Senior Guidance

Board and Care Homes

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Your Guide to Board and Care Homes for Seniors

Moving to somewhere unfamiliar and new in our twilight years can be difficult, so even with the availability of nursing homes and assisted living facilities, most of us want to grow old in the house we have lived in for years. However, circumstances such as health and other care requirements may render this impractical, if not impossible. Fortunately, there is an option that can serve as a compromise between the two, and this is in the form of board and care homes.

Also known as residential care, domiciliary care, personal care and adult family homes, they all provide one similar and very important service: board and care for the elderly in a familiar, cozy and residential-like setting.

What to expect from board and care homes

If you are currently looking at options for an elderly loved one, you might have come across board and care homes as one of the choices to choose from. While there is no nationwide definition for this kind of housing, what is common among board and care homes is that they all have the following features:

  • Cozy, residential care – Board and care homes are situated in actual homes and are located in residential neighborhoods.
  • Limited occupancy – Because of its setup and size, board and care homes for seniors only admit a limited number of residents, mostly up to ten only.
  • Private rooms – The homes also feature a private bedroom for each resident, which is fitted with basic features such as a table, chair, reading lamp, closet and/or a television. In some more affordable facilities, rooms may be offered for sharing between two people. Bathrooms can also either be private or shared, depending on the size of the home.
  • Common living area – Like any other house, residents share common living and dining areas. There may also be a patio and garden or yard, for most.
  • Handicap accessible features - These homes are often remodeled to make them handicap accessible and safe. Bathrooms, for example, may have grab bars and no step showers to prevent accidents like slipping. There may also be other modifications throughout the bedroom and common rooms, but they are usually done discreetly to keep an air of normalcy around the house.
  • Assistance with daily activities – Staff members are available throughout the day to provide assistance for daily activities like dressing, personal grooming, eating, toileting, setting up healthcare and other appointments and getting around.
  • Meals – Meals are served thrice daily. Residents, however are free to eat out or order food elsewhere if they prefer. They may also arrange to have guests eat with them in the dining area. Aside from meal preparation, staff members also monitor residents’ eating habits, taking note of any changes in patterns. Sometimes, elderly residents may just need to be reminded about their meals, but there are also cases where they may need to be encouraged to eat or seek medical attention to determine the underlying reason for loss of appetite.
  • Housekeeping – Housekeeping services are also provided in elderly residential care homes, with dedicated personnel to do the laundry and keep bedrooms, bathrooms and common rooms clean.
  • Medication management – Medication management is also another common feature, and this can range from storing and administering medication, to simply reminding residents to take them on time.

Are all board and care homes the same?

Just like each house in a certain neighborhood is different, senior board and care homes are very different from each other, too. Some homes are simple and offer the most basic amenities, while others are more luxurious.  Originally, board and care homes were run by individuals or families who also lived on the premises, and were closely involved with the day to day care of the residents living in the house. Over the years, however, there has been a shift in the kind of ownership as there are now many corporate run facilities that employ caregivers 24/7.

Prerequisites for residents

Residential elderly care homes do not provide the same level of supervision as assisted living facilities, nor are they completely independent living facilities. Nor do they provide medical care as one would receive from a nursing home. Hence, these homes may have some prerequisites before admitting prospective residents.

One crucial requirement is that the resident must be ambulant, or at least able to move around independently. While walking around may be a prerequisite, most facilities will usually accept those using wheelchairs and walkers, too.  As these homes do not provide medical care, it may not be ideal for people requiring 24-hour attention from health-care providers.

Cost of board and care facilities

The cost of residential senior care homes varies greatly and will depend on a wide range of factors such as location, amenities and whether or not the home is licensed by the state.

What is common among most board and care homes, however, is that they are less expensive than assisted living facilities and nursing homes. The total cost per month can range from $1500 to $4500. Residences that offer specialized attention for patients with dementia or Alzheimer’s can cost a little over $4500 a month. These rates already include all the amenities and services mentioned previously such as three meals a day and around-the-clock staff assistance.

Paying for board and care

Most board and care homes are private pay, which means residents pay out of pocket from long term insurance policies or other means. Medicaid may also be an option for elders who cannot afford to shoulder monthly costs, but this is ultimately dependent on whether the facility in mind is Medicaid accredited or not and whether the person is eligible for benefits.

Eligibility and other financial guidelines vary from one state to another, so it’s important to contact your state Medicaid agency as early as possible, since the process of determining eligibility takes quite some time.

Advantages and disadvantages of board and care homes

Senior board and care homes have their own advantages and disadvantages. Some advantages that make them ideal for many include the following:

  • Residents live in a homey environment. Unlike nursing homes or assisted living apartments, board and care facilities are oftentimes situated in an actual house. They are integrated into the community, in residential neighborhoods, giving them a familiar feel. This helps new residents easily adjust to their new environment.
  • Residents get more specialized attention, given the lower staff to resident ratio. They also get more interaction with the staff. Meals may also be prepared according to personal choices, which is not always the case in larger facilities.
  • Because these homes are residential, they have a relaxed and unstructured environment. Older adults are free to move around as they please as if they were in their own homes. They can go out for walks in the neighborhood, dine out, go shopping and have family and friends visit when they want.

Of course, this living set-up also comes with disadvantages, and here are some reasons why other seniors prefer other types of living facilities compared to board and care homes:

  • Residents usually only have a room to themselves and will share common areas with other seniors. This is unlike assisted living facilities where they might have a studio or apartment all to themselves.
  • Residential home care setting also have fewer activities in comparison to assisted living communities. Assisted living communities have amenities for outdoor exercises and socialization, and organize classes that seniors can join. This is often absent in board and care homes. Thus, it may not provide the amount of stimulation that many active senior citizens may require.
  • The limited number of residents may also be an issue for seniors who like to socialize with more people.

Choosing board and care homes for your loved one

Given the variety across board and care homes, it’s crucial to do some research to find the best one that’s perfect for your loved one. Here are some things to ask when comparing and looking around different facilities:

  • Fees. How much is the monthly fee, and what it includes. If there are services – like transportation or special dietary requirements – that are not included in the monthly fee, find out if they can offer them for an additional cost.
  • Payment policies. What are the payment policies – are there upfront payments? How much do you have to pay for moving costs? Also ask for their policy for residents who have to leave the home for a while for medical care. For example, if your loved one has to stay in the hospital for a month or more, will you be allowed refunds for the months that they do not stay in the home?
  • Cleanliness. Is the board and care facility clean? How does it smell like? Do the personnel keep the common areas clean? Another key indicator for cleanliness are the residents – are they well groomed?
  • Staff. Notice how the staff interacts with the residents. Are they respectful and courteous towards the seniors? What is the staff to resident ratio? You may also want to ask the minimum training requirements for their staff.
  • Resident interaction. Do the residents get along with each other? Does the facility organize activities for them on a regular basis?
  • Rooms and bathrooms. Check out the bedrooms and common rooms. Are they well maintained? Are they free of obstacles and hazards? How many exits are there and how accessible are they from the bedrooms? If the house features shared bathrooms, ask if there are enough for everyone, and if there are modifications to prevent risks of falls and other accidents.
  • Smoking. Some facilities allow smoking in designated areas. This is an important thing to consider especially if your loved one either smokes or wishes to live in a completely smoke-free environment.
  • Activities: Ask staff members and residents what a typical day is like in the home. Is it a quiet place where elders can do their own thing, or are there social activities organized on a regular basis? Both scenarios are actually great, depending on the preference of your loved one.
  • Inspection reports. Residential senior care homes are regulated by specific agencies in your state, and are inspected on a regular basis to ensure that they are up to standards. Ask to see the latest inspection report, and if there are complaints that have been filed against the facility in the past year.
  • Special care. Ask how the staff takes care of residents with special care needs. For example, how often does the staff check and clean residents who become incontinent, or do they have safety mechanisms for those with memory or cognitive problems.
  • Transportation options. It also helps to find out if the board and care home provides transportation to community activities or doctors’ appointments. If not, find out if they can make arrangements for your loved ones when the need arises.

Applying for a board and care home

If you are considering having your loved one move to a board and care home, you will have to go through an application process, which can be quite lengthy. It starts with a comprehensive application form that covers everything from the prospective resident’s medical history to finances and sleeping habits.

Aside from filling out the application form, he or she will also have to go through a physical examination and an interview. Once a decision is finally made, the applicant (or you) will be asked to sign a contract which will specify rights and obligations of both parties. It will also stipulate details such as the fees, what the resident receives for such fees and grievance procedures. Make sure that you go through the agreement document thoroughly and carefully to make sure that all the provisions are clear.

Moving to senior board and care homes

Making the move to a board and care facility can be a challenge for any person, especially when one is used to familiar surroundings like the family home. Thus, it’s important to take your time to look for a home, and if your loved one is up for it, include them in the search.

Many seniors and their loved ones ask, how do I find board and care homes near me? This guide should at least help you in your selection process and identify a place that is not only nearby and affordable, but provides the right quality of care, amenities and environment that you or your loved one needs.