Making Decisions about Eldercare: What you need to know.

by Nicole DeWoolfson Muller

Ms. Muller is a consultant with Brecht Associates, Inc. a consulting firm in Philadelphia providing market feasibility and planning services to the senior housing industry.

With the numbers of older Americans growing at an exponential rate and the baby boom generation beginning to enter their retirement years, the past decade has brought about a greater focus on the elderly and their needs. It has also formed a business environment where new professions, services and housing options are being created to serve the elderly. New social service professionals like geriatric care managers are evolving to meet the changing needs of seniors and their families. Long term care insurance is an idea that is catching on. And, people are becoming more and more saavy about their housing options. This article answers some basic questions about these issues and tells you where to turn for information and advice. 

What is a Geriatric Care Manager?

Oftentimes, seniors and their families don't know where to turn for sound advice when it comes to making decisions about eldercare. A geriatric care manager can help. Geriatric care managers, or GCMs are professionals with training in the areas of gerontology, social work, nursing, or counseling. Their extensive knowledge and experience about the costs, quality and availability of services in the community bring comfort to families faced with making arrangements and decisions about the care of a loved one. GCMs specialize in the evaluation, monitoring and coordination of services for seniors. Services are customized to meet the individual needs of seniors and their families and can be short-term or ongoing. Individual care planning assessments are often the first step in the process where problems, eligibility for assistance and the need for services are identified. GCMs can also act as a liason to families living far away, to ensure that proper care is given and alerting families should any problems arise. Other services include everything from crisis intervention to finding the right housing option and assisting with the move. Standards of quality and a code of ethics have been established by the National Association of Professional Geriatric Care Managers. Only care managers with professional degrees in human services and at least two years of geriatric experience are represented by the Association. Some families will find that hiring a geriatric care manager will give them peace of mind and comfort in knowing they have made the right eldercare decisions. 

What is Long Term Care Insurance and do I really need it?

It may be difficult to think that one day you will be faced with needing long term care for you or a parent. But industry statistics show that 40 percent of Americans over the age of 65 will enter a nursing home at some time in their lives. Long Term Care Insurance is private insurance that is designed to pay for future long term care costs. Policies cover care in a variety of settings that include the home, an adult day care center, assisted living facility, or if necessary, a nursing home. Although it is impossible to predict your future long term care needs, this insurance allows you to pay an affordable premium in order to avoid unforeseen catastrophic costs in the future. 

Just as health, automobile and homeowners insurance are available to secure a sound financial future, long term care insurance can protect you and your family's assets. "Long-term care insurance protects the financial security of American families today in the event that a loved one needs help handling day-to-day activities," said Donald Young, MD, president of Health Insurance Association of America. 

Long term care costs can be very expensive. According to an article in the Wall Street Journal, "A year in a nursing home now averages more than $40,000 and can exceed $100,000 annually in some parts of the country." "Here in the Philadelphia area, nursing home costs range from about $125 to over $400 per day and assisted living costs are typically between $1,500 to over $4,000 per month," explains Susan Brecht, president of Brecht Associates, a local consulting firm specializing in market feasibility for senior housing. Home care is also expensive. Home health aides can provide homemaker services for about $20 an hour but these costs add up. A home health aide coming into your home every day for four hours could cost as much as $2,400 per month. Typically, these costs are not covered on a long term basis through Medicare or Medicaid. That means that cash or private insurance will be required to cover these expenses. 

Your age, health and type of coverage dictate what your premium will be. In order to keep your premiums most affordable, the best time to buy a long term care policy is when you are in your late 50's or early 60's. Each year that you delay purchasing a Long Term Care policy, the premiums will increase by about eight percent. To be eligible for a policy you must be healthy and not currently in need of long term care. There are three major decisions that will affect your premiums. The daily benefit is the amount of money your policy will pay for your care on a daily basis. The benefit period is the number of years or length of time the policy will pay for care. Thirdly, the elimination period or deductible is the number of days you will be required to pay for care before the policy starts to pay.

In recent years, Long Term Care Insurance has become more and more popular. According to a recent survey conducted by the HIAA, the number of Americans who have purchased long term care insurance has increased more than tenfold in the last fifteen years. More than 1.4 million people purchased a policy during 2000 and 2001. 

For those opting to move to a continuing care retirement community (CCRC) offering lifecare, all future health care needs are taken care of and therefore replace the need for long-term care insurance. However, some policies may work together with fee-for-service CCRCs. If you have an existing policy or are thinking of purchasing one, this is an important question to ask of both the insurance company and the CCRC you are considering. 

What are the new trends in senior housing and eldercare?

The term senior housing no longer conjures up images of an old folks home or a nursing home. Today's communities are vastly different and come in all shapes and sizes. The continuing care retirement communities (CCRCs) have their earliest roots in Philadelphia dating back to the late 19th century. These communities were trendsetters of their time and have evolved with the ever-changing needs and desires of seniors to offer all the amenities and services today's seniors demand. The 1980s and 1990s brought about an emergence of diversified freestanding communities, some offering specialized care. Congregate housing was created to provide an independent living environment where seniors could have access to hospitality services like meals, housekeeping, transportation and social activities. Tremendous growth in the development of assisted living communities occurred in the 1990s. Communities that specialize in the care of residents with dementia and Alzheimer's disease also took hold. 

As we go into the 21st century, the existing communities are recognizing that the new generation of seniors want amenities like fitness and wellness centers, swimming pools, computer labs, internet cabling into their apartments, flexible meal times in a variety of settings, and the list goes on. New communities are building these amenities into their facility and older communities are renovating and expanding to create these spaces. 

Another emerging trend in eldercare is the concept of lifecare at home. Friends Life Care at Home, a non-profit Quaker corporation, started the program in 1990 in the Philadelphia area. The program enables seniors to stay in their homes and receive lifelong assistance including care management. Care coordinators arrange for the services members need and oversee every detail of their care - 24 hours a day. Whether for a short term illness or a catastrophic occurrence, these health care specialists coordinate a variety of services for members including home health aides, homemakers, companions or nurses, set up an emergency response system or even arrange for meals. 

After paying a one time entrance fee, members pay a monthly fee that covers services that are necessary should the member become ill. 

If I want to move to a retirement community someday, when do I need to start looking? 
Moving to a CCRC is a lifestyle choice and is a major decision. It is a decision that takes time and planning. There are a wide variety of retirement options available, particularly in the Philadelphia area. Understanding these options and researching the many differences is a crucial step in making the right choice for your future. 
The decision to move to a CCRC should be made earlier than you may think. CCRCs are oriented to healthy and active seniors who are able to care for themselves. For this reason alone, you can't wait until health issues trigger a need to move out of the home. In addition, many of the area's retirement communities have long waiting lists of several years. The longest waiting lists are typically for specific apartments that may have a highly desirable view, easy access to community amenities, bright sunlight, and a lot of square footage. "We are seeing people in their early 60's beginning to look at communities to see if that is what they want for their future," explained Janet Thompson of Waverly Heights in Gladwyne "The move may be 10,15 or even 20 years away but they recognize the value of planning ahead and getting their name on a waiting list." 
Elaine Kaiser of Dunwoody Village in Newtown Square also suggests starting the planning process early. "Most people don't realize that they need to begin planning early and put their names on a waiting list so that when they are ready to move, their desired apartment will be available." Thompson adds that the investment to get on a waiting list is reasonable, less than $2,000 at most area communities, and puts you in a good position for the future. 

Can I afford to move to a CCRC?

First, it must be said that there is a vast array of housing options to suit a broad range of incomes. Some of the most upscale communities may have smaller studio apartments or shared rooms for those looking for a more affordable alternative. On the other hand, large two and three bedroom cottages with garages can be found. Just as there are many different types of accommodations to choose, there are also a wide variety costs and fee plans. Your individual financial situation and personal needs will determine which option is the most appropriate for you.

Comparing the costs of continuing care retirement communities (CCRCs) is tricky business. The majority of CCRCs in the region have entrance fees which vary based on the type of contract (all-inclusive versus fee-for-service), size of the apartment selected, and whether the entrance fee is refundable. Entrance fees can be fully refundable, partially refundable, non-refundable or refundable on a declining basis. In addition to the entrance fee, CCRCs charge a monthly fee which supports all of the utilities, services and amenities provided for residents. Monthly fees are based on the size of the apartment or cottage, number and frequency of services like meals, housekeeping, laundry and transportation that are included in the fee. Monthly fees also vary according to contract type and the level of care being provided. 

In order to determine whether you can afford a retirement community, start by making a list of all your current expenses. Be sure to include all of the expenses associated with the upkeep of your home including all utilities, rent or mortgage payments, taxes, and home maintenance costs like shoveling snow and cutting the grass. Moving to a retirement community will also save you a significant amount of money on groceries and dining out, housekeeping and laundry because retirement communities typically include these services in their monthly fees. In addition, a portion of your medical fees may be tax deductible in certain communities. Don't forget to consider the value of all the recreational amenities and activities provided by the community.

When you are considering whether a CCRC is an affordable option for you or a parent, remember to account for additional discretionary income needed for personal items and interests. As a general rule of thumb, financial officers like to see monthly incomes about one and one half times the monthly fees with assets sufficient to pay the entrance fee. Many seniors pay the entrance fee with the proceeds from the sale of their home. 

How can I make the move from my home to a retirement community easier?

Downsizing from a family home into a retirement community may seem like an overwhelming task. Once you have made the decision to move and have found the right retirement community, you may be faced with deciding what will come with you to your new apartment or cottage. For most, this means sorting through furnishings and memorabilia accumulated over years and years. Cleaning out the basement, attic, and garage can be time consuming and emotional. 

Many communities offer special programs and even move-in coordinators to help you through the moving process. These professionals can help you with everything from determining what furnishings will fit most comfortably in your new space to directing the movers. Martin's Run in Media, for example, provides free seminars focusing on tips to help sell your home and what to do with your extra stuff. Martin's Run Welcoming Committee, guided by residents, also makes the transition easier for new residents. New residents are introduced to Martin's Run residents with similar interests and are invited to dinner and activities with new friends to acclimate them to the community. 

There are also local companies like Resettlers, Inc., based in Wilmington, Delaware, that can organize every facet of the move. Companies like Resettlers can assist with packing, sorting, arranging the move, discarding unwanted items, and they can even set up your new home. 

TERMS
CCRC - Continuing Care Retirement Community 
A continuing care retirement community offers independent living and health care including personal care and skilled nursing care. Residents have access to health care services as their needs change. Services typically include meals, housekeeping, activities, transportation and future health care. CCRCs are licensed by the Pennsylvania Department of Insurance. 

Independent Living
Independent living is oriented to seniors who are healthy and active and who do not require assistance with activities of daily living. CCRCs as well as other types of retirement communities offer independent living in apartments and cottages and typically offer many hospitality type services along with community amenities.

Assisted Living 
In Pennsylvania, personal care homes provide assisted living. Seniors who need assistance with their daily activities but do not need nursing care on a daily basis are appropriate for this type of community. Mandated by law, these communities provide three meals daily, housekeeping services, and personal care assistance. 

Nursing Home
Nursing homes are appropriate for seniors who require skilled nursing care on a daily basis but do not need acute care in a hospital. 

Lifecare or All-inclusive Contracts
CCRCs may offer what is known as a lifecare or all-inclusive contract. An entrance fee or upfront fee is charged and guarantees that the resident's future health care needs will be met. This type of contract provides all necessary personal care and nursing care throughout a resident's lifetime for no additional fee. 

Fee-for-Service Contracts
CCRCs may offer a fee-for-service contract which means that a resident pays for only the services they need. A fee-for-service community may or may not have an entrance fee. If a resident requires health care in the future, they will pay a significantly higher fee. 

Who can I call for help?

A good starting place is your local Area Agency on Aging (AAA). The AAA's are the local representatives of the Pennsylvania Department on Aging. Each County has an AAA staffed with caseworkers who can assist you with questions regarding housing options, care facilities, community services available. In the greater Philadelphia area: 

Pennsylvania AAA's
Bucks County 215-348-0510
Chester County 610-344-6350
Delaware County 610-490-1300
Montgomery County 610-278-3601
Philadelphia County 215-765-9040

New Jersey
Burlington County 609-265-5069
Camden County 856-858-3220
Gloucester County 856-384-6910 
Mercer County 609-989-6662

What resources are available on the web?

Thanks to the boom in the dot.com industry, there are just about an endless number of websites to help you find helpful information and resources on retirement planning issues. Most retirement communities have websites of their own and some even offer virtual tours of their communities. Here's a brief listing:

aahsa.org American Association of Homes and Services for the Aging 
panpha.org Pennsylvania Association of Non-Profit Homes for the Aging
aarp.org American Association of Retired Persons
aging.state.pa.us.org Pennsylvania Department on Aging
alfa.org Assisted Living Federation of America 
alzheimers.org Alzheimers Association Disease Education and Referral Center and Services for the Elderly 
aoa.dhhs.gov Administration on Aging/ Information on Older Persons 
Caps4caregivers.org Children of Aging Parents
Caregiver.org Family Caregivers Alliance
Caregiving.org National Alliance for Caregiving
Caremanager.com National Association of Professional Geriatric Care Managers
Carepathways.com Care Pathways
Elderabusecenter.org National Center on Elder Abuse
eldercare.gov U.S. Administration on Aging/ Eldercare locator
Elderweb.com Elder Web
Estateplanninglinks.com Estate Planning Links 
newlifestyles.com New Lifestyles Magazine (directory of retirement communities)
retirement-living.com Guide to Retirement Living
Seniorlaw.com Senior Law Center
Seniorresource.com Senior Resources
seniorsites.com Senior Sites: Housing and Services for Seniors
state.nj.us/health New Jersey Department of Health and Senior Services