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The Senior Living Continuum: Navigating Your Options

Since 2003 when Jeff Bird began working in senior living and care, the most significant question he's asked from elders and families alike is "How do I navigate the senior care continuum?" This led Jeff to set aside three years to form an advisory service to address this very question. Here are his Insights.

The first stage of senior care is independent living. These communities come in a variety of forms such as single-detached homes on campus and/or duplexes or apartment buildings with floor plans ranging from a small studio to a three-bedroom. Sometimes senior living providers provide all of these options on one campus or just one of them on a smaller site. The main purpose of independent living is to provide a more safe and convenient way for seniors to age in place. Seniors can also enjoy not having the responsibility of maintaining a home and yard and having greater accessibility for socialization and services.

Independent living comes in a wide range of affordability. Back in the late 60’s, the federal government established funding programs which allowed providers to build and maintain very affordable independent senior living communities. These programs came in the form of subsidies that have evolved over time and today exist in the form of Section 8 vouchers, tax credit or interest free mortgages. Numerous religious organizations took advantage of these funds to build not-for-profit communities for their aging members. They have since become a service to the larger community, while often remaining as a ministry to the church or another mission driven organization.


Investors also saw the potential by taking advantage of these funds to build for-profit communities. These communities function the same as their not-for-profit counterparts, but do not provide the services and attention you’d find from a ministry-based religious organization. For-profit communities are safe and convenient, but typically offer the bare minimum of services for socialization.


Independent living becomes a challenge when your loved one is no longer considered “independent”, meaning they are not able to care for themselves and thus unable to remain safe in an independent living community. In the industry, we call this phenomenon “ assisted living light.” In other words, the independent living community has allowed residents to age in place beyond their abilities and resources to remain independent. This can happen when a loved one resists a move from the community in which they have become established or the family hasn't determined their next steps.


The most common solution to this problem is for independent living communities to partner with 3rd party home health agencies who can provide assistance with activities of daily living, or ADL functions (bathing, dressing, eating, transferring, toileting and continence). There is a limit to what the agency can provide to allow the resident to age in place, so the resident may still need to move to a higher level of care.


That next level of care is assisted living. These communities are licensed by the state to provide a more comprehensive level of care (see ADL’s above). There is tremendous growth in this industry due to forecasts of the aging population. The industry does have a small percentage of not-for-profit providers, but it’s mainly dominated by investors looking for a significant return on their investment.

As such, the cost of assisted living can range from as low as $2,000 per month, up to well over $10,000 per month for the additional high-end luxury services. The large number of competitors that are growing in this area allow for some price negotiation, but the pressure from state regulators and resident expectations will continue to be reflected in the cost of services to come.


The last stage of senior living and care in the standard nursing home, which today is most often referred to as skilled nursing or long or short-term rehab. The main difference between assisted living and skilled care is that RN’s are on staff 24/7. In assisted living, there is only an LPN on site for limited hours.


Medicaid is the payor for Skilled Nursing Facilities (Nursing Homes) that provide long-term care for the elderly, ill, or infirm who require this level of care. Medicare, which is often associated with senior care coverage, is unfortunately very limited in what it provides for long-term care. Both programs were established in 1965 with very similar names; both are growing due to increased longevity in our populations.

We hope this article gives you a little more clarity on how to navigate the senior living and care continuum. If you have any further questions, please feel free to email Jeff at jeffreysbird@gmail.com.


Jeff Bird began his professional corporate career in 1984, then moved into senior living in 2003 with roles including executive director, geriatric care consultant, and comptroller.

He has experience in Senior Living & Care Operations, Arbitration & Mediation Tribunal Administration, IT Project Manager, Organizational Development, and Regulatory Compliance Oversight.

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At Elder Care Solutions, we pride ourselves in bridging the gaps relating to long term care decisions by providing consultation, coordination, and commitment during this process.

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