The CCRC concept is an ageist nightmare -- and it’s not just the name

I've visited CCRCs and have friends who live in them. Reading the NYT article, it doesn't surprise me that not only facilities, but also residents can get very petty on who's invited to activities, trying to block a fellow resident who now is in skilled nursing. Seems like some education is needed. Better yet, a better housing model is needed.

Laurie,

As you know, I have long been a huge fan of your work but I think your recent blog, "The CCRC concept is an ageist nightmare -- and it’s not just the name" is a bit lopsided. As someone who has spent the last 25 years of my career working with seniors and the dedicated staff of continuing care communities across the country, I have seen thousands that have benefited from this incredible product. I also saw my parents live some wonderful years at Erickson's Charlestown retirement community. Their community helped them age and die with dignity and grace. I should point out that they moved in when they were still relatively young and healthy. Funny thing happened, they didn't just "bare" their time there, they actually enjoyed it. I think this article by Frederick Funkul sums it up very nicely: http://www.washingtonpost.com/news/local/wp/2015/03/05/aging-in-place-co.... It's all about choice. Yes, there are some examples of bad human behavior, including ageism, at some of the communities. But I would argue far less than in the world at large. I don't think anyone ever wakes up and goes, "Yahoo! Today's the day I am going to move to a CCRC!" Facing one's own mortality is never fun and to a large degree, that what this move is all about. But I think you are overlooking perhaps the most important element of CCRCs, no, it's not the services, amenities, and health care. Humans are by design social animals ... and CCRCs make being truly social much, much, easier. If you look at the 7 dimensions of wellness, as laid out by the International Council of Active Aging, CCRCs are uniquely qualified to help seniors achieve all 7 dimensions. As my Dad said when my parents decided to move in to their CCRC, "It's the right place, for the right time." Can CCRCs be improved? Absolutely. But let's not throw the baby out with the bath water. I think the thousands of smart, able-minded and healthy, active, independent planners who make this move every year have made an excellent decision. Warmest regards, Tom

PS I loved your article on the new innovations in hearing technology. I even went so far as to buy the SoundHawk which I absolutely love! In 2007, I suffered from sudden sensorineural hearing loss in my right ear. My standard (and very expensive) hearing aid never did much for me BUT this new tool rocks! Particularly good for crowded restaurants and for TV viewing. I highly recommend it.

Thank you for the article about the age-ist nightmare that is the Continuing Care Retirement Community model of senior living and services. Friends and loved ones reside in a CCRC that practices the systematic age-ism and discrimination described below. Changing the name from CCRC to something else is not sufficient to erase the stench of age-ism. (As Shakespeare said, 'A rose by any other name....' ) I would note that the very real phenomenon of "transfer trauma" makes it unwise for some elders to relocate AGAIN after they discover how poorly "reality" matches the "expectation" of CCRC living.

FYI this CCRC's licensed units are in a section called the "health center."

1) No health center resident has an internal mail slot, thus CCRC residents who occupy health center units are instantly excluded from what might have become a years-long familiar and social exchange of notices, notes, cards, committee minutes, and personal communications with neighbors in the retirement community.

2) The systematic exclusion of health center residents from having internal mail slots is exacerbated by the fact that nothing in the mailroom informs independent living residents of any other means to continue to include a health center resident in the ordinary flow of communication that is conducted through internal mail slots.

3) CCRC residents pay for transportation as part of the monthly fee. Despite Federal and State regulations protecting the rights of long term care residents to receive care and services consistent with individualized assessments and care plans, the CCRC prohibits health center residents from using the transportation they are paying for unless they also pay for an aide for a minimum of 3 or 4 hours. This even applies to residents who have been assessed as being able to safely use the transportation for a round trip to a physician appointment or a pharmacy. Because the operator receives Federal funds in the form of Medicare reimbursements, it could also be argued that the operator is violating Section 504 of the Civil Rights Act. The operator refuses to adopt a policy of permitting residents to access the transportation consistent with a qualified individualized functional assessment, until a regulatory enforcement action, or court action, requires them to do so. As it is, the transportation "included in the monthly service fee" costs about $120 per trip if a CCRC resident occupies a health center unit. Of course this is not disclosed in advance to depositors.

4) The glossy monthly newsletter and calendar of events is delivered only to independent living residents, keeping health center residents from knowing about clubs, committees, entertainment and other opportunities that they might want to have written into their individualized care plans. Six years after opening, in response to repeated complaints, the CCRC began delivering "a stack" of newsletters to the "health center," but it is still no staff member's job to deliver one to each health center resident or to a legal representative (and the absence of internal mail slots makes it difficult-to-impossible to include health center residents in the individualized distribution of newsletters). It does seem as though this CCRC wants to make sure that independent living residents are able to move through life neither seeing, nor keeping company with, health center residents.

5) The CCRC contract says that all occupants of independent living units AND health center units are members of the "Resident Association." Despite this, the operator provided a set of "Resident Council by-laws" that excludes health center residents from having access to any voting member of the Resident Council. That exclusion remains today, because of the exclusionary bullying practiced voluntarily by the Resident Council members who have the authority to change the by-laws, but who choose, instead, to continue to exclude health center residents from having access to a voting member of the resident council. Because health center residents (and their legal representatives) have no access to a voting member of the CCRC resident council, the resident council has no means to include the health center residents' complaints and questions in each month's list for the provider, requiring (per the by-laws) responses at the following meeting.

6) Residents who use wheelchairs are bullied by residents who do not use wheelchairs. A man who uses a wheelchair, and his wife, took a wheechair-designated spot, and the adjacent chair, to hear a musical performance. Before the entertainment started, the man using the wheelchair, and his wife, were bullied out of the room, with no intervention by staff, by a chorus of "we can't see over him" by residents who had later taken seats behind the spot that was open for the wheelchair.

7) A man who used a physician-ordered power wheelchair was illegally prevented from using it by the State-licensed administrator who told him the power wheelchair would not be permitted in the health center, where the man was having a temporary rehab stay for daily PT and OT after an illness. Medicare paid the facility handsomely for daily skilled therapy that did the man little good, since the licensed administrator prohibited the licensed therapists and the Medicare beneficiary from using the physician-ordered assistive device during daily therapy.

A high-stakes and carefully-rigged Bingo game is, indeed, an apt metaphor for the age-ist practices of CCRC living. My experience on the sidelines of the game have turned me into an activist for CCRC resident rights.