Margaret Soncarty has talked over concerns with countless people in 22 years as resident liaison at St. Francis Extended Health Care.

In a dozen years of working with seniors in Whatcom County, Debbie Gann, the owner/director of Home Attendant Care, has seen seniors’ housing options diversify and multiply.

Three decades into her career with the Northwest Regional Council, an Area Agency for Aging, Executive Director Victoria Doerper and her staff find themselves providing more information than ever.

These professionals say it isn’t always easy for seniors and/or their families to determine what form of housing would be best for them. It is not, however, difficult to find information about whether to choose among independent living communities, assisted living facilities, nursing homes and adult family homes — along with deciding whether staying at a senior’s original residence might still be the best option.

For some seniors, finances or acute health problems can limit their options. Yet it’s still important to explore the range of residence services and their differences, say professionals. It’s a vital educational process for both seniors and family members, many of whom have little or no experience in this area.

THE DIFFERENCES

Independent living facilities generally require private pay. This means Medicaid — federal health-care funding for low-income people — is not an option. (Medicare does not pay for permanent residency in residential facilities away from a senior’s original home.)

People in assisted living facilities generally need less day-to-day intervention from health-care providers than do residents of licensed nursing homes, where skilled medical personnel are available on a 24/7 basis. In many cases, both of these types of facilities include some residents who can pay only through Medicaid after otherwise depleting their financial resources. “There’s a lot of variability in assisted living,” says Doerper.

Adult family homes, some of which take Medicaid reimbursement, generally offer living environments with far fewer residents than other senior options.

In every case, professionals say potential residents — and their families — should tour every facility they are considering. It’s also important to consider several options, since many seniors may not discover the best “fit” for them until they have explored several facilities.

At Bellingham’s Northwest Regional Council, Doerper and her staff can make the exploration efficient with a variety of informational handouts with titles such as “Choosing an Assisted Living Facility” and “Adult Family Home Checklist.” Likewise, Gann, in her other role as president of the consortium Elder Service Providers, offers a wealth of information about all the options.

At St. Francis, Soncarty has long dealt with the fears and misconceptions many seniors have when they enter the door. “When people come through the door, many of them are really frightened,” she says. “They’re often bewildered. They think you have to give up everything. They have all these ideas they’ve picked up from old TV programs and old movies about the horrors of nursing homes.

“People are often surprised when they see that our facility smells good, when they see that people are smiling and in contact with each other, and when they see how children are laughing.”

Children are often present through several intergenerational programs.

Tonja Myers, the director at St. Francis, says it’s a common misconception that people lose their rights at a licensed nursing home. “Not only is that inaccurate, but it would be illegal,” she says. “We give everyone a book outlining their rights, and this helps a lot.”

'A NEW CHOICE’

Theresa Taylor, executive director at Fairhaven Estates, an assisted living facility, feels it’s crucial that she and her staff make sure people know that the old stereotypes don’t apply.

“Some seniors don’t understand. What they see in their brains are the nursing homes of the 1950s and 1960s,” she says. “They don’t really know that assisted living is a new choice in our society. I’ve been in this field for 35 years, and I’ve seen all the improvements. It’s so much fresher and better now. We have training programs, so staff members aren’t just thrown into a situation.”

Gann echoes the thought about much-improved resources. “Elder Service Providers is a networking and resource organization,” says Gann, who has watched with fascination as the concept of assisted living has exploded during her career. (The 30 large residential homes in Whatcom County have more than 2,100 beds, according to statistics from the Northwest Regional Council.)

Gann notes that “retirement living” is pretty much synonymous with “independent living,” where a person might be healthy enough to stay in his or her original home but often chooses to live in a community of seniors. Social reasons and amenities, such as community dining rooms and housekeeping help, are a big factor.

Leslie Keller, community relations manager at The Willows in Bellingham, offers this definition of independent living: “Independent living is a great way to simplify your life so that you’re free to do the things you want to do, without worrying about the things you have to do.”

Until people decide to relocate to independent or assisted living — and have the financial means to do so — staying in their original home, condo or apartment is often the option they prefer. Some seniors like the intimacy and affordability of an adult family home, where compatibility with providers and other residents is important. Gann helps provide information about full-time or part-time caregivers, either from a licensed agency or a private source, such as another member of the family. She says consideration about personal safety is paramount for seniors who stay in their original residence.

LEAVING HOME

At the Northwest Regional Council, Doerper and Maureen Kane, supervisor of senior information and assistance, say the first step is for seniors to consider whether they should relocate to a senior living facility, whatever the type. “From my experience, people pretty much always want to stay at home,” Doerper says. “It’s almost always their first preference, and it’s cheaper to stay at home.”

“A lot of what we try to do is to consider home-rehabilitation programs,” Kane says. “I just want people to know it’s not a black-and-white decision (to stay or leave).”

Doerper and Kane stress that age alone does not qualify someone for a nursing home. “Being too old is not a physical condition,” Doerper says. “I work with people in their 80s who are in great shape” — and thus are not yet candidates for a nursing home.

When low-income people are considering any housing option, the first question they need to ask is whether a given situation — be it relocation or not — can be covered by Medicaid. One of the other programs for low-income people is known as COPES, for Community Options Program Entry System. To qualify, people must meet low-income guidelines and must need help with vital activities such as eating, toileting, bathing or location.

Many people meet low-income guidelines only after spending down available resources. “It is expensive; there’s no getting around that,” Doerper says. “Part of anyone’s decision-making process is, ‘If I run out of money, can I stay here?’”

But Taylor says she and many of her peers try hard because they believe so strongly in senior rights.

“Everyone deserves to live in a nice place,” Taylor says. “I don’t mean (necessarily) beautiful with chandeliers, but a great environment — comfy, cozy and just home.”