Eldercare Challenges

Tough Choices in the Golden Years

By Norm Miller, Senior Wealth Counselor

There are four kinds of people in the world:
Those who have been caregivers;
Those who currently are caregivers;
Those who will be caregivers;
And those who will need caregivers.

-First Lady Roslyn Carter

Aging is a natural part of life. Changes from both a physical and mental perspective (functional decline), may trigger the necessity to make difficult choices regarding housing decisions and caregiver services. It is best to plan ahead for functional decline in lieu of trying to make difficult decisions at stressful times or at a time when you do not have the ability to make decisions. I recommend thinking about what you would want done if/when functional decline requires changes to your situation. It’s a very personal choice and your perspective may even change over time.  Examples of eldercare issues are:

  • Do I want to stay in my home?
  • Who will be my caregiver?
  • Would I be better off at a senior care facility?
  • What are the costs of services and do I have the resources to meet them?


Just as you would seek experts in investment, tax, and legal arenas, there are professionals that serve the aging population. They are Geriatric Care Managers (GCM), and primarily come from the Social Work educational fields. GCMs are professionally licensed and operate in a fiduciary manner similarly as we do here at Versant Capital Management. A GCM acts as a guide and advocate for families that care for older relatives or disabled adults. You can learn more about this profession and its services at the Aging Life Care Association. The site can also help you find licensed professionals across the country. Aging life care experts are an additional resource that one should explore and utilize during transitional periods.

Staying at Home

Recent studies show that 90% of people over the age of 65 want to stay in their home for as long as possible. There is a high potential that aging at home will require caregiver assistance at some point. The typical home caregiver services are:

  • Family Caregivers (spouse, child, etc.)
  • Home Care Service Providers (non-medical assistance and companionship)
  • Home Health Care Providers (licensed nurses and therapists that provide skilled nursing care, physical therapy, etc.)


An emerging subset of staying at home is Active Adult Communities, which provide independent living (you own your own home) with a low-maintenance lifestyle, such as community-provided exterior maintenance, community pools and activities.

Senior Living Facilities

Loneliness is a trigger factor that drives the aging to senior living facilities. There are 4 service levels that cover this option:

  • Independent Living (rental based, typically apartments)
  • Assisted Living (covers non-medical needs and commonly referred to as custodial or personal care)
  • Skilled Nursing (medical care provided by licensed nurse practitioners and registered nurses)
  • Memory Unit (medical services that serve patients with dementia and Alzheimer’s disease)


As you can see, these services are a continuum of care. The actual housing solutions may be stand-alone or a part of a Continuing Care Retirement Community (CCRC). CCRCs typically charge an entrance fee (may be partially refundable upon leaving the facility) and they provide a seamless transition across care levels. CCRCs are becoming more prevalent as the Baby Boomers age.

Cost of Care

Genworth, a long-term care insurance provider, does annual cost-of-care surveys that detail cost by type of service and geography.   Click here for the current report..

An overview of median US costs is:

  • Home Health Aide Services – $20 per hour
  • Adult Day Health Care – $69 per day
  • Assisted Living Facility – $3,600 per month
  • Nursing Home Care – $220 (semi-private) to $250 (private) per day


The range in costs for nursing home care, however, is significant. Private care ranges from an annual cost of $60,000 in Oklahoma to $281,000 in Alaska. Cost is not necessarily the driving factor in eldercare decisions, but you should be aware of the geographical and service choice impacts.

This article scratches the surface of a complex subject area. If you wish to explore further, I recommend a book by Becky Feola tilted The Eldercare Consultant. And, as always, we at Versant are here to help with your eldercare planning issues.



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