What Do We Do About Mom and Dad
The newspapers, radio and television are constantly filled with the news about the baby boom generation aging into a social monolith driving everything from tax policy to consumer preferences and technology.
According to the Federal Interagency Forum of Aging, in 2003, nearly 36 million people age 65 and over lived in the United States, accounting for just over 12 percent of the total population. Between 1900 and 1999, the older population grew from 3 million to 35 million. Those age 85 and over grew from 100,000 to 4.2 million.
The Baby Boomers - those born between 1946 and 1964 - will start turning 65 in 2011, and the number of people over sixty five will increase dramatically during the 2010-2030 period. By 2030, in three short decades, the population of those past retirement age will double, representing nearly 20 percent of the total U.S. population.
There are many implications both macro and micro of this wave of retirees. Our focus in this series will be on the personal side of the spectrum. Examining the options for living well in the years beyond 65.
Whether you are desperately trying to figure out what to do about Mom and Dad or beginning to make your own plans for the future, there is no question that understanding the choices and making plans well ahead of time can prevent a great deal of heartache for you and those you love.
In this, the first of a four part series on retirement, Heart of New Hampshire surveys the landscape, looks at the range of choices available for Seniors in New Hampshire (and in a few cases elsewhere) as well as some of the things that those, who are still years away from retirement, should be doing to plan for the future.
We also take a look at the first and most often chosen option, remaining at home.
Lets face it, getting old is no picnic. If you have the luxury of time, don’t waste it. Use some of it to do the planning necessary to sustain your quality of life; or, if you are helping Mom and Dad with planning, to sustain their quality of life.
Alas, for many folks, the luxury of time does not exist. The luxury of planning time has given way to a growing sense of urgency regarding what to do about Mom and Dad. In the fall issue we’ll explore what we call the “finger in the dyke” options.
Surveying the Landscape
Making plans for yourself or Mom and Dad involves making living choices, financial choices and lifestyle choices. In this first part of our series we take a generalized look at the landscape as well as the choice of living at home.
Living Choices
Living choices for seniors are determined by the health and lifestyle needs of the individual; the urgency of the need for medical care; and, of course, the financial resources available to the individuals. In most cases, those who have just reached retirement age have lots of choices. Few of those choices, with the exception of continuing care communities (also known as “life care communities”) offer a permanent solution. As the individual or individuals age these choices begin to dwindle.
Remaining at Home
Still the most preferred choice for seniors, remaining at home can be a comfortable and humane choice for mom and dad. However it is not without its drawbacks. Planning for the future is critical if this option is not to evolve into a family crisis.
Changing Places
Perhaps moving mom and dad closer will help. Often family members will take it upon themselves to encourage mom and dad to move into an apartment attached to their own home or to a new residence nearby. If accompanied by long term planning this can be a fruitful approach. Without planning, it is a temporary fix that will likely evolve into a stressful problem.
The Bi-National and Bi-State Approach
For active seniors examining a living approach that involves two residences is a lifestyle choice with financial implications. For years NH’s snowbirds have chosen Florida or Arizona or similar places for their residence in the winter months. A growing number of seniors are moving part or full time to countries where the cost of living allows them a higher standard of living on a limited income. Both of these choices are interesting and viable options for seniors but in most cases still leave unanswered the larger question of what to do when medical needs necessitate a higher level of care.
Planned Retirement Communities
A retirement community is a very broad, generic term that covers many varieties of housing for retirees and seniors. Often they are age restricted. These communities are generally recognized to have three distinct types:
- Active Communities generally do not have self-contained healthcare services and rely on the available services of the broader community in which they are located. They may be housing and recreation developments geared to, or restricted to, retirees. They may also be communities where senior choose to live for the social opportunities and convenience of support services. One example of this is the Pleasant View Retirement Community in Concord. Pleasant View Retirement supports a philosophy of “aging in place” and collaborates with Concord Regional Visiting Nurse Association to assure residents are safely maintaining their independence. Pleasant View is a part of the Genesis Healthcare system. While geared to active seniors, should the need arise, residents are given priority access to Genesis HealthCare’s assisted living, skilled and intermediate care facilities. Pleasant View Retirement is a rental retirement community and does not require an entrance fee.
- Active/Supportive Communities
The only choice that provides a full compliment of care for seniors, these communities combine the active living style with healthcare facilities to create a continuum of services and care for those active and those needing a higher level of medical services. These kinds of communities are also referred to variously as “continuing care retirement communities” and “Life Care Communities”. One of the best examples of this kind of community in New Hampshire is Riverwoods at Exeter. RiverWoods at Exeter is a vibrant, self-contained, not-for-profit life care community with easy access to all the charms of New Hampshire and New England. Conceived by a grassroots group of seacoast area residents, RiverWoods opened in 1994 and operates on the belief that growing older should enhance, not diminish, the opportunity for a productive and rewarding life. Here, folks enjoy life to the fullest in an inspiring setting with people who share their interests and way of thinking.
As a Life Care Community, RiverWoods provides essential protection for residents’ personal and financial well-being. Nestled on two campuses within more than 200 wooded acres on the banks of the Exeter River, RiverWoods offers gracious living, four on-site dining rooms, a full range of social, educational, and cultural activities - planned and executed by a committee of residents. RiverWoods starts out with independent living but if the time comes they also provide unlimited access to on-site assisted living, and 24-hour nursing care. At RiverWoods, residents select one of 30 floor plans that include studios, one bedroom, one bedroom with den, two-bedroom apartment homes, or spacious cottage homes. However, unlike their past residence housekeeping, mowing the lawn and shoveling snow become the responsibility of the community.
These communities typically require an entrance fee up front and most also charge ongoing monthly fees as well. However they range widely and those who are examining this for mom and dad or themselves should be aware of the cost. RiverWoods, for example, charges both but 90% of the entrance fee is refundable to the resident or their estate. In many cases the fee at other facilities is not refundable.
- Supportive Communities are those designed around healthcare issues usually referred to as assisted living, specialty care and nursing care. These kinds of communities may or may not offer a continuum of care. They may also specialize in – or have a unit directed toward – specialized needs such as Alzheimer’s care. Assisted Living usually refers to a non-medical facility that is used by people who are not able to live on their own, but do not need the level of continuous nursing care that a nursing home provides. Assisted living may come in the form of a shared residence or the more popular alternative where individuals or couples have their own private apartment. In an assisted living facility, there is usually no special medical monitoring equipment, nor 24-hour nursing staff, though these things are often available within the broader facility. In all cases, however, trained staff are on-site around the clock to provide other needed services. A typical assisted living facility resident might be a man in his mid 70's who does not need the high level medical care of a nursing home but prefers more companionship and needs some assistance in day to day living. One of the great advantages of assisted living is the socialization aspect. Individuals have the opportunity to gather regularly for meals and activities thus reducing the isolation that elderly, disabled or handicapped people often feel when living alone. Assisted living facilities are designed with an emphasis on ease of use by disabled people. Bathrooms and kitchens are designed with wheelchairs and walkers in mind. Hallways and doors are extra-wide to accommodate wheelchairs. These facilities are by law fully compliant with the Americans with Disabilities Act of 1990.
Woodcrest Village is one example of an assisted living community. Woodcrest Village in New London was opened by the Brenner family as a 12-room assisted living residence in 1988. Originally built in 1850, their building is listed on the National Registrar of Historic Landmarks. Sparked by the personal need of an elderly family member, the Brenner’s founded Woodcrest on the premise that personal care and services in a warm and residential setting could provide greater independence, individuality and self-esteem. Gradually Woodcrest evolved into a care community with 44 apartments and a specialty unit, known as “The Courtyard” for individuals with Alzheimer’s and dementia as well as a need for more personalized health and wellness assistance in a more intimate setting. Woodcrest does not provide for the highest levels of medical need, those individuals, as with all strictly assisted living facilities, must then be placed in a skilled nursing facility.
Another, somewhat different, example of such a community is Granite Ledges in Concord. Granite Ledges of Concord is an assisted living residence offering seniors personal care and household services in the privacy of their own apartments and in affiliation with Concord Hospital right next door. Residents maintain their relationship with their personal physician but are assisted in that relationship by a Resident Care Director who acts as a liaison with the medical community and advocate for their residents for the medical services they require. Granite Ledges also has an Alzheimer’s unit.
In the fall issue we will be looking at many of the choices in NH for all of these types of retirement communities.
- Skilled Nursing Facility – Nursing Homes
When an individual requires around the clock care, including access to 24 hour clinical licensed nursing care a Skilled Nursing Care Facility or Nursing Home is the only alternative to all but those who can afford that service privately.
A nursing home or skilled nursing facility is a place of residence for people who require constant nursing care. Nursing homes are required to have a licensed nurse on duty 24 hours a day, and during at least one shift each day, one of those nurses must be a Registered Nurse.
It is important to note that not all Skilled Nursing Facilities are required to take individuals who cannot afford the monthly cost. If you expect that your parent will run out of money you will want to ascertain whether a SNF takes Medicaid patients.
Financial Choices and Options
While we will address financial options in greater depth in the Winter issue it is clear that none of the living options outlined above can be made in a vacuum. Careful financial planning is always a part of the formula for determining what the best option for mom and dad is under the circumstances.
Resources
RiverWoods at Exeter
7 RiverWoods Drive · Exeter, NH 03833 · 603.772.4700
800.688.9663 · www.riverwoodsrc.org
Woodcrest Village
141 Main St · New London, New Hampshire 03257
603.526.2300 · www.woodcrestvillage.com
Granite Ledges of Concord
151 Langly Parkway · Concord, NH 03301
603.224.0777 · www.graniteledges.com
Pleasant View Retirement
227 Pleasant Street · Concord, New Hampshire 03301
603.225.3970 · www.pleasantviewretirement.com
U.S. Administration on Aging
Information on senior services
1.800.677.1116 · www.eldercare.gov
Medicare Long Term Care Information
http://www.medicare.gov/LongTermCare/Static/Home.asp
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