Housing Options




by John Paul Marosy

Today, older persons can choose from a wider range of housing options than ever before. The list below provides an overview of choices.  Other options may exist in your community. You can obtain information about the availability of the full range of local housing options by contacting the Area Agency on Aging (AAA) serving the community in which the elder lives.  For the telephone number of the local AAA, call the Eldercare Locator at 1-800-677-1116.

Accessory Apartments

An accessory apartment is a home within a home – a living unit created for the purpose of allowing an older relative to live in his or her own quarters, with family nearby to provide or arrange support care, as needed.  Check to see if local zoning regulations allow accessory apartments.

For more information:

The University of Missouri offers a review of the pluses and minuses of this housing alternative, along with a step-by-step guide on how to do it. Visit www.muextension.missouri.edu/xplor/aging.  Or visit the AARP Webplace at www.aarp.org/contacts/housing/accessapt


Assisted Living

Assisted living is a combination of housing and supportive services including personal care (such as bathing and dressing) and household management (such as meals and housekeeping).  In recent years, assisted living has grown in popularity because it stresses privacy, dignity, autonomy, and individuality.  The goal is to provide the resident help only when needed.

Residences vary in size and style, from apartment or hotel-style structures to smaller, family-style homes.  Some assisted living residences have special units or wings designed to serve special populations, like persons with Alzheimer’s disease.

The definition of Assisted Living varies from state to state, as do regulations.  Assisted living is not designed for persons who need serious medical attention. They are not the same as nursing homes.  Assisted living may be the right choice for an elder who

·       needs some help with activities like housekeeping, meals, bathing, dressing, or medication reminders

·       would like the security of having assistance available on a 24-hour basis in a residential and non-institutional environment. 

Assisted living is usually paid for privately.  Costs can range from $2,400 to over $5,000 per month, depending on the residence and the services offered.

For more information:

The National Center for Assisted Living offers A Consumer’s Guide to Assisted Living and Residential Care.  Visit the center’s website at www.ncal.org or call 1-800-628-8140.  Most states regulate assisted living and publish consumer guides specific to the state.  Call the Eldercare Locator 1-800-677-1116 and ask for the number of the state unit on aging.


Congregate Housing

Congregate housing offers a combination of housing and services for elders who have some limitations in ability to perform everyday tasks or who are socially deprived but not otherwise ill.  The support services (meals, periodic housekeeping, transportation, social amenities and activities) in congregate housing can help the elder maintain or return to an independent lifestyle and prevent a premature move to an institution as the elder grows older. 

Generally consisting of individual apartments with areas for group socializing and dining, such housing caters to people who are fairly self-sufficient, mobile, and require no special care. Congregate housing built with federal, state, and local funds will have income eligibility requirements.  Licensure varies state-by-state.  For a list of facilities in your state, call the Elder Care Locator for telephone number of the state unit on aging.


Continuing Care Retirement Communities

A Continuing Care Retirement Community (CCRC) combines housing, personal care, and –unlike most assisted living residences - health care, usually in one location.  CCRC’s offer an environment and the services necessary for residents to “age in place.”  This means that, as personal and health care needs change, the elder can remain at the retirement community.

Entering a CCRC usually involves a substantial one-time entrance fee, plus a monthly fee.  In order for the CCRC to deliver contracted services over a long period of time, it must be financially sound.  Not all states assure the financial stability of CCRC developers and managers.  Before signing a CCRC contract, review the contract in detail, especially the CCRC’s financial statements, with particular attention to whether or not the CCRC has sufficient reserves to keep it solvent over time. 

For more information:

To find a consumer guide to CCRC’s for your state, call the Eldercare Locator. Ask for the number of the state unit on aging.


ECHO Housing

Sometimes called a “granny flat” or an in-law apartment, an Elder Cottage Housing Opportunity (ECHO) unit is a small, manufactured home that can be installed in the back or on the side of a single family residence and removed when it is no longer needed.  It is designed specifically for frail older persons or persons with disabilities and is intended to enable them to live near family and friends who will provide the support necessary for them to live independently.  The addition of an ECHO unit to an existing home or property is contingent on local zoning regulations.

For more information:

Visit www.aoa.gov/housing , the website of the federally-funded National Resource and Policy Center on Housing and Long Term Care.  Or call 1-213-740-1364 and request information about ECHO housing.


Home Modifications – Staying at Home

Most older people want to continue to live in their own homes for as long as possible.  Most family members want to help them do this as well, but they often have concerns about the older person’s safety and security.  Today, through a combination of home modifications and in-home personal services, many frail elders can live at home longer than ever before.

Home modifications are changes that you can make to the living environment to increase ease of use, safety, security, and independence.  Examples of home modifications include:  lever door handles that operate easily with a push, handrails on both sides of staircase and outside steps, ramps for accessible entry and exit, walk-in showers, grab bars by the toilet, in the shower, and by the tub, sliding shelves and lazy susans in corner cabinets.

Many home modification materials are available from home repair retailers and medical equipment companies.  In some areas, private companies specializing in home modification can assess the home and make needed changes.

For more information:

Visit the website of the National Resource Center on Supportive Housing and Home Modification at www.homemods.org, or call the Center at (213) 740-1364.  For a copy of A Consumer’s Guide to Home Adaptation, call the Adaptive Environments Center at (617) 695-1225.


Home Sharing

Home sharing is an option that may make sense for an older person who wishes to continue to live in his or her own home but who needs someone else to help share expenses and upkeep.  A program coordinator interviews homeowners and older or younger individuals to determine suitability and to make matches that may be long or short in duration. Home sharing arrangements can address the elder’s need for rental income, companionship, and performance of household chores, like light cleaning and yard work.  The local Area Agency on Aging can tell you whether or not there is a home sharing program in the older person’s community.


Living Together in Your Home

In a crisis situation, like a sudden hospitalization of one of your parents, you may instinctively think of inviting an older loved to come live in your home.  It is wise to carefully consider such a move. Take into account the views and feelings of all family members involved, including children if you have any. 

Ask yourself these questions:

·       Is your home equipped for this?  Most importantly, do you have enough space in the right location?  If you live in a larger home, are there separate living quarters (private bath, separate bedroom) in an accessible location (upstairs won’t work if the elder is becoming more frail)?

·       Can you get along?  Over the years, have you basically gotten along well with the elder?  If it’s been a rocky emotional road up until now, it is not likely to smooth out when the older person moves in.

·       How do other members of the family feel?  What’s the history of the relationship between your spouse (if you have one) and each of the children with the elder?  Hold a family meeting (see page 25) before taking any action.  Your desire to care for mom or dad should not disrupt relationships within the rest of your household.

·       How much care and attention does the elder need now – and how much will be needed in the foreseeable future?

If you decide to have the older person move in with you, set a trial period of three months or so. 

If you have not settled into a routine by the end of the trial period, it is often best for all concerned to consider another housing arrangement.  Do not wait until you are physically or emotionally exhausted or tensions are running at an all-time high.  You owe it to yourself, the elder, and the rest of your family to make a change before strains result in damaged relationships. 


Retirement Communities

Retirement communities can offer an attractive alternative for elders who are basically healthy but have some limitations in daily activities.  Such communities often provide club houses where residents gather for companionship and shared activities, including golf and other social amenities. Some offer personal care services, at additional cost.  Residents typically rent or purchase their own town houses or apartments.


Senior Housing

Senior housing developments offer an affordable housing alternative for many older Americans because rents are based on the elder’s income and subsidized by federal, state, or local programs.  Therefore, elders must meet income and asset eligibility guidelines.  A typical senior housing development offers one-bedroom units with a separate kitchen and bath and usually includes a common room for social activities such as arts and crafts, recreation, or meals programs.  If you feel this could be an attractive alternative, plan ahead.   Waiting lists of several years are not uncommon in some areas. 


Mental Health Care

If your older loved one shows on-going signs of confusion or depression (withdrawal from social relationships, apathy, crying, expression of feelings of hopelessness, changes in weight or sleep patterns), he or she may benefit from counseling.  Support groups for widows or widowers, often sponsored by senior centers or faith-based groups, can ease the stress of this life transition. 

For more information:

Your local Area Agency on Aging may maintain a list of mental health providers that specialize in care of the elderly.

The American Association for Geriatric Psychiatry offers fact sheets on mental health and aging.  Call 1-301-654-7850 or visit www.aagpgpa.org.

The local chapter of the Alzheimer’s Association can provide referrals to resources for elders and families affected by Alzheimer’s disease and other forms of dementia.  Call 1-800-272-3900 or visit www.alz.org.


Nursing Homes

Today, the nursing home, also known as a skilled nursing facility, extended care facility, convalescent facility, or continuing care facility, serves the needs of two specific groups of people:  1) those who need short-term, skilled care in a medical setting to recuperate, usually following a hospitalization, and 2) chronically ill persons who need on-going medical supervision and personal assistance on a 24-hour a day basis.

Most nursing homes provide 24-hour nursing supervision and on-call access to physicians.  Other services include meals, laundry services, personal care, counseling, recreation, nutrition counseling, recreation, social services, rehabilitation services, laboratory and pharmacy services.

Typical annual charges for nursing home care exceed $40,000. It is not uncommon to pay twice this amount.  Medicare pays for virtually no long term nursing home care.  Medicaid will pay for nursing home care, but the elder must have limited financial means and the choice of nursing home will be restricted to those homes that accept Medicaid patients.  See the section on Medicaid for more information about applying for Medicaid coverage.

When is nursing home care the right option?

Many family members dread the thought of ever having to consider nursing home care for an older loved one.  The image of the nursing home resident wasting away in a cold, impersonal institutional environment that smells of urine, receiving little personal care or attention, lingers.  Such conditions do still exist in some nursing homes today, but they are far less common than in the past.  In recent years, consumer advocates and government regulators have forced nursing homes to rethink their missions and the way they deliver care.  In particular, many have cut back on the use of physical restraints and on the use of sedative medications as a way of controlling behavior of residents.

With proper research and a commitment to maintaining contact with the older person, you can arrange for nursing home care that assures safety and proper care for the older person while making it possible for family members to maintain a caring relationship with the elder.


If you answer “yes” to the questions below, nursing home care may be the right option:

·       Does the older person need more care – especially medically related care – than it is practical to provide at home?

·       Is the primary family caregiver feeling overwhelmed, physically or emotionally, with the demands related to care being provided at home?

·       Is the older person behaving in ways that would make it impractical to live in another type of residential setting (e.g., dangerous wandering, incontinence, verbally or physically abusive)?

Choosing a nursing home

Any decision to consider nursing home care must be discussed with the older person, to the extent that he or she is mentally able to participate in the decision. Postponing such discussions only increases feelings of guilt and anxiety on the part of family members involved in the move.  It dishonors the older person who is entitled, as matter of basic respect, to be kept informed of plans to make this type of significant life change.

Elder care professionals report that quality of life of the elder is often diminished when the elder and family wait too long before making a move to a facility that can provide a more intensive level of care.  If you are the primary caregiver, you will need to take decisive action to assure that the elder obtains the level of care needed as health conditions change.

Nursing homes offer several levels of care, depending on the elder’s medical condition and need for skilled and custodial care.  Before researching specific nursing homes, consult with the older person’s physician to determine what level of care is needed. 

Good sources of recommendations about specific homes include the older person’s physician, hospital social workers and clergy in the community.  Ask which nursing homes have reputations for providing good quality care. 

Visit several homes and take notes – not just about what you are told by staff of the nursing home, but about what you see, smell, and feel.  See the information sources listed below to obtain checklists to use when making visits.

For more information:

The National Citizens Coalition for Nursing Home Reform offers consumer information.  Visit www.nccnhr.org or call (202) 332-2275.

Every State Office on Aging operates a Nursing Home Ombudsman Program that provides information on nursing home residents’ rights and investigates complaints.  Call the Eldercare Locator for the telephone number of the ombudsman office in your state.


From Elder Care: A Six Step Guide to Balancing Work and Family. Copyright © 2002 by Bringing Elder Care Home Publishing. Excerpted by arrangement with Bringing Elder Care Home Publishing. $14.95. Available in local bookstores or click here.