Simplifying Senior Living: What’s the Right Choice for You? (34:54)
As we grow older, we will all need to make choices regarding senior living. Whether you’re making decisions for your parents, a spouse, yourself or other loved ones, it is important to have a clear understanding of the housing options available. Choices can range from facilities with assisted living services or memory care to continuing care retirement communities (also known as life plan communities) to receiving assistance in your home, and each of these options has different implications for your health and finances. Join us as we talk with Sally Abrahms, an award-winning writer and nationally recognized expert on aging, as she shares her insights on trends in senior living that may influence your choice in housing options.
Brian: Hello and thank you for downloading another episode of Your Life, Simplified. My name is Brian Leitner, and I’ll be the host today. Today’s topic is about senior care and specifically senior living. It’s on the minds of allot of us today, whether it’s for ourselves, a spouse, a parent, a loved one or a friend. There’s a great deal of information out there, and it’s important that we have the right information. The good news is there are a lot of choices out there as it relates to senior care, whether it’s independent living, assisted living, skilled nursing care, memory care, as well as simply living on your own. There are a lot of different options to choose from. Having said that, it can be rather confusing to a lot of people because of all these options. So today, I’m excited to have Sally Abrams join us on the podcast. Sally is a nationally recognized writer and a consultant on baby boomers and seniors. She’s been published in The Wall Street Journal, Time Magazine, Newsweek Magazine, The New York Times, AARP The Magazine, Forbes, Kiplinger’s, as well as The Washington Post. She’s also authored two books and has been a contributor to four books. In addition to all that, Sally has spent 14 years of her life taking care of her parents. From a personal perspective, she truly understands this space. Sally, thank you very much for being on the show today.
Sally: I’m delighted to be here, Brian.
Brian: Sally, there is a lot taking place in this space today. There are a lot of different options. There are a variety of costs associated with this care. What are you seeing in this area today?
Sally: I’m seeing that, even though there are these other options of independent, assisted and skilled nursing, most people want to age at home. Every study, including an AARP study, showed that 90% of people surveyed want to age in place at home or in the community. These options of independent, assisted and nursing care are fantastic, but it really is only 4.2% of people who end up in nursing homes. And I think what’s important to understand is that most people are cared for by family members or friends. That said, there are all kinds of options.
People can’t really anticipate what’s going to happen. It’s really important to know all of these options and all of this information and where the resources are so that you don’t have to scramble in an emergency and get subpar care. Again, baby boomers are on the cusp; they may be thinking about care for their parents, but guess what? Baby boomers this year are 55 to 73 years old and some of them are going to need care quite soon. What I’m seeing is women who have married older men are now finding that they are at two very different stages, especially when it comes to care. It’s important to pay attention, because it’s not just about mom and dad, it’s about you or it’s about your spouse. And besides, these traditional places that we’ve talked about, the independent, assisted and skilled nursing, as well as places now that incorporate all three.
Brian: Thanks Sally. That was really interesting. You know, they call the baby boom generation, the sandwich generation for the reasons you stated. What’s also interesting is that the majority of people being taken care of by folks that, one may not have the skillset, and two, may not have the desire to take care of these individuals. And as such, these individuals can candidly become a burden to the families or their loved ones. So let’s talk a little bit about what the options are for individuals who are planning for this type of event or this type of situation.
Sally: Let me also tell you that one-third of people over the age of 50 are either widowed, divorced or never married. Some have children, but the children are either far away or unavailable for other reasons. You can’t really today be counting on your kids or your spouse to take care of you. And that’s why people are coming up with all sorts of creative communities.
Brian: Well, that makes a lot of sense. What are some of the options that are out there?
Sally: Have you heard of cohousing?
Brian: I have, and the thought of everything being decided by consensus is interesting. Have you ever been in a condo or something of that nature? Sort of everything that goes along with that, right?
Sally: There used to be a lot of affordable cohousing, and they are either for seniors, or they’re intergenerational, but now they’re creating very high-end housing. And another interesting thing about it is people who are in cohousing, unless they move in later after it’s already built, create their own community. In their common space, common houses, they might have a movie area or they might have a dance studio it or music room. It really depends on the interests of the community. But the really important thing about this is that even though it’s not formal care, people become like family and help take care of one another.
Brian: I have a relative in an assisted living facility. They have a movie theater there. They eat their meals together there. How was that different in assisted living? Is there more than just medical care versus what you’re referring to?
Sally: This is just a group of people who get together with a developer who create a community. Assisted living is, is more formal. It’s when you need more care than living on your own. It’s a completely different kind of model. I should also say that when we’re talking about independent, assisted and skilled nursing, oftentimes they are all under the same roof or on the same campus. It’s just different levels of care if you need it. The cohousing community is just a group of people who get together and get to know one another and then oftentimes become like family and interact informally with the people around whom they live.
Brian: That’s interesting when you’re referring to this campus lifestyle where everything is under one roof. Those continuing care retirement communities, they’re referred to as CCRC’s because effectively once you go onto that campus, you can be there for the rest of your life. And as you develop different needs and those types of facilities, they can continue to accommodate you. Is that right?
Sally: That’s right. And so you never have to worry about moving someplace else, because there are assisted living facilities that don’t have skilled nursing and then you might have to move or bring care in. I want to say something about CCRC, because there is one model that I think is particularly fascinating, and that is lifelong learning communities. These are CCRC’s that are either on college campuses or near college campuses. The residents of the CCRC either take classes from other people in the CCRC, or they can take classes at the university, but they can go to the cultural events at the university and the sports events. There’s a lot more intergenerational action than just going to a traditional CCRC where all the people are older.
Brian: That’s such a great idea. You know, they continue to educate themselves, obviously just simply keep themselves busy, but perhaps even more importantly they have that socialization component that we all know is so critically important as we get older. It’s just a great idea.
Sally: And some of them are ultra-high-end. There’s a LGBT one in Sonoma Valley, California that has a world renowned chef. Some CCRCs also have wine cellars or wine making. They have professors who are retired from Dartmouth and other schools who are there and they teach classes. They sometimes travel, go on trips together and study about it before. It’s a variation on your traditional CCRC.
Brian: All this care, especially with what you’re talking about on the high-end side, it’s fascinating that this is an industry that is constantly evolving just based upon the needs of general society, you know, as we age what we’re interested in and so forth. Let’s talk about the costs themselves. Maybe started with home care. As you indicated, a lot of folks want to stay within their own homes. What might that look like?
Sally: Today, home care or hiring a health aid is around $22 an hour. Some people also have their families doing adult daycare, so they’re out during the day with sometimes dementia, sometimes not dementia, but it’s $72 a day on a national average. That means it could be really anything, depending on where you live. Seasonally, CCRC’s tend to be super expensive. There’s an entrance fee, usually that’s a hundred thousand to a million, and then you’ve got your monthly fees of $3,500 to $4,500 a month, or more.
Brian: So that could get really expensive really fast.
Sally: Exactly. There’s also something that they have in a few places across the country, and that is adult day care for people with Alzheimer’s, but it’s actually in the middle of the night, and they do everything that they do during the day at night, and it allows caregivers at home to sleep, and they can get medical care, they can do cultural activities. And so I think you’re going to see a lot more of that because Alzheimer’s is just exploding.
Brian: To be clear, these individuals are doing these activities at night because that’s when they’re awake with their family members are home, obviously sleeping so they can get ready for the next day.
Sally: Right. It’s a model that’s in a very few places that you’re going to see a lot more of. It’s a brilliant concept, and they might get bathed in the middle of the night at their adult night care, but it’s also a very stimulating kind of environment. Literally the program is the same as it would be going to a day program. I think you’re going to see a lot more of that, especially as boomers get older. If I were to give you the statistics of the number of people with Alzheimer’s, it’s quite scary. They’re 5.7 million people with Alzheimer’s today in the United States and that is supposed to double in the next 30 years.
Brian: Wow. Those numbers are staggering.
Sally: You’re going to see a lot of people and they’re going to be a lot of programs and a lot of care around Alzheimer’s. I also wanted to say when I told you about the prices of the home care, the health aids, there’s this new model that a couple of companies have come out with. It’s sort of like an online matchmaking for caregivers, professional caregivers and families. It eliminates the agency fee, which could be double. Maybe it’s $15 an hour, but I think you’re going to see a lot more rather than $21-$25 per hour. I think you’re going to be seeing a lot more of this. These companies vet the professional caregivers, and they often do their taxes and give them coaching and support so that the caregivers aren’t isolated. Everybody seems to talk about social isolation and loneliness for the person who’s receiving the care. They don’t often talk about it for the person giving the care.
Brian: Yeah. So that’s interesting for a whole host of reasons. What are other options that are outside of cohousing?
Sally: There are all kinds. Remember I said there were niche communities where people who have similar interests get together. They have arts colonies like that in California. These are older people who live in their kind of apartment cause they’re rentals and they might be retired actors or would-be actors or playwrights or musicians. They take classes for artists, and they’re all older, and they’re all growing old together. Then one model I didn’t mention there, all these places, especially in New York where people have moved into the apartments when they were young, and they just stayed there and grown older They stay where they are but they need services. Social service agencies bring in the care to the people in the building. That’s called a naturally occurring retirement community or NORC. I don’t know if you’ve heard of that, but you’re going to see that too. You’re going to see all kinds of models that haven’t even been invented yet. There’s now this niche community that Jimmy buffet is rolling out in three communities in Florida and South Carolina and it’s called, guess what Margaritaville, of course, and it’s a 55-plus active community. I don’t know if I can say this on the air, but in Florida there is also a nude community. And last time I looked, no pun intended, they were talking about building in assisted living.
Brian: That’s terrific. It’s a something for everybody, right? It takes all kinds.
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Brian: Great options depending upon, you know, what the individual is looking for. It’s interesting, again, as these models continue to evolve, there will be even more options. Going back to some of the more traditional ones, whether that be assisted living or nursing homes or dementia, memory care, what are some of the costs associated with these other options?
Sally: The national average is $45,000 a year, and it can go up to $6,000 a month. A skilled nursing is usually $84,000 to a $100,000+. For a semi-private room it’s about $245 a day. For a private room, it’s $275 a day. Dementia or memory care be $1,000 more a month. My friend’s mother is in memory care in upstate New York, so it’s not a metropolitan area and they pay $14,000 a month.
Brian: Again, very costly. Yes. For those of us who are listening who are not familiar with the area, $14,000 a month in upstate New York is a whole lot cheaper than the Metro New York City area. While you expect those costs to be high in New York City, you wouldn’t think it would be that high in some of the rural communities in upstate New York.
Sally: Sometimes there’s a mix. My mother was in independent living in a CCRC, but she had a stroke. They said, “You’re not a candidate for assisted living.” She didn’t want to go to the skilled nursing on the campus. They said the only way you can stay in your independent unit is if you get 24-hour care. For 7 ½ years, my mother paid for her monthly independent living fee, which was probably at least $3,500 a month plus 24-hour care. Sometimes it’s a combination of these arrangements, but it is very, very pricey.
Brian: You’re absolutely right. It could be a fortune. And what that does to your overall financial situation, if you’re not prepared for that. You know people, they talk about Medicare and what it pays for, but Medicare does not cover this, right?
Sally: Medicare pays a 100% of costs of care in a nursing home for 20 days and 80% of costs up to 80 more days, but they won’t pay for a senior living, and they won’t pay for help with bathing, dressing, eating, and usually they don’t pay for assisted living, unless it’s medical care, and they don’t pay for adult daycare. They pay for medical care, even with Alzheimer’s, they don’t pay for personal care.
Brian: Wow. There’s no getting around it. All of these options can be very expensive and people are always asking what is the best ways to pay for this? Frankly, like many expenses, the best thing to do is to have a plan that will determine what you’ll need, the type of care, and the cost associated with that. The reality is that, there are a lot of folks out there that will simply not be able to afford this. Others will, and they’ll do so through financing it through long-term care insurance or potentially they’ll even sell funds, right? They’ll create their own investment account if you will, and they’ll save aggressively toward that goal so that they have the resources to pay for some of these expenses. As it relates to long-term care insurance, you know, the landscape has changed dramatically over the past 15 years. Whether long-term care insurance is the route to go or sell funds, the route is really a personal decision, and you will want to walk through it with their wealth advisor. What situation or what opportunities is going to be best for them. Because there are a lot of different factors that come into play.
Sally: The policies are all different. Some policies offer more. A day or less. Long-term care insurance can cover home care, it can cover assisted living, adult daycare, nursing, respite care, dementia and hospice and also some home modification.
Brian: That’s an excellent point. The way these policies are changing and evolving, it’s important to understand what is out there as people begin to plan for this type of expense. Now that we know the facilities that are out there, the options that are out there, how do you know what’s a good choice for your loved one and maybe even for yourself, like how do people make those decisions and where do they even get started?
Sally: I would hire a geriatric care manager, because they will coordinate your care. This is a professional who makes recommendations for what you or your parent needs in the community, knows the community resources and, for an additional fee, can oversee other needs. They also know the good home care agencies if you stay at home senior center offerings in the community and they are, in my mind, invaluable. Do you want to know how much they cost?
Brian: Yes, absolutely. What do they cost?
Sally: Okay. It’s usually $50 to $200 and there may be a monthly retainer, but if you wanted to find one, there’s a national association of geriatric care managers. You could just Google it. Just to complicate things, they’ve changed their name to aging life care professionals. If you Google geriatric care managers, you’ll get that. I also think that word of mouth is gold, because if you ask your friend about their parents facility or what their parents have done or who their parents have used, I also think that that’s great. I just wouldn’t count on word of mouth. I would go there and vet it, but also there are great resources. Your local or state area agency on aging. If you go to the national elder care locator website, they have a telephone number. They’ll give you resources in your community. AARP has a good website and there’s also something that the government does, one is called home health compare and one is called nursing home compare, and they will tell you what these facilities offer. These are Medicare facilities that take Medicare. There really are a lot of resources besides the geriatric care manager and word of mouth. You just really have to do your research and not wait until the last second.
Brian: Sally, thank you. Those resources will obviously be very beneficial to listeners who are interested in this. I guess my next question is, when do you know it’s the right time for a facility or to take that next step?
Sally: I think it’s a few things. It’s when the home is no longer safe, because a lot of people end up falling at home and the houses, especially in new England, the houses often have steep steps in narrow doorways, and they’re very vertical. If you can modify your house, or if you have a first-floor den that you can convert into a bedroom, and you have a full bath, it may be okay. There is a possibility that you can’t do that. Let me just give you another tip that the national home builders association has this new designation called certified aging in place specialists. These are folks who will come out to your house and tell you how to modify your house, what you need, how much it will cost. I’m sure they have recommendations. Some of them are architects, some of them are social workers, some of them are builders themselves, so they know. But that’s one thing. If your house is no longer safe, or you can’t take care of yourself, or you go visit your parent and there’s unopened mail or overdue bills or no food or rotten food. I think also loneliness and social isolation. What does it look like for you as an older person in this community? Because you could have the most beautiful house in the country with no steps and wide doorways and a bedroom on the first floor. All set up great technology. You don’t even have to get a smart house. If there’s nobody around, or you can’t get the services you need, or you can’t go to a restaurant or a movie, or you’re going to stop driving, eventually, what are you going to do? Is there transportation around? Are there buses? Are there trains? Is there ride sharing? Same with medical services and cognitive impairment—some people just can’t stay alone. It’s not safe or they have a condition, a chronic condition that’s getting worse, and they need more attention than they could get at home. Those are really the most important reasons that people leave or they want to be near family or friends and they want to downsize and decide they’ll try something else. I think there are lots of reasons that people end up leaving their houses. I would say the number one reason is that the house is not practical for them anymore.
Brian: Sally, those are all great things to look for. You know, one of the things I’ve been reading about recently, as you mentioned transportation and today you have the Uber’s of the world, the Lift’s of the world, and what they’re doing to make people’s lives easier and much more mobile even if they’re not able to drive. Whether that be for doctor’s appointments or other reasons that one might leave the house. Another question that some might have about their loved ones, is who’s going to change that light bulb in their house when that goes out. It could be a light bulb or it could be a handful of other things that they’re not going to be able to do anymore. How are they going to get that done? Are they going to leverage someone who lives close by or do they have an arrangement worked out with somebody? Those are excellent things to think about. I also know having conversations like this with loved ones is never easy. As advisors, we often help families with these conversations, with the individuals that they’re going through this process, but obviously their family members as well. It’s a major step in somebody’s life when they’re trying to think through, you know, their next phase. You may no longer be able to do these things and be as independent as you once were. There’s a great deal of sensitivity as it relates to the topic that we’re having and in those conversations that go along with it.
Sally: Absolutely. Those conversations are uncomfortable but they are critical.
Brian: Like most important decisions in life, right?
Brian: At this point, what do you think the most important thing for our listeners to know about this subject?
Sally: They need to not be relaxed about thinking about the future. They need to think either if it’s a parent or a spouse or themselves, what might it look like in the next two to five years? Do I want to live where I am? Do I have a support system here? If I think that someone might need care, where can I go? To know the resources, to know that there are excellent options out there and also that you’re not going to know exactly what’s going to happen. And as you know, circumstances change instantly. But if you have no idea where to go or how to fund it or what to do, then you’re going to not have the kinds of chances and opportunities and options that you would have. I would say do your research or know where that research is and you will feel a lot more comfortable and there’ll be far fewer surprises.
Brian: Two of my takeaways from the show are, regardless of how old you are, you know, you may be in your late 30s, 40s or 50s, this should be and needs to be on your radar. Believe it or not. I mean starting to think about this today is critical depending upon your age and your overall situation. You know, maybe start thinking about the long-term and how you’d like this chapter of your life to look and how to ultimately prepare for that. And on the other side is really beyond the financial side and it’s truly taking care of your health today. I mean, what decisions are you making today that can improve your health for tomorrow? Over that long-term, you may not need as much help in the future if you’re in good health and in good shape, and you’re being mindful of those things today, you know, staying mobile and maintaining your balance and those types of things.
Sally: I think that’s a great point, Brian. I would also say, to have a support system, and if you don’t, to plan for one so that you’re not isolated, and you’re not as lonely and that you make a very rich life for yourself.
Brian: Sally, thank you for your time, expertise, and the resources you’ve given us today. I know our listeners will greatly appreciate this.
Sally: It’s a pleasure, Brian.
Brian: Sally, before I let you go, we ask all of our guests the exact same question. And that question is, what is the worst financial decision you’ve ever made?
Sally: That’s an easy one, because when I was in my early 30s, my husband and I decided on a whim to buy a second house 2 ½ hours away in the Berkshires of Massachusetts. We looked at it the first day. We weren’t even house hunting. We saw this house the first day it went on the market. We bought it, and we realized that it was a money pit and had all sorts of problems with it. My kids learned to ski there. They learned to go to outdoor concerts, music, classical concerts at Tanglewood. We hiked. It wasn’t all bad, but they were very, very little kids, and they got older and then they got into sports at their primary residence and then the market tanked, and we couldn’t sell it. Ten years we had the house, and first two or three it was fabulous, and then it was a financial mess and the whole thing was a disaster. It was a very impulsive move. Don’t do that.
Brian: Wow. Okay. I’m sorry it was a money pit. I’m sorry it wasn’t a great financial assist decision, but at least you had a couple of good years there if there’s ever any silver lining and joy you have for you and your family. Thank you for sharing that. Thanks again for joining the show and as this industry evolves and the changes are made, we’ll have to have you back as a guest as a at another time. Thank you.
Sally: I’d love to thank you.
Brian: Well that wraps up another episode of Your Life, Simplified. Thank you for listening, and I hope this information was helpful for either you or, or someone you might know, as always. If you have questions about the show or you’d like to hear a certain topic, you go ahead and email us at firstname.lastname@example.org
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