Massachusetts Elder Care Options

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In the past, the question was often whether an elderly relative could remain in their home or had to go to a Nursing Home. Today, there are multiple options, offering a full range of services. Many of the facilities in this area have supplied us with copies of their material and you are welcome to take them.

Staying at Home
The first desire of most elderly people would be to remain in their own home. Properly supported, this option frequently yields the best long term results. Aside from financial aspects, the key consideration is whether the person will be safe at home. Specifically, if they are a fall risk, suffer from dementia, or are otherwise unable to perform some of the activities of daily life (known as ADLs) it may not be possible to provide a safe home environment.

HISC has extensive experience in helping people remain in their homes. Many times a relatively low amount of incremental assistance can substantially lengthen the amount of time an elderly person can remain home. A detailed list of the services we can perform can be found in our brochure which you can request by calling 781-314-0153 or by filling out the form on the page "Homecare From Us"

At some point, it is likely an elderly person will need additional assistance to remain in the home. When they are unable to bathe themselves, become incontinent or require the administration of medication it will be necessary to supplement the services provided by HISC with an agency able to provide these medical services. Many times these agencies will come in for short periods 2-3 times a week to assist in these areas.

Home Care agencies, such as HISC, normally charge between $18 and $25 per hour. For this you can expect a bonded and insured employee that has undergone an extensive background check. Alternatively, you can hire a Caregiver privately for $10-$12 per hour, however, you assume a significant insurance risk, especially workers compensation and unemployment coverage. If you hire a Caregiver privately, you will not have access to the State's Criminal database (known as a CORI check), nor will you be able to check your potential employee against the Elder Abuse Registrar. Finally, you will have no protection in the event the Caregiver does not show up for a shift.

Homecare agencies are required to be licensed by the Massachusetts Department of Occupational Safety. All licensed agencies are subject to a twice a year inspection and are required to maintain a Performance Bond.

Moving to an Eldercare Facility
If the prospect of maintaining a private residence is too much, or if is not possible for an elderly person to be left alone, it may be appropriate to consider one of the more than 600 eldercare facilities in Massachusetts.

Many people are under the misconception that the choice is either a nursing home or remaining at home. That is no longer the case. Today, there are 5 distinct and separate options to consider. These include Continuing Care Communities, Retirement Communities, Assisted Living Facilities, Alzheimer Facilities and Nursing and Rehabilitation facilities. Each of these options is discussed in more detail below. We should note that, except for nursing or rehabilitation facilities, most of these options are not covered by medicare or medicaid and must be paid for privately or with a long term care insurance policy.

It is absolutely critical to evaluate, at an early stage, the eldercare facility option. Many of the more desirable facilities have two or three year waiting lists. Additionally, each facility has their own criteria for admission. These criteria are both medical and financial and policies vary amongst facilities as to how they operate under them. For example, two facilities may both require a medical exam before acceptance but one may require an additional exam on the move in day.
It is also important that the appropriate type of facility is selected. Some facilities will require a resident to move out when their condition deteriorates while others, known as Continuing Care Retirement Communities or CCRCs will keep a resident for their lifetime.

While you can undertake the process of identifying and selecting a facility yourself the sheer number of different options strongly argues for the hiring of a professional to assist you with this process. Elderly housing specialists generally charge an upfront assessment fee of around $300 and then an hourly fee for additional services provided. Since facilities will range in cost from $2500 to $11,000 a month it makes sense to use a professional. We have the names of some of the good local ones in our office on Route 9 or you can call your local Senior Center or 1-800-AGE-INFO.

Types of Housing and Care
The following describes the various types of senior housing. We start with the most inclusive, a CCRC or Continuing Care Community, and then discuss the various other senior housing options. We have marketing materials from many of the Eastern Massachusetts facilities in our office on Route 9 in Newton. Please feel free to stop by and take some without the pressure you may feel in an actual site visit.

When the time comes for a site visit we STRONGLY recommend you take one of the checklists offered by Senior Communities to assist you in your evaluation. You can find the checklists online at

Continuing Care Retirement Communities. Combine independent living, assisted living and nursing in a single setting. Typically these facilities have a hefty entrance fee but promise a lifetime of care. Generally they will only accept new residents that are initially capable of living independently for a number of years. It is not unusual for these facilities to have lengthy waiting lists. In this area, there are 8 CCRCs, including North Hill in Needham and Brooksbury Village in Peabody. CCRC's generally require a large up front payment in return for a lifetime of care.

Independent living with amenities such as meals, transportation and activities. These facilities offer an excellent transition from the burdens of home ownership but will normally require residents to move out when they require additional care. Two highly respected ones in the area include Cabot Park Village in Newton and Norumbega Point in Weston. Retirement communities are unusually rented on a month to month basis.

Assisted Living
A combination of housing, personalized supportive services and healthcare. Assisted Living facilities offer more than retirement communities but significantly less than that offered by Nursing homes or rehabilitation facilities. There are a number of excellent local facilities including Goddard House in Brookline, Boylston Place in Chestnut Hill (New England's only 5 star rated facility and also its most expensive), Evans Park at Newton Corner and the Falls at Cordingly Dam.

Facilities offering specialized programs for residents suffering from memory loss. Some Assisted Living facilities also have Alzheimers units (frequently called harbor units) including Goddard House and the Falls at Cordingly Dam. There are also specialized facilities such as Epoch of Weston that just focus on the unique needs of these clients. 

Nursing and Rehab
Nursing and Rehab facilities offer the most intensive level of care for those people with complex or potentially serious medical problems. Youville in Cambridge is good and the Newton Center is improving under new management. Briarwood in Needham has just been bought by a family and will likely rapidly improve.

Hospice Care
If a Seniors primary doctor determines the Senior is unlikely to live more than 6 months Hospice care can be arranged. Hospice care can occur either in the home environment in in an elder care facility. Generally hospice care is funded through government programs.

Hospice Care is especially traumatic for all involved although we have found that the elderly person is probably the most comfortable with what's happening. The one thing to really watch out for is that ALL parties that may be in the home or facility understand what a DNR order is and how they should respond (we intentionally don't discuss it here to force you to ask about it).
A searchable on line database of all the elder housing options can be found on the New Lifestyles website at

This Site is Sponsored and Maintained by Home Instead Senior Care of Waltham.

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