Estate Planning & Elder Law Blog

We want to help you make that decision and provide the context for what each type of senior care facility can offer. We also want to share the benefits of housing assistance, which allows for your elderly loved one to age in place in the comfort of their own home.

In order of care intensity, we discuss some of the facility and care options available to seniors as they age.

In-Home Healthcare Services

With home healthcare services, elders have the opportunity to age in place in a familiar location but with the help of an aide. This alternative to moving your elderly loved one into a long-term care facility is a great option if your elder only requires minor assistance. An aide usually works during a select timeframe, as opposed to providing 24-hour care. The services an aide can provide to your loved one may include: household maintenance with daily chores, home modification, personal care (such as dressing, bathing, meal preparation, assistance with medication administration, etc.), transportation, and socialization (often through activities and companionship). Depending on the particular organization you select to provide this care, these services may vary. There are benefits to remaining at home if your loved one is reluctant to move, but it is important to acknowledge the limits to in-home care, as it often does not provide skilled nursing.

Elder Communities and/or Continuing Care Retirement Communities

Elder communities or Continuing Care Retirement Communities (“CCRC”) are life care communities that can offer multiple different levels of services in one location. One advantage of a CCRC is that it creates a space for elders to live in a shared space with peers. As a senior’s needs change with time, an elder community can offer multiple levels of housing options in one place, so a senior can stay in a familiar location as they continue to age. These housing options may include independent housing or assisted living, adult day care, and more skilled nursing care facilities, like nursing homes or hospice centers.

Assisted Living and Independent Living Facilities

Independent living and assisted living facilities are for people who may need assistance with their daily care (dressing and grooming, hygiene, medication administration, personal and social skills, etc.), but do not require skilled nursing help on a day-to-day basis. The terms “assisted living” and “independent living” often encompass adult day cares and homes for the aged.

Adult Foster Care Homes

Adult Foster Care (“AFC”) homes can provide care to any adult in need of foster care services, not just elderly folks. This often means that persons with developmental or mental disabilities, physically handicapped people, and elders are housed in one place together. Under Michigan law, an AFC must provide adult foster services for 24 hours a day and at least five days a week for two or more consecutive weeks. An AFC is a residential setting, but it is restricted to assisting no more than 20 adults with varying abilities at a time. AFCs may not offer continuous nursing care to its residents – this can be offered to residents through outside nursing or hospice services, not by the AFC directly. Exact arrangements (dining, bedroom set-up, security, available life enrichment activities, shared spaces available to all residents, etc.) offered in an AFC will vary based on the specific location.

Homes for the Aged

A Home for the Aged (“HFA”) houses people 55 years of age and older. In Michigan, an HFA may provide 24-hour room and board to elders. Supervised personal care is available at HFAs. This means healthcare professionals are hired to assist elderly residents with dressing and grooming, hygiene, medication administration, and personal and social skills. However, unlike nursing homes, an HFA may not provide continuous nursing care to its residents. If this level of care is provided to residents, it is done through an outside organization qualified to offer more intensive support to seniors. 21 or more residents may reside in an HFA at a time. Exact arrangements (dining, bedroom set-up, security, available life enrichment activities, shared spaces available to all residents, etc.) offered in an HFA will depend on the specific home.

Nursing Homes

Nursing homes are also referred to as skilled nursing facilities. State licensing is required for a nursing home. A nursing home can provide a variety of health and personal care services to its residents. Often, these services focus on medical care and advanced nursing, allowing the facilities to provide more intensive care to its residents than homes for the aged or assisted living facilities. Residents in a nursing home are typically supervised 24 hours a day and provided three meals a day. Assistance with grooming, hygiene, medication administration, dressing, and social skills is supported by healthcare aids. Rehabilitation services are also often available to elders in nursing homes. These facilities can be a permanent residence for the elderly or a short-term post-hospital housing location, depending on the senior’s needs.

Hospice Centers

Michigan state licensing is required for hospice centers and other hospital long term care units. Hospice can be provided through at-home services, as well, if that is preferential over residence in an established facility. Hospice services can also be available within a nursing home. In general, hospice is health care that assists patients – both elderly and not – whose disease or physical condition cannot be cured, often providing palliative care to ensure comfort and dignity is afforded to the ailing person. Hospice is only available when someone has been deemed terminal, with less than six months to live. When an elder is placed in hospice care, a team is assembled to assist the senior. The team will likely include a hospice nurse and a medical doctor. Members of the hospice care team are usually available all day, every day for questions family members or caregivers may have, or if the patient requires assistance.

We know these above-listed terms and housing options are not exhaustive, but we hope this guide provides the general background needed to understand the different levels of care each facility or housing assistance program may offer to an aging individual.

If you have any additional questions regarding this topic or end-of-life planning for your elderly loved one in general, contact a Foster Swift Elder Law attorney for advice. If you have further need of resources on finding the right senior care facility, please visit the following online resources below.

Resources

• Differences Between an AFC and a HFA (michigan.gov)
• What Needs to be Licensed (michigan.gov)
• Who Needs Foster Care (michigan.gov)
• Continuing Care Retirement Communities (CCRC) in Michigan | FindContinuingCare
• Residential Facilities, Assisted Living, and Nursing Homes | National Institute on Aging (nih.gov)
• Hospice Care in Michigan
• Hospice Care for Elderly Seniors | Is There Hospice Care Near Me? (seniorliving.org)