In-home nursing care: Live independently in retirement

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As you get older, wiser, and closer to the age of retirement, it's important to think about your options. Where do you want to live? What kind of medical care will you require? How do you see yourself spending your golden years?

Retirees have a lot of choices when it comes to their living arrangements, from nursing homes and continuing care environments through to condo communities and other forms of independent living. If you're like most people and want to live independently for as long as possible, in-home nursing care can be a fantastic alternative to residential care.

What is in-home nursing care?

In-home nursing care involves professional support and medical care from licensed healthcare professionals in the home environment. Also known as home health care, this form of care supports people as they age by enabling them to live in their own private homes for as long as possible. While some people require full-time residential care as the result of a medical condition, in-home nursing care is a suitable option for a wide range of people.

In-home nursing care, or formal outpatient care, can be distinguished from non-medical home care or private-duty care.

Unlike non-medical care, in-home nursing care involves the services of healthcare professionals, either in isolation or with the assistance of certified nursing assistants (CNAs) or non-medical caregivers. In-home services can be useful in a range of scenarios, either as a form of transitioning care after a hospital stay or as a way to support people while they live at home and avoid unnecessary residential care.  

In-home nursing care is provided by a number of healthcare professionals, including licensed nurses, registered nurses, physical therapists, occupational therapists, and social workers. While doctors do not normally form part of the formal care package, they may be available for home visits. While non-medical home care is mostly privately funded, formal home health care is often government or insurance funded.

Regardless of who pays for it, in-home health care can be a very affordable alternative compared to full-time residential care.

Professional home care concepts and tasks

In-home nursing care and other forms of home care are often confused, with different terms used interchangeably across the United States and Canada. There are also a number of state and provincial distinctions depending on how the industry is regulated. Regardless of the terms used, all home-care packages, either skilled or otherwise, are designed to make it easier for people to remain at home.

In-home medical care is often split up into activities of daily living (ADL) and instrumental activities of daily living (IADL), with the former referring to the patient's capacity for self care and the later referring to the patient's ability to live independently in the community. Depending on the professionals involved, home care may include the following services:

  • medical assessment

  • psychological assessment

  • medication education and reminders

  • pain management

  • physical therapy

  • occupational therapy

Home health vs home care

In-home nursing care is a form of home health care, which should be distinguished from regular home care. While home health care is a form of clinical care, home care is non-clinical in nature. Not only does this affect the services available, it also affects your health insurance and finance options. Home health care typically involves a registered nurse along with other trained healthcare professionals.

This level of care often follows an inpatient hospitalization, but can also be applied to help people live independently for longer. When people experience an overall decline in their physical function, home therapy may be applied to compensate for their condition.

While non-clinical home carers are able to remind people to take their medication, only home health carers are able to administer medication.

In contrast, regular home care is carried out by care aides to help deal with everyday life issues and challenges. While many of these carers have been trained, this level of care is sometimes referred to as unskilled on non-clinical. Home care involves things like meal preparation, physical grooming, housekeeping, help with driving and transportation, and companionship.

In-home nursing care is a form of medical care and is therefore covered by insurance programs such as Medicare when prescribed by a doctor, and Medicaid if conditions are met. Private payment is also available if services are needed and insurance is not available. In contrast, home care involves private pay arrangements, long-term care insurance, or possibly Medicaid for qualified low-income seniors. Combined home health and home care services are available from many companies.    

Residential options for in-home nursing care

In-home nursing care is available in all private homes, from detached houses through to apartments, condos, and dedicated retirement communities. The flexibility and affordability of these care programs make them an attractive option for many retirees. Whether you've been living in the same home for decades, just downsized into a condo, or moved into a 55-plus retirement village, in-home nursing care can give you the medical and practical support that you deserve.

  • Family homes

  • Rented apartments

  • Standard condos

  • Specialized retirement communities

If you're thinking about living independently, it's important to distinguish between houses, apartments, condos, and retirement communities. There are lots of different types of retirement communities out there, some of which offer no medical support services and others which offer extensive medical support. Many retirement communities operate in a similar way to standard condos with the addition of age restrictions and specialized amenities for older residents.

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In-home nursing care and other forms of outpatient care can be used by anyone who doesn't have access to residential support services.    

Living in your current home

Living in your current home can be a great option for retirees, with existing family homes already full of your memories and favorite possessions. There are also a number of practical advantages associated with staying put. You know where everything is, not just in and around the home but also in and around the neighborhood and wider area.

You may not want to deal with new traffic routes and other life complications after you retire. Your friends and family are also likely to be close, with most people developing support networks over a period of decades around their family home and local town.

Benefits of downsizing

Staying in your existing home is not all good news, however, with complications likely to arise as you get older. There's a very good reason why so many retirees choose to downsize, either to a rented apartment, a standard condo, or a dedicated retirement community.

  • First and foremost, you need much less space as you get older, with your children likely to have moved out and less room needed as a result.

  • Secondly, units are much easier to maintain than large detached homes, with no lawns to mow or guttering to clean out.

  • Last but not least, moving into a smaller home can give you a new lease on life and help you to develop new connections with like minded folks.  

Renting an apartment

Renting an apartment is a valid option for retirees who want to live independently. While rented apartments can be an insecure form of accommodation compared to owned residences, they can be affordable, low maintenance, and come with very few responsibilities.

It's easy to move from an apartment if your health condition or lifestyle needs change, which can be a source of great freedom for older people. While you can't build equity through capital growth like you can when you own a condo, this may not be an issue for many retirees who are looking to simplify their finances or hand money down to their children.    

Moving to a condo

Moving into a condo is a great option for your retirement years, with a range of standard condos and dedicated retirement communities available to choose from. There are numerous benefits involved with the condo lifestyle, including lack of maintenance, increased access to amenities, and the opportunity to get involved socially with other people in the condo community.

Condos also make it easier for people to live in desirable locations, with inner-city or beachside condos much cheaper to buy than detached homes in the same neighborhood.

While living in a condo does come with the responsibility of paying monthly condo fees, the combination of low maintenance and housing security can not be matched by any other form of housing. If you've decided to move to a condo after you retire, you have the choice between a standard condo or a dedicated retirement community. In-home nursing care is available either way, with most care providers happy to visit both regular and age-restricted condo communities.

While standard condos will give you more options, age-restricted communities are often the better choice.

Moving to a condo in a retirement community

Not all retirement condo communities are the same, with a range of options available to you depending on your budget, your health condition, and your lifestyle needs. Co-housing condos vary widely in terms of the healthcare support they provide, with some offering full medical support services from residential staff, some working with third-party care providers, and others offering fully independent living with the opportunity to organize your own in-home nursing care.

Let's take a look at the options so you can see what appeals to you.  

Co-housing with condo ownership

Full-ownership co-housing retirement communities are designed to function much like traditional condo communities. Individuals are able to own their home outright and organize their own in-home care and support services if needed. These communities are known by many names, including gated communities, active adult communities, and independent living communities.

Co-housing is designed for healthy and active people who want to live independently and be responsible for their own healthcare. While some communities will have existing relationships with in-home care providers, others will leave it all up to you.  

Co-housing with a rental arrangement

Many co-housing retirement communities are designed to function with a standard rental arrangement, with a few key differences. While residents pay monthly rental fees for a unit just like they were renting an apartment, they will also have access to age appropriate amenities and social support systems. Even though the resident is not able to build equity or have the security of owning their own home, they can still become part of the retirement community and live independently with the medical care which they deem appropriate.    

Niche retirement communities

Niche retirement communities are a relatively new phenomenon, with these projects designed around common beliefs, activities, and lifestyles. From Christian communities based on faith through to artistic and vocational communities, this can be a great way to live independently around people who are similar to you. While these communities are similar to other retirement communities in most ways, they may include dedicated amenities and group based activities based around the common element which makes them unique.

NORCs

A naturally occurring retirement community (NORC) is just that, a community of older people which have developed organically in a specific neighborhood. Retirees are more likely to gravitate to certain areas, with these neighborhoods often the result of older people moving in while younger residents move out at the same time. While NORCs offer a number of benefits to retirees who want to live independently, they are often something that happens almost by accident. If you want to buy a standard condo and live around other people of a similar age, there are certain neighborhoods in Florida and elsewhere which are known for their high proportion of elderly residents.  

The village model

"The village model" is similar to a NORC, only this time there is a formal arrangement between residents and in-home care providers. This can be organized by anyone, either the residents themselves or their families and friends. If in-home carers and healthcare professionals are able to visit multiple homes in a nearby location, it can be much more affordable to access their services. House sharing with other retirees can also be an affordable and practical option, with this "Golden Girls" model named after the popular TV show.  

CCRC

Continuing care retirement communities (CCRC) offer a continuum of care for elderly residents, from totally independent living through to in-home nursing care, assisted living, and full-time home care. While CCRC can be more expensive than other retirement communities, it can be a practical option for people as their healthcare needs change over time. Just like other retirement communities, residents have access to age appropriate amenities and social support systems.  

Benefits of condo living

Living in a condo during retirement offers numerous benefits over other forms of housing, especially if you want to live independently for as long as possible. While it may seem enticing to stay in the family home that you know and love, it can also be challenging as the years progress.

Keeping up with maintenance can be a major struggle as you get older, with even the smallest jobs turning into large and sometimes dangerous tasks. Boredom and loneliness can also be very real issues, with individuals and couples both likely to suffer from a lack of community engagement.

Whether you want to live in a standard condo or a specialist retirement community, let's take a look at the benefits associated with the condo lifestyle.

Lack of maintenance

One of the main reasons why condos are so popular with elderly residents is down to maintenance, or rather the lack of it. Condos are defined by a specific type of ownership arrangement that involves ownership of an individual unit and shared access to the common areas and assets of the community. Because you don't own the outside of the building, the surrounding land, or any of the amenities, you have very few responsibilities when it comes to maintenance and repairs. Instead, you pay monthly condo fees and leave the hard work for someone else while you relax and enjoy your retirement.

Sense of community

Along with the lack of maintenance, it's the sense of community spirit that drives so many people towards condos after they retire. Rather than isolating yourself away from the world behind four walls, condos allow you to make new connections and forge new friendships. This is especially true for retirement communities, with their age-restricted nature giving people of a similar age an opportunity to socialize and make friends. Along with the communal use of recreational and social amenities, many condos have active social clubs and activities for residents to enjoy.   

Access to amenities

Living in a condo is a great way to access amenities, many of which you wouldn't be able to afford on your own. Whether it's a swimming pool, a tennis court, or a gymnasium, amenities will help to keep you active and give you something to do close to home. While many of these amenities have a health and fitness focus, there are also a range of social, lifestyle, and commercial amenities in many modern condo buildings. For example, retirement condos often come with active social clubs, day trips, and regular visits from healthcare practitioners.   

Benefits of a dedicated retirement community

In addition to the benefits listed above, dedicated retirement communities offer a number of additional advantages over standard condo communities. While lack of maintenance, community connections, and access to amenities are still the biggest draw cards, these benefits are refined and tailored to people of a certain age.

  • Accommodation tailored to people of your age

  • Integration with in-home nursing and other care services

  • Access to social clubs and support structures

  • Access to age-specific recreational amenities

  • Commercial healthcare, wellness, and beauty services on-site

Choosing where to retire

If you've decided to make the big move into a condo community, the first decision you need to make is where you want to retire. The location of the community will have a huge effect on your finances and lifestyle for years to come, so it makes sense to take some time, do your homework, and make the right decision for your future.

While this decision is ultimately yours, it's important to consult with your family and any healthcare professionals who are familiar with your current and past health condition.

Location

Like all real estate decisions, the location of the condo or retirement community will have a huge influence on your lifestyle. People normally want to live somewhere with good weather when they retire, which is why Florida and other warm destinations are so popular. Hot weather is not for everyone, however, with a number of great locations up north and in Canada.

Moving far away does come at a cost, however, with people who move away from their family and existing social support systems often feeling isolated. Buying a condo in your home town can also be beneficial to your lifestyle, especially if you want to see your kids and grandkids on a regular basis.

Lifestyle

Even though some retirement communities are completely self-contained, it's also important to live somewhere that's close to amenities and attractions. Whether it's public transportation, cafes, restaurants, or shopping districts, it's important to find somewhere that works with your lifestyle.

Engaging with the outside world will help to keep you young, with some retirement communities offering regular trips to local attractions and commercial centers. While no-one has a crystal ball, try to anticipate your future needs, including the effects that your health might have on your lifestyle down the track.

Finances

Buying a condo is generally much cheaper than buying a detached home, especially when you take location into account. While dedicated retirement communities often come at a higher cost, this depends on the amenities and healthcare services available. As a retiree, you may be able to use your existing equity as a down payment, with 20 percent the standard amount.

Along with the deposit amount and mortgage payments, it's also important to account for condo fees, which you will need to pay monthly to the Homeowners Association (HOA). While condo fees can seem expensive, it’s important to remember that you don’t have to worry about maintenance costs and other expenses. Condo fees vary widely, so it's important to compare and contrast multiple communities to see what you get for your money.   

Benefits of independent living

There are numerous benefits to living independently after you retire, both to your finances and to your lifestyle.

If you need to utilize in-home nursing and other care services, the cost of these services is generally much cheaper than full-time residential care. In-home nursing is also more accessible because it's paid in installments rather than being a steep up-front payment. While payment schedules differ considerably between providers, in-home health care is generally quite flexible and capable of meeting your individual healthcare needs.

Along with the financial benefits of independent living, there are also a wide range of lifestyle advantages. People who live on their own terms for as long as possible are more likely to stay active and more likely to engage with the wider community. This can have a positive impact on self-esteem, feelings of self worth, and both physical and psychological health outcomes.

While many people will need to accept a nursing home or residential care arrangement at some point as they age, living an independent life with access to in-home healthcare is one of the best ways to stay young and age gracefully.