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Homes For Seniors Where The Living Is Easier

Personal Business: ELDER CARE


Christine Lawson was 76 and a widow when she opted for a lifestyle that many her age are choosing. She sold her house in St. Petersburg, Fla., and moved to a nearby assisted-living complex. Home today is elegant Lake Seminole Square, where Lawson, now 84, has a two-bedroom apartment and pays $1,600 in monthly fees. Unlike life in a typical Florida condo development, she has easy access on the premises to prepared meals, wellness programs, an emergency call system, and a nurse.

More important to Lawson is her contractual guarantee that she'll get care no matter how disabled she becomes. Should she no longer be able to live independently, she'll be able to transfer to a smaller unit on the grounds and get help with medications, bathing, and meals. If she needs a nursing home, Seminole Square operates one nearby where residents in most cases can stay even if they run out of money. That gives peace of mind, Lawson says, noting: "I'd be among friends."

If you're considering assisted living for yourself or aging parents, Lawson's lifestyle has appeal. For older people of sound mind but not always sound body, assisted living offers a middle way between managing alone and depending on a nursing home. The concept is catching on fast. About 25,000 facilities now serve some 1 million well-heeled residents, says the Assisted Living Federation of America (ALFA), a trade group. The demographics have drawn big, publicly traded outfits, including Marriott and Sunrise Assisted Living (page 90). Religiously affiliated no-for-profits, such as American Baptist Homes of the West and Kendal Corp., a Quaker enterprise, are also active.

Before you sign up for assisted living, you need to take a sober look at what's involved. Advocates for the elderly caution that marketing can play on emotions and obscure, difficult financial and legal questions. Says Bruce Vignery, an attorney with the American Association of Retired Persons (AARP): "Providers use language that suggests freedom of choice, dignity, self-autonomy, privacy, and security. It's certainly true for some assisted-living facilities. The question is, do facilities that don't fulfill those promises get a free ride?"

Assisted living comes in a confusing array of formats--regulators and providers can't even agree on a definition of the term. Seminole Square is a continuing care retirement community (CCRC) and represents the top tier of the industry. Its 365 independent-living residents have resources far beyond Social Security and pension checks: Lawson had to prove a net worth of $1 million before her application was accepted; newer residents have just had to prove sufficient resources to cover fees. That generally means at least $200,000 in assets.LOW FEES. Typically, CCRCs require up-front payments of $50,000 to $200,000 to help pay for long-term care, plus $1,200 to $1,500 in monthly fees to cover housing and maintenance. "A CCRC is a community that has insured itself for [residents'] future health care," says David Cole, continuing care director of the American Association of Homes & Services for the Aging, a trade group. Even so, experts advise buying separate long-term-care insurance to defray nursing-home costs that threaten individual resources. Seminole Square residents who graduate to the nursing home pay about $110 a day.

CCRCs vary widely. Some are rentals, with lower entry fees; the newest are full-ownership condos. Seminole Square is one of the latter--with a twist. Lawson holds the deed to her condo, but has signed an agreement allowing the provider exclusive repurchase rights once she moves out or dies. She or her heirs will receive 50% of her initial investment.

Less comprehensive than CCRCs are freestanding independent complexes. Their residents receive meals, medical services, and light assistance as part of their contracts. No up-front payments are made, and fees average about $2,000 a month. But residents lack the option to "age in place." Once they require nursing home care, they must move.

In choosing an assisted-living facility, ask yourself whether you want a home where you can live out your days--and if you can afford it. Then focus your search. Finding facilities is easy: ALFA provides a state-by-state listing. And newspapers are packed with ads.

When you visit a complex, expect a marketing representative to show you the grounds and model apartments. Pay close attention to staff-resident relationships. "When I'm taken on a tour by an administrator and she barely acknowledges a resident in the hallway, that's a red flag," says ALFA President Karen Wayne. Her group provides a checklist of criteria: Are prospective applicants free to talk to residents? Is the decor tasteful and homelike? Are apartment floors nonskid?

Once the facility passes a surface inspection, it's time to delve deeper. If you're interested in a CCRC, check if it's accredited by the Continuing Care Accreditation Commission. This industry self-regulatory group watches financial operations closely--a particular concern to residents who have paid big up-front fees.

Call your state commission on aging or attorney general's office to inquire about complaints. Then hire a good elder-care lawyer and review the contract line by line. AARP lawyers say the best contracts clearly spell out personal services. One AARP-endorsed contract defines "grooming" as helping residents shave, brush their teeth or clean dentures, comb their hair, and, on a scheduled basis, wash and dry hair as well. Watch out for statements such as "service level fee will be subject to change as resident's condition changes." If a contract says transportation is provided, check if that means only one trip a week to the store.

Residents also must grapple with the future, uncomfortable as that may be. As elder-care attorney John Kearns III of Hartford says: "I have never had a client say, `I want to go to a nursing home."' Yet applicants should know the score: To what degree will the facility allow you to age in place? If you're likely to develop Alzheimer's disease, is there a special wing to serve you? Can you stay in your apartment if you become incontinent? "People are really sold on the idea that they can move to this place and stay there," says AARP's Vignery. "It's not clear whether that's going to happen, either in terms of contract law or state regulation."

Regulation in fact, remains scarce: 29 states don't even use the term "assisted living" yet, according to the National Academy for State Health Policy. Other states don't distinguish between assisted-living facilities and small--sometimes, deficient--board and care homes for recipients dependent on government aid. While the largest assisted-living providers have been most active in Florida, Texas, and California, states awarded the highest marks for flexible "age in place" policies are Hawaii, Kansas, Oregon, New Jersey, and Vermont.

That list will likely grow, with the 85-and-up population expected to double by 2020. For seniors like Christine Lawson, with resources to back them up, the expanding number of providers is a healthy trend.Joan OleckReturn to top

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