One of the most difficult decisions we may need to make as we age—among the many that we have to make as we face the limitations of our life—is how to provide care for ourselves and our loved ones.

How well we care for ourselves and others depends on our strengths. As we age, our ability to do this well may be challenged. While most prefer to stay in their own home for as long as they can, there may come a time when it’s no longer safe or comfortable to do so.

You may need to find alternative living places for yourself and/or for those you are responsible for. Options you never considered before may be the ones we have to evaluate now.

This article is an overview of choices and an evaluative guide to help you make the decision of a residency that best meets those in need. There are no verifiably ‘right answers,’ rather factors to consider when making your choices.

Part I of this topic provides an overview of the types of facilities that operate; Part II (next month) provides a checklist of questions to ask as you sort through your options. I hope you find it useful.

Understanding the Level of Care Required

To begin, talk with your physician, nurse practitioner, or physician’s assistant; it is critical to understand the level of care required. This diagnosis and its anticipated progression will determine what to look for in a facility, how much the recommended care will cost, and how you will fund your choice.

Be aware that health conditions will likely change over time and the solution that is viable today may need to change with it.

Successful living and care arrangements can be found within each option. Knowing how these options differ and the cost implications of each can help you make a good decision.

Comparing Aging Care Facility Provider Options

Here’s what you can expect from assisted living vs. nursing home vs. memory care facilities.

Assisted Living

Assisted living facilities provide a supportive environment with a focus on independence, offering less intensive care compared to nursing homes and memory care.

• Services Offered: Preparing meals, recreational activities, transportation, help with medication, and assistance with activities of daily living.
• Level of Care: Does not offer round-the-clock care.
• Rules and Regulations: Governed by individual states; laws vary by location. There are no comprehensive federal regulations.
• Living Arrangements: Shared and private rooms are available, with facilities ranging in size from small with as few as five beds to large with several hundred beds. Common areas provide opportunities for socialization, and safety/security measures are emphasized.

Nursing Home

Nursing homes offer comprehensive medical and personal care, providing more extensive support and 24-hour nursing care than assisted living or memory care.

• Services Offered: Continuous medical care, rehabilitation services (including physical, occupational, and speech therapy), medication management, meals, social and recreational activities, assistance with daily living activities, and palliative and hospice care.
• Level of Care: Provides 24-hour nursing care, suitable for both short-term and long-term care.
• Rules and Regulations: Regulated by the federal government with consistent laws across states. Nursing homes are certified to provide services to people with Medicare and Medicaid. They are highly regulated in terms of licensing, certification, inspections, staffing, resident rights, and health and safety standards.
• Living Arrangements: Offers shared and private rooms with common areas. Emphasis is placed on safety and security measures.

Memory Care

Memory care facilities specialize in providing structured, safe environments tailored to individuals with memory impairments, offering more specialized care than assisted living and more focused supervision than nursing homes.

• Services Offered: Assistance with bathing, dressing, eating, and other activities. Care plans are individualized to meet the specific cognitive and physical needs of each resident.
• Level of Care: Continuous supervision and security are provided, with staff specially trained to handle the unique challenges of dementia and Alzheimer’s.
• Rules and Regulations: Memory care facilities are generally licensed by state health departments or aging services departments, with additional federal laws on safety and well being. States have specific licensing requirements, including staff qualifications, training, facility standards, and care protocols.
• Living Arrangements: Shared and private rooms with common areas designed to minimize confusion. Emphasis is placed on safety and security measures.

Cost Considerations

The choice of a type of facility cannot be made primarily on cost, and any report of average costs can be misleading. Though there is a good deal of overlap of services, each type of facility (assisted living, nursing home, memory care) reflects a different model of care and offers different levels of care.

That said, there are many additional factors that influence costs, including, but not limited to:

• The part of the country the individual lives in.
• Private vs. shared room accommodations.
• Special needs that must be met.
• If the services are governed by state regulations, federal regulations, or some combination of both.

Typically, assisted living costs less because seniors receive less care and less support is required. Nursing homes typically cost more due to the constant skilled care provided. Memory care options tend to fall in the middle of this price continuum.

Generally, within each type of facility:

• Level I care refers to basic care.
• Level II is enhanced care/longer-term care, which can add up to $2K per month.
• Level III care is specialized care and can add an additional $2–$3K per month.

Quality of Care

To identify the quality of care provided, you must visit the facility—not just once, but a couple of times across days and times.

While a paper view of options can help initiate a review of your choices, nothing can communicate the quality of care to be expected better than a visit and conversations with the staff you would be typically interacting with and the individuals that reside there.

Locating Resources

The task is challenging. The approaches listed below can help identify available options in this area. That said, there are relatively few facilities in our area. I suggest that you network through as many as possible and isolate the ones that come closest to filling your need. Depending on your time frame, you may need to search beyond this geographic area for an appropriate choice.

Local and Governmental Agencies

• The Pine Knoll Shores Council on Successful Aging maintains a list of options for the Morehead City area. We can be reached through our website: PKS Council on Aging, by email [email protected], and phone 252-726-1986.
• In Carteret County, the Leon Mann, Jr. Enrichment Center maintains a source book of agencies in the county. The Center is located at 3820 Galantis Dr., Morehead City, NC 28557, phone: 252-247-2626. They are open Monday through Friday from 8 am to 5 pm.
• The Eastern Carolina Council (ECC) is a multi-county, local government, planning, and development organization ([email protected], phone: 252-638-3185). The ECC (specifically the ECC’s Area Agency on Aging Department) is a conduit between local governments in our region and state/federal partners.

Online Clearinghouses

Clearinghouses for patients and families can be found online. The value in using the clearinghouses is that they try to maintain the most current lists and easily allow comparisons across options.

Here are some tips if you use this approach:

• Searching Online: If you are searching for local assisted living facilities, enter prompts in your browser for assisted living facilities in the Carteret County area to reach these sites. If memory care options are not listed with the assisted living contacts, you can confirm the availability of this type of care when you call. As assisted living options are governed by each state, you must enter your zip code and answer several questions to obtain the list.
• Clearinghouses: Be aware that many clearinghouses for assisted living options are compensated by the referrals they generate. Providing them with personal information is a catch-22: your personal needs guide the choice of options but also can invite a variety of follow-up phone calls.
• Nursing Home Search: If you’re exploring nursing homes, Medicare offers a searchable website called Nursing Home Compare, where you can find and analyze nursing home options in your area.
• Review Local Options: If you are familiar with the names of local options across resident types by name/reputation, a thorough review of their websites should provide enough information to generate a list of questions that can be addressed with a phone call and in-person visit.

Final Considerations

If your search leads you to an acceptable choice, but your need is not immediate, consider putting your name on a waiting list as options are limited.

The importance of visiting each facility you are considering cannot be overstated. Part II provides a checklist of questions and factors to consider as you sort through your options. These are questions you should ask yourself and your family, as well as the professionals and residents in each facility. I hope you find it useful.