Select Your Long Term Home Before You Need It!
The Best Retirement Community is the third of a three-part series on senior life planning:
- Best Retirement Location
- Best Retirement Advice & Support
- and Best Retirement Community (this blog)
Your Best Retirement Community
In the previous segments we chose the best geographical area for retirement. And we authorized trusted representatives to provide help when we need it. This blog covers the third major segment of senior life planning, selecting a residence to serve our long term needs.
Finding your best retirement community requires only three steps:
- Senior Living Options – finding your best long term residence.
- When To Move – deciding when you will actually move.
- Exercise, Diet & Health – taking care of today.
1. Senior Living Options
90% of people 65 and older want to live in their own homes indefinitely. That’s not surprising. After all, we spent years adapting our home to us, and adapting ourselves to it. It fits us.
However everyone, unless he dies young, will in time grow old. And when you get old, eventually you can no longer handle one or more Activities of Daily Living without assistance. There are many definitions of ADLs but here’s a typical list: eating, bathing, getting dressed, toileting, transferring (transportation) and continence.
What are your options when you need help with ADLs? A family member can help you, but that is stressful and demanding, more than a full-time job. You can hire a home care aide for $16 to $26 per hour. That cost sounds reasonable until you compute the annual total: $184,000 a year to have an aide available round the clock.
So yes, if you have the big bucks you can bring in help and live at home for as long as you choose. However, for a lot less money you can have better care and a wide range of services at an assisted living or nursing home facility. And because senior life planning involves thinking ahead, you don’t want just any facility. You want a home that provides increasing services if you need them.
Continuing Care Retirement Community (CCRC)
A Continuing Care Retirement Community features independent living units that resemble an upscale condominium development: attractive lodging plus communal facilities and a full menu of activities. However, a CCRC also provides progressive levels of care: assisted living, skilled nursing and dementia care. Residents know that if they need additional assistance as they get older, the help is close at hand. They don’t have to shop for a nursing home and go through the trauma of moving.
Doesn’t a CCRC sound like the best retirement community? Yes, it does! Unfortunately, here is the reality: there’s a lot of money to be made providing housing for vulnerable elderly people with resources to spend. Many senior facilities are operated simply for a profit, with no concern for the residents themselves.
You might say for yourself, oh, I see a lot of ads for them, so I’ll just contact A Place For Mom. I beg you, please don’t do that until you first read the Better Business Bureau’s daunting collection of complaints. Their reviewers say that this service recommends every facility that pays them a fee, never inspects them, and harasses you with sales calls forever.
You need persistence to find a place that genuinely provides caring and compassionate care. However, you can do it! I have searched for and visited CCRCs in California, Texas, Virginia and Michigan. And I will share with you what I learned. (For a personal take on what it’s like to be a patient in a skilled nursing facility, see the blog on my hip fracture.)
Finding the Best Retirement Community
Here are the steps I found valuable in locating a wonderful CCRC:
- Read. Scan through some of the excellent noncommercial advice available. Time’s 2016 article is one of my favorites.
- Get Help. Check the sources listed under “1. Best Retirement Advice Sources for Help” in the previous blog. You’ll find these particularly useful: personal recommendations, government agencies and charities/nonprofits. And talk with people: sympathetic employees of care organizations have offered me casual comments that turned out to be valuable tips.
- Ratings. Definitely, check the Medicare Skilled Nursing Facility quality ratings of any retirement community such as a CCRC that includes nursing home care. You should consider an overall rating of 4 or 5 (out of 5) as a minimum requirement for any CCRC. However, many for-profit facilities have learned to “game” the Medicare rating system. Thus a 4 or 5 rating is necessary, but definitely not sufficient. It’s also worth looking at the US News nursing home ratings. US News uses the Medicare data base but follows a different methodology to derive ratings. For Art’s “inside view” of skilled nursing, see his blog Hip Fracture 2.
- Inspections. The Medicare numerical ratings depend in part on self-reported data, which is only as valuable as the facility’s honesty. However, the ratings also include third-party data. Study the detailed Health Inspection Summary and Statement of Deficiencies. Note the facility ownership. And see whether there’s a Resident Council, a Family Council, or no advisory councils at all. More participation and oversight is better!
- Reviews. Carefully read reviews of CCRCs in your chosen locality. Recent third-party reviews are available at Yelp, the Better Business Bureau and US News. Other reviews are widely scattered, often at sites who want you to enter personal information so they can pester you with sales calls. I’ve found it useful to use Google, searching for the name of a CCRC and the word “review.” Google shows you summary ratings in the right column, with links, plus search results with links that you can follow and study. Don’t ignore reviews from employees on sites such as Indeed, GlassDoor and Kununu, since happy employees may mean happier residents.
- Website. Study the CCRC’s own website. If they post newsletters, press releases or financial information, read through them. Knowledge is power!
- Visit. Personally visit several CCRCs in your chosen geographical area. They will probably require you to make an appointment and to be escorted by a staff member. Try not to be limited to a set tour – ask your guide to veer off to other areas that you spot. Your goal is to look behind the scenes. Do residents look content, or depressed? Are there residents walking or rolling their wheelchairs in most hallways? Are there multiple dining facilities rather than one huge one? Especially, use your nose. If you smell urine or disinfectant, that’s a sign of less-than-perfect sanitation.
A digression: Two months ago I visited Birmingham Green, an excellent CCRC in Manassas, Virginia. While I waited for my guide, I spoke with a visitor in the waiting room. He introduced himself as a retired minister who had visited many nursing homes during his career. He said, the reason my wife is living here is because this is one of the few facilities I’ve ever visited that doesn’t smell to heaven!
- Talk with Residents. The folks living in the CCRC know better than anyone else what life is like for them. How do they feel about the food, the care, the staff attitude? Does the management respond to complaints and suggestions?
- Study the Contract. For your top CCRC candidates, find out their cost. Also, request copies of a sample contract plus several years of audited financial statements and annual reports. There are three basic contract types and a wide range of contract provisions. For example, the Type A (lifecare) contract provides you with the most protection.
Ask questions about their resident turnover, staff turnover, fee increases and financial strength. Do they have plenty of beds in their nursing home section, or do they sometimes have to put their own residents into another facility? And if you have long term care insurance, how would that coordinate with your CCRC contract terms? You may want an estate attorney, tax accountant and/or nonprofit case worker to help you understand the contract terms and the financial soundness of your chosen CCRC.
- Trust, But Verify. If you might move to one of these communities, make sure there are checks and balances to protect you. State requirements differ, and so do facility policies. You can expect the facility to employ one or more social workers. There may also be a state-provided Ombudsman to oversee resident care. But you may want more than that. That “more” may be a nearby relative who will act as your patient advocate to make sure you are receiving good care. It might instead be a Geriatric Care Manager, a “professional relative” paid for by you or by a distant family member. These are trained and licensed social workers or nurses who typically visit once per week and charge $60 to $120 per hour of their time.
- Ask About What Ifs. Stretch your imagination and imagine possible futures. And then ask the CCRC what will happen in those cases.
For example: Suppose that you move into the CCRC as a couple and are sharing one apartment. What happens if one of you has to move to a dementia ward, or passes away? Can the other keep the same apartment without a second occupant? Since this reduces the bed count, do you have to pay extra? As another example: Under what circumstances might they require you to move to a higher-care section of the CCRC? Do you have the option of staying in place and hiring a personal aide?
2. When To Move
Here’s where we stand with your senior life planning:
- You have chosen a geographical area and you are probably now living there.
- You have friends, activities, and appointed representatives to assist if you need help.
- And you have chosen one or more preferred CCRCs to which you will move when you need or want personal assistance.
So, when do you actually leave your home and move into a retirement community?
The best CCRCs have a waiting list, and you should get onto that list. Many also issue a newsletter that they post on their website or which they can send you. Reading it will help you become part of the community even before you arrive.
If you have moved specifically as part of your senior life planning, then you are probably living in a rental to which you have little sentimental attachment. In that case, you should consider transferring to your chosen CCRC as soon as they have space available.
On the contrary, if you are living in your longtime home, you may not be in a hurry to go anywhere. The decision is a personal one. However, if you notice yourself deteriorating physically or mentally, that’s a signal that you should move as soon as possible.
Do not delay! If you choose a lifecare contract, in which the CCRC commits to provide lifelong care, you will have to pass both a physical and a mental exam. And if you wait too long, your chosen CCRC may refuse to admit you, or admit you only on a trial basis.
For your information, the median age at which people move into a CCRC is 81. However, the “right age” may be higher or lower for any individual.
How Do I Decide?
Here are guidelines to help you make that decision to move to a CCRC:
- Consider Your Family History. Which older family members are you closely related to and/or resemble? What medical conditions did they suffer, and at what ages? Those may give a clue to your own future.
- Consider Your Medical History. Do you have chronic conditions whose symptoms are steadily getting worse? Many people suffer gradual arthritis, heart trouble, osteoporosis, memory loss and other problems. These usually get worse with age, not better.
- Watch for Signals. Some symptoms are universal as we get older, and you should watch for them: mental confusion; falling down; losing your balance; difficulty going up or down stairs. In addition, household chores may seem more difficult: raking leaves, clearing snow, house cleaning.
- Shared Decision Making. Moving to a CCRC is partly driven by medical issues. This and other major medical decisions should be made jointly by you, your family members, and your physicians.
Here’s a suggestion to help you make the decision to move. Pack up, and move into your chosen CCRC for a trial period where your financial risk is minimal. I know of a woman for whom the no-risk trial was 60 days. A friend said to her: “think of it as a two-month vacation.” Before the two months were up, the “fear factor” had disappeared and the woman had come to see the benefits of moving into the CCRC.
3. Exercise, Diet and Health
If you have persevered in senior life planning to this point, congratulations! You have found selected professionals to advise you, taken care of your advance directives and targeted the best retirement community where you may want to live. You may even have moved into a CCRC.
Those choices take care of the future. However, now it’s important to handle the present time. Cherish and maintain the miracle of your ongoing life!
You need regular physical exercise, in whatever form and intensity your doctor advises. You need to keep a healthy diet and weight. And you need to see your doctors as often as they suggest, taking the medications they prescribe.
What about mental exercise? Companies marketing “brain games” and “brain training” would have you believe that their products will keep your brain youthful forever. However, advertising claims for mental exercise programs are shamelessly exaggerated. If you practice a mental exercise, the only benefit is that you get better at that particular exercise. There is no benefit to your brain function in any other dimension.
Scientists say that the best brain-health advice is not “brain training,” but rather:
…to lead a physically active, intellectually challenging, and socially engaged life…
That advice is great guidance for all of us, at all ages!
This concludes our step-by-step guide the best retirement community, the third segment of senior life planning. I invite your comments and critiques to improve these posts. And I wish you a long, high-quality life!
– Man and Woman from rawpixel.com on pexels.com
– Food for Mom, Senior Exercise, Senior Shopping, Women of the Family from The Print Shop 2 Collection. Not for download or reuse.
Acknowledgements: I thank Dinesh Telang MD, Robyn Mullinger DDS, and my friends Zenon Neumark and Gary Boyd for helpful discussions on choosing the best retirement community.
Art – I’ve been reflecting on your thoughtful articles for several days, and have one major reaction: engineers and scientists who have spent their live constructing and controlling their destiny to a considerable extent are now being asked to engineer a very passive final stage. All details are put in place to allow us to degrade gracefully from an active take-charge state to one in which things are done to, and for, us, as we slowly decay and expend a lifetime of resources on staying in the equivalent of a padded cell. I, for one, have deliberately sought a “final State” that has a “right to die” law, that will allow me to pull the plug when that time comes. In fact, I’m hard over on this issue: I propose a human right to have installed, after a lifetime of productive work for society, an “on-off” switch that can be triggered by its owner at any time, even on a whim, without committing a felony. It’s our life; we should get to decide, after having “paid our dues” to society. Yes, there can be abuses, and there needs to be reasonable guidelines, but my gosh, let’s take control of our destinies and not spend our final days sniffing around for the padded cell with least objectionable smell.
Thanks for your very thoughtful comment.
You make a logical argument in favor of assisted suicide. Wikipedia tells me that assisted suicide is legal in California, Colorado, District of Columbia, Hawaii, Montana, Oregon, Vermont, and Washington but not in the other 43 states.
Of course, assisted suicide only works if the person wanting the right to die is still rational and able to communicate. Therefore for additional protection, everyone needs to prepare a healthcare Advance Directive with as many details as they can think of, instructing what care they want and don’t want.
In that Directive, if a person decrees that they will not accept artificial or forced nutrition and hydration under any circumstances, then I guess they could end their life at any time by refusing to eat and drink. It would not be pleasant, but it would be under their control. An attorney would have to advise whether this privilege, if it were enshrined in an Advanced Directive, would be legally protected in their state of residence.
Great post Art. Lots of good planning ideas which retirees need to consider.
Something we all need to face, but denial is hard to deal with on the subject.
Thanks for your ongoing quest to keep us alert.
Joe, I too am tempted to postpone these long-term things. But if an unpleasant surprise came along, that would be a real ouch!
Hi Art and thanks for the articles. Under a POA I’ve been looking after a “young” lady who is in her nineties. Your comments ring true to my considerable experience — which has included visiting many long-term-care facilities. One of the most useful advisors which I’ve had is an experienced nurse who works for an agency whose purpose is to help the elderly find the best long term housing solutions. She seems to know every facility and every manager of every facility within fifty miles. “My” young lady is now in a memory unit of a BrightView facility — and is doing well even with her limited cognitive capability.
Hi Dick, and many thanks for your comment. Inside knowledge is wonderful! It’s great to have success stories like yours to give us all hope in our quest for the best long-term residence. – Art