February 15, 2012

What's Best: Aging in Place or A Retirement Community?

Last August I wrote  about one of the more important decisions you will make for your retirement: Do you move to a retirement community or is it better to stay in your present home and age in place? That post outlined the advantages and disadvantages of each choice. Because there were lots of  comments it seems appropriate to look at the subject again.

This time I am going to provide links to several web sites. Some are arguing for one choice over another. Other links are more like the first post: providing a comparison and not drawing any conclusions.

After each link I will make a few comments about that link's information and the value of that information to you. I urge you to click on the link, check out the web site, and read my thoughts. Ultimately, the final choice will be one you make based on a whole series of factors that no one article can address. Nor am I able to steer you one way or another for the very same reason: your situation is not the same as mine.

The first site is from Canada.  "Helping Canadians Find the best retirement options." In a free, downloadable book, this site offers different scenarios for a couple in their late 70's. The choices range from staying at home with just community resources, through in-home care, and finally living in a retirement community that provides a full range of services. While the prices and services are somewhat different for those in other countries, the report does a solid job of detailing costs associated with each scenario. The information is very complete. Drop down menus across the top provide lots of resources to help you.  Disclaimer: This site is clearly hoping you choose one of their sponsoring communities.

From the web site, womenbloom, comes another article that stresses the advantages of living in a CCRC (continuing care retirement community). Not nearly as detailed as the previous site but still quite helpful, this article provides a simple overview of the positives of such a living choice. It does not provide any cost comparisons or guidelines. Disclaimer: this article is a reprint from a site that helps provides referral services to nursing homes. assisted living, and retirement communities.

Maturity Matters provides all sorts of articles on virtually every subject of interest to aging folks. The link provided here takes you to a page with over twenty different articles. For our purposes, take a look at the following:
  • What are Care Homes and How Much Should they Cost?,
  • Helping an Aging Parent Adjust to Assisted Living,
  • Top 10 Design Trends for Aging in Place
  • What do you know about home care?
Modern Maturity seems to provide a good balance of various points of view and solid information from experts in their fields. Disclaimer: I provide articles for Modern Maturity (in fact one is on this page). They do not compensate me for reprinting my posts.

Understanding Senior Housing Options  seems to be an excellent site with lots of unbiased information on your various choices. There are also links galore at the bottom of the page to all sorts of additional information. Be sure to click on the "Independent Living for Seniors." What I found particularly helpful were the basic questions and answers section. Many of the concerns we all have are asked and answered.

A more scholarly approach is available at Suburbs, Cities, and Aging in Place. The author uses demographics trends to argue that cities will have to do a better job of caring for seniors as the population ages and more people decide to stay in their home for as long as possible. He describes this as "naturally occurring retirement communities," or places where the aging have lived and continue to reside. Disclaimer: this site is connected to Urban Land magazine, an organization that is concerned about the viability and growth of urban areas.

Clicking on Retirement Homes will take you to the web site, 55communityguide. It is chock-full full of articles and links that tell you all about retirement community living and how to select the best one for you. Disclaimer: this site is a sponsor of this blog.
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Like the decision when to retire or start taking Social Security checks, the choice of where to age and how to plan for the inevitable is intensely personal. It has a major impact on not only you, but your partner, spouse, and family. It affects the quality of life you will enjoy in your later years. While it isn't a subject that is pleasant, it is a necessity unless you want others to make these important decisions for you.

My wife and I are still at least 10-15 years away from finalizing our decision, but we lean toward aging in place until prudence requires relocating to a CCRC. My dad's living situation (and my mom's before her passing) is likely to be our ultimate choice. Both Betty and I are agreed that we do not want our daughters or grandkids to be burdened with our full time care.

What are you thinking at the moment? Have you made a final choice? Do you have family members who have chosen a particular path that has turned out well, or poorly?  Please leave a comment and help us all learn from your experience or advice.

28 comments:

  1. I wonder what will be available when we are ready. Current plan is to move near kids in five years. After that I guess our finances will determine our choices. With so many boomers competing for the same good facilities- we might not make the cut. Like health insurance, elder care depends a great deal on what is affordable. I'd like something like my mom's independent care- but the cost to move in is much more than I think we will have even after we sale the house.
    Elder care is a major splitter between have and not have enough.

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    1. I'm afraid you are correct, Janette. The top quality CCRCs tend to be populated with only upper middle class folks. When my parents bought into their location the entry fee was over $200,000, plus the month fee of $2500. Only by selling their home at a market peak could they afford to cover that initial cost plus have enough extra to cover the first 2 years of monthly rents.

      Also, if you wait too long, you may be denied entry if you aren't healthy enough.

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  2. Twelve years ago when I retired from the corporate world we chose to buy and rehab a 1925 farmhouse in a rural area of Indiana. I am a native Hoosier; my wife is a long time transplant from Wisconsin. We enjoy the change of seasons and have no desire to be "snow birds" or move anywhere else. My wife, who is seven years older than I am and not in the best of health, plans to die here. I"m not sure that is an option for me. I think the circumstances will dictate what happens to most of us. When health fails or the money simply runs out the options are pretty much forced on us. If that happens we must joyfully, if that is at all possible, accept what the Lord has given us. To do the opposite is a path to a bitter end.

    I guess I have the philosophy of the Kenny Rogers gambler. I plan on just playing the cards given me.

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    1. That is really the problem, isn't it RJ: at some point you can't stay in your home until you die, unless there is someone willing to care for you 24/7. Even then, there will come a point for most of us when the needs outstrip our ability or finances to maintain someone outside a medical facility.

      Kenny also said you have to know when to fold them. In this case it may mean making the best choice from less than optimal options.

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  3. Two perspectives:

    1. When my father passed in 1993 we moved my mother into a retirement community (apartment complex really) that had varying levels of care. It has been great for her, and it wasn't until very recently that we had to up her to more than just her apartment and meals. She is now 88 years old so it was only a matter of time, but she has had a lot of years in a safe, convenient housing situation. Between my father's pension, SS, and some investments that I have handled for her over the years, she stayed in good shape financially (plus, she is frugal Irishwoman, which always helps). So for the right person, such as my Mom, those communities can be a blessing.

    2. Deb and I moved to a city in TN that has a high proportion of retirees from the North and Midwest. At 58 we often are the "young ones" in the group, but even the folks that are 70 years old or more own their own homes, are very active, and look like they have a lot of years to go living independently. Many maintain large homes and I find that seems to be a positive more than a negative. I cannot imagine these people leaving their situations, living in their own homes, until the very last minute.

    I think they and ourselves would definitely lean towards living in our homes until the very last minute, just like your wife and yourself, Bob. It is not for everyone but the costs are probably low(er) due to paid off mortgages and so forth, and the lack of restrictions that would come from not living in a true retirement community are enticing as well. Age in place as long as you possibly can - the options will still be there if you ever need them, and hopefully many of us never will.

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    1. I think our track with be to stay in our current home until housing prices recover enough that we can cash out at a decent point. Since we bought this house for cash every uptick in price is more money in our pocket. Betty and I project that to be 5-7 years from now.

      Then, we'll move into a condo or town home. That will eliminate most of the maintenance hassles and yard work but still allow us to live both independently and in an area with different ages and types of people. That should hold us for 8-10 years.

      Then, a three-tiered retirement community will be the last move so our daughters don't have to worry about heavy-duty care for us.

      Of course, major changes in health for either one of us could alter this rather dramatically, so we'll make plans but stay flexible.

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  4. I'd like to stay in my home as long as possible, but not if I'm going to be housebound or dependent on my children. My grandfather, his wife and his sister spent years in a retirement home (they all died in their '90's)--they resisted the move, but all were grateful to be there once they settled in. At a time when everyone else's social world was closing in, they suddenly had many more opportunities. Watching them removed many of my fears of being 'put in a home.' Ideally, I'd like a place with independent apartments but with the option to move into long-term care if necessary at the same location. I just wish it didn't cost so dang much.

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    1. The cost makes such a continuing care community too expensive for most. Moving from independent, to assisted, and finally to a nursing care facility all at the same location does make it easier on everyone. It takes a good chunk of one's retirement investments, or the profit from a previous house sale to pull it off, unfortunately.

      One word of advice: be sure the nursing care facility is approved by Medicare. The costs can bankrupt even the most prudent of us in a nursing facility if it is not part of the system.

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  5. Bob, I am a social worker specializing in Geriatrics and a common misconception about Medicare is that it pays for long term care. It does not. Most people usually either use long term care insurance or pay privately. In a worst case scenario, once you have almost no assets left you would then qualify for Medicaid which does cover long term care. Unfortunately many higher end nursing homes will not accept Medicaid and once your assets are depleted, will send you to a lesser facility which does. It's very important to meet with an attorney specializing in elder care issues because in the state where I live, Florida, the state will look back up to 5 years to see if you've given away any assets to disqualify your ability to use Medicaid. Any property, monies, cars, ect given to your children will be considered distribution of assets. Just FYI .

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    1. I'm glad you helped clarify this important point. Medicare pays for short-term nursing care after a hospital stay, but not long term care.

      My mom's CCRC nursing facility did have Medicare cover her stay in the nursing center for a certain number of days after a qualifying hospital stay. Since she was in and out of the hospital a lot in her final 18 months, most of the time she re-qualified for a Medicare room. Twice, though, she was moved to a different room that was not Medicare supported because she had exhausted her eligibility for that period.

      Luckily, in that CCRC she received nursing home room and board as part of the monthly rental payment. Medicines were partly covered by Medicare and her supplemental policy, but the pills did add up, as well as extra charges for extra meals and supplies.

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  6. We're in Ecuador for a few weeks, where the cost of living is far lower than in Seattle. I see ex-pats settling down here because of the affordability.

    We have stairs in our house at home, and a steep driveway, and not very good or convenient public transportation. On the other hand, we love our community. I'm talking to my husband about downsizing inside the house so we could move if necessary, but he's a bit of a pack rat and I think it will be difficult for him.

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    1. I've been following your stay on your blog with interest. I think you reported the home you are staying in is at 8500 feet elevation. That is quite high. Did you or hubby suffer any altitude sickness or headaches until you adjusted?

      We live in a two story house that will eventually present problems. That is one of the reasons we are anticipating a move to a single level condo or town home within the next 5-7 years.

      My wife and I have both caught the simplify/downsize bug and have been streamlining possessions quite aggressively over the past 6 months. Luckily we are both on the same page. I wish you luck!

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  7. Bob, My mom & dad retired from the northeast to Florida and had a very nice retirement (almost 20 years). This would be more of the old style retirement. However, along came dementia for my mom and my dad denied it as it progressed. It is a slow, horrible progression, this disease is. After my dad died in 2007, she went through two or three assisted living facilities (we learned that this is not that unusual) with varying levels of independence. Her dementia progressed to the point where she was going to have to be moved into the alzheimer (lock down) unit. With the disease she had her ins & outs of awareness and at points could comprehend (we think) what was happening. She became combative, pulled the fire alarm at one point and was taken to the hospital (psychiatric). It got to the point where, in essence, she was blackballed from many facilities because they really only want nice dementia patients. Long story short, the place we found, psychiatric, geriatric, type place, cost her about $15,000 (15 thousand) a month. We were 2-3 months out from running out of money when she died. The last few years of her life were horrible. Getting the medicaid room is similar to threading a needle. We do not know what would have happened. After talking to many people, agencies, attorneys,... we believe she would have been located somewhere in the state (maybe close by to where she was, my sisters were near or it could have been far away - you do not have much/any control at this point). This is not a pretty picture.

    Live each day to the fullest.

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    1. My wife and I have the same greatest fear: the situation you described. I can't imagine a worse life for the person having to care for the one losing his or her mind. To see the person you love become unable even to recognize you must be heart-breaking.

      $15,000 a month? That is a mind-numbing number that would be beyond the reach of the vast majority of people.

      I better follow this up with a happy post because I'm getting depressed just thinking about this whole subject.

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  8. $15,000 a month! Amazing! Scary! Wow! That really makes me nervous.
    My understanding of an laws is that a person cannot be forced to leave a care facility because of funds.
    But $15,000.....ow!

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  9. Hi Janette, What we discovered regarding laws - they come in all shapes, colors, and sizes. It is amazingly complex. Different states can be as different as countries (10th amendment), and within in a state, county by county can be different. With my mom, if the facility she was in did not have a medicaid slot/room available (they never have more than a few total medicaid slots in a facility - usually), she would have been moved to a facility the had one available - anywhere in the state. When you are not paying the bill, you have no/little control.

    Again, we never got to that point but were in the final approach for it.

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    1. I meant AZ law, but I know that in MD you can be booted to the street. Kansas does what you say- they shuffle- and Kansas is a big state! I am glad you never got to that point.

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    2. I believe you are correct about AZ law, Janette. I am aware of a fellow who is dying of cancer. He is homeless and without family or money. The state has paid for 5 rounds of Chemo and now is paying for a nursing home for him. Obviously, there is no choice as to where he was sent. But, the state does have to insure a certain level of quality to keep the feds happy.

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  10. As a nurse in NY and having gone thru some issues with my in laws and now my parents I can tell you what your hearing about situations is true.The common thread is if you are not paying the bill you have little control over issues.One of the other issues facing people now as we age is the rules and regulations keep changing.Rules for Medicare change,rules for Medicaid change.Some tools like long term care insurance will help but being as self sufficient as possible is still one of the best defenses.And staying as healthy,mobile and independent as possible.Last maybe as a society if we help each other? I can drive great maybe I pick up groceries for seniors near me that have a difficult time getting out or offer a ride.Some one else knows or can still do something else? great they help with that.Between neighbors,friends,family and children you would think we could age and die with dignity.We shall see.

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    1. I love you answer, lita: watching out for each other. The days when we can depend on the government or other organizations to care for us are coming to an end. There are so many ways we can help each other that costs us little but enriches the life of someone who is hurting or in need.

      Remember when we used to watch out for and care for our neighbors? THat mindset needs to return.

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  11. My home is 75 years old, and I am only the second owner. A young couple bought the house new and raised their son here. I don't know when the husband died, but the wife stayed in the house until she died. I bought the house from her estate. The house was so absolutely charming and full of good energy, her energy. I've lived here now for 20 years. I raised five kids here, and I'm waiting for the last two to start their own lives and leave me with an empty nest to enjoy for my remaining years. I hope to stay here till I die, and leave the house for the next family with the same good energy that was left here for me. Of course, I don't know what will happen down the road. If my mobility becomes limited, I won't be able to stay here. But I'm hoping!

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    1. Are there good in-home services available in your area, Galen? No matter how lucky we are, at some point having a nurse or caregiver available becomes pretty much a given.

      Are your children (at least some of them) living in the area? Even if they can't provide heavy duty care, running some errands or driving you to and from a doctor's appointment can make staying in your home much more doable.

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  12. This issue is one that we've been dealing with in my family for some time now that my mom is getting more and more home bound so this idea of "aging in place" is one that keeps coming up. We've tried to help her out seeming to be telling her what to do or how to do it - my little sister even went so far as to buy her a prepaid 'senior' cell phone from an SVC line and taught her the basic functions so she can feel a little more independent. A nice idea, but I'm always looking for better ways and ideas on how to approach with this notion.

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    1. The biggest risk I am aware of is waiting too long to get into a decent facility. Most assisted living and nursing centers have a waiting list and often a requirement that the person not have certain limitations (esp. for assisted living).

      My dad is still living alone in a condo, but he is part of a retirement community with a guarantee that he can move when he needs to. Even so, we worry that he will wait too long and hurt himself.

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  13. I'm saving this post for future reference. My husband turns 75 this month. I will be 62 this year. He still commutes 3 hours a day for full time work. We have begun the discussion about whether to live out here in the suburban country, with no grown children living in the area, or move closer into town. Although there is a "aging in place" group organizing just south of us, it does not extend this far out. Also, our closest friends still live in the city. Part of the consideration is whether any of them decide to move away. I would prefer to grow old near good friends. While my daughter acts totally confident that she and her husband would want me to come live with them should I outlive my husband, I'm not at all sure that is what I want. We are lucky to have resources to consider CCRC. I want to be in an intergenerational community with diversity as I age.

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    1. Your husband is 75 and still commutes 3 hours a day to a full time job...wow!

      Personally, I must be near family and friends as I get older and need more help. You have identified part of the problem, though. There is no guarantee that those you move to be close to will stay. I get e-mails all the time from parents who move across the country to be near a grown son or daughter only to have that child move somewhere else. Then, the parents are left in a strange environment with no support system.

      At the same time, living as far out of a more stimulating environment as you do might leave you feeling quite isolated.

      A CCRC with lots of activities and various ages from 50 on up may be your answer. New friends are easy to make in such an environment and you have the guarantee of care and security. If the community is located near your current batch of friends or family you will be establishing your own social circle if those others move away.

      BTW, nice picture of a giant saguaro in Tucson on your blog. They are magnificent.

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  14. Bob wonderful conversation starter…This has stimulated thoughtful responses on the topic of our times. I keep going back to that old line from the Eagles: “Every form of refuge has its price.”

    Thanks for this terrific and helpful post.

    Best, Patrick Roden

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    1. Thanks for stopping by, Patrick. Your web site looks like a great place for folks wanting more information.

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