travo importantly, they have responded to seniors’ desire to have access to a con-
tinuum of services in familiar homelike surroundings. For residents in need of mini-
mal to moderate assistance, they have the option to pay privately for home healthcare
services within the privacy of their apartment. For those requiring more extensive as-
sistance, the vast majority of communities built in the last several years offer residents
on-site access to licensed assisted living. Some rental communities also offer special care
for residents with memory impairment, and the vast majority of entrance fee commu-
nities offer skilled nursing (Schless, 2007).
Quality of Life
Seniors also want the quality of their life to not only not decline when they move into
senior housing, but to actually improve. Many communities have responded by expand-b51106
ing their menu choices and hours of dining service and offering such service amenitiesebrary
as a wet bar, massage therapy, indoor swimming, a business center, banking services,
concierge services, a fitness center, and movie theater. The physical designs have been
adapted to accommodate seniors’ demands for more spaciously designed apartments,
greater choice of floor plans, and enhanced common areas that promote a more inti-
mate dining and social experience.
High Occupancy Rates
As a result, demand for senior housing is at a record high with occupancy levels run-
ning at more than 90 percent throughout most of the country. Current estimates of in-
dependent living capacity in the top 100 metro markets in the United States are
approximately 365,000 units. Over the next two decades, it is expected that inde-
pendent living capacity will need to increase by at least 50 percent in order to meet tu-
ture demand (Schless, 2007). Projections for other forms of senior housing are similar.
Senior housing is not all that well known as a segment of long-term care, but it has long
existed and is becoming much better recognized as a vital part of that system. It has
developed largely in response to the desire of today’s seniors for additional options
concerning where (and how) they live. It is also a good example of how the long-term
care system overlaps and interacts with other social systems in the overall continuum.
Senior Housing Case
Don and Rose have been married for more than half a century, and during that time, have
never been apart for more than a few days. Now, they are faced with the possibility of having to live apart for the remainder of their lives. But to intelligently discuss the cur-
rent situation, we must look at how it came to be.
Don, now 80, and Rose, now 71, have both been retired from active professional
lives and, until five years ago when Don suffered a stroke, their personal lives were ac-
tive as well. Upon giving up work, they moved to a continuing care retirement com-
munity (CCRC) in a southern state where they could take full advantage of the outdoors
that they both loved so much. The CCRC provided them with the social support they
sought, living among other seniors like themselves. They also traveled a lot and fully
enjoyed their hard-earned retirement. However, after the stroke, Don was unable to
do most of the things he had previously enjoyed. Rose, in part because she needed to
care for Don and in part because she didn’t want to do the things alone that they used
to do together, also stopped most activities. She spent virtually all of her time and en-
ergy being Don’s caregiver.
However, it eventually became too much for her. Don, who once played football, brary
is nearly twice as large as Rose, making it very hard for her to help him with the activ-
ities of daily living (ADLs) such as bathing and dressing. To make matters worse, Rose
does not really like to drive the family car, because Don generally did all of the driving
when he was able to do so. Thus, she went out only when absolutely necessary.
As the caregiver burden became more and more difficult, Rose was able to get
some assistance from the CCRC. It began providing staff for an hour or two daily to
bathe and dress Don, delivered one meal each day, and a woman to come in and clean
the house on a weekly basis. Those services sufficed for a time, but it soon became
obvious that they were not enough. During the remainder of the day (and night) Rose
had to do it all by herself. Don was becoming increasingly distraught over his inabil-
ity to help Rose or even to take care of himself. Rose, on the other hand, was also be-
coming depressed and even found herself beginning to resent having to spend all of her
time caring for Don.
00871422 She began thinking, reluctantly, about placing Don in the nursing facility located
on the CCRC campus, but his medical requirements did not really require that level
of care. However, the CCRC also had an assisted living facility, which was just what
Don needed–at least at that point in time, and he was admitted. In addition to help-
ing Don with the ADLs he could not manage for himself (such as dressing, bathing,
and making sure he took his medication when needed), the facility provided Don with
supervision and with activities to keep him occupied that were designed to help him
gain back some of his independence.
Rose visited regularly, but her depression continued. She simply missed Don too
much. Her own health began to deteriorate as she neglected to eat properly and be-
came more and more withdrawn from outside activities.
One day a neighbor of Rose’s in the CCRC told her she should investigate the in-
dependent living apartments on the campus. After getting all of the necessary infor-
mation, these apartments seemed to be designed just for her, so Rose moved in. It
meant that she could more easily be close to Don and be part of his life. His need for supervision and assistance was still too great for him to live with her in her apartment,
but they were only a short distance apart.
She could visit Don and he could visit her. They even play bingo together, with
Rose helping Don to play. Rose no longer has to drive to see Don, and the facility pro-
vide transportation for shopping and other short trips.
This setting is just perfect for Rose and Don. His physical condition is not going
to improve markedly, but he is learning to be more independent. In addition, being near
him without the burden of being primary caregiver has lifted a load from Rose’s shoul-
ders. Perhaps most importantly, the assisted living facility is part of a larger, multi-
level complex. That means that as Don’s condition changes for the better or worse, he
can be moved to the appropriate unit without having to be transferred to another fa-
cility. Rose will still be close to him, and should her own health worsen, will be able
to get the services she needs as well.
The following terms are included in this chapter. They are important to the topics and is-
sues discussed herein and should become familiar to readers. Some of the terms are also
found in other chapters but may be used in different contexts. They may not be fully de-
fined herein. Thus, readers may wish to seek other, supplementary definitions of them.
Continuing care accreditation
00e71422024 commission (CCAC)06
Continuing care retirement
Life care community
Life care/extensive contract
Modified/continuing care contract
Section 202 subsidized housing
Supportive Housing for the