Elder Law: Options abound for next home
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Marie and Ralph have been married for more than 40 years, living, for the last 30 years, in a "typical" Pittsburgh house (two stories up and one cellar flight down) on a hilly lot in a neighborhood they enjoy. They have no children and both of them, over the last few years, have had some physical issues that have decreased their mobility.
As a result, they have begun, before a crisis hits, to look at what their options are for alternate housing. This is a difficult decision for them, as it is for most people, as they enjoy both their house and their neighborhood. Nonetheless, they want to be prepared to take action in a pre-planned manner if it becomes necessary to do so. So, let's see what some of these options are -- which are not just nursing facilities as many believe.
Village: A growing option, but presently limited in number, is to become a member of a "village" such as Mt. Lebanon Village where residents of Mt. Lebanon, age 50 and older, can reside in their own place of residence in the environment they value as they grow older.
This is done by paying an annual fee and, through support services such as help with transportation, connections to social/enrichment activities, and referrals to a variety of services for home maintenance and home health care, allowing one to stay in the home.
Independent Living: This is a type of housing, usually apartment living, that can relieve the individual of the burdens of home ownership. They often have a community dining area, library, fitness area and TV room. Apartments can vary from studio to two or three bedroom. Note, however, that the resident bears the responsibility of medication administration and services are only paid for privately.
Cohousing: A new phenomenon where like-minded individuals join together in a type of collaborative housing in which residents actively participate in the design and operation of their own neighborhoods. Cohousing residents commit themselves to living as a community. The physical design encourages both social contact and individual space. Cohousing usually offers a greener and more affordable option than other senior housing. Private homes contain all the features of conventional homes, but residents also have access to common facilities such as open space, courtyards and a common house. Most cohousing is multigenerational, but an increasing number are for adults over 55. At the present time, the Pittsburgh area lacks this type of housing, although there are plans in the development stage (http://pittsburghcohousing.wordpress.com).
Personal Care Homes: Personal care homes are residential facilities that offer personal care services, assistance and supervision to four or more persons. They are inspected and licensed by the Pennsylvania Department of Public Welfare. Sometimes they are advertised as "retirement homes" or "boarding homes," but cannot call themselves "assisted living facilities." A personal care home must have a license in order to operate in Pennsylvania. These regulations are aimed at protecting the health, safety and well-being of the residents. However, there are no federal regulations for personal care homes. There is no third party reimbursement for personal care homes, but many personal care homes accept residents of low income who receive Supplemental Security Income. Allegheny County has approximately 145 personal care homes; thus a large number of choices.
Assisted Living Residence: In January 2011, a new option in long-term living became available in Pennsylvania. At that time, assisted living residences began to be licensed based on a regulation that was published in July 2010 from a law passed in 2007. The intent was, unlike a personal care home setting, to allow individuals to age in place and receive supplemental health care services maintaining their independence and to exercise decision making and personal choice without having to transfer to a nursing care facility. These facilities are licensed by the state Office of Long-Term Living. Similar to personal care homes, residents have an initial assessment, development of a support plan and are subject to a contract between the resident and the facility.
An assisted living residence is constructed differently from a personal care home. Personal care home residents live in bedrooms that may be shared by up to four people. Assisted living residents have living units with kitchen capacity. No one is forced to share a living unit. Living units have a door with a lock and a private bathroom. It is similar to a studio apartment where the resident can make meals if desired and have a private bathroom.
Because of the new law, personal care homes that previously called themselves assisted living facilities that could not or decided not to meet the new law's requirements are no longer permitted to call themselves an assisted living residence. At the present time, there are only 22 such facilities in all of Pennsylvania and none in Allegheny County. However, a number of applications are pending.
Nursing Home Facilities: A nursing facility has registered nurses helping to provide 24-hour care for individuals who can no longer care for themselves due to physical, mental or emotional conditions. A physician supervises a patient's care and the facility provides services such as wound care, IV medication administration, tube feedings and rehabilitation services after surgery or an accident. The state Department of Health, Division of Nursing Care Facilities, is responsible for the licensing and oversight of Pennsylvania's nursing care facilities. As of December 31, 2010, there were 714 facilities with a total bed capacity of more than 88,000 in Pennsylvania. There are approximately 67 nursing homes in Allegheny County. These are the most expensive facilities in which to live on an annual basis, averaging approximately $93,000/year in cost.
Continuing Care Retirement Communities: CCRCs are part independent living, assisted living and skilled nursing. They are designed to accommodate aging residents' changing needs. Healthy adults can reside independently in single-family homes, apartments or condominiums. When assistance with everyday activities of daily living becomes necessary, the resident can move into the assisted living or nursing care portion of the facility. A CCRC gives a person the option to live in one location for the duration of his life, with much of their future health needs dealt with.
Generally the most expensive of all long-term-care options, CCRCs usually require a substantial entrance fee as well as monthly charges. The entrance fees are used to prepay for care as well as to provide the facility money to operate. Monthly charges can vary but may increase as needs change. In Pennsylvania, there are almost 230 CCRCs, with 26 being in Allegheny County.
As one can see, with Ralph and Marie doing proactive planning now they can help address their future needs in an educated manner and, perhaps, minimize any time they might have to spend in a "nursing home."
First Published June 24, 2012 12:00 am