Conscious Aging: Living Arrangements as We Age

Whether or not I do anything about a retirement community any time soon — and it clearly isn’t going to be now — I’ve learned a lot by going around looking. There are different financial models. Some require a big upfront buy-in, part of which your estate gets back assuming the soundness of the underlying business model of the facility and whoever owns it — a big and often poorly documented assumption unless you really dig into the financials. Some require a smaller buy-in, and you get little or nothing back. Most offer a continuum of care, so you can go from independent living to assisted living to memory care or skilled nursing if and when you need it. There’s no necessary equivalence among the levels of care in any one facility. You might like the independent living part well enough, but find that the skilled nursing gets panned in reviews. But if you are part of the independent living community in a facility, there are likely financial incentives for you to get other levels of care there too.

My big conclusion, as I said in the previous post, is that you can’t outsource the uncertainties of aging, even if you have piles of money. All the promises depend on the financial stability of the place, which is hard to predict over time and actually hard to model. It’s not that easy to predict with a high degree of reliability how many people will live a long time and need complex and expensive care, creating a drain on the system. Therefore it’s hard to make accurate financial projections.

We’ve seen that unpredictability with the long term care market, where policies were initially underpriced relative to the actual risk. People who pay annually find their premiums going up at a much faster rate than anticipated.

Another big conclusion: most of the day to day care, if you need it, is provided by low-wage, possibly undocumented workers who, no matter how kind and compassionate they are, have far too many vulnerable people to care for and far too little time in which to do it. With Trump’ immigration crackdown, that problem will get worse.

On a more personal level, should you go into a facility like this sooner rather than later, when you can take advantage of all the things that are offered? Or, will you tire of the same relatively small group of active people over time, and age faster because you are surrounded by people mostly older than you?

Is it inspiring to see aging people surmount their infirmities and continue to lead fulfilling lives? Or is it depressing to go to dinner when half the room is using canes, walkers, or trailing oxygen?

I think it’s hard to know the answers.

Tomorrow: deciding what you really want.

12 thoughts on “Conscious Aging: Living Arrangements as We Age

  1. Helpful info. I’ve always primarily considered the quality of care, and less the financial stability of the institution.

  2. This is turning in to a fascinating and thought provoking series. I am taking notes for discussion in the future.

  3. What to do when aging is an important issue that is often poorly planned. Last week we went to a conference in Florida We spent a few extra days to visit friends that have retired to Florida. Three couples lived in 55+ communities. One was luxurious, but private homes are $1M+. Another private home was beautiful but in he middle of nowhere, and another in a community of 7,500 apartments with lots of activities. As you said, more than half the population was very elderly. However, at the Latin dance, most were out on the dance floor. If ourdoors and participative activities are a measure of quality of life, there’s is pretty good. My Mom, on the other hand, lives in her home of 64 years in NYC with a live in “assistant” but only gets out to church. Some who move to Florida end up returning to their hometown or other northern city to be near children when their health fails.

    We don’t know what we’ll do. Our kids live near us. But, we sure are sick of the winters.

  4. for Phyllis: Everything about quality of care over time depends on the financial stability of the organization, AND on the ability to hire enough help. Have to look harder at the financials than at the activity list in the glossy brochures. Re the help, Trump’s immigration policies are going to hurt, without a doubt.

  5. for Ada: I’m learning more and more about the business of elder living — which is based on a lot of financial assumptions. My personal conclusion, that you can’t outsource the uncertainties of aging no matter what the facility promises about continuum of care, doesn’t say what you CAN do. Not sure about that yet.

  6. for Katie: I get being sick of winters. New York gets pretty cold. I think being near someone who can advocate for you and pitch in to help in a crisis is pretty important, be that family or good friends. Beyond that, I’m just learning about the underpinnings of this 55+ industry. Lots of financial and actuarial assumptions are being made in order to advertise promises that may or may not be able to be kept.

  7. Look forward to the continuing posts on this topic. We have friends who have started the looking process. Money no problem but I was amazed when he told me some of the many options these places offer. E.G. down payment money goes to your estate when you die; facility gets it all to begin with, etc. Lots of other things – too many for a post. But I’ve decided it is very complicated, a maze!

  8. We looked at 3 Continuing Care Communities on Long Island & in the Binghamton area. One issue was that none of them accepted payment from our Long Term Care Insurance if at some point we needed skilled nursing care. We’ve had the insurance for 22 yrs. & would lose that investment if we bought in.

    Our friends who live in a CCC, say that the different age groups – 60’s, 70’s, 80’s 90’s, – tend to “hang out” with similarly aged folks & they did not feel they were in a elderly “ghetto”. Especially, if you still drive & are engaged in the surrounding town’s cultural & civic activities.

  9. for Ada: Tomorrow, I’ll try to make it simpler. If you start by looking at all of them as self-insured health care pools, that gives a framework for evaluating the risks.

  10. for Eileen: That’s really interesting. I wonder why the facility would care where the money came from if you needed skilled care? I have Long Term Care insurance too, so in a sense the facilities that offer reduced fee skilled nursing care in exchange for the big upfront payment have you doubling up unnecessarily on protection. God, isn’t it weird that we’re talking about things like this? It is to me.

  11. I, too, was really surprised by the long term care thing. We have had that for many years. Kodak offered it before Bob retired (in 1993) so we think in late eighties, and we took it. It was with Met Life, so even after Kodak went belly up and we lost our retirees’ health care and survivor’s benefit insurance, the long term care was not affected. But that is certainly something we will keep in mind when we get to the looking stage.

  12. for Ada: If you have decent long term care insurance, you and Bob have already pooled your future costs of needing skilled nursing care with a much larger base of elders than you’d find in a CCRC. Instead of double coverage, the best option might be to find a place where you can put down as little as possible in terms of entry fee, write that off, and trust that your own insurance will cover your costs at the facility of your choice if and when skilled nursing is needed.

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