Bell discussed five issues that should be considered when deciding where to move once one begins to age and decides not to age in place

Bell discussed five issues that should be considered when deciding where to move once one begins to age and decides not to age in place. The five points are aesthetics, neighbors, value, unit price shifts, and reliability (Bell 2016). When choosing a continuing care retirement center, the resident does not design or choose the decorations, so he or she should consider the aesthetics when touring and deciding to ensure that where they will be living is not uncomfortable. Most continuing care retirement communities provide individual rooms for the residents, so if an elder is looking to meet or share a space with someone or needs more help, he or she should consider an independent living facility or assisted living facility instead. Bell reported that some residents may feel as though the money they invested and paid was not valued and went to corporate managers and investors (2016). One important issue that Bell noted was unit price shifts when moving from one level of care to another. When the resident moves levels, he or she may be responsible for out of pocket payments to cover the new living arrangement within the continuing care retirement community (2016). The last point was reliability of the continuing care retirement community. Some residents may have concerns of whether the community originally promised to provide for the resident (Bell 2016). Continuing care retirement communities are one option for seniors who wish to live and age in community, however, there are other options that may cost less for the elder and the elder’s family. There are a couple options for elders to live in communities with elder care if they are unable or do not want to live in a continuing care retirement community.
One option that elders may look into transitioning into instead of a continuing care retirement center is independent living facilities. Independent living facilities house the residents in apartment style buildings where the resident is able to take care of him or herself. The attraction of independent living facilities is that the resident does not or is unable to care for the home, so the facility offers these services to the residents (Davidson 2015). Some services that Davidson listed that are unique to independent living facilities when compared to assisted living facilities are, “transportation locally to places such as grocery stores and malls, and they provide organized social and recreational activities that residents may choose to participate in” (2015). Independent living facilities are similar to assisted living facilities in that both are regulated by state and local law only, so each facility and the services it offer may vary from state to state. While independent living facilities give some room for residents to live while only assisting in home care, transportation, and other aspects of the community, assisted living facilities offer more personal care for residents.
Assisted living facilities are designed for elders who are unable to live independently and need help with activities of daily living, however, assisted living does not provide as much care as a nursing home. According to Tish Davidson, author of “Assisted Living Facilities,” assisted living facilities may often be called or referred to as multiple different names including, “residential care, personal care, board and care, adult living facilities, supported care, enhanced care, adult homes, sheltered housing, and retirement residences” (2015). Most of these names simply mean that elderly men and women move into a facility that is able to provide support, care, and services that he or she may not be able to do completely independent and safely. Assisted living facilities can also offer specific services and specialize in specific medical disorders. One example that Davidson gives is an assisted living facility for men and women with Alzheimer’s disease (2015). Assisted living facilities vary from state to state depending on the different requirements. However, most assisted living facilities share the same basic services. Davidson listed these services as, “24-hour staffing, three meals a day, personal supportive services (e.g., bathing, dressing), medication management and basic health oversight, recreational services, social services, housekeeping, laundry services, and transportation to medical and other appointments” (2015). Along with a basic list of services provided by most assisted living facilities, assisted living facilities have some advantages and disadvantages according to Davidson (2015). Some advantages that Davidson noted were twenty-four hour security, access to healthcare personnel, little to no responsibility of homemaking, assistance in activities of daily living, disability accommodations, and ensuring that medication is taken correctly through supervision (2015). However, when moving from being completely independent to living in an assisted living facility, there are some adjustments and drawbacks that one must become accustomed to. These drawbacks include a lot of loss of freedom of personal choices, having a nonfamily member assist in personal activities, restricted access to the community, routine that may differ from previous routine or schedule, and the financial cost of living in an assisted living facility (Davidson 2015). If an elderly person is looking for more individual and in depth care, he or she may want to consider living in a nursing home.
A nursing home is a facility that provides long-term, sometimes lifelong care to people who are unable to live independently and complete activities of daily living without assistance (A Dictionary of Public Health 2018). Nursing homes also help manage medication and meals that a resident receives daily. Nursing homes receive the majority of their residents from hospitals. Mukamel et al wrote that most patients enter nursing homes directly from hospitals, about ninety percent (2016). Nursing homes and hospitals must work together when referring and transferring patients to ensure that no patient information is lost and that the patient has all the information available in order to make a decision. LaMantia et al describes the relationship and passing of information between the hospital and nursing home as “fundamental to providing quality care to all patients” (2010). Ensuring that the patient is transferred from the hospital to the nursing home safely and with all the information needed is the first service that nursing homes provide to their residents. There are short-term and long-term care options in nursing homes. Short-term care may be offered when someone has just be released from the hospital but still needs to gain strength and ability to live independently again. Once he or she has recovered, they may go home (Residential Facilities, Assisted Living, and Nursing Homes 2017). However, most residents are long-term residents who will need life-long assistance. Nursing homes offer similar services to assisted living facilities with the exception that most nursing home residents need more assistance than those in assisted living facilities. Some service that are offered at nursing homes are “nursing care, 24-hour supervision, three meals a day, and assistance with everyday activities” (Residential Facilities, Assisted Living, and Nursing Homes 2017). Nursing homes are also unique in that they offer a variation of therapy rehabilitation services such as physical therapy, occupational therapy, and speech therapy (Residential Facilities, Assisted Living, and Nursing Homes 2017). Nursing homes typically house residents with chronic, debilitating, or serious ongoing disabilities. Residents who live in nursing homes need may assistance with activities such as bathing, dressing, eating, managing medication, and moving (walking, wheelchair). Elders who are needing to move into a nursing home may need more assistance than family is able to give, or if no family is able to provide, they are not able to live on their own.
As people age, they face multiple decisions about future or current living arrangements. There are many factors that influence where an elderly person may decide to live as they continue to age. Some of those factors are finances, health status, family, or age. Some of the living arrangements for elders can be expensive, such as the continuing care retirement community. Whereas some can be more affordable, such as aging in place or living with family. Some living arrangements may also be necessary for safety and health reasons, such as the nursing home. Whereas, other living arrangements may be by both choice and necessity such as the independent living facility where there is someone managing the home and property but the elder is able to live independently still. Regardless of financial status, health status, family proximity or willingness to help, or age, there is an option that may suit each elder looking to change or alter their current living arrangement.