“The deciding factor was proximity,” says David Sterling about the decision to move his 83-year-old father, who has dementia, from assisted living in Kentucky to Sunrise Senior Living in Alexandria.
“If he’s right down the road, I’ve got no excuse. If traffic is bad, I can walk there. It’s less than a mile,” he says.
In Sterling’s case, a desire to spend more quality time with his dad precipitated his family’s decision. But for many older people, the idea of moving into a retirement community starts before their health declines.
A 2023 survey of 255 people by myLifeSite, a website that provides community-specific information about continuing care retirement communities, found 54.6 percent said having access to care so they would not burden their families was the most important factor in deciding where to live in their senior years.
In a CCRC, which may also be called a life plan community, you start out living independently and transition to assisted living or nursing home care, if more medical attention is needed.
The Elephant in the Room
With seniors living longer and healthier lives today, they need to consider a number of factors as they evaluate one of the nation’s roughly 2,000 CCRCs.
“What I hear from a lot of the folks is that, ‘No. 1, I’m making this move because I don’t want to be a burden on my family,’” says Steve Gurney, who produces the Positive Aging Sourcebook, a guide to NoVA’s retirement and assisted living communities and nursing and rehab centers. “Another group of people who are very advanced planning–focused are solo agers, and those are individuals who may not have a strong family network, and they recognize that ‘Hey, if something happens to me, health care or otherwise, I’m pretty much on my own.’ And by moving into a community like this, they now have an automatic backup plan and support system.”
Gurney started the Reston-based Positive Aging Community in 1990 and lived in different senior living communities while he was in his 40s to experience for himself what they were like.
One challenge people face, he says, is that after decades of living in multigenerational neighborhoods, they are leery about moving into a community that’s segregated by age.
“Even though the community is robust, and it has lots of amenities — and you’re going to make new friends — this is one of the things that people get hung up on, and one of the reasons why they say, ‘I’m not ready yet.’ And what I found is that by simply addressing the elephant in the room when I’m talking to people, that opens their mind up to ‘OK, I get it. Let me take a look at this, and it might be a nice environment for me,’” Gurney says.
“A lot of this transition is mindset. It’s having a positive mindset, and these communities facilitate that,” he says.
‘Pretend You’re a College Student’
While it’s important to look at the hard data about a community, Gurney says people also need to think about what they want. “Imagine that you’re choosing the next college that you’re going to go to. Pretend you’re a college student going onto campus for first time,” he says.
“What [prospective college students] look at are the other students, and they look at the faculty, and they say, ‘You know, is this a place where I can thrive and have purpose and start a new chapter of my life?’”
Gurney recommends making a list of your interests to give to the marketing staff before you tour a CCRC. You can say, “Here’s my list of who I am and what I enjoy. It would be really great if you could introduce me to some people who live here that I might get along with,” Gurney says.
One of the great benefits of these communities is something society never used to take into account, he says. “We all realize now that loneliness and isolation are not healthy. And these communities really support a lifestyle that minimizes loneliness and isolation.”
In addition, a 2023 study by the nonpartisan research institution NORC at the University of Chicago found that older adults’ vulnerability to illness and impaired mobility quickly plateaus and then even declines once they enter a senior care housing property. Frailty levels declined one year after moving in, the study’s review of Medicare claims from 14,201 senior living properties determined.
Related to visiting the community, Lori Stahl, elder resources case manager for the Area Agency on Aging for Loudoun County, recommends going unannounced to take a second look.
“That’s when I would talk with staff. I would talk to residents. What is the staff-to-resident ratio? What is the staff turnover? What is the staff training? Are there activities that are going on? … Are the events actually going on as per the activity calendar?” Stahl says. “One thing that’s really important: We also encourage folks to stay for a meal. How is the meal served? How are the residents addressed during meals by the staff? Are there options for food, or is it just whatever the cook or the dietitian decided that day? Is there a dedicated chef? Is the food freshly prepared, and do you have choices?”
Review the Hard Data
The lifestyle of a continuing care retirement community can be expensive.
CCRCs, which typically have apartments, generally charge an entrance fee and a monthly fee. The average entrance fee, as of the end of 2023, is $442,352 nationwide — that’s 2.3 percent higher than a year earlier, according to the National Investment Center, which tracks costs and other analytics related to senior housing. The average monthly rent, according to NIC data, is $3,897 for independent living, $6,694 for assisted living, and $8,399 for memory care.
“You need to basically understand what real financial resources you have and how that fits in with these communities,” Gurney says.
CCRCs have different types of contracts that range from full care inclusive to fee-for-service. The Consumer’s Guide to Continuing Care Retirement Communities by the National Continuing Care Residents Association recommends you have a lawyer review any contract before signing it.
In addition to the contract, look at the community’s different levels of care, long-term financial strength, accreditation, and indebtedness, the guide said.
“Many times, when I’ve interviewed people after they’ve made the move, they’ve said to me, ‘Gosh, you know, I thought that this was expensive, but I didn’t realize how many costs I had in staying at home aging in place, and more importantly, the peace of mind that I have,’ especially if somebody has had to use the health care services in one of these communities,” Gurney says.
In Virginia, the State Corporation Commission, an independent state government department, regulates 51 continuing care retirement communities. Of those, 13 are in NoVA. CCRCs provide the agency’s Bureau of Insurance with annual disclosure statements that include everything from admissions requirements to contracts to audited financial statements.
The guide said consumer advocates want at least 30 percent of a community’s governing board to be made up of residents and for residents to have access to the person in charge.
“If possible, it’s always a good idea to meet the executive director, whoever is the captain of the ship of this community, because you’ll really get a sense of their leadership style, and the overall experience that they’re trying to create,” Gurney says.
Other Considerations
As you look at communities, AARP recommends you consider the proximity to shopping centers, the nearest hospital, and your own doctors.
Stahl says you need to know what medical care is available on site. She says you need to ask questions such as: “Is there a physician or a clinic in the facility? Do you have to use that clinic or physician, or can you still retain your outside doctors?
“One of the big things that I hear from families all the time [is] … how are families informed about a change of condition? If your loved one needs to go to the emergency room, is a call made automatically to 911? Are families informed first? Is their doctor called? What happens if they can’t get ahold of the family?”
Stahl says family members need to be involved. “You need somebody to be your extra eyes and ears. You need someone to be your voice, to advocate, to help monitor, to attend care plan meetings,” she says.
And, of course, like the move David Sterling arranged in order to see his aging dad in Alexandria more often, location is key.
Gurney says for your friends and family, “It should not be a burden for them to pop by on the weekend and say ‘Hi,’ and be a part of the community with you.”
What he hears from most people after they move is: “I wish I had done this earlier.”
Tips for Hiring In-Home Care
For families considering in-home care, you need to do your homework before hiring an agency — and realize the change will likely be a stressful one for the person receiving the care. Here are some tips to make the process easier.
Talk with your medical professionals.
“It’s very important to connect with your physician to see what they believe your health care needs may be,” says Lori Stahl, elder resources case manager for the Area Agency on Aging for Loudoun County.
Make a list of your needs.
Do you need a companion agency or a skilled home care agency? A companion aide could help a few hours a day with dressing, meal prep, and errands but may not be able to administer medications. Skilled care services might include physical therapy, occupational therapy, and speech therapy.
Interview home care agencies.
It’s best to get word-of-mouth recommendations. When an agency comes to your home for an initial evaluation, ask lots of questions. “You want to find out what is the background of the companion or the aide that’s being sent over because they all have to be vetted and insured, and typically they all have background checks,” Stahl says. Sometimes, it takes a few tries to find the right person.
Understand the fee structure.
Some agencies require a minimum number of hours per day, or maybe 20 hours a week, while others will customize a package for you.
Don’t let family members burn out.
Stahl says caretaker family members need “breathing space” to take care of their own health, since those needs often get totally ignored as they handle the needs of an aging loved one.
Feature image, stock.adobe.com
This story originally ran in our April issue. For more stories like this, subscribe to Northern Virginia Magazine.