with the rent.

If you have questions about any of these options and how Medicaid or VA benefits might play a role in helping to afford them, you are welcome to call our office.