Power of Attorney
-This person can pay your bills, make investment decisions, market and sell your house
-Depending on how you want it written, it can become active immediately or based on certain criteria

Private Personal Information Profile
-Power of attorney will thank you if you have one of these

Physician Orders for Life-Sustaining Treatment – Good if you have a life-limiting condition, such as dementia and heart disease. Typically has four sections:
-CPR this is the same as the Do Not Resuscitate (“DNR”) form.
-Medical Interventions – life-sustaining treatments
-Artificial nutrition – feeding tubes

Advanced Healthcare Directive – Referenced when a patient cannot make his/her own decisions and is on life-sustaining treatment. Typically composed of two parts:
1. Living will – important for describing what you want your end of life treatment to be. You want to consider what level of mental awareness and physical functioning is acceptable for doctors to continue to provide prolonging treatments. Give a copy to friends, family, your physician, hospital, and lawyer. Carry something in your wallet that says you have an advanced directive and who to call to access it.
2. Medical power of attorney – you appoint a person to fill in the gaps that your living will doesn’t address. A doctor may reference both your living will and your medical power of attorney to create the POLST form, if you haven’t done so already.

HIPAA release – For someone that you trust to get access to your medical records.
-“The HIPAA Privacy Rule allows HIPAA-covered entities (healthcare providers, health plans, healthcare clearinghouses and business associates of covered entities) to use and disclose individually identifiable protected health information without an individual’s consent for treatment, payment and healthcare operations. In all cases, when individually identifiable protected health information needs to be disclosed, it must be limited to the ‘minimum necessary information’ to achieve the purpose for which the information is disclosed.”
-May come in handy so that your medical power of attorney or agent can have access to information that gives him or her the information to make decisions about you if you’re incapacitated, to dispute a bill, or to discuss medical conditions with your doctor if you’re still lucid.
-People also may give their lawyers permission, since their lawyer may have a copy of their living will.

Will or Living Trust
-Will – Gives directions on how to distribute assets after one dies, their estate will enter the probate process, by which a judge will give legal permission for assets to be distributed to heirs.
-Living Trust – may reduce legal fees in the long run, may have certain estate tax advantages, and mitigates the estate from going through probate.

End of Life Wishes –
-Talk with a funeral director to learn about your options and let you know the costs of each.
-Write down instructions and share them with family members and include them in your will or trust.
-Make sure you either pre-pay or have funds allocated to pay for your arrangements in your will or trust.


Clearing a house full of stuff is a daunting task. Here’s a guide to help you sell and remove the items of an estate.

First, contact your realtor to make sure both of you are on the same page about selling furniture. You may want to have a buyer pick up a piece of furniture after your realtor takes pictures of the house to market it.

Second, define your goal for clearing the house by determining if you want to:
a.Clear the contents of the house quickly?
b.Maximize your earnings?

In order to keep the message simple, we are going to split this post into two separate posts. This week we will discuss option a. “Clearing the Contents of a House Quickly.” In two weeks, you can count on us discussing option b. “Clearing the Contents of a House to Maximize Value.”

In our opinion, the best way to clear the contents of a house quickly is to host an estate sale. An estate sale is when a seller turns their home into a store – effectively becoming a large-scale yard sale. There are businesses that will organize, promote, and operate an estate sale for the seller. Families can also host one themselves, but estate sales can be tough to organize and emotional, as families find it difficult to see sentimental items sell at bargain prices.

Firms that run estate sales will have an appraiser value the items for sale. Most firms require a minimum value of total goods before accepting a job, but not all firms require the same minimum. Once a job is accepted, the firm’s organizers will organize all the contents of the house on tables and other areas around the house so that guests can easily see what’s for sale. The marketers of the firm may take pictures of rare items and post them to social media or other advertising avenues to generate interest in the estate sale but are careful to never release the location of the estate sale until 24 hours before the sale commences.

A good estate seller will have a large network and know the right channels to promote an estate sale. It’s usually the case that if an estate seller has a large network, then it is able to attract more buyers to the sale. A typical sale lasts two days; however, depending on the size and the quality of the items for sale, the firm may recommend hosting a sale for more than two days. Each day the sale starts and stops at the same time, and the operator of the sale will lower the prices of the remaining goods. Operators typically choose Sundays as the last day of the sale.

Estate sales are a great way to clear the contents of a house because (1) it’s a relatively quick process; (2) there’s likely a monetary benefit to the seller; (3) the seller doesn’t have to transport any of the items, such as driving them to a consignment store or shipping them to a buyer; and (4) anything can be sold, such as furniture, used kitchen cleaners, and frozen meats. The buyers that come know that just about everything must go. Many will come looking for that one “gem,” and leave with things that you were sure that you were going to have to take to the dump later. Because it takes knowhow and work to run a sale effectively, hiring a firm will typically cost between 40%-50% of the sale proceeds.

Once the sale is complete, hire a junk removal service. A junk removal service will send people with trucks to your house who can clear the remnants and all unsold items. Usually, junk removal services charge by volume, but some may have different pricing models.

After a junk removal service hauls away your unwanted items, it would be a good idea to touch base with your realtor. He or she will consult with you about the next steps that you should take to sell your house.

In two weeks, we will release another post about a strategy we would use to clear a house and maximize earnings. 


Two weeks ago we gave our opinion on how to clear the contents of a house quickly. This week we want to give you our opinion on how to clear the contents of a house so that you maximize the value that you get from its contents.

​First, contact your realtor to make sure both of you are on the same page about selling furniture. You may want to have a buyer pick up a piece of furniture after your realtor takes pictures of the house to market it.

Second, define your goal for clearing the house by determining if you want to:

  1. Clear the contents of the house quickly?
  2. Maximize your earnings?

Herein we are going to discuss how to maximize your earnings. To know that this post applies to you, you’ll want evidence that some contents in the house are actually valuable. Find an appraiser; we recommend doing so through the American Society of Appraisers. An appraiser will give you a rough idea of how much your belongings are worth. If you have a lot of valuables, we recommend that you explore selling them through several different channels.

We believe that if you don’t have a lot of expensive items, then you should start your sale process by hosting an estate sale. However, if you have some valuables that you want to maximize your earnings from, then sell them through other channels. Rare art, guns, valuable collectables, cars, antiques, designer rugs, expensive jewelry, and farm equipment are examples of items where you should explore the best marketplace. There isn’t a hard and fast rule as to the value of an item that you should explore which marketplace to sell it, but here are a few things to consider:

  • Difference in commission amounts – could you earn more money by choosing a marketplace that charges a lower commission?
  • Transportation costs – how much money will you spend to transport the item?
  • Your time – what’s your time worth?
  • Quality of the marketplace – some marketplaces may be able to generate better demand for your item (e.g. very expensive items require a unique marketplace).

When in question about which marketplace to use, we advise our clients to start their research by calling online auctions, auction houses, online consignment sites, and consignment stores to question them about selling a piece that they want to get rid of. People who buy expensive items through these channels typically trust them because they have secure payment mechanisms. In other words, the likelihood of the buyers and the sellers getting scammed is very low. That’s why we suggest approaching these four channels over Ebay and Craigslist to sell valuable items.

Online auction

  • There are two main players, Soetheby’s and Christie’s. At the time of writing this article, Soetheby’s prices were lower than Christie’s. Sotheby’s charges 20% on the first $100,000 in sale value and 12% on the sale value that exceeds $100,000. You’ll want to double-check the terms that an auction house sets for your items.


  • You’ll have to locate your local auction house. The fees are generally between 20%-50% of the sale price but check with you local house for actual pricing.

Online consignment

  • The main player in the online consignment industry is TheRealReal. It charges between 15% and 60% of the item’s sale price. It’s a big range, but the charge depends on the item and its value.


  • You’ll have to locate a local consignment store. Consignment stores generally charge between 10% and 60% of the item’s sales price.

Because prices vary through all of these channels, you’ll want to call around to get quotes on what you want to sell. You’ll also want to inquire about how often these channels sell merchandise similar to the one that you’re proposing to sell—you want to choose a seller that is familiar with selling the item that you have.

Don’t be afraid to explore other channels as well. You want to find a marketplace that best suits your listing. For instance, if you have a motorcycle to sell, consider selling it on a website that specializes in selling used bikes, such as Cycle Trader. Do you have a used car? Try selling it through Autotrader.

These fees are absurd. If that’s what you’re thinking after you’ve called the auction houses and the consignment shops, then consider using Ebay and Craigslist to sell your merchandise, especially if they are everyday items. You may pay a lower price to sell them through either of these sites, and possibly nothing at all. However, we would not advise that you use these sites for substantial transactions for a couple of reasons: (1) buyers may be reluctant to bid on your item because they may not trust you; and (2) you could be scammed. Ebay and Craigslist are a great way to sell run-of-the-mill merchandise because the money at risk is very low.

Once you’ve sold all the items you’d like through auction sites or consignment shops, consider hosting an estate sale. For an overview of what to do from here, reference our last post Clearing the Contents of a House Quickly.

If you’re hesitant to pay the fees of an estate seller, you may want to host an estate sale or yard sale on your own. Afterwards, call a junk removal service or take whatever’s left to a thrift store first, then to a recycle center, and lastly to a dump. If you do all that yourself, you’ll deserve a pat on the back.


Adjusting to life in a retirement home can be tough – it involves big changes, like leaving behind a home and all the memories it contains, as well as the feeling of losing a measure of freedom. Psychologists say that even positive changes can be as hard to adapt to as negative ones are, but you can help your loved one make a smooth transition.

Preparing Your Loved One – and Yourself – for a Move to a Retirement Home

Before your parent, family member or friend moves into a retirement home or assisted-living community, everyone involved needs to know what to expect. Sharing the timetable with your loved one can take some of the uncertainty away, so make sure that everyone involved knows when to start packing, when the move will occur, and when you’ll come to your loved one’s new home to help with the transition.

Also, keep in mind:

  • This type of move can involve significant downsizing that requires you to put your organizational skills to the test.
  • Your loved one may have mixed feelings about the move, and he or she may be reluctant to make such a big change.
  • Your attitude about the process, and the way you handle the situation, can have a big impact on how easy (or how difficult) it is on your loved one.

Set Firm Dates

Photo by Pixabay

Create a calendar to share with your loved one and others involved in the move. Pick dates for:

  • Downsizing and packing
  • Charity pick-ups, agarage or estate sale, or trash pick-up
  • Booking a moving truck or asking friends and family come to help
  • Moving day
  • Unpacking boxes and setting up the new place

Decluttering and Downsizing

Packing is stressful no matter how you look at it. Take it slowly (and start early, if that’s what it takes) to make things easier on your parent, friend or family member. Remember that your loved one’s participation can help him or her feel in control, which can minimize anxiety and quell nervousness about the big move – but also remember that this is a big job, and too much at once can be overwhelming. Try to keep packing, sorting and organizing confined to less than a couple of hours per day, and make it a sociable experience. If your loved one wants to stop and reminisce, join in; it’s not going to hurt anything.

If the person who’s moving has a lot of stuff (furniture, keepsakes, and other things that can’t come along), there’s a big decision on the horizon. He or she will have to decide whether to put everything in storage, hold a yard sale, or divide items between family members. This should definitely be your loved one’s decision – we’re talking about his or her belongings, not yours (think about how you’d feel if someone suddenly took the reins and dictated what was going to happen to your stuff).

Together, you can categorize each item and decide what your family member, parent or friend will take, store, donate or sell. Storage may be the best option, at least psychologically speaking, for your loved one. He or she still owns the furniture, mementos and other items, which can make adjusting to the retirement home that much easier.

You can usually get rid of old and useless items, like old bills and paperwork that’s no longer necessary, but be on the lookout for important documents that you and your loved one must keep, such as:

  • Birth certificates
  • Deeds
  • Diplomas and degrees
  • Financial documents
  • Medical records
  • Military records
  • Passports
  • Powers of attorney
  • Wills

Keep all the important documents in a central location, and let other family members know where it is so nobody gets the wrong idea or feels left out of the process. Try to put it all somewhere neutral, like a safe deposit box.
If your loved one is okay with it, have adult children claim their own (but only their own!) keepsakes during the process. Old sports trophies, high school yearbooks and other items can go home with their owners to make things easier for everyone.

Pro tip: Sort before you start packing. Go through each room with colored tags to mark items for their final destinations. Remember that seniors can – and should – bring mementos and keepsakes to his or her new place so it feels like home.

If your loved one has pets, you may want to find a community that accepts them. By doing so, you’ll make the transition for your loved one smoother. Atul Gwande, author of “Being Mortal”, cites that pets can enhance a person’s will to live, which is associated with experiencing life with greater meaning, pleasure, and satisfaction. If your loved one cannot take his or her pets to the community, then he or she should decide where they’ll go.

Pro tip: It’s important that your loved one has purpose in his or her life. Purpose can be as simple as caring for a pet, visiting a grandchild regularly, or having a daily walk with friends. Choose a senior living community that supports your loved one’s purpose. If you need help, a senior advisor can speed up your search at no cost to you.

​What if You Can’t Get Your Loved One to Part With Items?

Many people don’t want to let go of things they feel are important. If it’s absolutely necessary (like when storage isn’t an option), you can try:

  • Talking to an antique dealer to find out how much items are worth.    Sometimes a dollar figure can make a big difference in a person’s decision-making process.
  • Hiring a professional organizer. If you’re too close to the situation and your help becomes frustrating for your loved one, it might be best to bring in an impartial third party who’s used to helping people let go.
  • Letting your loved one know where the items will go and that they’ll be treasured. This is especially important with things tied to the family legacy, like old documents and photos.

Handle the Paperwork

Photo by Pixabay

You may need to change your loved one’s address, transfer utilities to someone else’s name, or finalize registration at your friend or family member’s retirement home or assisted living community. Make sure you tackle each of these issues early so you’re not scrambling later. Don’t forget to update the address for your loved one’s:

  • Bank accounts
  • Credit card accounts
  • Driver’s license and vehicle registration
  • Insurance policies
  • Investment and retirement accounts
  • Medicare and Social Security
  • Newspaper and magazine registrations
  • Voter registration

After the Move

​Adjusting to a new environment, particularly if it’s a lot different than the old one, can take weeks or months. Your loved one needs plenty of time to settle in, get to know people (including caregivers) and start to feel at home, so don’t try to rush the process. Everyone reacts differently; where one person may feel relief at not having to maintain a big house alone, another might feel a little lost and miss their home, friends and belongings.

Here’s how you can help.

Understand That the Move Represents a Loss

​As an adult child, friend or family member, it’s easy to look at your loved one’s move as a “fresh start.” He or she will have cooked meals, nothing to clean and friends living right next door.

Your loved one might see that, too, but he or she is also mourning the loss of a home, belongings and community – and at the same time, the realization that old age or health issues has necessitated the move is sinking in. Avoid trying to force your family member or friend into the new social scene, too. Making new friends and getting comfortable takes time.

Be kind, patient and understanding with your loved one. Remember that you, too, will one day be in a similar situation.

Make Memories and Continuity a Priority 

Photo by Pixabay

​Find a shelf, cabinet or drawer where your loved one can easily access photo albums and other mementos. Hang his or her favorite pieces of art on the walls, and try to set up the space so it’s comfortable and homey. If your loved one has a favorite recliner, a family heirloom or other important items, make room for them.

If your loved one wants new items, like a flat-screen TV or something that will make the space more enjoyable, go for it – sometimes having something shiny and new makes the transition easier.

Show Support and Visit Often 

​Familiar faces can make living in a new place a lot easier, so visit as often as you can (or as often as your loved one wants you to). If you can’t visit, see if someone can help your loved one Skype or FaceTime you, or make regular phone calls to check up on him or her.

Refer to the new place as “home,” not “the home” or anything else. The way you talk about the assisted living facility will impact the way your parent, family member or friend feels about it, and it’s important that you don’t forget how powerful that can be.

Originally published on Redfin


Medicaid is a complex program, and when it comes to senior care, there are a few terms that people commonly mix up. In this blog post, we attempt to clarify any confusion between Medicaid, Medicaid Long-Term Care, and the Medicaid Waiver Program.


Medicaid is a social program that provides health insurance to millions of Americans including people with low income, children, pregnant women, elderly adults, and people with disabilities. It is administered by the state, according to federal requirements, but it is funded jointly by the state and the federal governments. It does not provide full coverage, meaning not all things medical are covered under Medicaid. Federal law requires that states provide certain mandatory benefits including: inpatient hospital services, outpatient hospital services, clinic visits, doctors’ office visits, and transportation to medical care. While it is common for folks to say that Medicaid does pay for a stay at a nursing home; just because someone has Medicaid doesn’t mean Medicaid will pay for his or her permanent stay at a nursing home.

Medicaid Long-Term Care

To have Medicaid pay for a permanent stay at a nursing home, a person must meet the law’s income and medical criteria, even if he or she is already covered under general Medicaid. If approved, the person is said to be covered under Medicaid Long-Term Care.

To be medically eligible for Medicaid Long-Term Care, a person must need routine skilled services or help with his or her activities of daily living (“ADLs”). Examples of skilled services include:

  • Medication management
  • Immunizations
  • IV care
  • Podiatry
  • Wound care (level 3 and 4)
  • Tube feeding
  • Assistance with breathing
  • Help with catheters

Nursing homes also provide aides that will help a patient with his or her ADLs. Transferring, walking, using the bathroom, showering, dressing, and eating are the six ADLs. The rules are vague as to how many ADLs one needs help with to qualify for Medicaid Long-Term Care, but at Senior Advisors Plus, we’ve generally seen that people who need help with three or more on their worst day would qualify for Medicaid Long-Term Care.

To financially qualify for Medicaid Long-Term Care, a person must meet two criteria, assets and income. Each state differs on its income and asset restrictions but generally the laws work like this:

  • A person can’t have more than $2,000 in countable assets to qualify.
  • A person can’t have monthly income that exceeds the average cost of a nursing home in the state.

A person who makes less than the income limit but has too many countable assets may need to spend down his or her savings to qualify for Medicaid Long-Term Care. In this situation, he or she may also benefit from talking to an elder law attorney. After spending down assets, the person should qualify for Medicaid Long-Term Care. Medicaid will then pay the difference between the person’s income and the cost of the nursing home.

Medicaid Waiver Program

A hospital is the most expensive setting of care, while nursing homes are not far behind. After a patient stabilizes following a procedure done in a hospital, he or she may be discharged to a nursing home or skilled nursing facility to recover and build strength. A skilled nursing facility’s goal is to help the patient transition back to the community. Commonly, people are forced to stay in nursing homes because they can’t afford to hire help at home. The Medicaid Waiver Program was designed to help these people transition back to the community, despite their financial constraints. The Medicaid Waiver Program may pay for home care services, assisted living, and other services that may prevent someone from returning to a nursing home. While people under the Medicaid Waiver Program do need assistance, the cost of the assistance that they need is far less than the cost that the Medicaid fund would incur if they remained in a nursing home. To be medically eligible for the Medicaid Waiver Program, a person may need help with the activities of daily living but not routine skilled services. Here’s the tricky part: it’s harder to qualify for the Medicaid Waiver Program than it is Medicaid Long-Term Care. The asset restriction is the same—$2,000—but the income limit is generally lower. We’ve generally seen the income limit to be around $2,300 per month; however, the income limit depends on the state. If a person makes over the income limit, then he or she is required to pay for assistance themselves. If a person makes less than the income limit, needs at-most intermittent skilled services, and needs help with some of their activities of daily living, then he or she may qualify for the Medicaid Waiver Program.

If you’re confused or worried about your current situation or the future, it may help to talk to someone. We offer free advice; just contact us.


If you’re considering moving into a continuous care retirement community (“CCRC”), you may find out that there can be a large entrance fee. If a community charges an entrance fee, it’s likely there are multiple options for you to choose from. Our post below attempts to explain the factors that you need to consider before making your selection.

We’ve identified a practical way and a strategic way to think about the entrance fee question. Practical, herein, means what works best for the payer. Strategic, herein, means the cheapest option.

Let’s set the stage: imagine a community that, regardless of which entrance fee option you choose, will charge you the same monthly rate. The three entrance fee options you have are: (1) you can pay $300,000 upfront, but it completely amortizes over 25 months; (2) you can pay $500,000 upfront, but it amortizes down to $250,000 over 25 months; or (3) you can pay $1,000,000 upfront, but you will receive only $900,000 no matter when you leave.

Practical people may choose to pay the entrance fee option that requires them to commit the least amount of capital. This allows them to spend the remaining amount on themselves, rather than having the community hold onto it until the end of their stay. A practical thinker may use the proceeds from the sale of his or her home to pay for the entrance fee, and then use their social security, pensions, and savings to pay for the monthly fee. The strategy of opting to pay for the lowest entrance fee makes sense to us for those who want to maintain as much discretion over their wealth as possible. In the example above, someone who chooses option (1) over option (3) has $700,000 more to spend on trips, gifts, charity, clothing, etc. On the other hand, option (1) is not necessarily the most economical option, because he or she may spend $300,000 on the entrance fee whereas someone who chooses option (3) will only have spent $100,000.

The strategic thinker is going to look at this as a math problem—which option is going to be the cheapest for me and my heirs? A strategic thinker is going to consider what he or she pays for the entrance fee and what he or she is going to get back, in addition to the opportunity costs. The opportunity cost, in this example, is what else could the tied-up money have been invested in. If the strategic thinker chooses option (3) over option (1), then he or she has committed an additional $700,000 in capital. That’s $700,000 in capital that is not earning a return in the market or in an investment such as a rental property. The lost earnings from that $700,000 should be taken into account when considering the actual costs of the entrance fee. Through our analysis, we can distill the entrance fee question into its most fundamental parts. For the above example, we assumed that the opportunity cost is 4% annually. The follow yields the per month entrance fee cost based on the number of months stayed:

​The above chart shows the per month cost of the entrance fee according to the number of months that the person stays in the community. For instance, someone who stays at the community for 21 months who elects to pay via option (1), or the blue line, will have paid an average of $12,000 per month. $12,000 plus the monthly fee that the person pays to the community is the total monthly cost of staying at that community. Those that wish to estimate their life expectancy may use this information to choose the entrance fee that is the least costly. Additionally, someone who is trying to compare the costs of two communities, one with an entrance fee and one without, may use this analysis to do so.

At Senior Advisors Plus we serve both the practical and strategic thinkers. Call us and we will help you with your senior living search.


We’ve spoken with a few people who have parents that live outside of D.C. and who are worried about them living independently. The children have talked with them about moving to D.C., but the parents aren’t interested. The children are stressed out. Here’s a post for all those people who are going through something similar. You are not alone.

You may have begun to worry about your parents living situation because they don’t do the simple tasks well. You may see signs of this such as their house is dirty, refrigerator has a lot of spoiled food in it, or body weight is dropping. You may have also begun to worry because a few severe things have happened such as your parents have begun falling, have developed attitude issues, or are wondering. These are all signs that it is time to have a conversation with mom or dad about getting help.

Start a casual conversation with your parents during their best time of day; typically, its morning. Suggest something small, such as offering to hire a cleaning service, someone to shop for them, or a driver to take them around to do errands. If they agree, then hire a caregiver to do these tasks. If the caregiver is successful at developing a relationship with your parents, then when more care is needed, the caregiver can step in and help with their personal care as well.

If your parents refuse additional help, it’s okay. It’s their life and they are entitled the take the risks they wish. Chances are you are more stressed out about their situation then they are. Try bringing up care one more time, but after an event that care could have prevented or has caused them to need help thereon. If they refuse again, then drop the discussion for now. There are two things that we suggest at this point:

(1) Talk to their doctors. See if they agree with you. If so, have them suggest that your parents should have someone around to help them.

(2) Create a back-up plan. There may be a time when they step forward and ask for your help. If you have a backup plan, you’ll be prepared.

To create a back-up plan, first think about their care needs—the activities of daily living (“ADLs”) and instrumental activities of daily living (“IADLs”) are lists that you can reference to gauge how much help they need. Transferring, walking, toileting, bathing, dressing, and eating are the six ADLs. Shopping, cooking, managing medications, managing communications, doing house chores, driving or using public transportation, and managing finances are the IADLs.

Think about the activities that your loved one needs help with and how long those take to complete on a daily basis. Then consider your care options–the two most popular are home and community-based care. Home care is a great option for people who want to remain in their homes; however, it can become very pricey as peoples’ care needs escalate. The other option is community-based care. For people that want to relocate or be around peers, assisted living and memory care communities are wonderful options, which can be much more affordable than home care. Whether you decide on home or community-based care, interview a couple agencies, caregivers, or communities. Narrow it down to a couple so that you’re comfortable selecting one if you need to make a decision quickly.

If you follow these steps that we’ve identified, you will have successfully controlled the things you can. Contact a Senior Advisor if you need help with your search. We can help you explore your options quickly and, if you’d like, at no charge to you.


In this post, we describe the general differences between assisted living communities and nursing homes. We gathered the information below from Washington D.C. and Maryland sources. While the laws vary from state to state, generally, assisted living communities and nursing homes of each state operate similarly. Prior to your loved one moving into a nursing home or assisted living community, a nurse will assess him or her to make sure that he or she qualifies for the level of care that you are applying to. To save on costs, we recommend applying for the lowest level of care first. With that said, here is a guide to help you determine the appropriate setting of care for your loved one.

Assisted Living Communities

Assisted living communities may prepare meals, do house chores, organize activities, manage medications, and provide custodial care for their residents. Custodial care means helping with the six activities of daily living, which include: transferring, walking, toileting, bathing, dressing, and eating. Before becoming a resident, a nurse may assign a level of care to an applicant1.

Level 1 – Needs oversight of one or more of the ADLs
Level 2 – Needs occasional hands-on assistance with one or more ADLs
Level 3 – Needs frequent hands-on assistance with one or more ADLs

The community will charge the applicant based on the level of care the resident requires. If a person requires too much care, then the assisted living community may reject the application. A person cannot live in an assisted living community if he or she2:

  • Is dangerous to him/herself or to others
  • Needs more than intermittent skilled nursing care(generally needs more than 35 hours of home health or skilled care per week)
  • Need treatment of stage 3 or 4 ulcers
  • Needs ventilator services
  • Needs treatment for an active, infectious, and reportable disease or a disease or condition that requires more than contact isolation.

Nursing Homes

Nursing homes must provide three meals a day, housekeeping, laundry, and maintenance to the building. Just like assisted living communities, nursing homes also provide custodial care and medication management. They differ from assisted living communities because they can provide routine skilled care.

Most nursing homes employ nurses, physical therapists, occupational therapists, and doctors. With these professionals onboard, nursing homes can provide a higher level of care than assisted living communities. While some of the following services may be provided at an assisted living community, those who need the following on a routine basis should consider moving into a nursing home.

  • Immunizations
  • Feeding tubes
  • Catheters
  • Treatments requiring direct nurse supervision and observation

Those who require the following, even on an intermittent basis, should consider moving to a nursing home:

  • Ventilator services
  • Wound management, particularly stage 3 or 4 ulcers

Again, these are general rules, so if you are confused if your loved one requires too many skilled services or not, check with a nurse. If you don’t know one, then have one come assess your loved one from the assisted living community that you are considering. From our experience, nurses from assisted living communities are happy to qualify potential residents. If you’re not comfortable with that option, then some states have programs set up at local health departments to provide assessments. In Maryland, the program that does assessments is called Adult Evaluation and Review Services (AERS).

We also wanted to shed some light on the costs of assisted living communities and nursing homes. Here are the average monthly costs that we’ve researched in the DC, Maryland, and Virginia areas:

​Here are several payers for each type of care. Some payers require the applicant to qualify before the payer will sponsor the care. Not all counties have the same sources of payers as the ones we’ve listed below, but it’s worth checking with your county to see if the county has the program and if you qualify.

Once you’ve selected a care setting, if you still need help choosing the right community, we do an assessment using the following criteria: health, wealth, lifestyle, and preferred location. You can contact us here. You may choose to use our services for free or for a fee. We’re happy to help in the capacity that you choose.