FOCUS ON: Housing Options

When a family member, or someone you know, is ready to consider housing options, an elder law attorney can guide you through the potpourri – which come in all sizes, settings, and shapes. Briefly, housing options generally fall into three categories, based on level of services and/or care provided:

Independent Living Retirement Communities: These complexes are for seniors who are able to live on their own, but want the convenience of a comprehensive service package. Meals, housekeeping, activities, transportation and security are provided to active older adults.

"Assisted Living" Facilities: In addition to the services mentioned above, these facilities provide personal care assistance to residents. This means that, in addition to housekeeping services, residents receive assistance in managing their medications, and a helping hand with bathing, grooming and dressing. Settings can range from three or more older people in a homelike setting, to dozens of residents in an institutional environment.

Nursing homes: Nursing homes offer continuous round-the clock nursing care as well as other support services in a single setting. Nursing homes are certified to provide different levels of nursing and medical services, from custodial to skilled nursing (services that can only be administered by a trained professional).

Other options are continuing care retirement communities (also called Life Care Communities), group homes, share housing, adult foster care, home and community care, and elder cottage housing (commonly known as ECHO housing). There is also the option of home health care.

Who Pays?

• Medicaid will not pay for long-term care in a nursing home, in an assisted living facility, or at home, unless the individual has virtually no income and no assets.
• Medicare and health insurance plans pay for doctors and hospitals, but not for long-term care.
• Supplemental Security Income (SSI) is a source of income that is administered by the Federal government, and paid for by general tax funds, not by Social Security. SSI is for disabled (including blind) and/or aged people who have little or no other income. People who receive SSI can use the money for food, clothing, and shelter. SSI can help to pay for senior housing, but the amount is not nearly enough to cover skilled nursing care.
• Social Security a small retirement income for people who have paid into the program during their income-producing years. Social Security payments may go to certain people who are disabled, who are the spouse or ex-spouse of a qualified Social Security recipient, or who are survivors of a deceased qualified Social Security recipient. Those who receive Social Security income can use the funds for whatever purposes they wish; certainly one of these might be housing. Social Security benefits can help to pay for senior medical care and housing, but it is not enough to cover the entire amount of long-term care.
• Long-term-care insurance can provide funding for long-term care.
• A reverse mortgage, or home-equity conversion, is a means of borrowing money from the amount you have already paid for your house. You are freeing up money that would otherwise only be available to you if you sold the house. You can stay in the house until you die, without paying back the loan. After your death, your heirs must pay back the loan, either through the sale of the house, or with other funds. The lending agency makes sure that the value of the house will always cover the repayment of the loan, which includes loan fees and interest.

You can use the funds from a reverse mortgage to cover the cost of home-health care, if the lending agency does not restrict use of the funds. However, the conditions of a reverse mortgage require you to repay the loan if you cease to live in the home; therefore, long-term care outside the home initiates the repayment period.