Conscious Aging: Approaching the Retirement Community Decision Part One

I’m quite new to this question, so take my level of expertise with a grain of salt. But here’s how I’m approaching this possibility going forward:

What am I most hoping to gain in a CCRC, or facility with similar acronym?

If the goal is security and predictability no matter what turns my physical or cognitive health takes, that goal is probably an illusion. CCRC’s are a tricky business, with lots of pitfalls. To get in on any favorable terms, you need to be healthy and have stable finances. But how long and how intensively the facility will have to provide you and fellow residents with care is based on actuarial assumptions, and priced accordingly. Assumptions are just that: assumptions. If they are off by a little or a lot, places like this can and do go bankrupt. Short of that, a contract is only as good as the ability of the facility and its owner to deliver the goods. If the owners come to you and say, “Look, we can’t give you what we promised and what you thought you were paying for. We can give you X. Or, we can file for bankruptcy and you take your chances with other creditors”, you’re likely to accept a reduction in amenities and service as the best of two bad options. There are several points in the operation of a CCRC that are difficult financially, such as the shift from taking outside patients into skilled nursing at market rates — which happens in the early years of a facility — to filling all the beds with insiders who, contractually, get a much lower rate. Skilled nursing care isn’t going down in cost, it’s going up. How do the financial projections propose to pay for that shift?

As I said in an earlier post, CCRC’s and the like kind of facility are basically self-insured health care pools, with a very small N on which to base the projected shared burden. If  you have long term care insurance, you’ve already joined a pool with a much larger N. If not and you have the assets to self-insure, great. If neither of those are true, you probably don’t have the balance sheet to get into one of these places anyway.

Maybe we have to give up on the  notion that we can ever construct predictability and certainty into life, even as we age and feel more vulnerable and wish we could.

Tomorrow: What if the primary goal is social?

4 thoughts on “Conscious Aging: Approaching the Retirement Community Decision Part One

  1. There are other options for care for the elderly. My Mom will be 91. She’s lived alone for four years since my dad died. She drove until last July when she fell at home and cracked her pelvis. Another for two months later center nearly off the proverbial cliff. After two months in my home recuperating, I moved her back to her home with a live-in help. Of course she would like to go back to the way she was, but she knows that’s not physically possible. Staying in her own home has given her life that she wants and having a living has an able to stay there safely. She calls the living her “assistant“. The Roll or reminds me of that of the ladies maid in Downton Abby. Continuity with the caregiver is better for the elderly. Having help does require resources that many. Can’t afford. For those without the resources there often forced to go to a nursing home, not an option I’d like for myself or my mother.

  2. Another suggestion for dealing with finances and care systems during aging is to get a good elder care lawyer. A friend who is in her late 70’s is very arthritic and has trouble with cooking, cleaning, shopping, etc. but otherwise was not ready for assisted living. An EC lawyer helped her get funds from her long-term care insurance to get a home assistant for X hours per week. Initially the insurance said no, but the lawyer persisted and they found a way to make it happen. For those less versed in financial matters or in negotiating with care systems, someone like this can be helpful.

  3. for Katie: I think your mother’s situation is great. My mother lived in independent living until she died at age 92, with help coming in and out — mostly out, as she gave them a hard time and they tended to quit. But you’re right, most of us would rather stay in our own homes as long as possible, with a consistent caregiver if needed.

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