C.C.R.C. Fees: Prepare to Be Bewildered (NYT)

By PAULA SPAN

With most varieties of senior housing, families looking for a rough idea of costs can turn to a number of sources.
The Metlife Mature Market Institute, for instance, publishes annual studies of nationwide and local averages for assisted living, nursing homes, home care and adult day services. So you can see that a one-bedroom assisted living apartment runs a relatively economical $2,595 a month in Phoenix and averages a daunting $4,034 in Boston.
Genworth Financial provides a similar array of data annually, including handy maps showing local costs.
But when it comes to the continuing care retirement communities (or C.C.R.C’s) I’ve been posting about lately, there’s no comparable repository of current information.
C.C.R.C.’s, remember, allow residents to transfer from independent living apartments to assisted living to a nursing home, all on the same campus or in the same building, as their needs increase (though in the event, they seem as reluctant as other seniors to actually move ). “Yes, being able to take that burden off your kids is wonderful,” reader Alice Payne commented. “But I suspect that the costs are going to prohibit most from taking advantage of such care.”
To which I can only reply, after many phone calls: That all depends. The reason it’s hard to know what a C.C.R.C. costs is that price tags vary enormously, reflecting not only regional costs of living and amenity levels (communities range from modest to superposh) but contract types. Unlike assisted living facilities or nursing homes, C.C.R.C.’s around the country — there are about 1,900, after a period of growth largely squelched by the recession — offer fundamentally different products.
In what’s called a Type A community, for instance, new residents pay an entrance or buy-in fee, plus a monthly fee; in exchange, they’re guaranteed that same monthly rate, although adjusted for inflation, even when they move to higher levels of care. In the classic early C.C.R.C. model, the appeal is that lifetime costs remain predictable. You’re essentially buying a form of long-term care insurance.
Then came Type B communities, where the monthly fees (also inflation-adjusted) rise as you move from independent living to the pricier units. Typically, you’re entitled to free care in assisted living or the nursing home for a specified number of days, after which the higher fees kick in. Entrance and initial monthly fees run somewhat lower, however.
Less common is Type C, where after the entrance fee, you pay as you go, at market prices, for whatever level of care you need.
To muddy the picture further, C.C.R.C.’s have different policies about refunding entrance fees to the resident or his estate if he leaves or dies. And there can be hefty tax deductions, depending on the nature of the contract. And you can select independent living quarters ranging from studios in apartment buildings to freestanding three-bedroom “villas” with decks and gardens. The monthly fees typically include meal plans, utilities, housekeeping, maintenance, transportation and activities.
At the moment, moreover, since seniors are having trouble selling their houses to finance a move, some C.C.R.C.’s are reducing or deferring entrance fees, offering upgrades in their apartments, discounting monthly charges, or offering free appraisals and house-staging services.
Small wonder no one has attempted to compile this welter of confusing information in a publication or chart. The best I can do for Ms. Payne and other readers wondering about prices is to give a few examples from C.C.R.C.’s around the country — and advise that if you’re considering this option for your parents or yourself, you’ll want to visit several communities, amass a lot of information, and then sit down with an accountant and a lawyer.
Like more than 80 percent of C.C.R.C.’s, these examples are all non-profits. I’ve included just some of the variety of apartments and villas, and rounded off their prices. Note that these are prices for a single person; communities charge higher entrance fees, or monthly fees, or both for additional residents in an apartment.
(Mary’s Woods, by the way, is the community that Greg and Evelyn Hadley, featured in a recent post, happily call home.)

Granite Farms Estates; Media, Pa.

Type A contract
Independent Living

• Studio: Entrance fee, $97,000. Monthly fee, $1,800.
• One bedroom: Entrance fee, $153,000. Monthly fee, $2,000.
• Two bedrooms, one bath: Entrance fee, $204,000. Monthly fee, $2,300.

The prices for assisted living and skilled nursing will remain the same, adjusted for inflation.

Friendship Village West; Chesterfield, Mo.

Type A contract

Independent Living

• Studio: Entrance fee, $43,000. Monthly fee, $1,400.
• One bedroom: Entrance fee, $108,000. Monthly fee, $2,000.
• Two- or three-bedroom villa: Entrance fee, $262,000 to $306,000. Monthly fee, $2,600 to $2,900.

The prices for assisted living and skilled nursing will remain the same, adjusted for inflation.

Mary’s Woods; Lake Oswego, Ore.

Type B contract
Independent Living

• One bedroom: Entrance fee, $210,000. Monthly fee, $1,900.
• Two bedrooms, two baths: Entrance fee $315,000. Monthly fee, $2,700
• Three-bedroom villa: Entrance fee, $496,000. Monthly fee, $4,700.

Assisted Living

• One-bedroom apartment: $160 to $248 a day, depending on care needed.

Skilled nursing or dementia care: $218 a day

Abbey Delray South; Delray Beach, Fla.

Type A contract
Independent Living

• Studio: Entrance fee, $88,000. Monthly fee, $1,800.
• One bedroom: Entrance fee, $136,000. Monthly fee, $2,200.
• Two bedrooms, two baths: Entrance fee: $168,000. Monthly fee, $2,395.

Prices for “assistance in living,” personal care provided in the resident’s apartment, and skilled nursing will remain the same, adjusted for inflation.
Paula Span is the author of “When the Time Comes: Families with Aging Parents Share Their Struggles and Solutions” (Grand Central).

Ley Habilitadora para implantar el Plan de Alerta SILVER

Título :	Plan de Alerta SILVER, Ley Habilitadora para implantar el
Fecha :	26-oct-09
Cita :	2009LPR132
Plan de Alerta SILVER, Ley Habilitadora para implantar el Ley Núm. 132 de 26 de octubre de 2009 (P. del S. 513) Para establecer la "Ley Habilitadora para implantar el Plan de Alerta SILVER", activar este sistema SILVER en la jurisdicción de Puerto Rico, a los fines de ayudar a proteger a las personas que padecen de impedimento cognoscitivo; establecer las facultades y deberes de las entidades gubernamentales; para añadir un nuevo inciso (t), y reenumerar los subsiguientes, en el Artículo 2, y enmendar el inciso (n) del Artículo 5 de la Ley Núm. 53 de 10 de junio de 1996, según enmendada, conocida como la "Ley de la Policía de Puerto Rico" a los fines de atemperarla con lo aquí dispuesto; y para otros fines. EXPOSICION DE MOTIVOS En Puerto Rico de una población de unas 500,000 personas mayores de 65 años, alrededor de 70,000 tienen diagnóstico de Alzheimer, para un 14%, según datos de la Oficina del Procurador de las Personas de Edad Avanzada. El Alzheimer es una enfermedad neurodegenerativa, que se manifiesta como deterioro cognitivo y trastornos conductuales. Se caracteriza en su forma típica por una pérdida progresiva de la memoria y de otras capacidades mentales, a medida que las células nerviosas o neuronas mueren y diferentes zonas del cerebro se atrofian. Datos del Censo indican que en los próximos 10 a 20 años la mayoría de la población de Puerto Rico será mayor de 60 años de edad lo que requerirá un esfuerzo mayor para ofrecerle y garantizarle los derechos a una vida plena y digna. En 1999 se estableció en Puerto Rico un Registro de casos de Alzheimer en Puerto Rico, a través de la Ley Núm. 237 de 15 de agosto de 1999. Dicho Registro lo administra el Departamento de Salud, y les impone a los médicos que practiquen su profesión en Puerto Rico y que diagnostiquen o tengan conocimiento de algún caso de la enfermedad de Alzheimer y así informarlo al Departamento de Salud. Una vez este registro esté funcionando a su capacidad, las estadísticas que de éste se deriven serán de mucha utilidad en futuros estudios, para tratamiento y prevención de la enfermedad. El Plan de Alerta SILVER está siendo implantando en varios Estados, siguiendo como modelo el Plan de Alerta AMBER, para menores desaparecidos, ambos programas tienen como objetivo difundir información rápida sobre niños (en el caso de AMBER) y sobre adultos mayores de 60 años con condiciones de Alzheimer u otras formas de demencia. Estados como Colorado, Florida, Georgia, Missouri, North Carolina, Oklahoma, Texas y Virginia, entre otros, ya tienen el Plan SILVER establecido mediante legislación. Según establecido por la Asociación de Alzheimer es común que una persona con demencia pueda perderse, y algunos en repetidas ocasiones.De hecho el 60% de éstos se han perdido al menos en una ocasión. En aras de establecer esfuerzos encaminados a proteger a las personas que padecen de la enfermedad de Alzheimer o de demencia, entendemos necesario que se establezca en Puerto Rico el sistema de alerta SILVER. DECRÉTASE POR LA ASAMBLEA LEGISLATIVA DE PUERTO RICO: Artículo 1.- Esta Ley podrá citarse como "Ley Habilitadora para implantar el Plan de Alerta SILVER". Artículo 2.- La Policía de Puerto Rico establecerá un "Plan SILVER", cuyo propósito será alertar al público sobre la desaparición de una persona, que esté diagnosticado por un médico autorizado a ejercer la medicina en Puerto Rico, por las condiciones de Alzheimer o algún tipo de demencia. La Policía de Puerto Rico será la agencia primaria responsable de operar el Plan y determinar si procede o no emitir la alerta, en colaboración con el Departamento de Transportación y Obras Públicas y el Departamento de Salud. Además, cualquier otra entidad pública estatal, federal o municipal, empresa privada, al igual que cualquier medio de comunicación, podrá voluntariamente participar y unirse en este esfuerzo de colaboración. Artículo 3.- La Policía de Puerto Rico notificará a los medios de comunicación y difusores de Puerto Rico la activación del "Plan SILVER" y los invitará a participar voluntariamente en el mismo. Artículo 4.- Los siguientes criterios deben concurrir, previos a emitir una Alerta SILVER: La persona deberá tener diagnóstico de la enfermedad de Alzheimer u otro tipo de demencia; (2) el ciudadano que notifique a la Policía sobre la desaparición de esta persona, deberá acreditar que padece de las condiciones de Alzheimer o demencia, por medio de carta certificada por su médico o presentar evidencia de medicamentos recetados para tratar la condición; (3) y que debido a las condiciones antes mencionadas carece de facultad para consentir y que existe un peligro inminente de daño corporal o muerte; (4) que la Policía de Puerto Rico ha determinado que en efecto la persona con los requisitos antes mencionados ha desaparecido; y (5) la persona que notifique debe proveer la siguiente información: nombre, edad, diagnóstico, descripción física de la persona desaparecida, vestimenta la última vez que fue visto(a), hora que se fue visto(a) por última vez y toda otra información que pueda ser de utilidad para identificar y localizar la persona desaparecida. Artículo 5.- Tan pronto la Policía de Puerto Rico remita la información, los medios de comunicación y entidades participantes acordarán voluntariamente, transmitir las alertas de emergencia al público, relacionadas con casos de desaparición de una persona diagnosticada con la enfermedad de Alzheimer o demencia. Luego de un sonido distintivo, la alerta debe leer:"Esta es una Alerta SILVER de una persona desaparecida". Las alertas deben ser difundidas lo más pronto posible y repetidas frecuentemente, siguiendo las guías del "Emergency Alert System (EAS)" y la "Federal Communications Commission (FCC)". En el caso del Departamento de Transportación y Obras Públicas, deberán ubicarse carteles electrónicos en las vías públicas destinados primariamente, para la emisión de estas alertas. Las alertas incluirán información sobre la descripción de la persona, y la dirección del lugar donde último fue visto. Luego de emitirse la alerta, será deber de la Policía de Puerto Rico suplementar y actualizar la información disponible a los medios de comunicación y entidades de comunicación y entidades participantes. Las alertas también proveerán al público información específica en torno a cómo puede el público comunicarse con las autoridades para proveer información relacionada al esclarecimiento del caso. Independientemente del esclarecimiento del caso, la alerta podrá concluir en cualquier momento en que la Policía de Puerto Rico lo solicite. Artículo 6.- La Policía de Puerto Rico designará a un comité coordinador del Plan SILVER, quienes emitirán las normas, reglas o reglamentos que sean necesarios para el fiel cumplimiento con esta Ley. Artículo 7.- Se designa al Secretario del Departamento de Salud la divulgación de las normas, reglas o reglamentos establecidos por la Policía de Puerto Rico sobre la ejecución del Plan SILVER. Estas agencias divulgarán la información por medio de folletos informativos, conferencias, mensajes de servicio público en estaciones de radio y televisión que voluntariamente quieran participar y por medio de organizaciones sin fines de lucro y base comunitaria que dan apoyo a personas diagnosticadas con la enfermedad de Alzheimer u otro tipo de demencia. Artículo 8.- Se añade un nuevo inciso (t), y se reenumeran los subsiguientes, en el Artículo 2 de la Ley Núm. 53 de 10 de junio de 1996, según enmendada, que leerá como sigue: "Artículo 2.- Definiciones Para fines de interpretación de esta Ley, los siguientes términos tendrán el significado que a continuación se expresa, a menos que del contexto surja claramente otro significado: (a)... (t) Plan SILVER.- Significa la alterta nacional para atender casos de personas con impedimentos cognoscitivos desaparecidos. ..." Artículo 9.- Se enmienda el inciso (n) del Artículo 5 de la Ley Núm. 53 de 10 de junio de 1996, según enmendada, para que lea como sigue:"Artículo 5.- Superintendente; facultades, atribuciones y deberes (a)... (n) Desarrollará, en coordinación con el Comisionado de la Comisión Federal de Comunicaciones en Puerto Rico, la implantación del Plan AMBER y del Plan SILVER; además, promoverá su adopción entre los distintos sistemas de cable y emisoras de radio y televisión locales, hasta tanto la Comisión Federal de Comunicaciones no lo haga mandatario mediante la aprobación de la reglamentación correspondiente. ..." Artículo 10.- Esta Ley comenzará a regir inmediatamente después de su aprobación.

Limited Mobility of Another Sort (NYT)

By Paula Span

In theory, the continuing care retirement community, or C.C.R.C., makes great sense: build different types of senior housing on a single campus, or even in a single building, so that as residents need more care, they can transfer within the facility — from independent living apartments to assisted living units to a nursing home — instead of being uprooted from familiar surroundings. More than a half-million older Americans find this an attractive idea and have moved into such a retirement community.

Yet ever since reporting a few years ago in an assisted living facility in Bethesda, Md., and hearing about a resident who pushed the wrong elevator button and then screamed in horror when the doors opened onto the nursing home floor, I have wondered how these transitions work in practice.

Tetyana Shippee, a research associate at the Center on Aging and the Life Course at Purdue University, chose an unorthodox way to learn more. Ms. Shippee, then 21, moved into a C.C.R.C. in a Midwestern town and, for two years, observed, ate with, got to know and interviewed its residents.

Ms. Shippee’s findings, recently published in The Gerontologist, show how elusive the aging-in-place ideal remains, even in a facility expressly set up to foster it.

People liked their independent living apartments just fine, Ms. Shippee discovered, but were often reluctant to move to assisted living when their health and mobility declined. “There was a certain level of stigma involved,” she said. It was not that the assisted living units and nursing home, with their separate dining room, were particularly far away; they were just a seven-minute walk from the independent living apartments. “Mostly,” she explained, “there are social boundaries.”

In Ms. Shippee’s facility, where introductory tours often bypassed the assisted living/nursing wing altogether, the health and vigor required for independent living had become an important source of status. To leave an independent living apartment meant not only losing one’s home and social network, but also a part of one’s identity. Friendships often did not survive the move; visits became more like duties or favors than part of reciprocal relationships. Small wonder, then, that Ms. Shippee observed anger, stress and a keen sense of loss when residents were faced with moving.

It is possibly different in other facilities. At least, said Steve Maag of the American Association of Homes and Services for the Aging, a C.C.R.C. allows for the possibility of continuing social connections, so much harder to maintain across geographic distances. Mr. Maag pointed out, too, that C.C.R.C.’s were adapting to these unexpected social wrinkles, adding home care programs to accommodate residents who did not want to move.

But wasn’t the ability to move within the facility — with the assurance that as one needed more help one could remain socially connected — the whole point of selecting a continuing care community?

The prospect of an involuntary move led Sally Herriot, who cherished her cozy independent-living apartment in Palo Alto, Calif., to make a federal case of the issue — literally. Mrs. Herriot already employed private aides and had agreed to increase their hours, but in 2006, when C.C.R.C. administrators told her she would have to move into assisted living anyway, she filed suit in federal court and charged that forcing her to move was a violation of the Fair Housing Act. “It amounted to a loss of control, a lack of privacy and dignity,” her son Robert Herriot said.

A judge sympathized but ruled that state law permitted the C.C.R.C. to make such decisions. Mrs. Herriot, represented by AARP lawyers and by Relman & Dane, a civil rights firm in Washington, has appealed the verdict; meanwhile, Mrs. Herriot, 91 and very frail, remains in her apartment with her helpers.

Could C.C.R.C.’s improve the situation by promoting more interaction, with less physical and social separatism, among residents who require different levels of care?

“Independent living residents don’t like that,” Ms. Shippee pointed out. “They view themselves as healthy and active. If you try to integrate them with people in wheelchairs who have problems, they will object.”

In the dining room, she added, “they want to feel like they’re in a nice restaurant, conversing with friends; they don’t want to be faced with those in declining health.”

Mr. Herriot has heard of residents who have gone so far as to conceal their health problems, fearing that they will be the next ones moved.

So much for theory. Most C.C.R.C. residents who are told to move will comply, but having to leave a home is disruptive and distressing, it seems, whether you are moving 7 minutes or 70 miles away.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”