I have gotten questions from several friends asking for more information as to why we moved to a retirement community, specifically a “continuing care retirement community” or CCRC, and how it is working out for us so far after a couple of months.
Here is my answer:
Last time I checked, we Homo sapiens—like all life on the planet Earth–have a beginning and an end. On average in the United States our allotted life spans are around 75 years though factors such as income, education, genes, race, gender, lifestyle, and luck affect the outcomes. It is also a fact of life that as we get older, we can’t do many of the things we used to be able to do. For some this is physical and for others it is mental, but we all slow down. And we all die. And there is great variety in how the checking out process works. For some it could be fast and quick like a heart attack or stroke. For others it could be a long, slow, and often painful slog. A continuing care retirement community provides one option that tries to make the most of the remaining years we humans have left by providing a support structure that allows people to get through the aging and checking out process, minimizing the pain and suffering that often accompanies it, along with enriching the time we have left. I call it squeezing the last drops out of the lemon.
The definition of a continuing care retirement community or CCRC (now also called a Life Plan community) is a senior living community that offers a continuum of living/care options under one roof or on the same campus—independent living, assisted living, and long term care. The concept, however, has evolved over time. When it was first “invented” in the early 1950s, it was called “life care” (started by the Pacific Homes of the Northwest, a Methodist group in California, followed soon after in Philadelphia by several Quaker life care communities), there were only two levels– independent living and long term care–but this has changed over the years due to government regulations and a better understanding of the aging process. Long term nursing care, for example, has morphed into rehab due mainly to Medicare reimbursement regulations, which provide government financial support for up to 90 days for seniors coming out of the hospital. Also, in the early 1980s when it became evident that people who were in the natural aging process did not benefit from being in nursing homes with a hospital-like setting, assisted living emerged and became a popular alternative to the traditional nursing home. In addition, in the 1990s when it became evident that people who were physically in need of support did not mix well with people with dementia, the concept of “memory care” was invented. So today what distinguishes a CCRC from other retirement options like a Sunrise or other assisted living or residential senior living communities is providing a continuum of living options under one roof or on one campus—independent living, assisted living, memory care, and skilled nursing care, now often relabeled rehab. Some communities provide three levels of living/care on site with access to skilled care/rehab offsite, though monitored by the community. Collington falls into this category with arrangements with nearby private rehab facilities, where residents stay for up to 90 days following a hospitalization before returning to Collington. The concept of having the full support system in place distinguishes a CCRC from other options like assisted living or service enriched, independent living, senior living communities. Collington also has on site a full service geriatric medical practice, which is part of the Medstar system.
Most CCRCs require both an upfront fee called an entrance fee and a monthly fee which is adjusted annually based on the cost of providing services and care. There are all sorts of options regarding how entrance fees work. The early entrance fees (called “founders fees”) were amortized over a five year period so that if you died after that period your estate did not receive a refund. Due to the high cost involved in developing, financing, and operating a CCRC, the entrance fees have increased considerably though the higher fees usually have a refund provision, refunding up to 90% of the initial amount. Also, in some CCRCs (“Type A” communities), the monthly fee does not increase significantly when you relocate to a higher level of care. There are also CCRCs which are coops or condos. These communities all provide meals, housekeeping, lots of activities, and scheduled transportation. (Usually, the cost of a daily dinner is included in the monthly fee as are the costs of these services.) The vast majority of CCRCs, like Collington, are not-for-profit communities.
Because of the high cost of developing and operating these communities (which are passed off to residents), the resident populations tend to be relatively well off financially, but certainly everyone is not rich. At Collington because of the wide range of living accommodations, there is a wide range of prices of entrance and monthly fees, and the Collington population seems to me to be, for the most part, solidly middle class–and also highly educated. Collington has a large library with several shelves displaying books by current residents and another entire section for books by former residents. (I proudly placed a copy of Hard Living on Clay Street and Civil Rights Journey in the current resident author section.)
The preferred retirement option for most people, of course, is remaining in their own homes. Moving is extremely stressful and costs money, and most people do not want to leave familiar neighborhoods where many old friends remain. The senior village movement got started a few decades ago to help seniors remain in their homes, and local senior villages provide activities, transportation, and fellowship for seniors. Some CCRCs now even offer “life care at home.” Most people will slog it out and take their chances, bringing in home health care aides or getting help from their children if they need it. While sticking it out is the option that most people follow, however, it often fails to address the challenges of loneliness and isolation; and if you need in-home care from aides, it can be extremely expensive though long term care insurance provides some cushion on the cost issue.
There is no silver bullet or right way or wrong way to manage the aging process, and there are pros and cons with all the options. Ironically, Embry was the prime motivator for our moving to Collington rather than me, even though I was the one with professional senior living experience. I think that the thought of having to take care of a cranky, aging old husband in a small apartment was too much for her, and she was right.
What struck me immediately upon moving to Collington was how many really old people there are here. Well, duh. It figures. Collington is approaching its 40th anniversary, and someone moving in in 1986 at age 75 would be approaching 115 in 2025. While Collington does have some people over 100, a whole lot of people are in their mid 80s to mid 90s. Since new residents coming in are typically in their late 70s, there are really two generations of old folks living here. Also, like all CCRCs, the vast majority are single, older women. Another “duh.” Men in the U.S. typically marry younger women, and women outlive men. That is just the way it is. I was surprised by my initial reactions when I ventured into the community center and entered the main dining room the first time and looked around seeing so many people using walkers and canes, and some in wheelchairs. “Oh, my goodness,” I thought, “These people are really, really old! I am not one of them! I don’t belong here. I am too young.”
Then I heard the voice of the better angle in my brain, “Yes, you do, Joe. You are 83. You may not be as old as some, but you will be in a few years, if you are lucky, and by the way, you too now use a walking stick.”
Shame on me! Plus, over the two months we have lived here, I continue to be impressed with the energy, determination, wisdom, community engagement, and cheerfulness of those using walkers or are in wheelchairs–and others who are considerably older than me. They are an inspiration.
And yes, in a community this large with over 350 old folks, you are constantly reminded of the fact that our lives on the Earth are limited. There is a display area that posts every week or so the names and photographs of people who have recently passed away, and there are memorial services that regularly happen. But people take this in stride, and out of this I think comes a wisdom of how short, yet how miraculous life is, and how blessed the survivors are–those who have lived long enough to be in a CCRC– to have had our short time on this small, blue planet in a vast universe containing trillions of galaxies.
More to follow ….