Housing and Long-Term Care

Assisted living facilities, also known as supportive housing, offer a group residential setting for older adults who want their own living space. Residents may need help with dressing, bathing, eating, and toileting, but do not require the intensive medical and nursing care provided in a Nursing Home.

What is an assisted living facility?

In an assisted living facility, residents usually have their own studios or one-bedroom apartments. Units may be furnished or unfurnished, have a private or shared bathroom, and a kitchenette or full kitchen. Some facilities provide meals in a group dining room.

A facility may be located near a hospital or nursing home with which it has an established relationship. It may function as part of a Continuing Care Retirement Community, or it may exist independently. Assisted living facilities usually provide personal care services and arrange transportation, laundry and linen service, and housekeeping. They sometimes provide health services. Facilities range from high-rise apartment buildings to residential homes.

Assisted living facilities are not regulated by the federal government but are licensed by the Kansas Department for Aging and Disability Services.

How do I select an assisted living facility?

It is important to get personal recommendations and visit the facility. Be sure to ask your lawyer or a trusted advisor to review any contract before you sign it or pay a fee.

How do I pay for an assisted living facility?

Costs for assisted living facilities vary greatly depending on the size of units, services provided, and location. Rent and fees can range from around $1,000 to more than $3,000 per month. It is important to find out what services are included and which require additional fees.

Nursing homes provide 24-hour care at a sub-acute level for a variety of needs and for individuals who can no longer live independently. A nursing home setting may also be appropriate for people who need extended post-operative care or complex medical monitoring. Some nursing homes are called skilled nursing facilities.

What are nursing homes?

Nursing homes provide medical care, room, and board to individuals of all ages on a short-term or long-term basis. Patients recovering from an illness or surgery often go to a skilled nursing facility to recuperate before returning home. Nursing homes also provide long-term care to individuals requiring 24-hour nursing or custodial care. All nursing homes are licensed and regulated by state governments.

What services are generally offered?

Nursing homes provide comprehensive nursing, medical, social and rehabilitative care. Licensed staff administer medications and coordinate treatment regimens. Residents are under the care of a physician, and all nursing homes have a physician on call to respond to acute needs, write prescriptions, and order treatments and tests. Rehabilitation may include physical, occupational, recreational, and speech therapies. Residents receive assistance with personal care such as bathing, meals, dressing and toileting. A registered dietician evaluates residents’ dietary requirements and ensures that they are met.

Social activities and recreation are frequently provided; many facilities schedule activities based on a resident’s needs and preferences.

How do I choose a nursing home?

The federal government regulates nursing homes that accept Medicare payment, because these facilities receive federal money. Most states have additional regulations. The Medicare Website maintains includes a tool for comparing nursing homes, with detailed information about the performance of every Medicare- and Medicaid-certified nursing home in the United States.

Be sure to review the nursing home contract with a lawyer or other trusted advisor.

How do I pay for a nursing home?

Medicare pays for only a limited amount of skilled nursing care, limited to medically necessary recuperation or wound care. This is restricted to 20 days of full coverage and 80 days of partial coverage. Medicare does not pay for custodial care. If you have long-term care insurance, check your policy to see whether skilled nursing is covered.

Monthly nursing home costs can range from $1,500 to $6,000. Since skilled nursing care can be costly, many people who need it on a long-term basis eventually exhaust their own funds and become Medicaid beneficiaries. Check with your insurance carrier, lawyer, or a qualified social worker to determine the type of reimbursement for which you qualify.

Board and care homes offer a group living situation for seniors and people with disabilities who need help with meal preparation, medication monitoring, and personal care. They provide a safe, supportive, home-like setting for people who cannot live alone but do not need daily medical care.

What is a board and care home?

Board and care facilities offer a home-like environment for small groups of elderly or disabled residents. Unlike residents at an Assisted Living Facility, residents at a board and care home may have their own room but usually not an apartment. A board and care home may also require residents to share their room with one or more roommates. Meals are eaten in a group dining room, and housekeeping services are provided. Staff usually live at the home and may assist residents with daily activities like bathing, eating, and toileting.

Board and care homes do not offer nursing or medical care, but they often provide greater assistance with personal care needs than is available at supported housing facilities. They do not generally offer planned activities or transportation services. Some board and care homes specialize in meeting the needs of people with specific diseases, such as Alzheimer's disease, or with specific developmental disabilities.

Board and care homes are not regulated by the federal government but are frequently licensed by state governments. Your state’s licensing requirements will affect the services and levels of care that board and care homes in your community are required to provide. The licensing agency may use a different name, such as residential care facility, to describe board and care homes.

What should I look for in a board and care home?

The range of services offered by board and care facilities varies greatly. Since board and care facilities may or may not be subject to state regulations, it is very important to obtain personal recommendations and to visit the facility several times before considering a move. Board and care facilities provide a limited range of services, and it is important to consider whether a facility can meet one’s short-term and possible long-term needs. Have a trusted advisor or lawyer read over any contract before signing or paying a fee.

How do I pay for a board and care home?

Board and care facilities are often less expensive than other housing options, but rates vary greatly depending on services provided and geographic location. Since there is no common broadly accepted definition of services included in board and care, it is important to find out exactly what is included in a facility’s monthly or annual fee. 

Hospice care provides pain and symptom relief to individuals in the end stage of life. It does not try to prolong life. Rather, hospice workers and volunteers help clients live their remaining days in comfort and dignity.

What is Hospice Care?

Hospice is a service that provides care and support to individuals and families coping with terminal illness. There are many independent providers of Hospice services. A physician’s orders are required to receive Hospice care. Each patient is cared for by a team. Nursing and other medical and home-health personnel, social workers, chaplains and volunteers provide a range of services including pain relief, symptom management and supportive services for the patient and caregiver. Hospice agencies are certified and surveyed by the Kansas Department of Health and Environment.

Services are provided whether the patient lives in a private home or a nursing home, under a doctor’s direction and in cooperation with a designated caregiver. Arrangement for inpatient care is made when needed. Hospice staff assists the caregiver in caring for the individual. Members of the care team will visit on a regular basis or at the request of the caregiver. Staff can be reached 24 hours a day, seven days a week.

What Programs Help Pay for Hospice Care?

Hospice care may be covered by Medicare and Medicaid if the patient has Part A Medicare, a physician’s orders and a diagnosis of terminal illness. Check with other insurance options to see if hospice coverage is provided.

Who Do I Call for More Information?

Hospice agencies are located across Kansas. To learn what is available in your area, contact your physician or your Area Agency on Aging for more information.

Related Links

• Hospice Foundation of America
• The National Hospice and Palliative Care Organization
• Centers for Medicare and Medicaid Services
• Social Security Administration

A continuing care retirement community (CCRC) provides a range of housing and services designed to meet seniors' changing health needs. Many older persons enter CCRCs while they are healthy, active and independent, knowing that they can receive nursing care services if there is ever a serious change in their health status.

What is a continuing care retirement community?

These communities are designed to meet seniors’ health and housing needs as they change over time. Seniors who don't need help with the daily activities like dressing and bathing reside in a single-family home, apartment, or condominium in the retirement complex. If one’s health care needs become more complex, one can transfer to an assisted living or skilled nursing facility at the same site. This enables residents to keep in close contact with a spouse or friends who live in the retirement community. Seniors who choose to live in a CCRC know that their long-term care needs will be met without the need to relocate. CCRCs offer three types of health care agreements:

• Life Care/Extensive Agreement:
  Long-term nursing care for little or no additional cost, for as long as nursing services are necessary. This type of agreement requires higher monthly fees.

• Modified/Continuing Care Agreement:
  Long-term care services for a limited period of time. Beyond that period, the resident pays standard rates for additional nursing care.

• Fee-for-Service Agreement:
  Residents pay for each health-related service they need.

What should I look for in a continuing care community?

When choosing a community, it is important to find out what health services are available and who will decide when those services are necessary. It is also important to understand what will happen if one can no longer function independently and the community’s nursing home or assisted living facility is fully occupied. Before making a decision it is very important to have a trusted advisor, preferably a legal advisor, read the contract and investigate the retirement community's financial status. If a CCRC goes bankrupt, it may be impossible to recover one’s entrance fee.

The Commission on Accreditation of Rehabilitation Facilities (CARF) is an organization that accredits only communities that meet or exceed specific standards.

How do I pay for continuing care?

Payment plans vary. Residents may pay a lump sum entry fee and a monthly fee, or they may pay monthly rent and purchase a separate service and/or health care package. In some communities, residents own a condominium or become members of a cooperative, then purchase service and/or health plan. Entry and monthly fees vary greatly. Monthly rates depend on the size of the entry fee and the type of contract, size and quality of the living unit, services and amenities offered in the community, and geographic location.

Congregate housing, also called supported housing, is a group housing option for elderly individuals and adults with disabilities. Congregate homes have private living quarters and common dining and social areas. Support services vary, but may include meals and activities. People living in a congregate housing facility require little or no assistance with personal care.

What is congregate housing?

Congregate housing facilities range from large apartment buildings with hundreds of units to small groups of apartments. There is usually a live-in building manager and sometimes a services coordinator. Usually, at least one unit in the congregate facility is equipped with adaptive devices such as grab bars and handrails to make moving around easier and safer. Services may include meals and social activities, transportation, medication reminders, a barber shop/beauty parlor, and fitness activities. Housekeeping and personal care (assistance with daily activities like eating and bathing) are usually not provided.

Unlike Board and Care Homes, congregate homes offer private apartments. Also, congregate homes employ professional staff such as social workers, counselors, and nutritionists who provide services and activities. Most congregate housing facilities make an effort to monitor residents’ health and well-being.

What should I look for in a congregate home?

It is a good idea to visit your prospective home more than once. Talk with residents about the facility and staff, and find out whether the facility offers the services you need and want. Consult with a trusted advisor, preferably a lawyer, before signing a lease.

How do I pay for congregate housing?

Federal, state, and local governments subsidize construction of congregate housing facilities and frequently subsidize rent at these facilities. However, rent varies greatly, depending on services offered and geographic location.