Alternatives to Nursing Homes

Clark and Altave Vandenberg enjoyed living by themselves in their El Sobrante, California, home. Even though their eyesight and health were failing, they adamantly opposed moving to a nursing home.

But when Altave fell and broke her hip, her injury shattered the fragile accommodations the couple had made to continue living independently. Clark's ill health left him unable to care for his ailing wife. When she left the hospital after her fall, Altave stayed with a friend who could care for her.

"I didn't drive, and his eyes were bad," says Altave, who was 85 when she fell. She couldn't do simple household chores anymore, either. It had become apparent that the Vandenbergs needed some type of occasional nursing care, and the home they loved was too much for them to handle.

But the Vandenbergs never set foot in a nursing home. Instead, an assisted-living center became the compromise between total self-reliance and utter dependence.

They decided on a one-bedroom apartment at Summerville at Creekside Lodge in San Pablo, California, where they moved their furniture and personal belongings. They didn't have to cook their own meals or clean the house. They could keep their favorite knickknacks and furniture with them. Should the unexpected occur, there were emergency call buttons around the apartment, and the center provided certified nursing assistants as well.

The Vandenbergs are among many older people who are proving you can keep living independently and get the care you need without moving to a nursing home. Among the alternatives are assisted-living communities, which allow seniors to live independently while giving them access to occasional nursing care and household help when they need it. Many such facilities resemble large apartment houses and town-home complexes; others look like upscale hotels with gourmet restaurants.

"Assisted living is an attempt to give people who are frail a chance to live their own lives according to their own rules as much as possible," says Whitney Redding, a spokeswoman with the Assisted Living Federation of America (ALFA),which represents more than 7,000 for-profit and nonprofit communities across the country.

Assisted living centers cost about a third less than living in a nursing home, but they're not a cheap living arrangement. The median cost of a one-bedroom apartment is $3,600 a month. The centers -- some of which cater to people with Alzheimer's disease and other forms of dementia -- may also offer a range of housekeeping, transportation, personal services, and social activities. Summerville at Creekside Lodge, for example, hosts bingo as well as health-oriented exercise classes and blood pressure screenings. And there are recreation rooms to watch travel videos and play games or music -- something that the Vandenbergs particularly enjoy. "My husband plays pool practically every day," Altave Vandenberg says.

About 38 percent of all assisted living communities also offer some type of nursing service, which costs more, Redding says. But be forewarned: most assisted-living communities stress independent lifestyles. Unless it is equipped to take care of them, people who need more ongoing care -- especially those with any type of dementia -- could be at grave risk in an assisted-living home.

"Do-it-yourself" assisted living

If you're the kind of senior who prefers the comforts of living in a private home, however, you may want to fill your own house with people who want to pool expenses and chores. In some cases, seniors with fixed incomes may be looking for roommates or decide to search for a house together. Some college student and part-time workers are glad to exchange room and board for some caregiving duties, as are some relatives. Home health agencies sometimes offer "live-in companions" who also are paid for caretaking services.

Look for rental services that link roommates and houses. You may be able to find them on the Internet or through local housing or social service agencies, community college or university housing programs, churches, and senior centers. If you're on a fixed income, you may also be able to cut costs by contacting the Department of Housing and Urban Development (HUD), which subsidizes apartments for low-income seniors and offers limited services, such as meals, housekeeping, laundry, and transportation. (Call the local housing authority to find out how to apply.) Many communities also have programs like "Meals on Wheels," which deliver hot meals to seniors and convalescents; you can usually find listings in your local phone book. If you have trouble cooking or shopping, senior centers also offer daily hot meals at little or no cost.

But not everybody lives in a place where seniors have access to these arrangements. If you have children or other relatives who own a home, you might want to speak with them about living on their property: They may be able to erect a small cottage on the property. Such a house is usually a small modular building in the back or side yard, with wheelchair-accessible entrances and one or two bedrooms, a kitchen, bath, and living area.

Your local housing department or Area Agency on Aging office can tell you if such renovations and buildings are allowed in your relative's neighborhood.

If that's not possible, you may want to investigate an accessory apartment, also known as in-law or granny flat. These are separate units usually located in or attached to a home. Many have separate entrances, kitchens and bathrooms.

Group living not just for the young

If you remember the move toward rural communes in the late 1960s, you may be surprised to find out that some seniors have also gravitated toward group living, known as congregate housing. This type of community -- often built by and around religious and community groups and nonprofit organizations -- may include 30 to 300 living units.

These centers, also known as retirement communities, are reminiscent of college dormitories. They often offer less privacy than assisted living centers, but provide ample opportunity to socialize. Seniors usually live in individual apartments that may include a kitchen, or they may be offered private bedrooms in a large house. But seniors eat their meals in a central dining facility, and the operators often provide housekeeping, personal care, recreation, and social activities.

Many nonprofit housing developers say they focus on seniors because so many want to stay independent. However, be forewarned -- waiting lists are usually very, very long, and it can take years to get into an apartment.

Cooperatives and support networks

Some seniors have taken things into their own hands, banding together to buy land and housing for a cooperative (an updated version of a commune) in which to grow older together. At least one senior cooperative in California created by a group of old friends has yoga classes, a communal dining room, and a live-in nurse. What could be better?

And seniors in many cities have created support networks. Ashby Village in Berkeley, California, for example, has volunteers -- often seniors themselves -- who help seniors live active, independent lives in their homes and the community they love by everything from driving someone to the doctor to trimming the front lawn. They also organize trips and celebrations where seniors and volunteers can meet up and socialize.

But the number of assisted living facilities is on the rise, and persistent seniors can often find an opening. The Vandenbergs feel extremely fortunate to have evaded a nursing home, and have grown fond of Summerville at Creekside Lodge, because there's a gratifying feeling of community. "We'll stay here as long as they keep us," Altave Vandenberg says, "or until the good Lord takes us."

Further Resources

National Shared Housing Resource Center
Serves as a national clearinghouse for consumer inquiries into shared housing programs.
http://www.nationalsharedhousing.org

Area Agency on Aging (AAA)
202/872-0888
For a list of facilities, visit the AAA Web site at http://www.n4a.org.

Assisted Living Federation of America
This nonprofit group has a directory of residences and checklist of questions for consumers to ask when looking at an assisted living center.
1650 King Street, Suite 602
Alexandria, VA 22314-2747
703/894-1805
http://www.alfa.org

References

Down, Ivy. Between Home and Nursing Home : The Board and Care Alternatives, Promethean Press.

Joy Loverde. The Complete Eldercare Planner: Where to Start, Which Questions to Ask, and How to Find Help. Times Books.

Russell CK, Phillips LR, Cromwell SL, Gregory DM. Elder-caregiver care negotiations as dances of dependency. Sch Inq Nurs Pract;13(4):283-98; discussion 299-304.

Chris Adamec, et al. The Unofficial Guide to Eldercare (The Unofficial Guide Series). Hungry Minds, Inc.

AARP. Assisted Living in the United States. http://www.aarp.org/research/housing-mobility/assistedliving/assisted_living_in_the_united_states.html

Assisted Living Federation of America. What is Assisted Living? http://www.alfa.org/alfa/Assisted_Living_Information.asp?SnID=1106650195

Assisted Living Federation of America. Cost of Assisted Living. http://www.alfa.org/alfa/Assessing_Cost.asp?SnID=1290354545

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