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The WSJ offers bad advice – move into a CCRC sooner vs. later

The Wall Street Journal offers advice to well-to-do older adults.  This time the advice comes from Glenn Ruffenach, a frequent writer for the WSJ retirement section.  The query comes from a healthy couple in their early 70s who wonder if it is time to move into a CCRC (Continuing Care Retirement Community). They hesitate, observing that the residents seem decidedly older. A good observation – they are!  Glenn says to move now, rather than wait. Really? For people in their early 70s? The median age of move-in to CCRCs is climbing – noted as of 2016 to be age 81 – and the residents’ average age is now 85.  The CCRC has been a buy-in offering combining independent living homes, assisted living and skilled nursing facility (SNFs). Many faith-based non-profits are structured that way. But the nation’s largest for-profit firm, Brookdale, offers a ‘rental’ model -- Caring.com’s 2017 description – why? People are deferring the move. In 2016, CCRC occupancy has reached 90% in only one quarter

The CCRC conundrum and WSJ advice sounds like the LTC insurance dilemma. The CCRC rationale -- hedge against changes in future needs (independent to memory care). Hedge against future costs (average price increase for assisted living rose 2% in the past five years). Hedge against change in circumstances (from married to widowed, for example.)   So it sounds practical and smart to plan for the future – and insurers thought so too, selling long-term care insurance policies to people in their 50s.  See what happened to the crumbling long-term care insurance market and the consumer’s experience -- hedging in your 50s against future risk in your 80s or 90s. Every life expectancy assumption was wrong, many insurers left or are leaving the market, and some consumers wish they still had their money from all of those recently quadrupled premiums.  

So should the reader listen to WSJ and buy something 14 years before it is needed? If the real need doesn't arise until the mid-80s, why advise people to buy in their early 70s?  Are there no other options?  Here are six that he did not mention.  1) Sell the house and move to a 55+ community. 2) Sell the house and move to an rental assisted living community at age 81-85. 3) Work together to form a NORC.  4) When needed, ask adult children for an in-law apartment or buy a home that has one and move with them. 5) Form a village that coordinates home care, transportation and food delivery options near the current home. 6) Consider co-housing options – now there is even an association of them!  

WSJ: the CCRC is a place, not an investment strategy.  And moving there doesn’t even imply just one place – consider the scenario of a couple moving into a shared apartment -- later the wife must move into the locked memory care unit, another place. Or both to assisted living in another part of the campus – that counts as another place – mroe downsizing and moving yet again.  Perhaps this is appreciated up front. Iif a couple has substantial financial assets, wants what a CCRC is offering – and recognizes themselves there when visiting.  But like long-term care insurance, there may be a mismatch between what’s been built and what people really need when they move in.  And assisted living (with memory care units) is similarly opaque. There is no nationwide regulation of either CCRCs or assisted living. Practices and services such as restricted access to dining rooms may be poorly understood at time of move-in, and many residents in assisted living sections of CCRCs may already have some form of dementia

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Comments

Planning for the future based on the way things work today doesn't make sense. If there are going to be enough resources for us to take care of ourselves and each other as we get older it will be because we have used technology to get rid of the inefficiencies in our medical and general consumption systems, and amplified the abilities of care laborers and other carers to make them more productive. We have no choice.  Localizing and aggregating demand to achieve economies of scale labor cost reductions will no longer require brick and mortar CCRCs and giving up personal choice and freedom.  You might want to consider a getting a smaller smaller place with a larger bathroom, and getting rid of at least one of your cars so you will have more money for the devices and machines you will really want.   

  

We have been in our place for 18 months and we like it.  We are mid-70s and are younger than most, but it is kind of nice to be the kids. We moved from out of town because our daughter and grandchildren live here. We are happy that we don't have to depend on them for sociability--we have good friends here, mostly in their 80s and 90s, which doesn't make them less interesting. We participate in Lots of activities, formal and informal, but we also value having quite a private apartment. 

Here at least, most residents who move to assisted living or even skilled nursing keep up their friendships and activities, so long as they are physically and mentally capable.

Of course a spouse becoming weak or ill is a problem, and dying is a disaster, but no more so than when living in a house--probably being in a CCRC would make it easier to cope.

Certainly it is important to find out if a place will suit you, and in particular whether its assisted living is at least as good as the nearby stand-alone places. But for many people I think a CCRC is a better deal than hanging on at home too long.

I was happy to read that, "Here at least, most residents who move to assisted living or even skilled nursing keep up their friendships and activities, so long as they are physically and mentally capable," and first wondered where you were. But, that's not necessarily going to help me.

I would love to know a resource where I could find out how CCRCs are run, including such details as how residents fare if / after they become unable to take care of themselves.

Does such a website exist? Is there a relevant page on this site?

It would be useful to know the median age of people moving into CCRCs. Average is interesting, but not as useful for conveying the whole picture. Thanks!

Per December, 2016 article and a referenced survey by Love & Company.

A big problem with CCRCs is the low quality of care that can be offered at the stage in your life when you really need help. My parents were staying at a very fine CCRC and were happy there until they became unable to take care of themselves and were moved into the "Health Center." where their basic needs, such as meals and medications were well handled. However, they were ignored most of the time, including when they needed to use the toilet, and developed recurring urinary tract infections. They were frequently sent to the hospital, and returned to more of the same at the CCRC. One time I happened to be there when my father was taken to the bathroom by a nurse who closed the door and began to scream at him, including repeated shouting that he had to stand up, when he was physically unable to. I was shocked and reported that nurse, but it left me wondering how often that sort of behavior was occurring unnoticed. I did hire additional help, but it had to be through the CCRC, and was still not enough or satisfactory. In the end, I was paying at least $10,000 per month for inadequate care.

It was very disheartening, and left me not just angry, but frightened about my own future.

 

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