Monday, August 20, 2012


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?


  1. Hi Joared....thanks for stopping by my blog. We too are thinking about buying something one story. There;s a cute cottage across the street...but it has a pool. Yes, I will keep on writing, but I will miss the friends who are fading away from my old group.

  2. Dear Joared, you've provided a timely and informative column here for those of us who are older--I'm 76--and for whom these facilities and these questions are of immediate concern. I would like to stay in my home and grow older and older and older here. It is a one-story home with no steps or basement. However, I also long to return to Minnesota, where I lived for 38 years. It is, I feel my real home in the sense of the area in which I want to live. Also, there are more possibilities there for other ways to live should I need to leave my home/house. All that you point out is quite valuable to me and so I will return to this particular posting again and again to follow its links and to consider all you've explained. Thank you. Peace.

  3. Thank you for your very excellent insights into exploring the options available to we elders when we re no longer able to take care of ourselves. I would add that it is less expensive to stay in your own home if at all possible. Like most of us, I am hoping that is the option I can choose when I become dependent on others for help.

    I have a spare bedroom and bath in the event I need full time care, but moving someone into your home is very expensive and risky. It would require a thorough background check and, even then, they might not give you quality care.

    Unless you are wealthy, there are no options without a downside. It is frightening and makes me think of sitting on an ice floe when the time comes.

  4. Funnily enough among other duties, I worked on age 65+ statistics when I was at the Census Bureau. I recall that we broke the age groups into older and elderly. Those over 85 were called the elderly frail.

    I don't anticipate needing a retirement home for many years, although we have had a few scares in recent years. David will be 83 in two weeks, so he fits the description of the average resident I think. However, a mere 70, I will not live in a retirement home for a very long time, health allowing. David will live in our house til he dies, he says. Dianne

    PS thank you for a long and thorough discussion. Now I am off to check on some of these links.

  5. Excellent information; thank you. We're hoping not to have to make an assisted living decision for some time, but I'm trying to gain information to be ready when the time comes. Posts like yours are very helpful.

  6. My wife is currently struggling with helping her father with Alzheimers continue to live in his own home. Both his Executive Function and Memory are at 20% for his age (89). The house is filthy, in disrepair, his personal hygiene is poor but he THINKS he is doing great and doesn't need any help. After a car crash he lost his drivers license and car a year ago.

    My wife has taken him to visit a couple of Assisted Living places but he 1. Doesn't want to spend ANY amount of money, and 2. doesn't think he needs any care. So all we can do is mark time until some issue presses a decision upon him, unfortunately.

    But this is also a good crystal ball for our own retirement planning and I am trying to emphasize to my wife that we need to start divesting ourselves of all the "stuff" we have accumulated over the years. On several of these complex issues, we really don't quite know where to begin!

  7. Mage: Pool can be excellent exercise for elders, but I know other pool care issues can be deterrents. Swimming is a very prevalent exercise recommended by physical therapy for some elders. Often the retirement communities pools are well-used, too,including by some of the older residents.

    Dee: Sounds like your weighing your options with pros and cons list which is what we need to do.

    Darlene: Yes, costs are less for some options other than nursing homes. A lot of issues with which to contend, including having enough staff to help all those who need assistance and live independently. I can tell you from my experience years ago with my mother the amount of money that can be paid makes a difference in the quality of caregivers from which to choose. I doubt that's changed.

    Sounds like a good plan to have extra room and bath for live-in help which I've thought could work for me, too. I had a college student come to my door wanting to rent a room shortly after my husband died. Don't know how much help that sort of arrangement might be for any of us.

    Schmidley: I'm glad there's recognition that the over 65 years group has a wide difference in function, so they've designated a 85+ frail group. There needs to be awareness that even the 85+ group has an increasingly fair share of individuals who could hardly be classified as frail based on those I encounter.

    Individuals seeking retirement community admission, and those applying just for skilled nursing admission (i.e. to recover after hospitalization before going to their home outside the retirement community,) do receive medical screening in terms of the amount and type of needed care. In some instances individuals may not be admitted. (If a person is already a retirement community resident, generally skilled level will have to accept the patient since it's their own resident who has already paid into the system.) The point is, if someone not a resident has a sudden too debilitating event, or waits until they're too dysfunctional, they may not be accepted. Admission cost may be higher, also, in the event they were accepted.

    From my observations most retirement community residents enter independent living not too long after age 65 years. Age and health state may have some bearing on the cost of admission and any monthly charges. Some may have long term care insurance which is ideal but can be expensive, especially if not started until the person is older.

    Retirement communities costs will vary, so they need to be individually checked. I've not had occasion to obtain such costs anywhere, so have no personal experience to share.

    Dick: I think your checking into available information now is wise. Don't know if you're familiar with Millie who blogs at "My Mom's Blog" (see link on my blogroll.) She just moved into a retirement community, has written several blog posts describing her living changes over time to get to this point.

    Robert: What you describe with your FIL does present a challenge, especially when judgement issues are present, maybe interfering with decision-making, possibly contributing to safety issues. You may have considered this already, but perhaps some outside professional guidance could provide some solution suggestions you might not have thought of. This is a very difficult wearing situation for any caregiver(s). Your wife, and you, must take good care of your own health lest either of you becomes physically/mentally depleted.

    You're so right about the situation with which you're coping being "a crystal ball" for retirement planning for any of us.

    1. I hadn't thought about the fact the rates of admission would increase depending on your health. Nevertheless, when there are two of you both must make the decision. I agree the designations can't be by age, as people differ, but that's often the criteria. I dare say I am a young 70, despite various medical complaints. Dianne

  8. Thank you very much for your visit. This post has a lot of very helpful information. The cost of assisted living in Hawaii really scares me. We just keep hoping we won't need it. Sigh...

    1. Keep in mind there are increasingly more options should individuals live in place -- their home, apt., etc. -- possibly some other arrangements. Retirement communities entrance costs that may be too expensive for couples do become more affordable for only one person should a person be left alone.

  9. All you have shared is on my mind a lot lately.
    My 78th birthday arrives in October.
    I relocated to my homeplace 3 years ago and built a small cottage
    I love it. Enjoy time in nature and visits from family. But always the thought of future years which are not that many.
    Longest family member my grandmother lived was 92 and my mother lived until 82. I pray I can stay here with some help. At present only help once a month with outside maintenance and need to stop keeping everything so groomed. But love gardening and do need some help. Some of my children would like to see me in the big city in a condo near them. Hopefully that will not happen. I take one day at a time with thankfulness and pray for wisdom to make right decisions as time goes by. Thank you for visiting me...

  10. Since we have a reverse mortgage, we get to remain in our house until we die. That sounds like an ideal situation, but would our two children be willing to assist or care for us if we develop dementia or some other serious condition? Time will tell.

  11. Thank you for this comprehensive look at elder living options from a person who has seen many different situations and has a good overview.
    We know our children will help us as much as they can, but they are busy with their own families, so we will try to remain independent as long as possible.
    Our experience looking after my husband's mother in her last years should help us to make reasonable decisions about what we need when we get very old. We have to face it that we may not be able to stay in our beloved home in Hawaii if we have health problems or become frail. We have a condo in Seattle near where our children live that we could move to but hope we never have to. Still, if we do have to move there we will be able to live in the condo and not have to move into a nursing home. There is a nursing home right across the street from the condo, which looks very expensive, but we could hire our own people and live well in the condo with the help of our children, since it is on one level in a building with an elevator and even has an extra wide bathroom door that could accommodate a wheelchair.
    We're great believers in planning things out! Still, we know from seeing what has happened to our older friends that you never know what can happen! We elders have to keep our fingers crossed and hope for the best.

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