Smaller personal care homes are a growing senior living option

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Leslie Spirer
Leslie Spirer

Smaller personal care homes are a popular option the West Coast, enjoying more popularity there than on the East Coast or in the South. But popularity is growing elsewhere, too.

Let's examine this trend.

Personal care homes, also known as residential care homes or board and care homes, are residences that provide shelter, meals, supervision and assistance with activities of daily living. Typically, these services are provided for older adults or individuals with physical, behavioral health or cognitive disabilities who are unable to care for themselves but do not need nursing home or medical care.

Personal care homes often are smaller, home-like residences found in neighborhoods typically where residents already were members of the community. In many states, residential care facilities, by regulation, are not permitted to provide skilled nursing services, such as administering injections, maintaining catheters or performing colostomy care, unless a credentialed RN or LPN works there. They may provide assistance with ADLs, however, such as bathing, dressing, toileting and urinary or bowel incontinence care.

In California, 90% of senior living facilities accommodate four to six residents. (It is important to note that both residential care and assisted living facilities in the state operate under the same state regulations regarding care services; the differences, if any, are due to a particular facility's program rather than differences in community care licensing regulations.)

Smaller residential care settings are common in California because the residential care system there was established in the early 1970s as a way to provide non-institutional, home-based services to dependent care groups such as children, older adults or those with developmental disabilities or mental disorders, under the supervision of the Department of Public Social Services. At that time, homes for the elderly were known as board and care homes, and the name still persists as a common term to describe a licensed residential care home.

Since the 1990s, however, these facilities also have been growing in popularity in Nevada and elsewhere as an alternative to large, more institutional assisted living facilities for older adults.

What is the appeal? As you know, most older adults have needs that fall beneath the level of skilled nursing services. The small personal care home, licensed for two to six people, can be a safe, comfortable and dignified option for those who need help intermittently throughout the day and night.

A feature also touted by many assisted living communities, in smaller personal care homes, older adults still have the freedom from house regulations to carry on as “normal” a life as they wish and for which they have the capacity. Residents can go shopping, welcome friends and family members for visits, take walks, dine out, etc. Personal care can be a dignified and cost-effective way to live when one no longer is able to live independently. Many families, if given the choice, will choose personal care over nursing home care for these reasons, although a loved one's health and ADL needs will be the most important considerations.

The small personal care home also can be a good option for those who have Alzheimer's disease or another form of dementia. Why? The number of staff members is small — one or two people — enabling close supervision and support for residents. And anxiety and stress can be lower for residents because they have fewer people with whom they must interact.

One potentially negative characteristic of smaller facilities, however, is that, often, they have limited activities. For some older adults with Alzheimer's who are active or very restless, this characteristic can be a detriment to well-being. To make up for the potential shortcoming, some personal care homes use community resources, such social day care programs, for residents. Such programs can address the need for stimulating mental and physical activity.

On average, in my experience, costs for personal care homes are about half that of residential skilled nursing care and also are less expensive than many assisted living communities. The monthly cost can range from $1,500 to $4,500, depending on the level of care needed, the quality of the home, the location and whether the room is single or shared.

These data from the Centers for Disease Control and Prevention's National Center for Health Statistics describe the characteristics of smaller residential care settings (see the links at the end of the article, too).

Leslie Spirer is president of the Adult Day Care & Assisted Living Group Consultants, a 14-year-old company based in Skippack, PA, that helps with the start-up and operation of adult day care centers and assisted living facilities through consulting services and manuals. She has an undergraduate degree in health education from Temple University, a master's degree in technology in education from the Rosemont College and a certificate in home modification from the USC Leonard Davis School of Gerontology.

McKnight's Senior Living welcomes marketplace columns on subjects of value to the industry. Please see our submission guidelines for more information.

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