Types of Aging Services
There is a wide range of services and housing options available for older adults in a wide range of settings. Many older persons prefer to remain in their current home for as long as possible and are able to do this by bringing services into their home or by attending an adult day program. Others with increasing needs or a desire to live with others in a more social setting may choose to move to a continuing care retirement community, senior housing, assisted living residence or residential care facility depending upon their needs and resources. Those that need round-the-clock nursing care may find the services of a skilled nursing facility best meet their needs. Over time, options are expanding to allow elders to receive the services they need, when they need them, in the place they call home.
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2. Other community based options, including adult day health, hospice, and intentional communities, villages, or at-home programs
3. Managed long-term care programs, which include:
a. The Program of All-inclusive Care for the Elderly (PACE)
b. Senior Care Options (SCO)
4. Housing and long-term care options, which include:
a. Senior Housing (includes public, privately-owned subsidized, and congregate and supportive housing)
b. Continuing Care Retirement Communities
c. Assisted Living Residences
d. Rest Homes / Residential Care Facilities
e. Nursing/skilled-nursing and rehabilitation facilities
Services in the Home
Below is a list of some of the services available that can be provided to individuals in their own homes. Many of these services are paid for with private resources. In Massachusetts, funding through the state Home Care Program may help to pay for services for eligible individuals, while in certain circumstances, MassHealth (Massachusetts Medicaid program) may also be available for eligible individuals. Home health care is also covered by Medicare in limited circumstances. The Executive Office of Elder Affairs, www.mass.gov/elder (or call 617-727-7750), can provide additional information on the following home and community based services:
- Homemaker services help older people live independently at home by helping with home management tasks, such as shopping, meal preparation, and light housekeeping.
- Personal care services include assistance with activities such as bathing, dressing, grooming, and toileting.
- Home health care services offer clients health-related services such as wound care, dispensing medication, IV therapy, and are provided by home health aides. Skilled nursing and therapeutic services are provided by licensed nurses and therapists.
- Home delivered meals or congregate meals offered in group settings such as senior centers provide nutritious meals to seniors.
- Transportation services are available to drive seniors to various appointments upon request.
- Money management and representative payee services assist lower-income older people who need basic support budgeting monthly financial obligations. Volunteer staff is monitored and supervised by local agency staff, Mass Money Management
- Home modification: The Commonwealth of Massachusetts provides loans for eligible seniors and others with disabilities to make modifications to improve the accessibility of their home. Adding a ramp or a lift, widening doorways, adding grab bars or a walk-in-shower can make a home more accessible and safer. Loans range from $1,000 - $30,000 and 85% of loans have 0% interest that do not need to be repaid until the home is sold or transferred. For more information go to www.mass.gov/mrc/hmlp.
- Respite care offers care on a short-term basis, usually for the purpose of relieving caretakers of their responsibilities for a brief period.
- Adult Day Health programs offer a safe secure, stimulating environment for people whose family circumstances allow them to remain in their homes in the evenings (and possibly on weekends), but who need some sort of supervision during the daytime. In addition to providing meals, transportation to the center, social and recreational activities and support, most adult day health programs also provide ongoing health care monitoring and coordination through medication assessment and management, management of chronic conditions, personal care, and physical, occupational and speech therapy. In Massachusetts, adult day health care is covered by MassHealth for eligible individuals.
- Hospice programs are well known for their care and services they offer people who are dying and their families. Hospice care is provided in the home, a nursing facility or a free-standing hospice. For more information about hospice, go to www.hospicefed.org
- Intentional Communities, Villages, or At-Home programs have developed around Massachusetts in recent years modeled after Beacon Hill Village in Boston. Such communities were designed to allow older members in a given community to remain in their homes by providing information and access to a range of support services at reduced fees, transportation, volunteers, social and recreational activities and other services to individuals who pay an annual membership fee.
Managed Long-term Care Programs
- The Program of All-inclusive Care for the Elderly (PACE) is a model of managed care for very frail elders who are nursing home eligible but receive services, such as adult day health care and interdisciplinary team case management, in the community. In Massachusetts, PACE programs are referred to as the Elder Service Plan.
- Senior Care Options (SCO) is a coordinated comprehensive health plan that covers acute and long term care services for MassHealth recipients enrolled in one of four Senior Care Organizations. For more information, contact MassHealth at www.mass.gov/MassHealth, or at 1-888-885-0484.
Housing and Long-term Care Options
Senior Housing facilities contain apartments for independent and/or congregate living for adults between the minimum ages of 55 and 62. Some senior housing facilities also house younger individuals with disabilities. They provide a secure, residential environment, but do not routinely provide the type of extensive health care or services associated with nursing homes or assisted living.
Senior housing apartments are available at market rates, or for those that meet financial eligibility requirements, at a lower rate. Some may offer a 24-hour emergency call service if residents need help right away, and some may offer or provide access to different kinds of services to the people who live there like meals, transportation, social activities and other programs usually for a separate fee.
The U.S. Department of Housing and Urban Development (HUD) funds several rental assistance programs for seniors who qualify. These programs include:
- Public housing, or low-income housing that is owned and operated by a local housing authority. To apply for public housing or Section 8 certificates or vouchers, you must go to your housing authority. Each housing authority has a system for accepting applications. They can tell you what their system is and the steps you will need to take to find an apartment. You can find information about your local housing authority by contacting the Department of Housing and Community Development at 617-573-1100 or at www.mass.gov/dhcd.
- Privately-owned subsidized housing includes units where the government provides subsidies directly to owners of qualified properties developed with loans or grants from the Federal government. The owners pass along the federal rental assistance subsidy to qualified residents to cover the gap between the resident payment, generally 30 percent of adjusted income, and rent costs. To apply for housing in a privately-owned affordable housing community, you will have to visit the management office for each community that interests you. A listing of nonprofit privately owned subsidized housing sites are included in this directory, or for more information, you can contact HUD at www.hud.gov, or MassHousing, the state’s affordable housing bank at www.masshousing.com.
In Massachusetts, there are two types of state funded housing programs that include additional services for those who reside there:
- Congregate Housing Facilities offer a shared living environment in state-owned public housing where elders can maintain their independence and receive supportive services.
- Supportive Housing creates an “assisted living like” environment in state funded public elderly/disabled housing. Services are offered on an as needed basis 24 hours per day, such as medication reminders and personal care.
For more information and to get a list of state-owned Congregate Housing or State Supportive housing, contact the Executive Office of Elder Affairs at 617-727-7750 or go to www.mass.gov/elder.
Continuing Care Retirement Communities or CCRCs are different from other types of senior housing because they provide various levels of housing, personal care services, and health care services— all usually in one location. CCRCs offer a supportive environment in which elders can live amongst their peers and receive services that will allow them to “age in place.” As their personal and health care needs change, elders may receive increasingly comprehensive care while remaining in the familiar setting of the community.
In CCRCs, the variety and intensity of health care provided varies greatly by CCRC. Some offer pre-paid insurance as a part of their regular fees; others require residents to purchase insurance on their own. Most CCRCs require a one-time entrance fee and then monthly payments thereafter. These fees vary by community, depending on the type of housing and services they offer. At some CCRCs, residents pay the same monthly fee whether they are in an independent living unit or the nursing facility, while at others, different rates apply to independent living, Assisted Living and skilled nursing care. Fees vary for services, so it is important to ask questions to be sure to understand the differences between basic and extra fees and how the fees may increase in the future.
The most common types of contracts are as follows:
- Type A (Extensive) Agreement: Includes housing, residential services, amenities and unlimited, specific health-related services with little or no substantial increase in monthly payments, except to cover normal operating costs and inflation adjustments.
- Type B (Modified) Agreement: Includes housing, residential services and amenities and a specific amount of health care with no substantial increase in monthly payments, except to cover normal operating costs and inflation adjustments. After the specified amount of health care is used, persons served pay either a discounted rate or the full per diem rates for required health care services.
- Type C (Fee-for-Service) Agreement: Includes housing, residential services and amenities for the fees stated in the resident agreement. Access to health care services is guaranteed, but it may require full fee-for-service rates.
Assisted Living Residences combine apartment-like living with a variety of support services including meals, assistance with personal care, housekeeping, laundry, social and recreational programs, oversight of residents’ self administration of medication, 24-hour security, and on-site staff to respond to emergencies. Some assisted living residences offer special services for residents who have Alzheimer’s Disease or other related dementias. In Massachusetts, Assisted Living Residences are regulated by the Executive Office of Elder Affairs. Most assisted living residences are paid for privately, while some accept payment for eligible residents through the Group Adult Foster Care program at MassHealth. Some long-term care insurance policies also pay for assisted living. For more information about Assisted Living regulatory requirements and the Group Adult Foster Care program contact the Executive Office of Elder Affairs at 617-727-7750 or at www.mass.gov/elder.
Rest Homes / Residential Care Facilities provide housing, meals, 24-hour supervision, social and recreational programs, administration of medications, and personal care to individuals who do not routinely require nursing or medical care. In Massachusetts, residential care facilities are licensed and regulated by the Division of Health Care Quality at the Department of Public Health (617-727-7765) www.state.ma.us/dph. Public assistance through the Supplemental Security Income (SSI) program (800-772-1213) and Emergency Aid to Elderly, Disabled and Children (EAEDC) is available at some residential care facilities for individuals who cannot afford to pay for their care privately and who meet financial eligibility requirements. EAEDC is administered by the Department of Transitional Assistance (800-249-2007). In addition, some long-term care insurance policies may pay for residential care.
Nursing/skilled nursing and rehabilitation facilities offer 24 hour nursing care, in addition to providing personal care, recreational activities, physical and occupational therapy, and all meals. Many facilities provide short-term rehabilitation services for individuals recuperating from a hospitalization in addition to longer term care for individuals. Some nursing facilities have special units for residents with dementia or Alzheimer’s disease. In Massachusetts nursing facilities are licensed by the Division of Health Care Quality at the Department of Public Health (617-493-8333), www.mass.gov/dph. Some residents or their families pay for nursing facility care out of their own private funds or with private long-term care insurance. Others, who have limited finances or who “spend-down” their finances on their care become eligible for MassHealth. Medicare covers some nursing facility care for shorter-term stays following a hospitalization.