In increasing numbers, baby boomers are becoming sandwiched between caring for their aging relatives and becoming grandparents themselves.
To ease the burden of everyone involved, many elderly people are making the move to an independent living facility.
Generally, such a facility allows residents to live on their own in an apartment-type unit while still having 24-hour assistance with daily tasks.
Services vary from place to place, but residents of assisted living facilities usually require help with at least one daily activity, such as dressing, eating, transportation, general movement or keeping track of their medicines.
"In the past, these facilities were thought of as nursing homes," said Ray Landis, advocacy manager for AARP in Harrisburg. Now, elderly people are choosing long-term care as consumers who want to be as independent for as long as possible.
"I think it's a national trend," he said.
A 2006 census update estimates that 22 percent of the Allegheny County population is older than 60 and, when compared with figures in 2000, the county has about 6,000 more seniors who are older than 85.
A forecast by the University of Pittsburgh Center for Social and Urban Research predicts that the number of people ages 65 to 84 will increase from 170,000 in 2012 to about 200,000 in 2020. Those numbers will continually increase. The number of those 85 and older will stay at about 190,000.
In Allegheny County, assisted living facilities are having no problems filling beds. Many have waiting lists, making it difficult for those who need a place quickly.
The average age of entry for many communities is 88 to 90, much older than 10 years ago when the average age was from the late 70s to mid-80s. That's because of improved home care and medications, said Jim Pieffer, senior vice president at Presbyterian Senior Care.
At the Presbyterian Senior Care facilities offering assisted living arrangements, the average waiting list is 60 to 90 days, said Pat Kornick, director of communications. Currently, 300 residents live in Presbyterian Senior Care assisted living communities in Washington, Oakmont and New Wilmington. The waiting time depends on the specialty of care and varies by community.
A national problem
The waiting list is longer for those with dementia, Mr. Pieffer said. He added that in the late 1980s, most independent living facilities were run by nonprofit organizations. In the 1990s, there was an explosion in for-profit facilities.
Barbara Kolonay, owner of Options for Elder Care, assists several families with relocating a senior to an assisted living facility. When there is a waiting list at a client's first choice of facility, she can recommend temporary assisted living arrangements.
A geriatric care manager and registered nurse with geriatric nursing experience, she closely examines all aspects of a facility. Location, she said, is a factor that most greatly affects a family's choice of facility.
She has one client with Alzheimer's disease who, for a year, has been ninth on a waiting list to be in the same assisted living facility as his wife. He currently is in a facility in a nearby community.
"This is a national problem," she said.
At Atria South Hills in Baldwin Borough, 90 seniors currently live in a facility with 99 apartments. While it has no waiting list, other Atria communities across the nation do, according to Beth Bryant, a public relations representative for Atria.
"According to the U.S. Department of Labor, overall employment for the assisted living industry is expected to grow much faster than average through the year 2014 due to an aging population," she said.
Medicaid last limits
According to Chuck Keenan, housing coordinator for the Allegheny County Department of Human Services, it's impossible to track the specific number of independent living facilities in Pennsylvania because they are not licensed by the state.
In July, the General Assembly passed legislation to regulate assisted living. Those regulations are expected to be written by the Department of Public Welfare in the next year. Until then, anything in Pennsylvania calling itself an independent living facility is officially regulated as a personal care home.
"Medicaid does not cover costs of assisted living once the [individual's] money runs out," said Mr. Landis, of AARP. When the state has its laws in place, it can apply to the federal government for a waiver to get Medicaid payments for these facilities.
"This is one reason why Pennsylvania so desperately needed to pass assisted living regulations," Mr. Landis said.
According to Health Policy and Tracking Services, the average cost of assisted living is $2,000 to $2,900 per month. Rates vary depending on services, location and types of accommodations.
At Presbyterian Senior Care, the average cost ranges from $80 to $100 a day. For residents with dementia, that cost will increase by $30 to $50 more a day, Mr. Pieffer said.
At Atria, the flat rate for an apartment is $2,500 per month, with increased rates as services are added.
Where to start
So what do daughters and sons do for their aging parents when faced with so many decisions in difficult situations?
Ideally, elderly people should have a discussion with their children or caretakers before they are in a crisis situation and faced with quickly making a decision of where to go, Mr. Landis said.
On its Web site, AARP recommends hiring a geriatric care manger, if you can afford it. Such a manager will be able to research the best options with unbiased opinions. It's also a good idea to visit about three facilities.
Ms. Kolonay suggested that families find out who runs a particular facility. Is it run by a social worker or someone with more of a marketing background? She said that it's her experience that social workers tend to be more in tune with a resident's needs.
Another suggestion is to find out if the staff has more of a medical background or a business background. For example, if the activities director is a specialist with a degree, he is more likely to encourage a variety of activities to stimulate different parts of the brain. Someone else, while caring and kind, might not have the background to know how to vary activities effectively.
What to look for
At the top of the AARP checklist is knowing how much independence residents are permitted, Mr. Landis said. Get information on whether your senior is will have a roommate and whether there lockable doors to the units. Look into safety issues such as handrails in bathrooms and security and fire safety alarms. Ask if trained medical personnel are on site 24 hours a day.
Too often, he said, families are looking for a facility in a crisis situation.
"When a patient is discharged from a hospital, often the hospital says, 'You must go here,' " he said. Patients have the right to look at a facility and don't necessarily have to accept the first recommendation.
If you're in a hurry and there is a wait, try to stretch out a hospital stay for another day so you have choices, he added.
With the holidays approaching, Mr. Pieffer recommended initiating a conversation about future accommodations for older relatives at a family gathering.
"Most seniors are happy to talk about it," he said. "It's their kids who are afraid."
Laurie Bailey is a freelance writer.