A Step-By-Step Guide to Finding the Right Retirement Community by Nicole D. Muller Have you ever thought about moving to a retirement community? Do you think it is the perfect option for your parent or neighbor? Even though it may sound like a good idea, many people don't know where to begin. You've probably seen the ads and the glossy brochures but what does it all really mean? The term retirement community encompasses a variety of housing options, the choices are numerous and often confusing. How do you determine which one is right for you or someone you know? This article will help you sort out fact from fiction and guide you through the process of selecting the right retirement community. Step 1: What are my housing options? Compared to other areas in the United States, the Philadelphia region has a broad array of senior housing choices, some dating back as far as the 1800's. "People in the Philadelphia area are very fortunate to have so many options in senior housing," explained Lisa Fiora Grech, administrator of Senior Quarters located in Media. "The first step should be determining which level of care is needed and what type of community is the most appropriate." The various types of retirement communities found in the Philadelphia area are described below: Active Adult Communities: Active adult communities are specifically designed for adults over the age of 55. These communities alleviate the worries of home and lawn maintenance and provide 24-hour security to residents. Amenities may include a golf course, pool, fitness center, tennis courts, club house and social activities. Additional support services such as meals or housekeeping are not provided in these communities but residents can arrange for outside assistance from local home care agencies as needed. Independent Living Communities: For those who are healthy and active, independent living communities focus on security, socialization and care-free home and garden maintenance. Some communities include housekeeping, activities, the option of meals, and transportation. Many seniors living in independent living communities enjoy traveling and find it comforting to know that their home and belongings are safe and secure. When the need arises for more supportive services, outside help can be arranged through home care agencies. Assisted Living Communities: Assisted living communities, also known as personal care homes in Pennsylvania, are becoming an increasingly popular housing choice. Older adults who need a little extra assistance but do not need nursing care on a daily basis are appropriate for this type of community. Supportive services such as three meals daily, housekeeping, transportation, medication reminders and assistance with bathing and dressing are provided and are designed to maintain a resident's independence within their own private apartment. Residents can remain in an assisted living environment unless they begin to need a substantial amount of nursing care daily. Assisted living may co-exist with an independent living community and/or a nursing home or it can be a free-standing community. Some assisted living communities are specifically designed to care for individuals with Alzheimer's Disease and related dementia. These communities are state-of-the-art facilities with programming and activities geared to improve the lives of those suffering from this condition. Assisted living communities charge a monthly fee which covers services either on an unlimited basis or what is known as a basic services package. The basic service package includes all of the supportive services except there is a limit on the amount of personal care provided. Communities offering a basic service package increase the monthly fee as the resident requires more care and assistance Nursing Homes: Seniors who require nursing care on a daily basis but do not need hospitalization are appropriate for a nursing home. The length of stay depends on the individual situation. In some cases, a senior may require a short-term stay for rehabilitation and then may choose to return home or move into an independent or assisted living community. Both private and shared rooms are available. Continuing Care Retirement Communities: Sometimes referred to as life-care communities, CCRCs provide independent living, assisted living and a nursing home all on one campus. These communities cater to older adults who want to take control of their future by planning for their health needs in later years. They offer many services and amenities designed to keep residents socially stimulated and active. In a CCRC, all of the benefits of an independent living community are combined with the peace of mind in knowing that your needs will be met. Because CCRCs require residents to meet specific health and financial criteria upon admission, it is best to plan ahead. There are many types of CCRCs available, with various financial arrangements to consider. Generally there are three types of CCRC contracts: All-inclusive: A CCRC with this type of contract charges an up-front entrance fee which serves as a form of insurance to guarantee that a resident's health care needs will be met in the future. In addition to the entrance fee is a monthly service fee which remains the same, except for slight inflation increases, regardless of the level of care needed. Modified: CCRCs with modified contracts provide the same lifetime guarantee and amenities as the all-inclusive CCRC but limit the amount of nursing care or health care days included. Once this specified amount of care is received, the resident pays for the health services rendered, usually at a reduced rate. Fee-for-Service: Some CCRCs are fee-for-service which means that the monthly fee is increased according to the level of care required. A fee-for-service CCRC which charges an entrance fee still guarantees that your health care needs will be met within the community but at a monthly fee appropriate for the health care you are receiving. A rental CCRC does not require an entrance fee and therefore can't guarantee that a bed in the health center will be available at the time you require one. However, they make every effort to meet the health care needs of their residents. In addition to the various types of housing described above, there are many innovative retirement communities being created in the Philadelphia region. Care Matrix, a nationally recognized provider of senior housing, is currently developing a Òsupportive independent livingÓ rental retirement community in Center City, Philadelphia. Expected to open early in 1999, this community will offer rental apartment living with services including a concierge, housekeeping, transportation, dining and personal care services available as needed. Step 2: Financial Considerations Now that you understand the differences between the many types of retirement communities you may wonder if you can afford to move into one. If you make a list of all the expenses you will save by moving, you will find that moving to a retirement community is much more affordable than you may think. Your list of expenses should include all utilities, rent or mortgage payments, real estate taxes, grocery and restaurant bills, insurance, housekeeping, laundry, and lawn and home maintenance costs. In addition, depending on the type of community you are moving to, a portion of your medical fees may be tax deductible. Don't forget to add in the value of everything the community has to offer; 24-hour security, social activities and outings, transportation, and amenities. The most important thing to remember is that it becomes nearly impossible to compare prices because each community offers a unique package of services. Monthly fees can vary drastically from community to community. The number of meals provided, frequency of housekeeping, the amount of health care included, and whether prescription drugs are provided can greatly affect monthly costs. There are many varieties of entrance fee plans which can significantly impact their pricing. Entrance fees can be either refundable or non-refundable and entrance fees that seem lower may have higher monthly fees. The reasons could go on and on but the point is that you need to find out exactly what you get for your money. A wide variety of housing choices can be found, from modest studio apartments to spacious cottages with garages, to suit a broad range of income levels. Your individual financial situation and personal needs will determine which type of accommodation is most appropriate. Unless you have purchased a long-term care insurance policy, most independent and assisted living communities will require that you have the personal assets to sustain the monthly fees. The actual costs depend upon the size of the apartment or home, services included, and the individual community. In most cases, fees are paid privately by the resident and/or family. A good rule of thumb is that "a resident's monthly income should be about 1 _ times the monthly fee," according to Nora Zolna, director of marketing for Riddle Village in Media. "Entrance fees are typically paid through the sale of one's home." Some communities are able to offer subsidized apartments for those qualifying with lower incomes. Depending on the length of stay, a portion of nursing home costs can be covered by Medicare, Medicaid, or long-term care insurance. In many cases, private funds are needed to sustain a long-term nursing home stay. Step 3: What to look for in a community Hopefully at this point, your research has narrowed down the type of retirement community that is most appropriate for you or your parent. Begin comparing brochures and touring a few of the top communities on your list. "Most people in this area are saavy shoppers. I encourage people to shop around because choosing a retirement community is one of life's major decisions," explained Renata Harrison, director of sales for the Quadrangle. "They should feel free to visit and re-visit and get to know the residents and staff." It is best to make an appointment to visit a community so that you will be given a thorough tour of the community as well as time to ask all of your questions. If you make a surprise visit, expect only to take a quick look around and then ask to schedule an appointment to have your questions answered. Before touring communities, prepare a list of questions and a checklist of things most important to you. "Look at every little detail and aspect of the community. Something that seems trivial now could turn into a major problem later," advises Marge Cain, director of marketing for The Evergreens. "There should be no surprises after someone moves into a community. They should know exactly what lifestyle to expect." Consider the following: Would I be comfortable living here? Does the decor and atmosphere appeal to me? Does the community offer the services and amenities you want? Is the community clean and odor free? Are the employees visible and approachable? Do the employees seem friendly and caring? Are they interacting with residents? What are the residents doing? Are they active? Do they appear happy? How do the residents look? Are they clean and well groomed? Are they dressed appropriately for the season? Observe what is going on around you. What activities are taking place? Are the activity rooms being used or are they empty? Ask to stay for a meal. Do you like the food? Are their ample selections available? When you are seriously considering a move, get involved personally with a community. Get on the community's waiting list. Ask to receive a monthly activities calendar and attend events regularly to get an insider's view of what it will be like to live there. Talk with residents and ask them to introduce you to their friends (they will tell you everything you wanted to know about the community). Many communities even have guest suites which allow you to stay overnight. Ask to have a copy of the community's annual report or financial disclosure statement and resident contract and have your attorney review them with you. Step 4: Questions to Ask Is the community owned by a for-profit or non-profit corporation; a large corporate chain or an individual? Be comfortable with the sponsor's financial stability and level of experience in the industry. Is the community accredited? CCRCs may be accredited by the Continuing Care Accreditation Commission which requires that a community meet or exceed specific standards of excellence in the areas of governance and administration, resident life, finance and health care. What are the admission and discharge criteria regarding health and finances? Know precisely which physical limitations or health conditions will preclude you from being admitted into a particular community or require you to leave. What services are included in my monthly service fee? What are the extra charges I might incur? Ask how often meals, housekeeping, and laundry are provided. Find out how much personal care is included daily. What are the fees for a la carte services you may need in the future. What percentage average annual increase may I expect to the monthly fee? Most communities raise their monthly fees annually to keep up with inflation. Ask for the average increase over the last several years. Typically this ranges from three to five percent. Is my entrance fee refundable? Under what circumstances? Many communities offer refundable entrance fee plans but be sure to know the terms of the agreement. What if I need more care in the future? How will this be handled? You should know whether you will be asked to move or whether all of your needs can be met in the community. If they can be met in the community, will your fees be increased and to what amount? Also, if you need temporary health care, will your apartment be waiting for you when you are able to return? Do I continue to see my own physician or is there an on-staff medical director? Find out how your health care needs will be met once you move into the community and what it will cost. How long has the administrator and other management staff been employed there? High staff turnover is one indicator that there may be some type of problem. What is the current vacancy level? If a community has a high vacancy rate there may be some type of problem. Communities which are new or have undergone recent expansion may appear to have lower occupancy temporarily. How will my long-term care insurance policy (if you have one) work together with the community? Your long term care policy may help pay for assisted living communities, nursing homes and some CCRCs. Is there a resident council and do they actively participate in decisions regarding the community? Particularly in CCRCs, residents may serve on the Board of Directors and are very involved with their communities. Resources There are many organizations which can guide you through the process of finding a retirement community. For informative articles and detailed listings of all retirement communities in the Philadelphia region: Guide to Retirement Living P.O. Box 7512 McLean, VA 22106-7512 1-800-394-9990 For lists of licensed facilities: PA Area Agency on Aging Bucks County 215-348-0510 Chester County 610-344-6350 Delaware County 610-713-2100 Montgomery County 610-278-3601 Philadelphia County 215-765-9000 NJ Area Agency on Aging Burlington County 609-265-5069 Camden County 609-310-8900 Gloucester County 609-582-9200 Mercer County 609-989-6661 The Continuing Care Retirement Community: A Guidebook for Consumers. To order, send a check for $4 to: AAHSA Publications, 901 E. Street NW, Suite 500, Washington, DC 20004- 2837. Checklist of what to look for in assisted living facilities: Assisted Living Federation of America. For a free copy, send self-addressed #10 envelope to: ALFA 10300 Eaton Place, Suite 400 Fairfax, VA 22030 or e-mail to info@alfa.org. INTERNET RESOURCES For those of you with access to a computer, there are many helpful resources available on the Internet for those considering a move to a retirement community. Some communities even have web sites of their own. The following sites are worth exploring and offer community directories and timely articles on senior issues: seniorsites.com lists over 5,000 non-profit retirement communities throughout the US. Newlifestyles.com facility listings in the Philadelphia and New Jersey area retirement-living.com consumer articles on long term care as well as facility listings in the region aahsa.org American Association of Homes and Services for the Aging, helpful information and articles aoa.dhhs.gov/aoa/pages/jpost.html Administration on Aging list of online resources for aging hcfa.gov Information on Medicare and Medicaid shs.net/ncoa/ncoa.htm National Council on Aging, consumer news and public policy, lists of videos and books available. Seniornet.org/intute/resource.html online resource directory including publications and links to other web related sites. Members.aol.com/carebooks/index.html Caregiver's Resource Homepage alz.org Alzheimer's Association aarp.org American Association of Retired Persons panpha.org Pennsylvania Association of Non-Profit Homes for the Aging