ELDER OPTIONS

I’ve been looking at options for living when I want to be free of my house.  And for what’s available if I need assistance.  I find the options have changed a lot since I was a child visiting aging great aunts. I’ll post some of my observations here.

My Focus:

I’m not looking for resorts or active living communities. I’m only looking at places that have some independent living and assisted living. Several also have memory care units. Mostly I’ve looked at Continuing Care Retirement Communities – places where you can come in initially in independent living and will be cared for at the same site when you need assisted living and nursing care.  Same site, not same apartment.

Apparently people used to move into some of the places when they were still active and didn’t need care. But with the economic downturn, most have waited until they needed the support.

Costs:

Cost is the question most of my friends have. I am looking at places close to my current living style. There are cheaper places and more expensive ones. In some of my descriptions of places I’ve visited I’ll give some prices we found at the time.  While I’ve including some regular elder living situations,  I’ve looked mostly at the Continuing Care Retirement Communities, because theoretically they would be ideal for me to move in while still active and would take care of me for the rest of my life. There is of course a price for that security. For those CCRCs there is a hefty upfront “buy-in” plus a hefty monthly fee. The monthly fee does cover a number of living expenses – some meals, housekeeping, utilities, facilities upkeep, etc.  If I move out of my home, I save on house expenses like insurance, property taxes, utilities, maintenance, food, etc, but as far as I can tell the monthly cost is still more than I spend in my own home.  Though being free of the responsibility for a house would be worth a lot to me.  Scroll to the bottom for comparative prices for the Continuing Care Retirement Communities I’ve visited.

CCRC Buy-in and Monthly Prices:

Here are “just the facts” about prices we saw for comparable sized apartments. Costs can be higher if you don’t have a Long Term Care Insurance Policy. Also note the year for these prices. They will have gone up since. Monthly rates have been going up about 3% a year.
These prices are for floor space less than 1600 sq ft. I currently inhabit because the prices for a comparable space are way out of my range.  If I simply moved from my large house into a comparably sized apartment in Santa Fe it would cost about $2000/month – plus any support expenses.

Note: Recently I went to Oak Hammock in Gainsville, a lovely large place that includes independent living, assisted living, skilled nursing and memory care. https://www.oakhammock.org/  Their pricing system is different and more complicated than other arrangements I’ve seen. Their smallest unit is 488sq ft for $181800 buy-in and $2511/mo under their Life Care contract. Financial qualifications are based on having assets that are at least 3.5 times the buy-in cost. There are at least 2 other types of contracts with varying buy-ins and monthly rates, like different insurance plans. To qualify you need to have at least $1.5 M in assets.

Update 2022:

I hear the “industry standard” for CCRC retirement living places is a 4% increase per year. Many of the places also had a move-in fee, a pet fee, a fee for covered parking. Independent living usually includes one meal a day, sometimes with a continental breakfast (hopefully not just pastries!); housekeeping every couple of weeks with linen service, activities, transportation on their schedule, maintenance, and an ability to call for help. In some places you still have to pay for phone & cable TV and internet in your apartment. There are common areas with free internet service.  If you move to assisted living,  your monthly cost will go up because they must then supply 3 meals a day rather than one. At one place, this increase was about $600/month. Hopefully that includes some assistance with eating if needed.

How Much Assistance in “Assisted Living”?

I do hear everywhere that for quality care in assisted living or nursing care, you need to hire additional helpers or sitters.  The assistance included in assisted living is minimal.  I had occasion to need some help in my home and I can tell you that an experienced home care person is well worth the cost. They don’t need to be a Certified Nursing Assistant but a number of years of experience shows. Even a couple of hours a day makes a big difference. Currently in Santa Fe an aid can run $20-25 an hour, more for someone who has particular skills such as massage or nutritional knowledge. I found with my mother that it was far better to pay for such help directly rather than going through the residence. The people hired through the residence cost me the same but they got paid minimum wage and didn’t have dependable transportation. Also our own helpers could alert me to where the residence was shirking on its care but helpers hired through the residence were afraid to.

Back then, the residence tried to claim that people hired through them were trained, but it was only a hour long video. Now a Certified Nursing Assistant does have reading ability and skills such as taking pulse, turning a person in bed, caring for their fingernails, and washing a foot and applying lotion. A CNA could be too expensive to hire as a sitter, but there should be several on staff in assisted living and nursing care.

Few of the places I’ve seen provide skilled nursing. For that (oxygen, shots, nutritional support, etc), I’d have to contract with an outside agency.  More $. Presumably that would be covered at least some by Medicare.

Questions to Ask & Observations to Make

I’ve seen several lists of questions. One is to the right.  And here are ones I felt were important.

Who owns this community and how long have they owned it? How long have they been in business?  (Some major companies turn over their properties – potentially resulting in confusion for the staff and therefore the residents.)

When showing you around, do they know the names of the residents?

Do they have an activities director and what sort of activities do they provide?

Does it smell?  Not just a urine or stale smell; also I don’t like heavily perfumed scents.

If you’re interested, can you come and hang around a while?  Spend the night? Have a meal at the very least?  Go to an activity and hang out with residents? For me it would be important to like the residents and feel I was accepted.

Demographics?   Number of men vs women, couples vs singles. Also I ask if they have any non-standard couples (gay, lesbian, etc).  I can’t ask for political leanings but I look around for indicators.

Who are the key people – overall director, director of nursing, etc.?  And how long have they been in that position?  If new, how long were the previous people there?  (High turnover tells me there are management problems.)

Of the people I’d come in contact with – caregivers, housekeeping, food servers, etc – what % speaks fluent English?  (As I age, I could find it harder to communicate especially with people who aren’t fluent in English.)

I also want to visit assisted living areas on weekends. That’s often when facilities have people not show up, especially if low paid.

If you’re considering a continuing care retirement community that you buy into, you’ll want to make sure they are financially sound. Wells Fargo has a list of questions that includes this: https://privatebank.wf.com/conversations/article/questions_continuing_care_community

Places I Visited in Tucson:

My friend Richard and I looked at Tucson because it has a lot of retirees living there – so more options than there are in New Mexico. It is also a lower altitude.  Here’s what I liked from my first trip.

Splendido! In Oro Valley a little northeast of Tucson proper.  The place is Drop Dead Gorgeous! It is a Continuing Care Retirement Community, like El Castillo in Santa Fe, but much prettier.  You buy in and also pay per month – and they will provide care throughout your life.  Pricey, of course.  1 bedroom = 846 sq ft = $195,200 buy-in and $2583/mo (if you have a long term care policy).  A nice feature here (and not at El Castillo) is that when you leave, the entrance fee is 90% refundable!!  There are other expenses – move in, covered parking, etc.  And for them to consider you, you have to have as assets twice the entrance fee and in income 1.5 times the monthly fee.  They’re only 4 years old, so I’m looking into the 2 companies owning it to make sure it’s a sound investment. On the downside, it is a for profit organization. Also the marketing person was snooty towards my friends, not an attitude that makes me want to live there.  http://splendidotucson.com/

Cascades:  Cascades of Tucson is not a CCRC, though it does have residence in independent living, assisted living and memory care.  Richard and I both liked this place. Nice place, very near a hospital. Warm people. Megan is a delight and very helpful.  She greeted residents by name. They have a wonderfully detailed assessment tool for determining how much care someone needs and when it will mean going to the next level of cost. That gives me the impression they really know what they’re doing!  It’s physically lovely, with a bus stop right out front. Owned by an individual – and probably his family will continue it when he dies.  When we visited, the average age of people coming in was 85 to 90.  Their activity calendar included games, exercise, outings, church services, movies. Happy Hour on Friday.  🙂  There are separate activity calendars for independent and for assisted living, each geared to the differing abilities. 2 full time activity directors.  Independent Living 1 bedroom starts at $1920/month. I liked the 1 bedroom with den & balcony but it’s $3005/mo.  You can have a well-mannered dog – and can get a first floor apartment so it can easily go outside.  A 2nd occupant would add $700/mo.  The most basic assisted living is $650/mo.  The basic memory care studio is $4020/mo. There are ~200 apartments.  http://cascadestucson.com/

The Fountains at La Cholla: I was warned to be leery of national chains – they buy and sell properties, stressful for both staff and residents. But The Fountains is a good one – knowledgeable, stable. A Watermark Community (they have classes). I had visited a friend at The Fountains in North Carolina – she found it lovely & pleasant and enjoyed the people. The Fountains we visited was very nice also. Extensive grounds. ~416 apartments plus a number of casitas. In the apartments, you can have a cat on any floor (a must for me); a dog on the first floor(which appeals to Richard).  The emphasis is on safety.  Independent living 1 bedroom starts at $1800, with $410/mo for a 2nd occupant. Assisted living 1 bedroom starts at $3595, plus $800 for a 2nd occupant. Memory care starts at $4250 for a shared “suite”.

Comparative Spreadsheet: In 2014 the Arizona Daily Star put out a supplement on aging options,  including an awesome spreadsheet on Assisted Living Facilities in Tucson.  It’s mostly valuable to see what the options are – what the columns are. Here’s my attempt to make it available to you. Not great – I had to copy & cut & paste.  :-} If you click on it, it will get larger, filling the page.  On a PC with windows, CTRL + will magnify it more.

Section 1 of 2Section 2 of 2
Places I Visited in Duarte, California (east of LA)

I expected anything in California to be outrageously expensive but that isn’t what we found.

Westminster Gardens: This lovely place felt like the summer camp I’d like to live in.  There is a wonderful library that invites me to find a book and curl up in one of the big chairs. Our guide (i.e. marketing person) was lovely and low key. Some marketing people at other places were snooty or had the sales person hype, but not here. The grounds were lovely – formerly an orchard. Granted we were there at the height of spring. The apartments I saw were modest but quite adequate. The residents were friendly. This

had started as a retirement home for returning missionaries but later expanded the scope. It is a non-profit organization, something I’ve come to look for.  A “HumanGood” community.  I find that in the non-profits, if you are accepted as a resident but at some point your money runs out, they won’t throw you out, though you may need to downsize.  Westminster Gardens has a small outside pool and many lovely walking paths. It has independent living, assisted living, skilled nursing from a sister community, and memory care. The buy-in cost here was substantially lower than the other places I’ve visited. Scroll down to see a cost estimate.  https://www.humangood.org/westminster-gardens

Sierra Vista Memory Care Community: This is the memory care place I wish I’d had for my mother!  A lovely building with lovely landscaping, but the first thing that won my heart was that there were small dogs all over. Residents had dogs or cats or birds. The staff brought in their dogs. One resident wouldn’t use her walker to walk around. The staff did a field trip to an animal shelter. This resident fell in love with a dog and now walks the dog around in her walker! This type of creative and loving care characterizes what I saw.  Residents aren’t restrained. They are free to walk around, to participate in classes if they want, to get healthy snacks from the refrigerator. Of course this kind of care is expensive. In 2016 costs were $7000/month.   https://www.silverado.com/silverado-locations/california/azusa/sierra-vista/