Practical Answers to Pressing Questions

Whether you are starting to think about your own retirement or are assisting your parents with making decisions about their future, it is never too early to begin planning.  Thousands of adult children are dealing with issues related to caring for aging parents.  One of these issues is clearly helping to make informed choices about retirement housing.  When it comes to researching housing options, children often sift through piles of literature and research numerous communities to ensure their parents will be well cared for. 

This article discusses some of the steps in the planning process including properly assessing the situation, talking with your parents, understanding retirement community options, and finding the right community. 

Assessing the Situation

Understanding your parents needs as well as their desires is a crucial first step in helping them make decisions about retirement housing.   “It is very important for children to examine their parents needs, often they become focused on their own needs,” explained Frank Wehr, vice president of senior housing for Genesis Health Ventures. 

Every individual situation is unique.   Knowing your parents mental and physical state as well as their current environmental and financial conditions will be important factors in beginning to research housing options. Many communities will assist you with this process.  They can send a trained staff person to provide an in-home assessment to evaluate the situation.  They can also help you understand the differences between independent living and assisted living and recommend the most appropriate options.

The following two fictional scenarios represent two very different situations but both may seek a move to a retirement community:

Mr. and Mrs. C raised three children in a lovely home in the suburbs.  They have created many fond family memories in the home over the past 40 years.  Now age 76, they remain very active in their local community.  She volunteers at the local hospital and he is active on the board of directors of a community organization.  Their passion is travel.  Every year they discover a new exotic location.  They no longer want to shovel snow, rake leaves, cut the grass, clean the house, cook all the meals and worry about home maintenance.  They are beginning to discuss their future and wonder what will happen if one becomes ill or needs long term medical care.  She doesn’t want to be a burden on any of their children who are busy with their careers and are raising their own children. Mrs. J is 84 years old and became a widow two years ago.  Her home is large and she is finding it more and more difficult to take care of.  Some days it feels as if she is on the phone all day arranging for workers to help her with the lawn and the house.  Getting to the grocery store and going to her doctors’ appointments is becoming a challenge.  She has lost interest in cooking and is feeling lonely and isolated.  Many times, she forgets to take the proper dose of her medication.  She loves music and enjoys going to the orchestra occasionally with her daughter.  Her daughter worries about her mother living alone.

The first scenario, Mr. and Mrs. C, represents an active and healthy couple who may choose to move to an independent living community or a continuing care retirement community to be free of the burdens of home and lawn maintenance.  The numerous amenities and social opportunities provided in a retirement community would be enjoyable for the couple.  They also want the peace of mind in knowing that health care services will be available should they need it in the future.  When traveling they do not want to worry about the security of their home.   

For those needing more assistance, like Mrs. J in the second scenario, an assisted living community may be the right choice.  Adult children may begin to recognize that their aging parent needs support and no longer seems able to easily manage daily tasks. 

When assessing the current situation, here are some questions to consider:

• How would you describe your parent’s lifestyle?

• What are their interests?

• Are the living conditions and surroundings safe and sanitary? 

• Is your parent able to keep up with the maintenance of the home and lawn? 

• Are everyday tasks like cooking nutritious meals becoming more burdensome? 

• Is your parent becoming lonely and socially isolated?

• Could your parent be forgetting to take medications? 

• Is driving to medical appointments and shopping becoming a concern?

• Do you worry about what will happen if your parent falls or becomes ill? 

• Are bathing and grooming becoming noticeably difficult?

Talking With Your Parents

Approaching a parent about moving out of their home can be very difficult for families. The majority of older adults prefer to remain in their homes so it is no wonder there can be resistance to move.  Seniors may feel defensive about their ability to live independently at home.  Often they feel that they are not ready to move to a retirement community.  “Once they realize that they are not going to lose their independence, they are not as reluctant,” explains Judy Miller, director of community relations for Sunrise Independent and Assisted Living Community in Abington.  Judy recommends actively involving the parent in the decision process and she works with families to openly discuss the fears associated with moving to a retirement community.    

According to AARP’s recent report “Can We Talk? Families Discuss Parents’ Ability to Live Independently,” the majority of adult children are thinking about whether their parents are able to live independently but many are avoiding discussing the issue with their parents.

Unfortunately, many families are forced to have this conversation when there is some form of crisis such as a serious health or financial problem.  "Senior housing is almost always a family decision, and usually a very emotional one," said Jeff Ferguson executive vice president and general manager, Marriott Senior Living Services.. "Supporting an extended family on a daily basis is demanding. We find that early education and planning can make this decision and transition much easier for adult children and care givers, as well as seniors themselves."      

Beginning the discussion and finding the best way to approach your parent can be very awkward.  In an article published by AARP, experts suggest some tips for raising the issue and ways to have a productive conversation:

• Watch for openings in a conversation that can lead to the issue.

• Create a list of questions or concerns you have and schedule a time to share them with your parents.

• Share your own emotions and thoughts about your parents situation and encourage them to do the same.

• Raise the issue indirectly by relating it to someone else’s situation.

• Focus on key points including safety in the home, everyday activities, driving and getting around, health, and finances.

• Keep the conversation positive and avoid role reversal.

• Respect your parent’s feelings and act firmly but with compassion.

“We encourage people to be very up-front and candid with their parents, “ says Frank Wehr of Genesis Health Ventures.  He suggests focusing on the positive elements of moving to a community.  “It is important to examine your parent’s concerns and help them identify how the community can meet their needs,” he adds.  Visit the community together and point out areas of interest and explain how they can address a particular concern.  For example, if your parent desires companionship, involve them in a social event at the community or ask to dine with some of the residents. 

Understanding Retirement Community Options

Today’s generation of seniors have a world of housing options available to them.  “The greater Philadelphia region is home to over 50 CCRCs as well as numerous other types of retirement communities,” explained Susan Brecht, President of Brecht Associates, Inc., a consulting firm in Philadelphia specializing in market feasibility and planning for senior housing. “The Philadelphia area has among the greatest concentration of retirement communities in the country.” While the number of choices available in this area allow for greater selection, the choices can oftentimes be confusing.

The following descriptions briefly and generally define CCRCs and two of its components: independent living and assisted living.  Independent living and assisted living can also be found in freestanding communities.  Within each of these categories there are many types of communities with various differences in terms of costs and the amount of healthcare available and included.  While not the focus of this article, there are many resources available to help you understand these differences more thoroughly (see internet resources).   

Continuing Care Retirement Communities (CCRC): CCRC’s (also known as lifecare communities) provide a full range of services and care on one campus.  Independent living apartments and cottages are offered to healthy and active retirees who want the security of knowing that their future health care needs will be met.  In order to provide a continuum of care, CCRCs typically have assisted living and nursing accommodations on site.  CCRC’s also provide the benefits of 24-hour security, emergency response, maintenance-free living and many social activities and amenities within the community.  Amenities are plentiful in CCRCs and can include a library, various activity rooms such as woodworking shops and arts and crafts rooms, fitness center, computer room, and indoor pools to name a few.  Services typically include elegant meals, housekeeping and transportation.  There are a variety of different types of CCRCs including those with up-front entrance fees as well as those considered rental communities with no entrance fee.  The amount of future health care included can also vary significantly.  Some CCRC’s include unlimited health care while others provide a limited amount of health care.  Rental CCRCs have on site health care but require payment for services as needed. 

Independent Living:  Independent living can be found within a CCRC or can stand alone as an independent living community (with no other levels of care).  Independent living communities may also exist with assisted living or a skilled nursing center.  For seniors who are capable of living independently without the need for assistance, these communities provide socialization, security and maintenance free living.  Most independent living communities offer private apartments or cottages ranging in size from studios to two and three-bedrooms.  Residents have access to the community’s common areas and amenities, which like CCRC’s described above can be very luxurious. In addition, independent living communities typically provide 24-hour security with emergency response, numerous social activities, and home and lawn maintenance.  Services such as meals, housekeeping and transportation are often available as needed.

Assisted Living: Assisted living is a component of a CCRC but can also be found as a freestanding community.  Some assisted living communities coexist with independent living or skilled nursing.   Also known as personal care in Pennsylvania, assisted living provides supportive services for older adults who need personal assistance but do not need nursing care on a daily basis.  Services typically include three meals daily, housekeeping, transportation, medication reminders and assistance with activities of daily living such as bathing and dressing.  For those with Alzheimer’s Disease and related dementia, many assisted living communities provide a specific wing designed to care for these individuals and some communities are exclusively designated for dementia care.  Monthly fees and the amount of service provided can vary drastically from community to community.

Finding the Right Community

The keys to finding the right community are research and planning.  Once you have identified which type of retirement community is appropriate for you or your parent, start by gathering lists of retirement communities in your area.  There are a number of resources available to help you with your search.  Your local agency on aging is a good place to begin.  They are often able to provide listings of licensed facilities in your area.  In addition, you can find a great deal of information on the internet including on-line tours of certain communities.   

The next step is to narrow down the list giving consideration to finances, location, amenities, services and any other criteria you deem important.  Once you have a more manageable list, you can call the communities to obtain brochures and ask questions about the community.  Now it is time to visit a few of the communities of most interest.  By appointment, community representatives are willing to spend the time to give thorough tours, answer all of your questions and even invite you to stay for a meal or a special social event. 

Be sure to write down a list of questions before your tour.  Include questions about accreditation, staff training, staff ratios and background checks.  Ask to see financial and inspection records.  Take home copies of the resident agreement to thoroughly review admission and discharge criteria.  Understand the financial obligations including up-front fees, monthly fees by level of care and annual percentage increases. Also, carefully identify the amount of services included in the fees versus those that are charged additionally. Observe the residents.  Are they well groomed? Do they look happy? Are they engaged in activities within the community? Observe the staff.  How do they interact with the residents? Are they friendly and involved?

Comparing the costs of various communities can be a complex task. The amount of services included in the monthly fee can vary significantly from community to community.  The number of meals, the frequency of housekeeping, transportation services and the amount of health care provided will all affect the monthly fee.  “Also take into consideration the benefit of what is included in the fees,” explains Jean Lawrence, advertising director of Cathedral Village, an accredited CCRC in Philadelphia.  For example, Cathedral Village includes unlimited access to community amenities like the health club’s fitness center, indoor pool and exercise programs, the greenhouse and horticultural classes, computer room, on-site concerts and educational courses as well as unlimited visits to physicians and nurses and stays in the nursing center.   

Adult children can assist parents with much of this initial research before overwhelming them with too many choices. Once a decision has been made, you will want to be placed on a waiting list which often requires a deposit.  Even though it may seem too early to take this step, there are many benefits to planning ahead.  Particularly if you are waiting for a specific type of apartment within a CCRC, it could be up to three years before an apartment becomes available.  Typically, the wait is not as long for an assisted living apartment. 

During this period of time, it is a good idea to become actively involved with the community.  Becoming familiar with a community through ongoing involvement will ease the transition of moving from home to a retirement community.  Martin’s Run, a CCRC in Media, Pennsylvania offers membership in the “Priority Club” to future residents who are on a waiting list for their desired apartment. Priority Club membership includes four complimentary meals in the community’s elegant dining room, access to the fitness center and outdoor pool, on-site Gratz College courses as well as a full calendar of cultural and social events including concerts and lectures. “We wanted our future residents to feel welcome and be part of the community,” explained Lorraine DellaFranco, marketing director of Martin’s Run.  “This gives them the opportunity to make new friends and become comfortable in our community.” 

With the proper research and planning, the entire family will be comfortable with the decisions made.  They will share the peace of mind that comes with making informed choices about the future.