Lending a Hand

Ask any older person about plans for the future and the answer will likely be, “I plan to remain in my own home.” “I want to maintain my independence,” he or she may say. “I don’t want to be a burden.” And who wouldn’t prefer to be in at home, free to choose how we live?

Yet there may come a time when that definition of independence is just too hard to maintain. The upkeep of a home becomes burdensome. One can no longer manage the tasks necessary for comfort, health and safety. At that point, many choose to pay someone to do yard work, heavy cleaning and snow shoveling. Some engage home care workers for help with household chores, shopping and cooking. A visiting nurse and a home health aide can be added to the team.

But sometimes, staying at home isn’t the best answer. Finding workers can be difficult. One can be lonely, with just the few hours of company provided by home care workers. Some elders need more. They don’t need 24-hour nursing care, but they do need the safety and comfort of daily assistance that can be immediate, if necessary. For that kind of support, an assisted living facility is a good choice.

Assisted living is a broad category that varies somewhat, state to state. In New Hampshire assisted living includes residential care, supported residential care and some facilities for people with dementia. In each, meals are served in a common dining room. Laundry and housekeeping services, transportation to medical appointments and community activities and on-site social activities are provided.

Nurses and health aides supervise medication and monitor a resident’s health status. They assist residents to carry out activities of daily living (ADL) such as dressing and bathing, as needed. Staff also arrange medical appointments and help residents maintain health routines. Supported residential care provides more assistance with activities of daily living and often more involvement with medical and rehabilitation services. Residents are less independent.

Assisted living is not suitable for a person who needs 24-hour nursing care. A resident must be able to “self-evacuate” in case of emergency. Staff will assist but the resident must be able to respond, for example, to a fire alarm at night, to understand the situation, get up, dress for the weather and get out of the facility in a short time period.

There are facilities that offer assisted living along with higher levels of care (see sidebar). The Inn at Spruce Wood in Durham (www.theinnatsprucewood.com, 659-1100), for instance, includes independent living, residential and supported residential care and an assisted living program for people with dementia.

Administrator Denise Cadorette describes options within the assisted living component. One can chose a studio, or a one- or two-bedroom unit. Each has a galley kitchen with refrigerator, sink and microwave. Common rooms provide space for visiting, entertaining and recreation.

Another model of assisted living is an enhanced version of what used to be called a retirement home. These are governed by the same regulations and provide the same required services as other assisted living facilities. They are usually smaller, and do not offer the apartments typical of larger facilities. They are often located in large older homes, adapted for group living. Generally, residents have private rooms with baths. Jan Silva, owner and administrator of Mont Vernon Inn (www.montvernoninninc.com, 876-3498) in Mont Vernon uses the term “bed and breakfast residential care” to convey a sense of the 24-bed facility.

Ownership and management of assisted living facilities varies. Some are private, for-profit corporations, often part of a regional or national health care corporation. Some are single-owner businesses. Others are chartered as not-for-profit corporations, overseen by a community board of directors or as a component of a religious organization.

Assisted Living at Sugar Hill in Wolfeboro (www.sugarhillrc.com, 569-8485) is located on the grounds of Sugar Hill Retirement Community. Executive Director Gene Goodwin explains that this facility operates as a department of Huggins Hospital, a not-for-profit corporation. Residents in need of hospital care have ready access to the hospital. The facility has both residential and supported residential care, with a choice of one or two room private units in each. It also offers respite care for family caregivers.

How do people choose a facility? Affordability is one factor. Costs range from $2,700 to $6,000 per month. Beyond that, choice is often based on location. A long-time resident of a community will usually prefer to stay nearby. A person moving to be near family will locate as close as possible to the family. The setting also makes a difference. Some elders prefer in-town facilities. Others respond to the beauty of a country setting. There is also the compatibility factor. “I want a place where I would find people like me,” says one woman, who was contemplating the possibilities.

There are 137 assisted living facilities in New Hampshire, with a total of 4,013 beds (2004 figures). Senior care providers see a growing need for assisted living facilities, especially for affordable programs. Currently about one third of New Hampshire seniors have household incomes of below $25,000, putting most facilities out of reach.

With the 65+ population expected to increase from the present 13 percent to 17 percent in 2020, the shortage of affordable assisted living facilities could become critical. NH


Some assisted living facilities are part of larger retirement communities that offer independent cottages or apartments, assisted living apartments and sometimes nursing home care. Some complexes also include units for people with dementia. For many individuals and families, there is security in being able to move from one level of independence to the next within the same complex. Below are some of the state’s major providers of multiple levels of care:

Hillcrest Terrace
(www.hillcrestterrace.com, 800-862-9490) in Manchester: Independent and assisted living, nursing home care

(www.rivermead.org, 800-200-5433) in Peterborough: Independent and assisted living, dementia care and memory loss, skilled nursing care

RiverWoods at Exeter
(www.riverwoodsrc.org, (800-688-9663): Independent and assisted living, skilled nursing care, memory support

The Courville Communities
(www.courvillecommunities.com, 800-638-5503): Aynsley Place, Nashua, assisted living; Carlyle Place, Bedford, assisted living; Courville at Nashua, skilled nursing care and rehabilitation; The Villas at Nashua, independent living; Courville at Manchester, skilled nursing care and rehabilitation, assisted living