Senior Housing Connection

Senior Living … Enriched Housing… Assited Living. What’s the difference?

Wednesday, June 15, 2011

“Senior Housing” is a broad term that covers an array of living programs from Independent to Skilled Nursing.  And there are a lot of terms in between that can be confusing to seniors and their loved ones.  You may have heard terms like “assistive living,” “adult home,” “enriched housing,” “senior living community,” “retirement community,” and “life care community.”  Many people believe these terms mean the same thing, but that isn’t true.  While it’s confusing, there are resources available to area seniors to help sort through the clutter of information.  Parkwood Heights offers consultative senior services as a courtesy to older adults and their caretakers to help determine what is the proper level of care to meet needs now, and as they age. 

In addition Lifespan, a Rochester based organization, that is dedicated to providing information, guidance and services that help older adults take on both the challenges and opportunities of longer life  has compiled the following as a tool for older adults and caregivers seeking information on housing options.

Seniors Only Independent Living Apartments

Independent Senior Housing refers to housing that is restricted to older adults, usually age 50 and over, although some facilities may include younger adults with disabilities. These facilities represent a tenant-landlord relationship where the owner/operator has no responsibility to supervise or provide personal care. This type of housing generally does not include supportive services to address the special needs of aging residents. Independent apartments are not licensed or monitored by government housing agencies.

Choices in independent senior housing are available as private pay, HUD subsidized housing and Section 8 Certificates.

Seniors Only Independent Living Apartments with Services

Parkwood Heights offers lifestyles that fall into this category.  These are apartments that include one or more of the following supportive services: meals, housekeeping, some assistance with personal care, transportation, socialization activities, laundry, resident/service coordinator who helps residents access other services and programs from community-based agencies. Personal/home care services through a licensed home care agency are usually available at an extra cost. 

These facilities are not licensed or regulated by government housing agencies, but may be offered in the same setting as other licensed levels of care such as Enriched or Assited living.  . According to New York State law they may not use the words “assisted” or “assistive” in their marketing or advertising.

These apartments are private pay –typically $2000 – $4000/mo.  Residents may purchase personal/home care services through licensed agencies, which can be paid for privately or may be covered by a Long-Term Care Insurance policy.

Assisted Living (licensed by NYS):

Until 2004, New York State did not have a common definition of “assisted living” and many housing facilities used the term loosely. But now an entity that uses the term “assisted living” must be licensed and regulated by the State and must provide or arrange for the following:

  • On-site monitoring 24/7 monitoring
  • Daily food service
  • Personal care services and home care services including help with grooming, dressing, bathing and eating (either directly or indirectly)
  • Case management
  • Housekeeping/laundry
  • Activities and recreational opportunities
  • Medication assistance and medication supervision.

It is very important to ask what type of personal care service is provided; some Assisted Living Residences include a minimum of personal care related services (e.g., daily dressing and weekly bath assistance) in the monthly rent, but charge extra fees, by the hour or by a flat fee, for assistance above and beyond the base level of care provided. Medication management may also be charged as an additional fee.

There are no Assisted Living Residences (ALR) licensed by New York State in our area at this time.

The costs for these units average around $4,000 a month. Some of the newer long term care insurance policies include an assisted living benefit or will cover home or personal care services provided by a home health care agency. Generally, there is no Medicare or Medicaid reimbursement.

Enriched Housing Program

Parkwood Heights is in the process of obtaining its license under the NYS Enriched Housing Program.  This program provides older adults with an apartment type setting, with a package of services that includes: meals, housekeeping, homemaking/chore, shopping, and transportation, social activities, some personal care services, and may include medication administration.

There are two models of Enriched Housing Programs.  The first operates in a freestanding building for all residents in the building. The New York State Department of Health’s Office of Continuum Care licenses this type of program.

The second model of Enriched Housing Programs provide the package of services for a limited number of residents in an older adult or age-integrated apartment building; these buildings are not licensed, however the Enriched Housing Program itself is licensed and regulated by the New York State Department of Health.

Most enriched housing in Monroe County requires private payment, with the exception of the programs operated by Family Services of Rochester.  Supplemental Security Income (SSI) depending on individual eligibility can fund these programs.  Some Long Term Care Insurance policies cover a portion of the cost of this program.

Adult Care Facility (Adult Home)

Adult Care Facilities are often referred to as “Adult Homes”.  They are licensed and regulated by the New York State Department of Health.  Most ACFs offer private and semi-private rooms with private or shared bathrooms.  ACFs provide the following services:  meals, housekeeping, laundry/linen service, limited transportation services, social activities, some personal care, medication management, and 24 hour supervision.  Some ACF’s have assisted living programs available (see below).

Many Adult Care Facilities accept only private payment while others require a fixed number of years of private payment. Some individuals may be eligible for Supplemental Security Income (SSI) funding depending on their income and resource levels.  If a monthly income exceeds the SSI limit, some facilities allow the individual to negotiate a fair rate with the administrator.  This agreement must be verified in writing upon admission.  A few Adult Care Facilities allow residents without available private resources to obtain SS funding upon admission.  Some Long Term Care Insurance policies cover a portion of the cost of this level of care.

Alzheimer/Memory Care Unit

This type of facility or unit is specifically designed to meet the needs of individuals with Alzheimer’s Disease or other dementia conditions. There are freestanding facilities as well as special units within an adult care facility, enriched housing program, or nursing home.  The physical layout, program goals, staffing, and care plans are specifically designed to address the needs of these individuals.

Dementia Care Facilities/Units are licensed and regulated by the New York State Department of Health Office of Continuum Care.

Many Dementia Care Facilities/ Units are private pay. The type of facility in which the dementia care unit is located and the funding source available at that facility governs exceptions to private payment. For example, units contained within a Skilled Nursing Facility accept Medicaid following the depletion of private resources. Some units within an Adult Care Facility may accept Supplemental Security Income (SSI) after resources are depleted. Some long-term care insurance policies cover a portion of the cost of this level of care.

Assisted Living Program (ALP)

Assisted Living Programs provide residents of adult care facilities and enriched housing programs with nursing home level of care. These programs allow residents to remain in their current environment (age in place) if they require additional medical or personal care services.

The New York State Department of Health’s Office of Continuum Care licenses this program.

Medicaid generally funds assisted Living Programs.  The resident is required to spend available private resources, down to a fixed amount that is adjusted yearly, before qualifying for Medicaid.  There are different rules that apply to single individuals versus married couples.  Some Long Term Care Insurance policies cover a portion of the cost of this type of program.

Continuing Care Retirement Community (CCRC) (Sometimes called a Life Care Community)

Continuing Care Retirement Communities are restricted to older adults. They include: independent living units apartments and/or cottages with supportive services such as social activities, meals, and personal care services.  These services are available on site. Nursing home type care can also be included on or off site.

What distinguishes a CCRC from other types of housing is the life care program which included pre-paid health care in the event long-term care is needed. Should a life care resident need assisted living or skilled nursing care, he/she would pay only the cost of independent living. There is only one certified CCRC in Monroe County at this time: The Summit/Jewish Home.

CCRCs are regulated by the New York State Department of Health and New York State Department of Insurance.

Communities of this type require a large one-time payment from applicants ($usually $100,000 or more) to prepay for the resident’s anticipated health care expenses.

Skilled Nursing Facility (SNF)

A nursing home provides 24 hour a day skilled nursing care and related services, or rehabilitative services for the injured or disabled. Nursing homes require the completion of a Patient Review Instrument (PRI) prior to placement.

(Eldersource can arrange for a PRI.) All nursing homes (SNFs) accept private payment or payment through long-term care insurance.

Most SNFs accept Medicaid, however policies vary from facility to facility. Some require a certain length of private payment before the resident relies on Medicaid. Some SNFs accept residents without private payment, however the Medicaid application process must begin prior to admission.

Medicare usually covers payment for short-term rehabilitative care in a skilled nursing facility in full for the first 20 days. Thereafter, Medicare pays a portion of the daily cost through day 100 for each “spell of illness.” Supplemental Security Insurance (SSI), Medicaid, long-term care insurance or private resources must be used to pay for care after 100 days.

If you have more questions, visit Lifespan, or contact our Senior Care Consultant by Email, or at 315.986.9100 or 585.223.7595.