Housing options for different levels of care needs

Part of creating a lifetime of care includes anticipating and planning for both short- and long-term housing solutions for you and your loved one, as care needs change over time. Generally as we age, the amount of care needed increases, and so does the cost of providing housing that will meet those needs.

Staying in your home

Most people would prefer to stay in their own home as they age. The sense of independence, comfort and familiarity — as well as the cost of in-facility care — are powerful drivers of the decision-making process. If you’re a caregiver of a family member who prefers to stay in their own home, or if you feel that in-home care will be the best option for you as you age, it’s important to balance the wish for independence and familiarity with the space and assistance needed to be healthy and safe.

Modifications for multiple generations:

Increasingly, Americans are “sandwiched” between caring for an adult loved one while also caring for children in their homes. Eleven million caregivers — or 28% of all caregivers — are Sandwich Caregivers** who may be living with multiple generations in their home. This living arrangement may require a rethinking of living spaces, requiring wider doorways or ramps for accessibility. If space allows, an aging loved one may want to have their own “apartment” within the home or you may choose to move to a different home that can better suit your family’s needs. Whatever works best for your family, there is likely a substantial cost to these changes, and it’s important to plan ahead for them.

In-home care and support:

Older individuals or individuals with disabilities who live at home may require some assistance with daily tasks, transportation, or medical needs. Hiring a service that can send an in-home professional on a regular basis may be a viable way to help you provide needed care or your loved one to continue living on their own. These services can be paid for out-of-pocket from savings or other personal assets, through long-term care policies or potentially with a government program like Medicare or Medicaid.

Adult day care:

Adult day care centers are designed to provide care and companionship for seniors who live at home and need assistance or supervision during the day. The program offers relief to family members or caregivers and allows them the freedom to go to work, handle personal business or respite knowing their loved one is well-cared-for and safe.* The daily cost of adult day care, when added to in-home care services, will increase the overall cost of care.

Assisted living facilities, group residential homes and continuing care retirement communities

Many people with special needs or disabilities are best suited to live in more supportive group homes or assisted living communities where help with activities of daily living — housekeeping, meal preparation, grooming or dressing — is always nearby but with minimal monitoring. These options also may allow for better recreational and social options for some individuals, but as the level of care increases, so does the cost of providing these housing options.

Skilled nursing facility

Individuals who require around-the-clock care assistance, and at-home care isn’t feasible, may be best suited for a skilled nursing facility. With skilled nursing facilities, your loved one will have constant supervision and care. Skilled nursing care facilities provide procedures that must be done by a licensed professional, such as tracheotomy, wound or catheter care, dialysis, chemotherapy and more complex medication regimes. This level of care is nearer the expensive end of the spectrum. However, in many instances, those with limited assets may qualify for basic skilled nursing facility assistance through Medicaid.

In-patient hospital and hospice care

On the highest-level end of the care spectrum, hospitalization treats disease or severe episodes of illness for a short period of time. Hospices provide support for the final phase of a terminal illness, generally when life expectancy is six months or less. It focus on comfort and quality of life, rather than a cure. Also the most expensive level of care, it generally is covered by Medicare.

Managing the cost of housing

Retirement planning: A long-term plan structured to last through retirement must include consideration of housing costs, as the level of care increases over time. But careful planning may not be able to make limited personal assets cover the high costs of care. Even high-net-worth retirees may not have the resources to pay for the high cost of care through to end of life, and alternative resources may be needed.

Long-term care insurance: A long-term care insurance policy provides an individual with the assistance they may require as a result of the general effects of aging. Primarily, though, long-term care insurance is designed to help pay for the costs of custodial and personal care, versus strictly medical care. Note, however, that LTC insurance needs to be purchased ideally beginning in your 50s, but could be purchased up to age 65, if you are in good health. If you wait too long to purchase coverage, it may be too late. Many applicants may not qualify if they already have a chronic illness or disability.

Medicaid: Medicaid provides healthcare coverage for low-income aging Americans, including long-term care services that Medicare does not pay for, including senior housing for qualified individuals. Special Medicaid-funded programs cover in-home and long-term personal care. In some states, these programs can pay for a portion of the costs of assisted living.

Section 8: A Section 8 voucher may allow your loved one with limited means to live independently in a community. This housing option subsidizes rent based on a sliding scale that considers family size and income. Your loved one may be eligible for a rental certificate or voucher in conjunction with a designated housing allocation plan approved by Housing and Urban Development (HUD).

Determining the level of care that you or your loved one may require is a vital part of retirement planning, especially estimating the potential cost and how to manage it. Cost, however, is not the only consideration in determining future housing needs; also consider location, quality of staff and safety to ensure that the highest quality is life is maintained through retirement.

This material is provided for general and educational purposes only; it is not intended to provide legal, tax, or investment advice. All investments are subject to risk. Please consult an independent legal or financial advisor for specific advice about your individual situation.

Products and services offered through the Voya® family of companies.

*”Levels of care.” The Caregiver Foundation. https://thecaregiverfoundation.org/learn-more/caregiving/how-to-plan-ahead-for-long-term-care/levels-of-care

**“Burning the Candle at Both Ends: Sandwich Generation Caregiving in the U.S.”, The National Alliance for Caregiving (NAC), November 2019.