By Leigh Ann Otte

Not long ago, the term senior care conjured images of dim, sterile nursing homes filled with glazed-over, lonely seniors. No one wanted to end up there. But today’s senior care industry is a burgeoning field of innovation and evolution. Options are more diverse, and seniors are finding that life in their silver years is fulfilling, friend-filled and fun.

Of course, with lots of options can come lots of confusion. If you’re wondering what’s best for yourself or your aging parent, start here, by learning some of the most common terms related to senior care. Afterward, if you’re still not sure about everything, a geriatric care manager could help. They’re trained to assess your situation and help you determine what to do.

Options for Seniors Needing Little to No Care

Independent Living

Independent living is one of the broadest senior-lifestyle terms. People sometimes interchange it with retirement living, but it’s not technically the same, explains Steve Maag, director of assisted living and continuing care for the American Association of Homes and Services for the Aging.

• Retirement living refers only to seniors and isn’t limited to independent lifestyles.
• Independent living includes people who are mentally or physically disabled who live on their own.

Independent living may require modifying your home to make it more accessible. Some remodelers and interior designers are becoming “certified aging-in-place specialists” (you’ll see the letters CAPS behind their name) or are training in universal design—making homes accessible for a wide range of people.

Independent living can also involve home care (see below) or moving into a retirement community. In fact, retirement communities are sometimes called independent-living communities.

Retirement Living

What pops to mind when you think of retirement living? Active seniors golfing, playing tennis and sailing in a vast sunny paradise? That’s how television often portrays it, but the reality isn’t so lavish.

While retirement communities like that exist, they’re not the rule, says Maag. “Some have pools, fewer tennis courts and only a small number golf courses.”

Retirement communities range from apartment complexes to resort-style developments. They may offer secured access, housekeeping and transportation services, activities, entertainment, trips and community meals.

They often focus on independent living—but not always. Any type of senior development can market itself as retirement housing, says Maag. “Retirement living” tells you it’s for seniors, but then you have to discern whether it offers independent living, assisted living, or some other arrangement.

Continuing Care

Continuing-care retirement communities offer various living options within one development. The idea is, once you’re in the community, you never have to leave, even if you end up requiring care.

Typically with CCRCs, seniors pay a large entry fee to move into a rented apartment or house. They also pay a monthly fee. Then, if they ever need assisted living or nursing-home care, they just transfer to an on-campus facility. Depending on the contract, they may receive the care for no extra cost.

Like regular retirement communities, CCRCs offer recreational, wellness and dining options, as well as secured access. While convenient, CCRCs aren’t cheap. Entry fees range from about $20,000 to over 500,000, according to the American Seniors Housing Association. The entry fees are usually partially refundable—either to you or your heirs—but only after your spot has been sold to someone else.

Concerns have been raised about these communities and how much financial risk may be involved for residents. For example, what if the community goes bankrupt? As with any type of senior community, it’s important to research the organization when considering this option.

Options for Seniors Who Need Moderate Care

In-Home Care

When talking about long-term senior care, “in-home care” usually refers to aides who come in and help with everyday tasks. This type of care can help seniors stay in their own home instead of move to an assisted living facility—a situation known as aging in place. In-home care can also help family members who are caregivers—to give them a little break or some extra hands.

In-home care aides can help with things like housekeeping, cooking, errands and personal care (such as bathing and dressing). They can even just keep the senior company to help relieve loneliness—chatting, playing games or helping with hobbies. The median national hourly rate for in-home care is $18, according to a 2010 report from the financial security company Genworth Financial.

When looking for an in-home care aide, you have a few options, including:

• Home-care agencies, which often require a minimum number of hours per week (such as four hours, three days a week). They may conduct background checks on their aides and ensure some amount of training, though you should ask the agency for specifics.
• An individual who’s not in an agency. In that case, you’ll need to look into your legal and governmental obligations and risks. Also consider that you may be the only person responsible for ensuring the aide is safe for your parent.
• Yourself or a loved one. Many people do care for their aging parents themselves. Caregiving can be rewarding but stressful. If you choose this option, please don’t miss the section on respite care below.

Another type of in-home care is home health care. This involves nurses or other health-care professionals. Genworth found the median rate to be $19 an hour. Often, people get this type of care after a hospital stay, though it’s also available for long-term senior care.

Respite Care

If you’re caring for a senior yourself, this section is for you. Caregiving is often a stressful, draining job. Respite care provides temporary relief. For example, an aide may take over while you run errands, go on a date with your spouse or just take a nap. Following are a few types of organizations that may offer respite care:

• Places of worship such as churches and synagogues (often free)
• Adult daycare facilities
• In-home senior-care agencies
• Nursing homes and assisted living facilities

Respite care may last a few hours or a few weeks. Besides allowing you a bit of time off here and there, it can also enable you to go to work or even on vacation.

Assisted Living

While many people want to live at home as long as they can, sometimes that becomes impossible. It can also get lonely. Assisted living is one option for seniors who don’t need a nursing home but do need help with everyday tasks.

Assisted living facilities generally offer apartment-style housing, with microwaves and small refrigerators instead of full kitchens. Caregivers help with so-called “activities of daily living,” such as bathing, dressing, going to the bathroom, eating and getting out of bed. Like retirement communities, assisted living facilities usually offer transportation and housekeeping services, community meals, trips, and events.

Each state has its own regulations on what assisted living facilities can and can’t offer, explains Lisa Gelhaus, public affairs director for the National Center for Assisted Living. On average, residents require help with 1.6 activities of daily living, according to the NCAL. Most also need help with meal preparation and medication management. Aid is available 24 hours a day. Genworth Financial puts the median rate for an assisted living room at $3,185 a month.

Options for Seniors Who Need 24-Hour Medical Care

Nursing Homes

Many of today’s nursing homes are more home-like than the ones you may remember. There are a wide variety of options, and you may want to visit a few to get a thorough idea of what’s out there. As with any senior-care facility, the quality of the nursing home—and how well it fits with you or your aging parent—can strongly impact health and happiness.

Nursing homes provide 24-hour medical care. Residents may have their own room or share one (a cost saver). Since some residents aren’t able to get out of the facility often, some facilities offer sunrooms or gardens with walking paths. They may also organize fun activities such as Nintendo Wii competitions, fashion shows and art classes. And some are designed to be more warm and homey than hospital like.

Elder abuse connected to nursing homes has been widely reported. That’s one reason to research facilities well and to keep an eye on your aging parents after they move in. That said, abuse doesn’t occur at every facility, and experts aren’t sure how widespread it really is, according to Sharon Merriman-Nai, co-manager of the National Center on Elder Abuse. In fact, it can happen in any setting—even home care.

The median rate for a semiprivate room (one with a roommate) in a nursing home is $185 a day, according to Genworth Financial. A private room costs about $206.

Alzheimer’s Care

Alzheimer’s care, also called memory or dementia care, is a specialized form of senior care. It’s available at some general assisted living facilities and nursing homes and also at places that provide this care exclusively. Some adult daycare facilities offer Alzheimer’s care as well.

When seniors with dementia who have been cared for at home get to the point where they need more care than the loved one can provide, it may be time to look for a facility that specializes in memory care. This type of care incorporates activities and philosophies specific to dementia treatment. Facilities may even have special design features that help residents orient themselves. And they help prevent dangerous wandering by securing access.

Even seniors in the early stages of Alzheimer’s who want to move into a senior community would do well to choose one that has memory care, says Gelhaus. Such facilities provide specially trained caregivers and programs that help residents maintain their independence as long as possible.

As you can see, senior care isn’t an all-or-nothing situation these days. It’s more personalized and focused on residents’ comfort and rights.

In addition to the common options presented above, other lesser-known possibilities are emerging. So-called virtual retirement villages—membership-based community organizations in which seniors support each other—are cropping up across the country. Senior foster care is available in some places: a few seniors move into someone’s home, and the homeowner—a trained caregiver—provides care, often treating them as part of the family. And some seniors are creating their own solutions, such as moving in together and hiring an in-home aide for all.

The overarching message for all these types of senior care is research, research, research. Whatever option you choose, visit the community and make sure it’s right for your situation. Never be afraid to ask questions, approach residents, request documentation and try the food. Senior care can provide fulfilling experiences. Pick wisely and enjoy.