Caring Communities : Several Housing Choices Available to Elderly Who Need Help Getting Along in Their Lives
Charles and Bernice Schatz, both in their 80s, enjoy a life style that’s usually reserved for movie moguls and banking barons.
They awake to a nicely prepared breakfast of fresh fruit, coffee, cereal and juices. Lunch includes a variety of salads, soups, fish and omelet. Suppertime brings more soup, salad and a selection of entrees ranging from meat loaf to brisket--all prepared by a kosher chef.
Maids change the couple’s linen and clean their home. If they want to go shopping or sightseeing, a driver will take them. And soon, a staff of nurses will be moving in a few doors down to provide them with 24-hour-a-day medical care if they ever get sick.
But the Schatzes aren’t millionaires: All these services and a roomy, two-bedroom apartment in Mission Viejo’s Heritage Pointe retirement community cost them $2,600 a month.
Although the rent isn’t cheap, it’s about what they would pay if they bought a modest-sized home in the same area and gave up all the pampering that they currently enjoy--not to mention the complex’s pool, spa, library and synagogue.
“We just love it,” said Bernice Schatz. “No cooking, no cleaning, and everything you could imagine is right at our fingertips.”
The sprawling Heritage Pointe project is just one type of development that gerontologists call “supportive housing”--homes where residents receive varying levels of assistance and service, from light housekeeping to intensive medical attention.
“There are all sorts of choices for people who need some help getting along in their lives,” said Leah Dobkin, a housing specialist with the American Assn. of Retired Persons.
“The type of place you choose depends a lot on your medical needs.”
If you’re basically healthy but want some help with housekeeping chores, Dobkin says, you might consider moving to a board-and-care home or cooperative-housing development. The rent you pay typically includes a room, board and utilities as well as housekeeping help and laundry services. For an extra charge, some board-and-care operators provide more personalized help with bathing, grooming and the like.
If you want more professionalized and extensive attention, you might be better off in a “congregate-care” facility.
Most congregate-care developments provide residents with their own apartment, including a small kitchen area, to prepare light meals and snacks. However, you’ll eat most of your meals in a central dining facility with other residents.
Unlike most board-and-care homes, congregate facilities usually house hundreds of people and typically employ several professionals--from nutritionists to recreation directors--on a part-time or full-time basis.
Many congregate-care projects are sponsored by nonprofit groups. Residents are often provided with transportation to shopping facilities or medical centers, as well as regularly scheduled social events and recreational activities.
“A congregate-care project usually offers more services than a board-and-care facility,” Dobkin said. “You don’t give up your privacy or independence, but you also have lots of opportunity to interact with people your own age.”
People who need more extensive medical attention--or expect to need it sometime in the future--often opt for “continuing-care” facilities. Sometimes called “life-care” complexes, they’re a hybrid of congregate-care homes and a small hospital.
Besides providing apartments, meals and social activities, the projects typically have nurses and even doctors on the site to provide various medical services.
Many operators of life-care developments require people to pay a hefty “entrance fee” before they’re allowed to move in--a charge that can top $50,000 or even $100,000. Most also charge monthly rents that can easily exceed $1,000.
In exchange, the operator promises to provide you with housing, certain types of medical care and other services for the rest of your life.
If you need more comprehensive and extended medical help than a continuing-care facility can provide, you might need to move to a nursing home facility.
Nursing homes typically provide around-the-clock medical care under the direction of a physician. They usually offer two levels of service--intermediate care and skilled-nursing care.
“If you can’t live independently but don’t need constant, intensive medical care, then you would probably require intermediate care,” Dobkin said.
“On the other hand, if you need a lot of medical attention, but you don’t need to stay in the hospital, the nursing home will give you skilled-nursing care.”
Many nursing homes also provide other services, such as meals and special help with bathing and grooming. Some also offer physical therapy programs, counseling services and social or recreational activities.
No matter which type of supportive housing you choose, you’ll need to ask lots of questions to ensure that you’ll be happy with your choice and get the help that you need.
“Don’t just talk to the salesman who’s trying to get you to move in: Talk to the director of the development, the manager, the people on the staff and especially the people who’ll be providing you with medical care if you need it,” said Carole Keller, an Irvine-based housing consultant.
“You won’t just be living in the complex--you’ll be depending on all these people.”
The location of the complex is also important, especially if you no longer drive or have problems getting around. Make sure it’s close to the people and places that are important to you: family, friends, shopping facilities, places of worship and the like.
If you’re planning to take meals at the development, eat there a few times before you move in to check the quality of the food.
Ask if there’s a variety of entrees every day instead of just one or two, and see if food can be served in your room if you’re ever unable to make it to the dining hall.
“Also make sure the kitchen can meet any special dietary needs you might have,” said Dobkin at the AARP. “If you’re a vegetarian, on a low-sodium diet or eat only kosher food, you’ve got to make sure that your needs can be accommodated.”
Find out what other types of services the operator of the project provides. If transportation, recreational activities or certain types of medical care are important to you, make sure that they’re available.
Dobkin also suggests that you talk to people who already live in the complex to see how they like their lifestyle and the services that the operator provides.
You can feel confident about moving into a development where people have nothing but good things to say, but be wary of a project filled with disgruntled residents.
Many congregate-care facilities, nursing homes and other supportive-housing developments have associations that allow residents to participate in the governing of the project.
Ask if the project has such a group, and then see if you can talk to one if its members to hear what kinds of issues are raised at the meetings and how management reacts to the residents’ concerns.
Also ask whether the development has rules on how long guests may stay. If you don’t have any room to have someone stay over, see if the project has guest quarters where visitors from out of town can spend a night or two.
It’s also vital to make sure you understand what’s covered by the monthly check you make out, and what costs extra.
For example, some operators provide light-housekeeping services but charge extra for linen service: Many limit the health and medical-care coverage that’s included in the regular fee.
If you’ll have to pay an up-front “entry fee” to move into the development, you’ll want to ask about the refund policy if you eventually must move away for health or other reasons.
It’s also a good idea to request a copy of the community’s most recent financial statements, and then have them reviewed by an accountant.
“Some projects have gone ‘belly-up’ and left their residents high and dry,” Keller said. “In some cases, people have lost their entire life savings.”
Of course, any contracts or other documents you must sign should first be reviewed by an attorney whom you trust.
All states require that nursing homes be licensed. So if you’re thinking of moving to such a facility, you’ll want to contact the state agency that’s in charge of the licensing program to check out the operator’s history and reputation.
As in many states, California residents can visit the nearest office of the state Health Services Department and request a computerized “profile” of any nursing home that they’re considering.
“The profile tells you whether the home is certified for Medicare or Medi-Cal, the results of the government’s annual inspection, and any citations that have been issued against the home,” said Scott Lewis, a spokesman for the agency.
The nearest branch of the department is listed under the “state government offices” heading in the white pages of the phone book.
The federal Medicaid program and California Medi-Cal program--as well as private health insurance companies--will usually only reimburse a portion of your nursing home expenses.
So, said the AARP’s Dobkin, it’s important to ask the nursing home operator what might happen if your personal funds become depleted and you must rely completely on government aid.
“Some nursing homes will accept the government’s check as payment in full, but others won’t,” Dobkin said.
“If you don’t work things out ahead of time, you might be forced to move if your money runs out. That can be really traumatic, especially for an older person who is sick or frail.”
Above all, experts say, explore all of your various housing alternatives before you make your move.
If you don’t need much in the way of medical attention, you might be able to simply stay where you are now and have someone come in once or twice a week to do your cleaning and other household chores.
Or, you could bring in a boarder who’ll help around the house and even administer medicine in exchange for free or reduced rent.
If mobility is a problem, most homes can usually be inexpensively retrofitted with “grab bars,” automatic stair lifts and other items to make it easier to get around.
Floor plans can be rearranged so you only need to live on one floor or spend most of your time in one part of the house. Lighting can be improved to help you see better.
Even if you’re in constant need of medical attention, you might be able to hire a nurse or assistant to look after you for less than you would pay to a nursing home or life-care facility.
“Most older people prefer to stay in their current home for as long as they can,” said Dr. Jon Pynoos, a professor at USC’s Andrus Gerontology Center.
“But if you have to move, don’t be afraid. If you study all your options, do some homework and keep an upbeat attitude, everything will turn out fine.”
