Assisted Living Facilities
Reinvent the nursing home and the result might look a lot like assisted living. Instead of the shared rooms of a nursing home, residents live in private apartments, usually with kitchenettes and bathrooms. There's staff available to help residents eat, bathe, and dress. Some meals are included, as are services like housekeeping, laundry, and transportation. And although assisted living doesn't provide medical care, the staff will often supervise medications. One quarter of the facilities offer special wings for those people who have Alzheimer's disease and other forms of dementia.
Costs: A private studio apartment runs about $27,000 a year, less than two thirds the cost of a nursing home. Ninety percent of residents pay out of pocket. Long-term-care insurance policies, which once covered only nursing home care, now commonly help pay for assisted living.
Advantages: More homelike than nursing homes, some properties are designed to resemble upscale hotels, complete with marble lobbies and concierge services. Residents get help remaining independent as long as possible, and it's hard to get lonely in a place with a lot of social interaction, exercise classes, and van trips to museums and malls. Over construction means many facilities are competing by lowering prices or guaranteeing no rent increases for a year.
Problems: The virtual absence of regulation. "It's the wild, wild West out there," says William Benson, a former federal official on aging policy. Move in and you might find hidden fees for things you thought you were already paying for–like laundry service, a nurse to supervise your medications, or simply someone to bring a meal to your room. These can add hundreds of dollars to your monthly bill. The rent also can rise. As needs for care increase, you may still have to hire a home health aide. And facilities in many states can evict residents with little notice.
Assisted living is not for those who don't like living and eating in a group setting, especially with older people who may be very frail or have dementia. It also helps not to be fussy. Maine humorist John Gould, in his new book Tales from Rhapsody Home, writes about the food at his pseudonymous assisted-living facility: "Everything is of the finest quality. Then they cook it."
Questions to ask: How will the facility meet the changing needs of residents as they grow older and need more care? Ask about possibilities and be specific. "It's striking what families go in not knowing," says Catherine Hawes of Texas A&M University, who conducted federal studies of assisted living. "More than three quarters [of assisted-living residents] leave and do so needing a higher level of care. They go in thinking this is forever."
Continuing Care Retirement Communities (CCRCs)
Continuing Care Retirement Communities combine different kinds of care in a single setting, so residents can live independently as long as they are able, move to assisted living when their needs are greater, and even switch to a nursing home, if needed. A continuing care retirement community can be a single high-rise building close to an urban center or a complex on a bucolic campus.
Usually residents get an apartment, but some CCRCs offer small houses. "All inclusive" or "life care" facilities usually cover all long-term health costs. Others charge less up front and more for greater care as you need it.
Costs: Bring your checkbook. The average entry fee is about $110,000 for a two-bedroom apartment and at least triple that at more luxurious communities. You rarely get equity in an apartment. And you must pay monthly fees-which average close to $2,000 for a two-bedroom-that can rise each year. Advantages: Peace of mind. All forms of long-term care are guaranteed and nearby, which can be especially appealing for couples.
Some retirement housing experts suggest that you move in while you are still active and healthy in order to take full advantage of the activities-and pay a lower entry fee.
Problems: It's tough to determine if the CCRC you are considering is the dream place where you want to spend the rest of your life. At least 10 percent of those who enter later leave, usually forfeiting most or all of the entry fee. When the concept was newer, in the 1980s, a string of CCRCs went bankrupt, leaving residents without their promised home. Failures are rare now that states require CCRCs to keep larger cash reserves.
Questions to ask: Is the facility accredited by the Continuing Care Accreditation Commission (202-783-7286) It checks consumer protections and the quality of health care, as well as a CCRC's financial health. And do your own investigation, advises Larry Minnix, president of the American Association of Homes and Services for the Aging, which sponsors the voluntary accreditation group. Ask the facility for its latest audit report or get the information from the state insurance commission, which in most states regulates CCRCs. If the contract is "lay-friendly and easy to read, that's a good sign," says Minnix. Still, get a lawyer to review it. Ask whether you can get the apartment you want now or if you have to wait. Find out what happens if the nursing home is full when you need a bed. And check the refund policy. |
