Here are some issues to consider and inquire about when you are
considering a retirement residence:

Services provided

The usual levels are independent living, assisted living, and
nursing care. If all levels are provided in one place, it is called continuing
care.

Is nursing care available 24/7?

Most places have a nurse on duty 24/7, mainly for triage and minor
care, not for extensive individual care. If you are living independently, it is
important to have a nursing unit on the premises, where you can go for care
temporarily on short notice. Not all illnesses require a visit to the ER or
admission to the hospital. What are you going to do if need help because you are
sick in the middle of the night or the ER sends you home in the middle of the
night?

Assisted living provides a certain number of hours of care per
week to each resident. Ratio of aides on floor may be one aide to 8 patients in
a good place. Nursing units have RNs in charge, supplemented by LPNs and nursing
aides. If you want your own personal nursing aide, you will have to pay out of
pocket.

What happens if your money runs out?

Will they let you stay in the residence when your assets run out
and you have to get on Medicaid. Some places will let you stay on and some
places will not. Find out ahead of time.

Who decides on your residence level?

The medical director has full authority to make decisions about
level of care. The medical director can over-ride the wishes of the resident,
family, and health care power of attorney. If there are 2 people living together
in a residence and they develop different needs, the medical director will
separate them according to their needs. For example, one has to go to the
nursing unit and the more mobile one stays in independent living.

Who provides safety systems?

Residents should be able to call for help at any time. If the
residence does not supply, you will need to supply and pay for your own personal
alarm system. Residence should supply grab bars in the shower or tub. If not,
the resident will have to supply and pay for out of pocket.

What are the arrangements for meals?

Mostly all places provide at least dinner, some provide all meals.
The meals can be the center of your social life. Assigned seating helps you make
friends in the beginning, but you should be able to change tables if you
desire.

What transportation is provided?

Residents can have their own cars if they want, but there are many
instances where other transportation is needed. Some residences provide
transportation to doctors or hospitals, some don’t. If you need a specialist or
imaging or lab work, not available on premises, you may have to pay for
transportation via taxi, van or ambulance. Or your family member may have to
drive you there. (Podiatrists are the only ones who make house calls.) If the
residence has a transportation service, can you also get a person to go into the
doctor’s office with you?

What size rooms are available?

In the better residences, you have a choice of studio or
one-bedroom. In some nursing homes, there are only double rooms.

How do you get around within the residence?

Residences in the suburbs are usually horizontal with very long
hallways to travel to get around, plus elevators. Residents may need electric
carts to get around. Residences in the city have elevators and less distance to
walk.

What can you hook up in your apartment?

Are you wired for multiple phones, cable TV, computer ports?

Expense issues:

How much do you have to invest, deposit, or guarantee? . Some
places require a chunk of money (may not be refundable) plus monthly payment.
Some places require a guarantee and you have to submit your financial
statement.

Are there any subsidies?

Some places are subsidized by religious organizations and/or HUD
and may cost less for those who qualify based on your financial statement.

What levels of care and services are included?

Some places cost less when you enter as an independent and then
they charge more when you move up to assisted living and then up to nursing
care. Others cost more initially but all levels are included. (In that case,
some of the monthly fee is tax-deductible as long-term care insurance.) Some
places include more services for a higher price while others may cost less
initially but charge extra for many services.

You need your own money:

Not all costs are covered and there is an advantage is having some
money held aside to pay for these extras.

• Major expense items:
  • Health insurance – Medicare supplement
  • Prescriptions
  • Private nursing aides
  • Nursing home, if not included
  • Funeral – at least $10,000
• Smaller on-going expense items, if not included:
  • Personal alarm system (monthly fee)
  • Over-the-counter drugstore items
  • Housekeeping
  • Hairdresser
  • Extra food, if not all meals are included
  • Special food, such as low salt products
  • Personal items: underwear, socks, cosmetics, watch batteries
  • Household items: paper items, laundry detergent, lightbulbs, cleaning
    supplies, soap, toothpaste, flashlight and batteries
  • Laundromat charges
  • Tips

Examples of other services that may or not be located on premises,
may or may not be included in monthly payment:

• doctors – what specialties, what hours?
• physical therapy facility
• laundry
• pharmacy
• housekeeping and maintenance
• commissary or store
• social worker
• entertainment
• bus trips
• religious services
• card rooms
• social and guest areas
• hairdresser
• nursing aide agency
• gym
• computer room
• library

What do Medicare and Medicaid pay for?

Recovery after a hospital stay is called rehab, and Medicare usually pays. If
you have to go into nursing care for long-term maintenance, Medicare does not
pay. (Long-term care insurance will pay something per day for nursing home or
in-home nursing.) Otherwise the patient or family pays for long-term care until
assets run out. Then the patient goes on Medicaid.

Medicare will pay for hospice, physical therapy, and visiting nurse, if
doctor orders, plus podiatrist home visit. Medicare will pay for equipment such
as basic walkers, tub chairs, and hospital beds.