For most people, aging in place (i.e. in the home they now live in) is a viable option, until they hit their mid-70s and the problems of getting around the house and maintaining it begin to take their toll. Some people solve those problems by contracting for services-Meals on Wheels, Merry Maids, etc.-that help them remain at home. Some people move.

Housing options for seniors fall into three categories based on the level of services and care needed. Unfortunately, said the American Association of Homes and Services for the Aging's Bruce Rosenthal, interviewed by phone at his Washington, DC office, "most people don't even think about exploring these options until there is a crisis."

Independent living facilities, sometimes called retirement villages, age-restricted communities or seniors-only facilities, are usually found in condo or apartment complexes. "They often spring up on their own, especially in areas of the country where the climate is nice," said Rosenthal.

These communities have dwellings with features-first-floor bedrooms and baths, levered door handles inside and swipe-card locks outside, and front-loading washers and dryers-that enable residents to carry out daily activities in a comfortable, safe, and secure environment. While recreational activities and activities geared to the tastes and needs of residents are usually part of the independent living "package," medical services are not, though they are usually located close by.

All costs for living in an independent living facility are picked up by the resident.

Assisted living facilities-often called catered care or personal care facilities-bridge the gap for those who are unable to live independently but do not need the skilled care found in a nursing home. Most seniors don't move to an assisted living facility until their early-to-mid-80s.

According to the American Association of Homes and Services for the Aging, good assisted living facilities "maximize independence and quality of life by providing and/or arranging for provision of daily meals, personal care and other support services, basic health care, and on-call emergency assistance," and they provide this care in residential units that are "homelike in nature."

Services at assisted living facilities are delivered two ways. With direct service delivery, care and services are provided by the facility. In the indirect service delivery model, the facility arranges for the provision of a variety of services and residents choose, and pay for, those they want. With this service delivery model, state licensure is not required because the facility does not provide hands-on services to residents.

In most cases, Medicare and Medicaid do not pay for, or supplement, the cost of care in an assisted living facility.

Nursing homes and/or skilled nursing facilities are for those who require 24-hour-a-day nursing care-for chronic illnesses and/or disabling conditions-as well as other support services.

The Administration on Aging's ElderAction makes a compelling case for nursing home placement. Despite the fact that "most older persons and their families see nursing home care only as a last resort," it explains, "it may, in fact, be the best setting for disabled persons with multiple problems and requiring multiple types of services."

According to the Older Adults Resource Guide, published by the Western Reserve Area Agency on Aging, the time to begin planning for a nursing home placement is three years or more before the need to do so arises because (1) the emotional issues and legal decisions that must be addressed when a loved one is placed in a nursing home should not be addressed during a crisis and (2) since a year's worth of nursing home care can cost between $30,000 and $45,000, family members need to be prepared financially for what is best for them and their loved one.

Life care and/or continuing care retirement communities (CCRC), such as Judson Retirement Community in Cleveland or Laurel Lake Retirement Community in Hudson, combine all three levels of care-independent living, assisted living, and skilled nursing care-in one location, usually a park-like "village." This long term care option, which includes total medical care, begins with residents living independently in their own housing units, and then, as they age and become less able and need more direct care services, moving into the community's assisted living and/or skilled nursing facility.

This option, noted health care/health policy writer Trudy Lieberman, in Consumer Report's Complete Guide to Health Services for Seniors, is "for those with significant capital.[because] most CCRCs require a large initial fee in addition to monthly fees."

For more information on senior housing options, visit the Administration on Aging's site at www.aoa.gov/aoa/eldractn/retrlivg.html or the American Association of Homes and Services for the Aging's site at www.aahsa.org/puiblic/consumers.htm or request a copy of the Older Adults Resource Guide or the Supportive Housing for Older Persons Guide from the Western Reserve Area Agency on Aging (216-621-8010).