Whether retirement is just around the corner, or that landmark passed years before, there are lots of options for senior citizens who are trying to decide where to live. Even people whose health is failing may not be as limited in their options as they or their families believe.
"The average individual doesn't know all the different services that are available," said Brooks Major, executive director of Keswick, a comprehensive care nursing facility which also offers independent living, assisted living and adult day care.
"People think that they either have to keep their elderly family members at home and devote their lives to their care, or put them into an institution," Mr. Major said. "But there is an in-between. Many people are not using the least intensive level of care they need. People are going into nursing homes who don't need to be there."
To help people determine what their needs are and how those needs can best be met, Keswick offers a geriatric evaluation service for $150. A medical team conducts the evaluation and then refers the patient to a facility that offers appropriate services.
There are assistance programs ranging from adult day care to home health care which help people to stay in their own or a family member's home as long as possible. Adult day care at Keswick costs $53 per day including transportation, Mr. Major said.
Home health care can cost from from $6 to $13 an hour for a health aide, and $14 to $35 an hour for an LPN or an RN, according to Beverly Erdman, a registered nurse who works in the home care field. Such care may cost as much as a nursing home, but may be affordable when a patient only needs a health professional a few hours or one shift daily, she added. Family members provide care the rest of the day.
Mrs. Erdman also is the owner of Helping Hands Health Care Professionals, a consulting firm which evaluates patients to determine whether it is safe for them to live at home. She then works with the family to develop a plan for keeping the person at home and, when necessary, assists in nursing home placement.
When independence as well as help are desired, senior-assisted housing, group homes or retirement communities may be the answer.
"Baltimore had the first senior-assisted housing program in the country," said Ilene Rosenthal, chief of housing and continuing care for the Maryland Office on Aging. "The program combines housing with services, addressing the needs of seniors who are between independent living and a nursing home. Senior-assisted housing projects provide meals, housekeeping and personal services to help delay or eliminate the need for nursing home care."
Call the Office on Aging at 225-1100 for information about the 46 senior-assisted housing units in the state which were established to meet the needs of people in low and moderate income brackets.
For people with considerable equity in a home -- in addition to income from pensions, social security, savings and investments -- continuing care retirement communities offer not only independence and services, but also the promise of a continuum of future health care.
Barbara Coleman White is an independent Baltimore consultant who helps seniors to make decisions about housing and then assists them with the details of moving and settling into their new living quarters.
"These are the most difficult decisions that people have to make," Mrs. White said. "I can help them to objectively think about what their options are and how they would like to approach the problems."
Continuing Care Retirement Communities
Charlestown is the second largest continuing care retirement community in the country. Open since 1983, it has been expanded three times and now has 985 apartments on its grounds in Catonsville, where seniors can live independently. When more supervision is needed, there are assisted living apartments as well as a nursing home for those who require full-time care.
"We make life care affordable," said Michael Erickson, director of marketing. Entrance fees range from $56,000 to $93,000 and are 100 percent refundable when an apartment is rented again. Monthly fees of $684 to $1,323 cover the cost of the apartment as well as utilities, some activities and one meal per day, but not health care or housekeeping.
"Most people are not interested in making huge capitaexpenditures to get into continuing care," said John Erickson, president and founder of Charlestown. "People can transfer their home equity to us and still give it to their kids when they move or die."
Charlestown is what is known as a "fee for service" facility, where residents pay for services, including nursing, as they use them.
Broadmead, on the other hand is a "life care" community with an extensive contract, where all services are included in the entrance and monthly fees -- right down to the handling of insurance claims. Entrance fees are between $52,000 and $145,000, with monthly fees from $1,220 to $2,684.
At communities like Broadmead, residents prepay for some or all of their health care as well as other services. Fees remain basically the same regardless of the amount of health care required.
Other communities have modified contracts which provide a limited amount of nursing care -- perhaps 30 to 60 days -- at no additional cost. After that, medical care becomes fee for service.
Today's concept of life care differs from the past, when it was common for people to turn over their assets to a community, which would then take care of them for the rest of their lives. While there are still a few communities which accept such arrangements, most have found it more financially sound to collect a sizable entrance fee as well as monthly fees. In return, they sometimes guarantee little more than priority for a nursing home bed, although many offer much more.
"It gets confusing for consumers," said Deborah Cloud, associate director of communications for the American Association of Homes for the Aging. "Under an extensive contract, typically the fees are higher because you're prepaying for services you may or may not need. In a fee for service community, the fees are lower, but the cost can jump up considerably if you need care. The individual has to weigh which arrangement sounds best."
Continuing care retirement communities are regulated by the state, and generally provide independent living, assisted living and nursing home care at one central location. Residents usually do not own their residence, but simply have purchased the right to use it. Entrance fees can range from several thousand to several hundred thousand dollars. Additional monthly fees cover rent and a broad range of services.
"At a continuing care community, people buy future health care or the right to purchase future health care," said Ms. Rosenthal, of the Office on Aging. "It's similar to insurance. People are pooling the risk with others. They may receive more or less health care than they paid for. But the bottom line for many people is the peace of mind of knowing that their needs are going to be met.
"The typical person who moves into a continuing care community is in his mid to upper 70s and in good health. He's concerned about the future and what will happen if he needs care. So he moves into a community that offers all of the services that he might need."
Entrance fee refund policies vary from one community to another. According to Ms. Rosenthal, the latest trend is the 90 percent refund. Some communities, however, give no refunds; others will give all of the money back when the home is re-occupied; still others offer reducing refunds, in which the amount is based on the length of residence in the community.
"At the Office on Aging, we always encourage people to get the proper legal and financial advice if they're considering a continuing care community," Ms. Rosenthal said.
Retirement communities
Retirement communities offer a place where seniors can live among their peers in an environment that stresses service, security and leisure. Residents do not pay entrance fees or turn over their assets in exchange for health care -- which may sometimes, but not always, be available.
While some communities have ties to nursing homes where residents are given priority for admission, others provide no health care at all -- save for an emergency call button in each residence. In between are those communities which have on-site clinics for routine medical visits or a nurse on duty or on call. Home health care and assisted living accommodations may be available.
The communities provide apartments, cottages, condominiums or town houses for independent living based on rental, purchase or right-to-occupancy agreements. Services often include housekeeping, meals, maintenance and security; there may be recreational facilities.
The purchase prices for homes at Heritage Harbour in Annapolis range from $130,000 to $250,000. Residents have access to the community's nine-hole golf course, tennis courts, bus service and community center.
"It's adults-only living," said Joe Sprows, sales manager for the community. "It does not prevent grandmothers and grandpops from entertaining grandchildren. But it gives us a quieter, more well-managed community.
Brightwood, a newly opened facility in Lutherville, offers homeownership as well as access to a full range of medical care at a Meridian health care facility on its grounds.
The price tag for the condominiums here can be anywhere from $350,000 to $543,000. Residents pay a monthly fee of $1,400 for one meal daily, housekeeping, transportation service, flat laundry service and 24-hour security.
They also have the option of purchasing a long-term care group insurance policy to help cover their expenses if they need nursing home care. For a 70-year-old, such a policy might cost $1,100 per year for two years of home or nursing home care, said Chip DiPaula, director of marketing and development.
Residents at Harmony Hall in Columbia pay a monthly rent of $1,250 to $2,200 for independent living, with extra charges for home health aid services. If they need 24-hour assisted living, they pay an extra $1,000 monthly fee. And they have priority at an adjacent nursing home.
Nursing homes
The Pikesville Nursing and Convalescent Center has 174 beds and is licensed to provide skilled nursing care to all of its patients. But not all of them need that kind of care.
"Each one of our patients is unique with unique needs," said Eileen Marks, director of admissions. "Some of them need help regulating their medications but are still active. Some may have a heart condition that requires close supervision. Others are confined to bed and have feeding tubes.
"You need to address the person's fears," Ms. Marks said. "It is very traumatic for an individual to realize he is giving up his independence.
Costs for nursing home care average about $100 per day but can range as high as $160. Many patients pay these fees privately, although some may have long term care or "nursing home" insurance to help cover their costs.
The average age of nursing home residents is 85, according to Fred Chew Jr., executive director of the Health Facilities Association of Maryland, a trade organization representing about 145 nursing homes in the state.