Dexter and Midge Barrett--he with a partially paralyzed leg, she with a reconstructed heart--fret more about their unruly rose garden and cranky model train set than about the prospect of a Medicare financial squeeze and the murkiness of impending health care reform.
The couple, in their 70s, have a deal at their nonprofit Claremont retirement community: a guarantee that all their basic needs--including 100% of their health care costs--will be taken care of until they die. At the upscale Mt. San Antonio Gardens, the Barretts and 425 other senior citizens have bought themselves the lifelong promise of surgery, medicine, physical therapy, round-the-clock care and a permanent bed in the community’s long-term nursing home, if they ever need it.
“We’d probably be wondering who’s going to take care of us, knowing how expensive it can be if you get a long, lingering terminal illness,” said Dexter Barrett, 76, a retired TWA airline administrator. “But now that we’re here, that worry is off our back.”
Mt. San Antonio Gardens is one of two state-licensed places in Los Angeles County that deliver life care--a promise of lifelong health care in exchange for a hefty sum up front as well as a monthly rental and service fee. The other local life-care community is Scripps Home in Altadena.
At the Gardens, 900 E. Harrison Ave., straddling the city boundary between Pomona and Claremont, healthy residents live in apartments, studios or cottages, while residents who require assistants or constant medical care live at the nursing home. Other medical care is provided through agreements with local health maintenance organizations.
Entry fees range from $32,000 to $150,000, based on the age of the resident and type of living unit. On top of that, there is a state-regulated monthly fee of $1,314, which covers rent, three meals daily in the Gardens’ waiter-served dining room, housecleaning, linens, utilities, maintenance and other basic services on the 27.6-acre complex.
Statewide, entry fees are as high as $200,000, with monthly fees averaging about $2,000, said Derrell Kelch, executive vice president of the California Assn. of Homes for the Aging. A portion of the entry fee is allowed as a one-time tax deduction, and one-third of the monthly fee is tax deductible every year.
As the nation waits for President Clinton to reveal his plans for health care reform, interest in life care appears to be growing. A recent spate of prospective tenants has arrived at the Gardens’ door, said Ruth Davis, vice president of marketing, concerned about what health care reform might mean to them and whether life care could stave off those changes.
“I notice that people are very concerned about where health care costs are going to go,” Davis said. “Making a lump sum payment as they do here, in 1993 dollars, for health care that they may not necessarily require until the year 1999 or 2000 or beyond . . . we, the corporation, have assumed their risk.”
It sounds great to many people who have the price of entry. And in the case of the Gardens, which has a clean, 32-year record with the state, it seems to measure up to its claims. But despite state efforts to regulate life care, the promises of lifelong health care sometimes end up less than guaranteed.
It took the state Department of Social Services more than four years to collect from a Thousand Oaks life-care community that went into foreclosure in January, 1989, but refused to pay refunds to residents. Last month, the state Department of Social Services announced that La Serena Manor Retirement Village would pay refunds of up to $80,000 to 105 former residents. The residents will receive a prorated refund of their entry fee, which ranged from $20,000 to $105,000, said Debra Ashbrook, the Department of Social Services senior attorney who oversaw the case.
State officials are trying to track down former residents, who moved in with relatives or to other retirement villages, Ashbrook said. Some residents stayed on after new owners bought La Serena, which is operated now under the name Castle Hill Retirement Village.
La Serena did not have a reserve fund, which is required by the state in the event of financial ruin. But La Serena residents signed an agreement waiver, saying that they understood that the company did not immediately have enough money for a reserve fund, Ashbrook said.
The Gardens, on the other hand, is financially sound, Davis said. But, should the Gardens fold, the corporation would provide a prorated refund to each person or arrange for a way to provide lifelong health care, based on the resident’s preference. The Gardens’ reserve fund totals more than $11.4 million, well over the state-required $3 million.
Full or partial refunds are available to residents who wish to leave. During the first 90 days, residents who change their minds get a full refund. Or, if someone dies in the first 90 days, a refund is sent to their estate.
If someone leaves or dies within the first six years, the resident or the person’s estate get a prorated refund. After the first six years, refunds are not available. But in the past five years, only three people have left because they wanted to live elsewhere, Davis said. The average length of stay is 16 years.
The Gardens is the largest life-care community in California, according to the state Department of Social Services’ Continuing Care Contract Program. Some retirement communities use the name “life care,” but do not provide full medical coverage that the state-recognized organizations provide.
The state’s 16 life-care communities house 4,325 residents. Nationwide, there are 144 life-care communities in 24 states, according to the Continuing Care Accreditation Commission, an independent accrediting group in Washington, D.C. Life-care communities have been around, in some form, for more than 100 years.
Life-care communities, which are licensed by the state, must provide residents with full medical care for life, a skilled nursing health center on or near the site and an emergency fund for those unable to pay their monthly fees. The Gardens has an emergency fund of more than $1 million.
Residents, who must be 60 or older, buy into the Gardens while they are still able to live independently. Prospective residents are screened for admission by the Gardens’ doctor. Only applicants with Alzheimer’s disease, senility or a terminal illness are denied admission, said Davis, the marketing vice president.
Residents buy a shield against the uncertainties of old age--possible isolation, fear of where they will end up and worry about being a burden to relatives. Lifted from their shoulders is the anxiety that catastrophic illness--such as cancer, Alzheimer’s disease or heart attack-- will sap their pension kitty or retirement nest egg and leave them destitute.
At Mt. San Antonio Gardens, residents who catch a cold or sprain a finger can visit the community’s on-site 24-hour health care center, which has a full time staff of 47, Davis said.
Residents also join an HMO for no additional fee or find a private doctor; expenses not covered by Medicare, the federal health program for the elderly, are covered by the Gardens. Medicare covers 80% of most doctors’ bills.
For long-term care, Medicare usually pays for the first 20 days of a patient’s stay at a $125-per-day long-term care center; the Gardens’ residents get care at the on-site, 66-bed skilled nursing center for as long as necessary. The Gardens also provides services and unlimited supplies that Medicare or HMOs either limit or do not cover, such as medicine, wheelchairs, walkers and physical therapy, Davis said. But neither eyeglasses nor dental work is covered.
One 85-year-old Gardens resident with heart problems, diabetes and a bleeding ulcer has had medical bills exceeding $132,000 since 1990, said Barbara Fenneman, the community’s director of health benefits. Medicare paid $3,250; the Gardens took care of the rest. But 75% of the Gardens’ residents live and die in their independent living units, without requiring skilled nursing care, Davis said.
The tantalizing prospect of guaranteed care was enough to get Gardens’ resident Frayn Garrick Utley to give up her beloved, orchid-shrouded Maui ranch house on a winding hillside above the ocean. As a widow, Utley, 89, a former NBC network news commentator, also did not want to grow older alone or burden her three sons with her medical care or bills.
Even though Utley could afford to keep her Maui home and hire full-time nursing help if she should ever need it, she decided to move to the Gardens eight years ago.
“I gave it up because I knew I was getting older and I might have health problems . . . and I might not,” said Utley, who still reads The Economist magazine and the Manchester, England-based Guardian newspaper to keep up with foreign affairs. “You have it either way. No one is going to say, ‘I wish I were sick so they can pay those bills for me.’ Everyone wants to be well.”
Utley’s care at the Gardens included quadruple heart-bypass surgery at Pomona Valley Hospital Medical Center and recovery at the Gardens’ skilled nursing center last fall, services for which she never saw a bill.
Residents say they pay for peace of mind, worry-free living as far as their financial future.
“If you had to worry about it, I think it would color everything you did,” said Gardens resident Patty Lawson, 75, whose major worry at the moment is what kind of spring bulbs to plant in her patio garden.
Most residents are lured by the health care and then hooked on the sense of community, in the form of early morning coffees with freshly baked cookies, the parties in the stately main lounge with wing-backed chairs and gilt-framed art, and the memorial to the Gardens’ first cat, Petunia, under a 300-year-old oak tree.
The average resident is 83 years old, and single women outnumber single men, 276 to 18. Residents include William Dunseth, 75, a vice president emeritus at Pomona College; Sam Atkins, 83, a retired Princeton University professor; and William Lawson, 79, a former general manager of the Tournament of Roses.
“You never know at dinner if you’re going to be next to someone who built dams all over the world or someone who built a nuclear submarine or someone in ‘Who’s Who,’ ” said resident Ruth Marson, a 77-year-old cellist who performs 40 times a year in the community with a string quartet.
The waiting list for prime units is about three years, Davis said. Prime choices include a 1,250-square-foot cottage, with two bedrooms, two baths, a kitchen, garden, patio and carport. The cottages are single-story, and so are all the apartment complexes, except one.
In early 1994, the Gardens is expected to begin a multimillion-dollar renovation and expansion project to eliminate some studio units and combine them into apartments. The Gardens will still have 294 units, but they will be larger, Davis said.
Life-care communities became popular in the 1930s, as church-run homes for aging clergy and congregation members, said Kelch, of the California Assn. of Homes for the Aging. In the past decade, for-profit companies, including the Marriott Corp., have dived into the life-care business.
But Kelch said the business is risky, given all the uncertainties surrounding health care and medical costs in the age of reform.
“You’re at risk for all their health care,” he said. “Also to be in life care, you must agree to continue to provide care, even if you run out of money. If a person runs out of money, life care must provide for their care out of endowments or charitable funds . . . and for-profits don’t want to do that.”
At lunch on a recent afternoon, Garden residents were not thinking about weighty problems like that. From their cushioned chairs around a linen-topped round table, they ordered from the daily menu or joined the buffet line. At one table, conversation turned to a resident’s son, who sent her home from her Alaska visit with pounds of fresh salmon, which the Gardens’ chef had served poached the night before.
But resident Ken Hixson, 84, a member of the Gardens’ food committee, was worrying about a complaint someone had made recently.
A resident was miffed, he said, about the fresh flowers on the dining room table. The flowers, the complainer said, just weren’t perky enough.