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Frequently Asked Questions
Manchester is happy to provide references!
Manchester Living was founded in 2009 and currently has four residential care homes
which are licensed by the State of Texas as Type B, small. Adam Lampert and Dean
Krasovitsky, the owners, make frequent spontaneous visits to the houses to check on
residents and staff, and are actively involved in the daily details of management and
upkeep of the houses and oversight of resident care issues. In this way, they get to know
all of our residents and their families, which further contributes to the “family” feel that
our residents rave about. We also have a Director of Care, Erin Shuford, who has been
with Manchester since we opened our first home. Erin, with our wonderful caregivers,
are the heart and soul of our homes. Erin visits our houses on a daily basis, offering
oversight and training to our staff and visiting with residents and their families to ensure
that everyone is receiving the very best care and attention. Our Medical Director, Dr.
Kelley Newcomer, is a geriatric specialist who provides training to staff as well as
concierge medical services to our residents, allowing them to receive medical care in the
comfort of their homes.
In our humble opinion, our caregivers are among the very best in the industry. Unlike
most other care homes, ALL of our caregivers are certified nurse’s aides (“CNAs”). In
addition to the many hours of training that they receive prior to taking their CNA exam,
our staff has hundreds if not thousands of hours of hands-on experience and training in
our homes and are provided with more than one hundred hours of additional training
prepared by our staff physician. We encourage anyone interested in moving into a
Manchester home to meet the staff during a house tour. We pride ourselves on staff
longevity and recognize that our staff is our most important asset. With that in mind,
we pay 80% of staff health benefits and we offer no-interest personal loans. All of our
caregivers are full time W2 employees, CNA certified, trained by our in-house staff
Doctor and director of care, and receive extensive training as well as hands-on
experience working with residents with memory issues
Manchester caters to high need residents that most institutional facilities are not able to
care for. We are very selective regarding whom we accept into the homes, and do a
very thorough assessment of all potential residents to better understand their needs
and also to be sure that they will thrive in a residential setting. The owners, medical
director and director of care then meet to discuss the level of care required for your
loved one and create a care plan. Manchester caters to all levels of need and we allow
our residents to age in place.
Dr. Kelley Newcomer is our Medical Director. She graduated from the University of
Texas Southwestern Medical School and is Board Certified in Internal Medicine and
board eligible in Hospice and Palliative Care Medicine. She has worked in a variety of
settings, including: Academic internal medicine, urgent care, and foreign medical
missions. She has devoted her practice to geriatrics and palliative care for the past six
years. While our residents are free to choose whichever medical care providers they
would like, most of our residents elect to use Dr. Newcomer as their primary care
provider. She’s in the homes weekly or as needed, so it’s like having a concierge doctor
without the fee! If bloodwork or x-rays are necessary, we arrange to have those
providers come to the house, so our residents are not forced to leave the house for
those services with all the potential discomfort or risks that might entail. Whether the
family member’s insurance is accepted is up to the medical provider, not us. Other
service providers visit our homes as needed, including podiatrists who visit every three
months, dentists and dental assistants who visit at the request of our residents and their
families, hair dressers who come to the houses weekly and manicurists who visit the
We have at least two CNA caregivers on duty – and awake – at each home 24/7/365.
Each shift varies, but they are typically 8-hour shifts. The caregivers communicate at
shift change briefings as well as through care notes that are entered in our secure care
program that manages medications. The resident to caregiver ratio is always 4 to 1 or
Turnover is low, but does happen. We are always hiring and training to ensure the best
care for our residents. Staff training is overseen by our in-house physician and Director
and Director of Care.
Medication administration and charting is provided in the houses and overseen by our
Director of care. We use Accu-flo, a secure server-based medication administration
system designed for use in institutional pharmacies, assisted living, long-term care, and
rehab facilities. The medicine is stored in a secure locked medi-cart in each home and
distributed by our staff as directed.
Our staff is trained to deal with agitated residents. In the event that a resident becomes
agitated, our staff will immediately take steps to identify and rectify the cause of
agitation, to de-escalate tension and create a safe and calm environment. They focus on
feelings rather than facts and attempt to limit distractions if possible. In addition to
creating a calm environment, they provide reassurance and utilize redirection
techniques in an attempt to engage the resident in an activity or other distraction.
When we know the potential triggers for a resident, we take steps to ensure that those
triggers are minimized in order to maintain calm and ensure that all of our residents are
safe and happy.
Our staff is similarly well trained to deal with medical emergencies. In the event of an
acute medical emergency, emergency medical services are immediately summoned for
non-hospice residents and the hospice provider is notified for hospice residents. After
help is summoned, the appropriate family/emergency contacts are notified and
informed about the nature of the emergency
Our staff are available 24/7 to assist our residents. All residents are provided with call
buttons to immediately notify the staff when assistance is needed. In addition, we
provide pressure pads on the beds of residents who are fall risks or unable to utilize the
call buttons. The pressure pads register movement and trigger alarms both in the
common area and wirelessly to pagers which the staff wear. In addition, our staff
provide bed checks routinely throughout the night.
We get all residents up, dressed and groomed every day. Residents are typically
showered three times a week, or as needed, in their own private en-suite bathrooms. In
addition, we assist our residents daily with shaving, hair and grooming, make-up
application and tooth brushing.
The majority of our residents require assistance when they use the restroom. If a
resident is or becomes incontinent, we will change them regularly and try to get them
on a regular cycle of going to the restroom every two hours in order to prevent
Breakfast is a la carte. Everyone gets up at different times and likes different things for
breakfast, so breakfast time is flexible and informal, and we keep a lot of breakfast
options on hand to cater to our residents’ personal preferences. A communal lunch is
served around noon and dinner at around 5. We prefer for all of our residents to eat
together at the dining table to encourage socialization, but we allow residents to take
meals in their rooms if they prefer. We encourage family to join at any meal time – free
of charge – to eat with their loved ones. Our delicious and nutritionally balanced weekly
menus are always posted in the kitchen.
Our Director of Care meets individually with prospective clients to determine the level
of care required. The results of that assessment will determine the cost of care. The
level of care is evaluated annually or when there is a material change in the resident’s
Our monthly fee includes all medication management, meals, showers, toileting, transfers and
ambulation, laundry service, room cleaning, television, utilities and basic cable.
While we are happy to assist your family in securing VA and long-term care benefits, the
family/resident is responsible for timely payment of all fees to Manchester.
Incontinence supplies, personal grooming supplies, medication, private caregivers,
supplemental nutrition (Boost/Ensure), pressure pads, personal phones, linens and
clothing are among the items which are not provided by Manchester. We are happy to
assist our residents in sourcing and procuring these items, and pass the costs directly
through to our residents.
Each of our rooms comes equipped with a large, wall-mounted flat screen television and
basic cable. If a resident wishes to include additional movie channels or premium
packages, the client may procure them on their own, or we arrange for service and will
pass the cost of those services or a DVR box directly through to the client.
Rent is due in full on the first day of each month and we prefer check or ACH
(Automated Clearing House) / direct withdrawal. Rent must be mailed to our office; it
cannot be left in the houses.
Rates assessed at admission are honored until care needs change. The annual rent
increase is 3%.
There is a one-time, non-refundable community fee of $1,500.
The exterior doors in our houses are locked and we’re very grateful that we’ve never
had a security issue. Since our caregivers are awake and working 24/7, the house is not
attractive to criminals. The staff checks on each resident overnight, throughout the day
and in the evenings.
Our staff is trained and proficient with multi-person transfers. In addition, we have
Hoyer lifts which we can utilize if necessary.
Our houses have no set visiting hours and friends and family are welcome and
encouraged to visit as often as possible, although for obvious reasons we prefer to limit
late night visits for fear of disturbing other residents. Families are able to take their
loved ones out anytime.
Rooms are available on a first come, first serve basis, subject to a waiting list. Out of
fairness to other families who may also be interested in a room, we do not hold rooms.
Since we allow all of our residents to age in place, we are unable to predict availability of
rooms, and often have a wait list for each house.
Each room is painted and the carpet is cleaned before each move in. We furnish a large
wall-mounted, flat screen television. The rest is up to the family to furnish and decorate
as they wish. We encourage our residents to make the rooms as comfy and close to
what they had at home as possible.
After the tour, if you decide that you’d like to move forward we will schedule an
assessment with our Director of Care. Once that is complete and we determine what it
will take to meet your care needs, we will draft a lease agreement and set a move-in
date. The process could take a few days, but is usually no longer than that.
Each family works with Erin Shuford, our Director of Care, to establish a game plan and
logistics for move-in. Move-ins generally take place between 8 am and 2 pm, Monday
through Friday. Furniture may be moved into the house in advance of resident move-in.
Laundry is typically done three times a week or as needed and rooms are cleaned daily.
. We do not directly provide transportation for our residents, but we are happy to assist
the family in arranging transportation for resident outings. Families may also choose to
hire a private caregiver to drive residents to and from appointments, and we are happy
to help arrange that as well.
We know that for some residents, cherished pets are like members of the family and we
are happy to consider them in our houses, presuming that they are well socialized, fully
housebroken and up to date on all immunizations. However, for the safety, comfort and
welfare of all of our residents, we reserve the right to evaluate each case on an
Transitions can be difficult, and each resident may respond to change differently. The
Director of Care will meet with each family and prospective resident to determine what
course of action is best, and will monitor the transition carefully to watch for any sign
that might indicate that a modification to the plan is necessary
Accelerated Death Benefits – pre-death benefits from a life insurance company to a terminally ill policy holder
Activities of Daily Living – are activities normally associated with the day-to-day personal care, such as personal hygiene, using a toilet/continence, dressing, cooking, eating and taking one’s medication.
ADLs or Activities of Daily Living – are activities normally associated with the day-to-day personal care, such as personal hygiene, using a toilet/continence, dressing, cooking, eating and taking one’s medication.
Adult Day Care – A daytime program for functionally impaired adults that provides a variety of social and related support services in a protective setting.
Adult Day Health Care – A daytime program for functionally impaired adults that provides a variety of social, medical and related support services in a protective setting.
Adult Family Homes – Are defined as a family-type living arrangement in a private home providing room, board, and personal care for no more than five disabled adults.
Adult Foster Care – Provides a 24-hour living arrangement with supervision in an adult foster home for people who are unable to continue living independently in their own homes because of physical, mental or emotional limitations.
Adult Living Facilities – An assisted living residence or assisted living facility is a housing facility for people with disabilities or for adults who cannot or who choose not to live independently.
Adult Social Day Care – is a planned program of activities in a professional care setting designed for older adults who require supervised care during the day, or those who are isolated and lonely.
Aid & Attendance – a type of pension program for wartime veterans
Alternative Home Equity Programs – A shared equity mortgage is a type of financing program that assists homebuyers with the upfront costs of buying a property. These programs are generally offered by nonprofit organizations, municipalities, or private investors
Assisted Living – A supportive housing facility designed for those who need extra help in their day-to-day lives but who do not require the 24-hour skilled nursing care found in traditional nursing homes.
At Home Care – Medical care provided to seniors in their place of residence other than in an assisted living or skilled nursing facility.
Board and Care Homes – are houses in residential neighborhoods that are equipped, adapted, and staffed to care for a small number of residents, usually between two and 10. These homes provide comparable care to what’s offered at assisted living communities but usually less than what a nursing home provides.
Board and Lodging – A place of lodging with daily meals, usually provided in return for rent or other considerations.
Care Allowance Plan – A type of long term care insurance benefit in which the insurance company pays out a set dollar amount for care on a daily, monthly or annual basis instead of paying for the actual cost of care.
Cash Surrender Value – the cash value of a life insurance policy were the policy holder to terminate the contract and resell the agreement to the insurance company.
CCRCS – A continuing care retirement community, sometimes known as a life plan community, is a type of retirement community in the U.S. where a continuum of aging care needs—from independent living, assisted living, and skilled nursing care—can all be met within the community.
CFL – is a health insurance and care program provided by the U.S. Department of Veterans Affairs (VA) for spouses and / or children of veterans permanently disabled or killed in the line of duty.
CHAMPUS – is a health care program of the United States Department of Defense Military Health System.
CHAMPVA – Civilian Health and Medical Program of the Department of Veterans Affairs, a medical insurance programs for veterans’ families.
CHAMPVA for Life – an extension of CHAMPVA benefits for individuals over 65.
Community Based Retirement Facilities – A retirement community is a residential community or housing complex designed for older adults who are generally able to care for themselves; however, assistance from home care agencies is allowed in some communities, and activities and socialization opportunities are often provided.
Community Residences – A group home or specialized residential care home serving unrelated persons with disabilities which is licensed, certified or accredited by appropriate local, state or national bodies.
Continuing Care Contract – is a CCRC contract that restricts the total number of days one can receive care. Should the senior require additional care, it can be purchased at the time for a discounted rate.
Continuing Care Retirement Communities – A community that provides a continuum of care, from private residences to assisted living and skilled nursing care. These are designed for individuals that want to remain in a single location for senior years and for seniors with declining conditions.
Convalescent Hospital – is a place where the period of recovery or anything related to the process of returning to health, like a convalescent program of physical therapy or a convalescent ward at a hospital.
Custodial Care – Care primarily for meeting personal needs such as assistance in bathing, dressing, eating or taking medicine which can be provided by someone without medical training.
Death Benefit Loans – a loan from a life insurance company to a policy holder that is secured by the death benefits.
Domiciliary Care – This is the kind of care provided to the elderly by a qualified home care worker at the senior’s own home.
Elimination Period – the number of days an individual must hold a long term care policy before benefits can begin.
Equity Release – Equity release is a means of retaining use of a house or other object which has capital value, while also obtaining a lump sum or a steady stream of income, using the value of the house.
Extensive Care Contract – Extended care services refer to those services that are offered to persons who need assistance with day-to-day activities or with medical needs by a recognized service provider.
Fannie Mae Home Keeper – a type of reverse mortgage that is now obsolete.
Fee-For-Service Contract – is a CCRC contract that requires residents to pay separately for their residential and medical costs.
Group Homes – a home where a small number of unrelated people in need of care, support, or supervision can live together.
Geriatric Assessment –A comprehensive assessment of an older person’s health, social and financial needs with the goal of improving the overall quality of life.
Geriatric Care Manager – A fee-based, professional that assesses a person’s long-term care needs and financial situation and arranges and monitors the necessary care services.
HECM loans – is a type of reverse mortgage that is insured by the Federal Housing Administration (FHA) Home equity conversion mortgages allow seniors to convert the equity in their home into cash.
Home Care Aides – help care for physically or mentally ill, injured, disabled or infirm individuals who are confined to their homes or living in residential care facilities. They may also provide daily care services to people with disabilities who work outside the home.
HCBS – Home and Community Based Services, assistance provided to persons in their homes or communities instead of in nursing homes. Term is commonly used by Medicaid programs.
Home Equity Co-Investment – Instead of taking out a mortgage from a bank, buyers work with a partnering company to purchase a home. Co-investors share the equity in your property, treating it as an investment, and in exchange, offer discounted monthly payments.
Home Equity Conversion Mortgage – is Federal Housing Administration’s. (FHA) reverse mortgage program which enables you to withdraw some of the equity. in your home. You choose how you want to withdraw your funds, whether in a fixed. monthly amount or a line of credit or a combination of both.
Home Equity Co-Share – that when you sell your home we both benefit from the value going up or share in the loss if the value goes down.
Home Equity Sharing Programs – an agreement in which a homeowner receives a cash payment today in exchange for some percentage of their home equity in the future.
Hospice – a care program that alleviates the symptoms but does not cure the underlying cause provided to dying persons and their families, in the form of physical, psychological, social and spiritual care.
Housebound – a type of pension program for wartime veterans
HUD reverse mortgages – enables you to withdraw a portion of your home’s equity to supplement your income, or to purchase a home. There are no monthly principal and interest payments.
HUD/FHA Home Equity Conversion Mortgage – is Federal Housing Administration’s. (FHA) reverse mortgage program which enables you to withdraw some of the equity in your home. You choose how you want to withdraw your funds, whether in a fixed. monthly amount or a line of credit or a combination of both.
HUD-insured Home Equity Conversion Mortgage – Reverse mortgages can provide a valuable financing alternative for qualified homeowners. Any lender authorized to make HUD-insured loans may originate reverse mortgages.
Improved Pension Program – a type of pension program for wartime veterans
Independent Living – Communities, typically of single family homes or townhomes for self-sufficient seniors that want the security and social activities of a community living environment.
Jumbo Reverse Mortgages – a type of reverse mortgage for high value homes.
Life Care Contract – is a CCRC contract in which all long term care costs are covered with no additional fees.
Life Insurance Settlements – A life settlement is the legal sale of an existing life insurance policy for more than its cash surrender value, but less than its net death benefit.
Life Settlement – the sale, by the policyholder, of their life insurance to a 3rd party in exchange for a lump sum of cash.
Life-Care Facilities – A residential development offering varying levels of housekeeping support,medical care, and community dining for senior citizens.
Lifetime Mortgage – you take out a loan secured on your home which does not need to be repaid until you die or go into long-term care.
Look Back Penalty – in an attempt to gain eligibility, some seniors transfer their financial assets to other family members. To discourage this activity, Medicaid considers “lookback” asset transfers as far as 5 years previous.
Medicaid Gap – If a senior’s assets are greater than the Medicaid eligibility requirement, but are less than the monthly cost of long-term care, the senior falls into this category.
Medicare Saving Program – a series of programs designed to help financially needy seniors who are not eligible for Medicaid with the cost of co-pays, premiums and care.
Medicare Supplemental Insurance – sometimes referred to as Medigap plans, this insurance extends Medicare benefits.
Military Retiree – a “retired” member of the military is someone who has 20 years of service. All military retirees are veterans but not all veterans are military retirees.
MIP – is paid if you as a borrower were to make a down payment of less than 20 percent on your home loan. It is paid by you, but is used to protect the lender from losses if you were to default on the loan.
Modified Care Contract – A contract modification may introduce or cancel specifications or terms of an existing contract, while leaving its overall purpose and effect intact.
Mortgage Insurance Premium – a special type of insurance required for reverse mortgages borrowers that provides additional consumer protections.
MSP – see These programs are for people with limited income and. resources and help pay some or all of their Medicare premiums, deductibles, copayments and coinsurance.
Non-Medical Senior Housing – Independent senior living properties do not provide health care or assistance with activities of daily living (ADLs) such as medication, bathing, eating, dressing, toileting and more.
Non-Traditional Home Equity Programs –Nontraditional mortgages often come with higher interest rates because of the higher payment risks associated with the loan.
Nursing Care and Rehabilitation – is to assist individuals with a disability and/or chronic illness to attain and maintain maximum function.
Nursing Home – a private institution providing residential accommodations with healthcare, especially for elderly people.
Origination Fee – a fee charged by a lender in loan transaction that covers the lender’s expenses and margin.
PACE – refers to the Program of All Inclusive Care for the Elderly which a comprehensive care program offered by Medicare.
Palliative Care – a care program that alleviates the symptoms but does not cure the underlying cause, usually provided to dying patients.
Personal Care Aides – individuals that provide custodial care, or non-medical care, in a senior’s place of residence.
Personal Care Facilities – offers housing, meals and assistance with medications and personal care tasks.
Personal Care Homes – are residences that provide shelter, meals, supervision and assistance with personal care tasks, typically for older people, or people with physical, behavioral health, or cognitive disabilities who are unable to care for themselves but do not need nursing home or medical care.
Priority Group – one of 8 different groups into which all veterans are assigned based on disabilities, assets and other factors. These are a major determining factor in what health benefits the veteran receives.
Progressive Neurological Condition – any of a number of conditions in which the patient has progressively declining symptoms such as Alzheimer’s or dementia.
QDWI – Program is one of the four Medicare Savings Programs that allows you to get help from your state to pay your Medicare premiums. This Program helps pay for Part A premiums only.
QI – is state-specific and some agencies may not have a requirement.
QMB – is a person for whom the government must cover certain health care costs, including premiums, deductibles and copays.
Qualified Disabled & Working Individuals – one of several programs designed to help financially needy seniors who are not eligible for Medicaid with the cost of co-pays, premiums and care.
Qualified Medicare Beneficiary – one of several programs designed to help financially needy seniors who are not eligible for Medicaid with the cost of co-pays, premiums and care.
Qualifying Individual – one of several programs designed to help financially needy seniors who are not eligible for Medicaid with the cost of co-pays, premiums and care.
Real Estate Equity Exchange – is the difference between the current fair market value of a property and the amount of debt owed against the property.
Residential Care – refers to long-term care given to adults or children who stay in a residential setting rather than in their own home or family home.
Residential Care Facilities –or group homes, are small private facilities, usually with 20 or fewer residents. Rooms may be private or shared. Residents receive personal care and meals and have staff available around the clock.
Rest Homes – a residential institution where old or frail people are cared for.
Retirement Communities – is a residential community or housing complex designed for older adults who are generally able to care for themselves; however, assistance from home care agencies is allowed in some communities, and activities and socialization opportunities are often provided.
Retirement Homes – a house or apartment in which a person lives in old age, especially one in a complex designed for the needs of old people.
Reverse Annuity Mortgage – is a loan that is secured against the value of your home. It allows you to cash in some of your home’s equity, without having to sell or move out.
Reverse Mortgage – a loan with high levels of consumer protection for seniors, secured by their home equity, in which the lender makes payments to the home owner.
Section 202 housing – a type of government assisted housing
Section 8 rental certificates – a type of government assisted housing
Senior Apartments – is housing that is suitable for the needs of an aging population.
Senior Housing – It ranges from independent living to 24-hour care.
Senior Life Settlements – involves selling an existing life insurance policy to a third party—a person or an entity other than the company that issued the policy—for more than the policy’s cash surrender value, but less than the net death benefit.
Senior Settlements – a life settlement where the insured individual meets a minimum age requirement, typically over 65, and has a life expectancy of fewer than 15 years.
Service-Connected Disability – refers to a disability incurred by a veteran that was in some way connected to their time in service.
Shared-Appreciation Arrangement – the lender provides a lump sum payment to the homeowner in exchange for a portion of the future equity appreciation in a property.
Sheltered Housing – is a term covering a wide range of rented housing for older and/or disabled or other vulnerable people.
Skilled Care – Care ordered by a physician that requires the medical knowledge and / or technical training of a licensed healthcare professional.
Skilled Nursing Facilities – A residential home for seniors in which care is provided by licensed healthcare professionals.
SLMB – Is aprogram that helps you pay for Medicare Part B premiums. A state’s Medicaid program funds the SLMB program.
SNF – is an in-patient rehabilitation and medical treatment center staffed with trained medical professionals. They provide the medically-necessary services of licensed nurses, physical and occupational therapists, speech pathologists, and audiologists.
Specified Low-Income Medicare Beneficiary – one of several programs designed to help financially needy seniors who are not eligible for Medicaid with the cost of co-pays, premiums and care.
Spend Down – refers to the process by which a senior will spend down all their assets on their care until their assets are depleted sufficiently to qualify for Medicaid.
TFL – see TRICARE for Life
TRICARE –a medical insurance program for military retirees and their families
TRICARE for Life – an extension of the TRICARE program for individuals over 65
Viatical Settlement – the sale, by a terminally ill policyholder, of their life insurance to a 3rd party in exchange for a lump sum of cash.
Wartime Veterans – Veterans that served at least 90 days and at least one of which was during the wartime dates below, but not necessarily in combat.
World War II: Dec 7, 1941 – Dec 31, 1946
Korean War: Jun 27, 1950 – Jan 31, 1955
Vietnam War: Aug 5, 1964 – May 7, 1975
Gulf War: Aug 2, 1990 – Undetermined