In many parts of California, there are senior residential communities in which members can purchase a townhouse, condo, or single family house (usually in a gated community). Aside from The Villages in San Jose’s Evergreen district, there are only a small handful of such areas in Silicon Valley. (There are 2 condo communities in Los Gatos, one in Menlo Park, and I believe two in South County which are ˜buy ins.)
For the most part, what is available as dedicated senior housing for folks over the age of 55 or 62 (depending on the community) is primarily rental housing. (Additionally, there are some ˜life care facilities which do involve a buy-in or admission cost, but it functions as an insurance policy too, such that if your money runs out, you would not be asked to leave.) There is not a lot of senior real estate to purchase in the San Jose area.
Types of Senior Residential Communities
Of the main types of senior housing available in Santa Clara County, there are three general types of service available. These could be to rent, or to buy and own in life care or other communities.
1- Independent Living
2- Assisted Living
3- Skilled Nursing (sometimes, when temporary, called Rehab)
Independent Living is for healthy, mobile adults. In many cases, its a lot like hotel living, except the senior typically has an apartment or condo (studio to 2 bedroom) and 1 to 3 meals are provided daily. This type of arrangement offers less work (less housekeeping, meal preparation, shopping) and more security, companionship, and transportation (rides to shopping, banking, worship services, medical appointments). No medical care is provided. If help is needed with administering medicines, for instance, this would not be the solution.
The Villages in San Jose is an example of an Independent Living Community. In that case, people can buy houses, townhomes, or condos, but be in a gated community of seniors. More often in San Jose, though, these communities are apartment rentals with meals, housekeeping, outings, and other non-medical services for seniors. A good example would be The Atrium of San Jose, which is in the Blossom Valley neighborhood near Oakridge Mall on Blossom Hill Road.
Who is it for? If the senior you love is lonely, becoming a bit of a recluse, feeling overwhelmed by taking care of a house and meal preparation, this is a great opportunity to make life easier and more fun for him or her. There is always an adjustment period (not infrequently of about 6 months) but in my own personal experience, a lot of people who move to an Independent Living Community come to really love it as they make new friends and have less stress in their lives. It has been great for my family members.
Independednt Living requires the least staff to resident ratio, the least level of care and therefore is the least expensive, generally. There is usually a lease with the non-buy-in places, and a deposit.
What to ask? Ask what the typical annual increases tend to be, and how hard it is to break the lease if the residents health changes etc. Also inquire about the deposit and what medical conditions would warrant the facility asking you or your relative to move out to a higher level of care.
What are the issues? As with other type of rentals, things can change and the senior may not be allowed to stay there even if he or she wishes to. There is definitely a loss of control. The most common reason for needing to leave is declining health and the need to be more dependent on others for help with the daily tasks of living. Those include things like help with bathing, grooming, eating, or remembering to take medicines. When the resident needs assistance at this level, it will warrant a move out of independent living and into assisted living (or nursing, if the needs are more extreme).
Assisted Living offers more help, whether it is related to taking medicines, assistance with mobility, memory impairment, or overall declining health. Folks in Assisted Living tend to be a little older, more frail, more needy overall than those in Independent Living. More of the residents are confused or have some dementia. This is definitely not a golf course community!
The need to get medicines administered properly is often a driving force in the move to Assisted Living. Sometimes the elderly get forgetful about what has been taken or missed, sometimes poor eyesight makes correct dosing a problem – whatever the case, at Assisted Living, the staff takes over the meds and gets you, your friend or relative on a schedule to make sure everthing is taken as needed. It is a huge relief for many families. But also with Assisted Living, the staff is a little more involved in the day-to-day tasks of everyday living. Some folks may need reminders to go to meals. Others may need an escort. And others still may need help just getting out of a chair or putting on shoes from time to time. Many Assisted Living residences offer a sliding scale so that residents are charged for the level of care they need. Someone who only needs help taking pills will not be charged as much as another who needs help bathing or toileting.
When someone moves to Assisted Living, often the biggest surprise is how many of the residents there have some stage of noticeable dementia. When interviewing at various communities, ask about this. When a relative is ˜sharp and sits at lunch with others who are very, very confused, it can be disheartening and depressing for the new resident.
Equally surprising can be the reasons why one is asked to leave Assisted Living and go to the next level of care, rehab or nursing. When agreeing to move IN, find out the reasons why the facility may ask you, your relative/friend to LEAVE. In my own experience, I have found some places a bit capricious in getting residents out when it seemed that they could have been allowed to remain. Transitions are very hard on the elderly – so its best to keep the number of moves to a minimum! There are state laws about these issues too. For instance, a diabetic with a pressure sore at “stage 1” or “stage 2” is allowed to be at an assisted living facility and be treated there (usually by a home health care nurse or similar professional). The state of California says that if the wound is a stage 3 or stage 4, it requires skilled nursing rather than assisted living.
While some assisted living homes have been accused of keeping residents longer than they should, presumably to keep the monthly income, in my experience, sometimes these residential care facilities for the elderly try to kick out residents prematurely. Why would they do that? Sometimes it’s because the current residents are paying lower rent than the facility could get with a new move-in. Sometimes it seems the reason is that the resident requires too much assistance. This can be the case with the elderly who are large and not so good with transfers. The facilities would rather assist a 100 lb woman than a 200 lb man to get in and out of chairs, for instance. So moving on the larger person to nursing makes life easier for the facility.
To go into the reasons for dismissal a little more…. Usually there is a specific list that the residential care facility has for agreeing to take, or demanding to dismiss, someone. Get a list and have it explained carefully. One place I am aware of required someone to leave because he needed to be on a ventillator a couple of hours a day, but that was never explained upon move-in. Most assisted level places require that the resident be able to ˜transfer – to get in or out of bed or a chair without aid. I believe the idea is that in Assisted Living, the folks who reside there should be able to get out of the building if theres a fire. But some communities will kick a senior out if they feel he or she is not reliable with the transfering – so you have people who can walk with a walker, get in and out of chairs, etc. but are told they are no longer eligible for Assisted Living. Even so, many folks who need to be wheeled in to meals three times a day are permitted to remain, so to me its anything but clear why some can stay and others are asked to leave. Ask, ask, ask.
Something seldom discussed, too, is the concept of a ˜waiver. Different levels of care have different types of licensing and different requirements from the state. If someone belongs in nursing, for instance, but is at a lower level of care and the family or spouse can provide for in-home care, the facility may object that its not allowed and the family must move the couple or person out from assisted living to nursing. This can be devasatating, especially if the one needing the level of care is clearly dying. If the facility is willing, it can apply to the state for a waiver to enable nursing care to be brought in at the familys expense. Some facilities are willing to go this extra mile to spare the elderly person and family the enormous burden of moving a person who is already suffering tremendously. So ask about policies related to waivers and see how ˜humane the place is. And try to get it in writing!
In rental Assisted Living, it is usually month-to-month (no 6 -12 month lease) and there is usually some kind of non-refundable entrance fee ($1000 to $2500 is what I have seen in my own experience, mostly the lower of the two).
Some nice Assisted Living communities include Belmont Village in San Jose (next to Santana Row), Atria in Willow Glen, and Carlton Plaza in Blossom Valley. There are many, many of these type of places in San Jose
A helpful link on Assisted Living: California Assisted Living Association
Skilled Nursing or Rehab is the highest and most expensive level of care. In fact, as you progress through these levels, typically the cost goes up and the living space goes down. By the time someone is in Nursing, it is usually a shared room and no longer an apartment (and at that will cost significantly more than a separate apartment in Assisted Living). Currently, the cost for a shared room may run from $250 to $300 per day. At this level, many long-term residents are extremely dependent, many have advanced dementia and need assistance with almost everything. It can be very hard on the sharp-minded person whos there to nurse a broken hip, or someone who lost the ability to get in and out of chairs alone but is otherwise quite mentally astute.
I have seldom seen a Rehab Facility or SNF (slang ˜sniff for Skilled Nursing Facility) where the family felt the care was very good at all. It just seems to be rare and so it is especially crucial to not just interview carefully, but drop in often and at different times to make sure everything is satisfactory. Elder abuse is a big issue too, especially for patients with dementia – so please make it a point to be there often. Your loved one needs an advocate here more than anywhere!
Multiple Levels of Care in One Campus Setting
A growing tend in Senior Residential Facilities is to offer several levels of care all on the same campus. This is great as long as the care is equally good at all levels! In such a multi-level of care place, though, once a resident lands in Nursing, it can be hard to get back to Assisted Living. Why? Because the Assisted Living facility has to agree that the resident is ˜safe to return. It does not seem to matter what the senior or his/her family members want – if the facility says no, the answer is no. It can be very frustrating. Again, the compassion of the community is at the heart of the situation – so interview carefully and get references before deciding on a move to a community, especially one with multiple levels of care where its hoped that if the need for nursing is short-term, the resident can move back to Assisted Living as soon as possible. Its necessary to look at all the contingency plans, just as if you were buying a house, to use an analogy from my work.
An example of a multi-level campus is Saratoga Retirement Community in Saratoga.
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