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Assisted living at your doorstep

When Stephen Foster wrote about the old folks at home way down upon the Swanee River in 1851, that's exactly where you would find the old folks -- at home. Senior centers, independent and assisted-living facilities and nursing homes, as well as such social programs as Medicare and Medicaid, were still decades away from developing into a support network for the aged.

But one thing hasn't changed: nine of 10 "old folks" ages 50-plus still wish to remain at home as long as possible, according to an AARP study.

To help them do so, several assisted-living communities are reaching out to old folks at home in new ways, offering medical care and assistance with activities of daily living, or ADLs, in the home, as well as opening their facilities for dining, recreational, cultural and social activities.

When it comes to our golden years, there's no place like home for most Americans, according to Margaret Wylde, president and CEO of The ProMatura Group, which does consumer research for the elder-care industry.

"Assisted may be a lovely, attractive environment and there may be other people there to visit with during the day, but it ain't home," says Wylde. "There is this sense of loss and lack of desire to go there."

As any senior will tell you, it's also cheaper to remain at home. According to a recent survey by the MetLife Mature Market Institute, the average annual cost, in 2005, of a private room in an assisted-living facility was $34,860; average cost for private quarters in a nursing home was more than double that at $74,095.

The survey found that the average cost of in-home health assistance ranged from $17 to $19 an hour, a far more attractive option for seniors who may only need occasional help with such ADLs as bathing, dressing, cleaning, taking medication and running errands.

Because Medicare does not pay for nonmedical home services, seniors or their family members can expect to pay out-of-pocket for ADL assistance unless they have a long-term care policy that covers it.

Frustration often sets in for seniors who hire their own caregiver; most have no idea how to prescreen applicants and have no backup plan, should their caregiver fall ill or fail to report for work. What's more, long-term care insurers often will not reimburse for home health care unless the caregiver is licensed or works for a home-care company.

Private-pay companies such as Sunrise Senior Living, Silverado Senior Services and Chateau Home Care view in-home service as a twofold opportunity to a) expand their business without adding facilities and b) introduce senior homebodies to the amenities they could enjoy as a resident in their assisted-living communities. Some even provide preferential placement on waiting lists to their home-care customers.

Assisted living with home delivery
Sunrise Senior Living, the Virginia-based operator of 380 U.S. facilities and one of the largest assisted-living companies in the country, led the move into home care in 1999. It now offers home services in eight states, with plans to expand soon into three more. Home-care services vary by task but average $18 per hour.

Two years ago, California-based Silverado Senior Living opened its home-care division on a business model that integrates it with their assisted-living and hospice operations. As specialists in caring for memory-impaired seniors, including Alzheimer's patients, Silverado assigns geriatric-care managers, typically social workers or RNs, to oversee the home-care needs of its customers.

Silverado home care costs $21 to $23 per hour, $240 to $270 per day live-in, and $552 per day for 24-hour awake care. A shared room at one of their 14 high-end facilities in California, Texas and Utah runs $5,000 a month, a private room closer to $10,000.

John Bowling, vice president for Silverado Senior Services, estimates that three of four seniors served by home-care companies suffer some form of memory impairment, yet home-care providers are rarely trained to address the issue.

"Why shouldn't people have the option to stay at home when all they need is specialized care?" he says.

Home delivery has been a hit for Silverado, which expects to exceed $7.5 million in revenue from in-home care this year.

"We became aware that about 75 percent of people with resources and a need (memory problems) will never move into any kind of long-term care facility," says Bowling. "What we wanted to do was to reach out and be able to serve those people as well."

Next: "It's going to be the same way lawn service is done?"
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