LIVING IN RETIREMENT YEARS

Retirees today are beginning to have a variety of living choices that are discussed in various blogs and at different sites when a browser search is made, so I won’t attempt to discuss all of them here.  

I’m committed to the concept known as “Living in Place” – remaining in my Southern California home through my remaining years.    Only twenty years or more ago, assists here for those who wanted to stay in their own homes were limited, when I was seeking help so my mother could continue living independently. 

 

Today that situation is improving locally though the options are such that out-of-pocket cost may be prohibitive for many.  One Southern California local area option for some may be a newly formed organization -- REAL Connections for Ageless Living offering support for most every daily living need to enable senior/elder/oldster residents to remain in their homes/condos/apartments/mobile homes.  

Some bloggers I’ve been reading have been sharing thoughts about moving from their home to retirement community housing.  At least one Southern California friend and her husband have been exploring that same possibility.  These communities often introduce prospective residents to their sites by offering downsizing sessions providing recommendations about how to ease making such a move to smaller living quarters.  

They offer more in depth counseling, if requested, to discuss the financial costs, various payment plans, any help that might be available to live in that particular community.  

Anyone considering a move into a retirement community would be wise to make comparisons with more than one such living arrangement, if possible.  

I’ve not attended a downsizing class, but I have provided my therapy discipline’s services in a half-dozen or more retirement communities that provide several levels of care typical in such settings.    Also, I have not investigated the costs to live in any of these communities.  This is a fundamentally vital bit of information that determines whether or not one can even afford to make the move.

Most of those communities I’ve served have been affiliated with prominent traditional religious denominations in some form or another, but that has been an incidental factor in my work location choices.    Each facilities reputation for exceptional quality of care, plus location, has been among the primary factors influencing my work place choice decision process.

Those exploring moving to a retirement community might want to consider that many studies have shown select non-profit organizations offer a higher level of housing, care and services compared to for-profit providers.  The reason is said to be because revenue produced is invested back into the quality of the communities, programs and services—rather than stockholders dividends. 

This seems to me to be a good argument for taking such health care entirely out of the commercial competitive for-profit business world.   Do we really want our health care subject to the Wall Street financial markets manipulations in which profit-making and taking might sometimes take precedence over quality of care?    

The same can be said for most private therapist-owned rehabilitation groups versus non-therapist businessperson owned companies in my experience—especially some of those that are part of Wall Street profit seeking corporations.   Stockholders generally take little or no responsibility for seeing that the company whose stock they own provides quality care -- they’re generally interested only in stock share price profit and dividend dollars.  The presumption is if the profit is high, that must mean the quality of care is, too.   We might wonder if that’s really true?

I can certainly confirm that the health center skilled nursing rehabilitation units in the non-profits I’ve served are generally among the best for overall services compared to others, and many stand alone nursing homes, or assisted living facilities.   There are likely some exceptions, but I can only report on those with which I’ve had personal experience. 

New ownership, time passing, government regulation changes, supervision and adjustments by different management can even make my knowledge of retirement communities and other facilities out dated if I haven’t worked there for a while.

The cost factor will deter many people from living in either profit or non-profit retirement community settings.   Costs and payment options would have to be explored and compared for each community as I've mentioned.   

Prospective retirement home residents would likely want to determine how much, if any, of the entrance fee is refundable and under what conditions.    Another consideration would be to understand how any future fee increases are determined, plus the increased amount that might have to be absorbed if additional payments apply beyond the entrance fee, if new fees can be added.  

The retirement communities I’ve served offer traditional levels of care which includes housing units and apartments for independent living, a multi-unit building with several levels offering assisted living, and a continuing care facility offering skilled nursing care.  Some may provide a special Alzheimer’s/Dementia unit.   

The Green House concept is being implemented in one retirement community here – the first in California.    The concept introduced by Geriatrician Dr. Bill Thomas as described in this NewYork Times article, as a new unit being planned for one local retirement community which will add a flexible level of living with care provisions variation.   Dr. Bill’s blog “Changing Aging” provides much current aging information.  

Each level of care has prescribed criteria that determine a resident’s placement based on their functional abilities.  These criteria will be applied in the event an individual’s functional daily living skills decline and can sometimes result in the resident having difficulty accepting the need for moving to a different level of care.    

Becoming familiar with the specified differences of each care level is information important to understand when gathering material from communities being considered.  The basic criteria differences between levels are the same throughout our State, but some organizations may exercise more leeway, especially if they have empty beds they want to fill.   Again, check your state’s regulations. 

Know your non-medical administration and community/facility physician, medical/nursing clinic director.

Though you don’t expect to need the skilled nursing center’s services, you might wish  to check the nurses to patient ratio there and at the other levels of care; your state’s mandated minimums.    Also, what onsite medical services are available for residents living independently?   What and where is the hospital to which you would be transported should the need arise?

The skilled nursing care/rehab center in some retirement communities may have limitations as to how much disruptive behavior will be tolerated from a patient whose manner is persistently troublesome and/or distracting to other residents.  Occasionally, a patient may require constant attention, become a safety concern, or create issues continuously disturbing to other patients.  This behavior may result in family being requested to incur additional costs to provide private duty nursing aides/companions for a varying number of hours and/or days if family members are unable to be present.  

Before an individual enters a retirement community skilled nursing facility as a non-resident, for rehabilitation and/or due to a variety of medical needs, expecting to ultimately go home they should acquaint themselves with cost of care once Medicare/insurance benefits cease to pay – in case they might need to remain longer.  

Knowing this cost is important in case the patient needs long term custodial care.   Can they afford to stay there, or will they disconcertingly have to be moved – once again – to a less expensive setting – which may create a problem in adjustment for some? 

Many residents generally identify strongly with their retirement community and those who entered as they did.    So, there can be a sensibility of difference from some residents toward those few who have entered solely into the health center skilled care unit from other settings than as retirement community residents.  If this does occur it isn’t necessarily an overt complication.  Staff will make an extra effort to be inclusive with new patient, and often there may be other residents who compensate for such insensitivity, especially when the newcomer makes an effort toward friendliness, too. 

Social factors deserve consideration.   Investigate a retirement community’s culture to help determine how compatible life there would be for you.   I’ve heard stories that some communities can have social groups whose members sometimes behave in ways reminiscent of Jr. High or High School cliques.    But that can be true in any social, governmental and business office group I’ve noted through the years.

The predominant female to male ratio may be of significance for some prospective residents.  The reality is that women outnumber the men the older we all become.   New friendships and companions are sought after with varying degrees of intensity, levels of interest and sometimes competition.  

Be certain to note what amenities are available in keeping with your preferred activities including a pool for use 12 months of year (heated, enclosed,) tennis court, putting green or golf course, computer room, library (may not be as important now with computers/e-books,) exercise center and equipment that could be called a Wellness Center, meeting rooms and other activities – whatever your interests.  

What of interest to you is available in the non-retirement community outside?  What transportation is there that you’re able to use, going where -- including for necessary medical trips – and will someone accompany you, if needed?  

You’ll definitely want to ascertain what high tech services are available and whether they’re available everywhere on the campus or only in select locations.  Is wireless Internet service present and what about television, the phone system?   Hopefully the system is fairly simple to use as some can be complex.  

Don’t forget to eat in the dining room(s) and explore the food fare, maybe asking for a copy of the week’s menu.   Any markets, shopping areas you’ll want to visit? 

Some retirement communities have been formed for a preponderance of those who have served in religious and charitable organizations, such as one here that includes missionaries who lived around the world.    Another community may be primarily composed of retired academic professionals, local government retirees, business/corporate executives, just to name a few groups. 

I’ve known of some residents who were single, alone upon retirement so moved here on the West Coast from the East Coast to join friends, others to be nearer family, some moved here because of the weather.  There are communities attracting individuals of modest means who prefer a social culture quite different from those I’ve noted previously.    The cost factor is a deciding factor influencing selection choices for most. 

Do meet and talk with the retirement community representatives.    Ideally if you could befriend a resident with whom you could freely talk insights would be gained.

Read and be aware of all agreements you sign, including how your rights are affected and any limitations that might be imposed and under what circumstances.  

What sort of communication systems exist within the retirement community, i.e. to obtain emergency help should you become suddenly incapacitated (fall.)   Do they have a newsletter, in-house TV broadcasts?    Are there maintenance helpers and what is the arrangement for using their services with what limitations? 

These are some thoughts and questions that come to mind, but are by no means all inclusive, when I think of choosing a retirement community in which I would live the remainder of my life.  They’re rather randomly presented here.   

My current plan is to “live in place” in my home which is another concept requiring similar but different planning arrangements.   This plan is subject to change should the situation warrant and can be more uncertain than being in a retirement community where arrangements for all levels of care have been established.   I’m following the local services developing currently that are designed to help individuals live in place. 

I do at times waiver in my mind with second thoughts about whether or not the plan I’ve selected is really the best one, especially when some friends talk about having chosen differently for themselves and their husbands.   

You may be wondering as I do, what are the odds any of us will need to go into assisted living or a nursing home?  I suggest you read this Nursing Home Diaries link that provides U.S. Census bureau figures on that very topic – something to consider in the decision-making process, including recognition additional retirement living options are developing. 

What IS available in this immediate future for many elders, especially in this fluctuating health care environment -- one that doesn’t presently support some of the most cost effective ways to provide long term care?