Living in a Community Setting

Communities living arrangements are another housing option very important to many older adults.  Community settings provide housing, a range of in-home support services and some social activities.

Both the housing and in-home support services are designed to meet the individual needs of those who require help with “activities of daily living” or “instrumental activities of daily living”.  (See below.)  However, group housing does not offer the level of medical care provided in nursing homes.

Activities of Daily Living are activities relating to personal care:

• Bathing or showering
• Dressing
• Eating
• Getting in or out of bed or chairs
• Using the toilet

Instrumental Activities of Daily Living are activities related to independent living:

• Using the telephone
• Doing light or heavy housework
• Preparing meals
• Shopping for groceries or personal items
• Managing money

It is very important to determine whether a particular type of community housing is the right match for an individual. 

As mentioned in the introduction, making sense of the names for categories of community housing options can be difficult.  There are almost 30 terms that states use to refer to these types of community settings – and every state describes and licenses community housing for older adults differently.

The following are some of the terms used for group housing for older adults.  They may refer to very similar group settings – the only difference may be what they are called and how they are licensed in a state.

• Board and Care Homes

Board and care homes are private and in residential settings.  A board and care home is often a converted or adapted single-family home.  This type of home provides the following services: a basic room, which may be shared with another person; meals; help with instrumental activities of daily living; the arrangements for or provision of transportation to medical and other appointments; reminders to take medications; and daily contact with staff. Services such as meals, supervision and transportation are usually handled by the home’s owner or manager.

• Adult Foster Care Homes

An adult foster care home provides room, board and in-home support services in a family setting. Generally, an adult foster care home provides more in-home support services than a board and care home. These homes may meet the needs of adults who require periodic or regular assistance with activities of daily living. Some adult foster care homes may offer more complex care if the staff has experience and is trained to provide it.  In some cases, visiting nurses provide the necessary assistance.

• Adult Care Facilities

Adult care facilities provide room, board and in-home support services to six or more adults who are not related to the operator. Services for residents may be similar to a board and care home or an adult foster care home.  Adult care facilities generally have more residents.  They are therefore less likely to resemble family life.  Adult care facilities may also be called congregate housing.

These facilities are available for older adults who are no longer able or willing to live completely independently.  Generally, residents live in a private apartment and are capable of getting to the communal dining area independently. They usually receive help with grocery shopping, meal preparation and housework.

• Residential Care Facilities

A residential care facility is a group residence that provides each resident with, at a minimum, assistance with bathing, dressing, and help with medications on a 24-hour-a-day basis. The facility may also provide medical services under certain circumstances. 

• Assisted Living Facilities

This term is probably the most confusing. In some states, the term “assisted living” or “assisted living facility” includes all types of group settings that provide some level of in-home support services. In other states, assisted living facilities are specifically licensed and regulated by state law.  In these states, assisted living facilities must provide the services and features the state requires. 

Assisted living facilities are a housing option for those who need a wide range of in-home support services to help them with activities of daily living.  However, residents in these facilities do not require the level of continuous nursing care that a nursing home offers.

People who live in newer assisted living facilities usually have their own private apartment.  Private apartments generally are self-contained, with their own bedroom, bathroom, small kitchen and living area. Alternatively, individual living spaces, consisting of a private or semi-private sleeping area and a shared bathroom, may resemble a dormitory or hotel. There are usually common areas for socializing with other residents.

• Continuing Care Retirement Communities (CCRC)

A continuing care retirement community provides a comprehensive, lifetime range of services, to include housing, residential services and nursing care.  A person moving into a CCRC is required to sign a contract with the provider which contains information on the services that are available and the costs of those services. All housing is usually part of one campus setting.

In these housing communities, residents live in the type of housing appropriate for their needs and desires.  They can move from one level of care to another, while remaining in the CCRC.  For example, a resident could start out living independently in a private individual home or apartment.  If daily care becomes necessary, the resident could then move into an assisted living facility.  The CCRC’s nursing home cares for those who require higher levels of care.  CCRC contracts usually require that residents use the CCRC nursing home if the resident needs nursing care.  CCRCs generally require a large payment, called an entry fee, before new residents move in.  CCRCs also charge a monthly fee.

These general descriptions of the various group settings portray some of the basic differences between them.  Many of these options are available throughout the country.  It is not a good idea to rely on advertisements to learn about these various group housing options.  It is best to get the most objective information available.  What is most important when considering group settings is this:  focus not on what it’s called but on the type of housing units that are available, the types of services that are provided and the monthly costs.

Those considering group settings in specific locations can obtain information and assistance from the Eldercare Locator at 800.677.1116.  The Eldercare Locator connects callers to the appropriate local Area Agency on Aging.  The agency staff will have information about the specific types of group housing available in the local area.  The information will include state licensing and regulatory requirements, ways to obtain information about specific facilities and whether the facility accepts individuals whose costs are paid by Medicaid.

Benefits: Group housing options offer a wide range of in-home support services, a variety of housing types and the choice of location of facilities.  They also give residents opportunities for socializing with others.

Challenges:Group settings may limit privacy.  Residents who need more care or supervision may need to obtain additional services or relocate.  Some older adults may not be able to afford certain group settings.