Ccrc--good bad and ?

[Nords]

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Originally Posted by nwsteve Okay, found the link to an excellent white paper on the CCRC living--put out by American Senior housing organization. https://www.seniorshousing.org/filep...whitepaper.pdf This actually links to a pdf so it may take a while to load. Warming it is long and uses a FAQ style of covering the topic. Suggest a quick scan for the FAQ that best suits your interest. Nwsteve

That's a very interesting summary. Thanks.

One big concern (as others have mentioned) would be the type of "nursing home" care. Does it include locked doors to keep residents from wandering or fleeing while sundowning? Does it have a memory care unit, which is different from typical nursing homes?

What happens if the resident doesn't get along with the staff or the other residents and is labeled as a safety risk? What if you're asked to leave? Or even worse, what if you "can't" leave? What if the CCRC doesn't want to deal with the finances of your departure and starts more coercive routines by shoehorning the patient (and their behavior) into the facility's preferences? In other words, what if the residents are forced to comply with group standards instead of being left alone to lead their own lifestyle?

For example, Alzheimer's patients initially benefit from extra socialization (occupational therapy, physical therapy, speech therapy). Eventually, however, their declining cognition makes it difficult for them to socialize. They can be overwhelmed and even intimidated by the hustle & bustle of the common areas (or roommates) because they can't handle higher background noise or track multiple conversations.

In my father's case, it eventually meant that he was first annoyed by "all those people" and then aggravated. If someone got in his personal space then he might even push them away, which is regarded by the care staff as "physically aggressive". That led to concerns about anxiety and depression, which devolved to medication. He'd been in the facility for nearly five years and the staff knew him well, but he was becoming a care challenge and he needed extra attention from additional staff to nip any problems in the bud before they developed into a shouting (or even pushing) match. At one point (after his roommate passed away) the facility suggested moving Dad to a private room where he'd be much less upset by another person's presence.

The care facility staff turnover was exacerbated by a new doctor who, frankly, was much less collaborative and much more authoritarian than the previous doc. He was impatient for a solution to what he saw as a behavioral problem (not an environmental one) and the medication experiments ramped up. They wanted Dad's behavior to comply with their standard environment instead of changing the environment in response to his changing behavior.

Eventually at a quarterly care meeting we were politely yet firmly advised that it was time to find a care facility which could be "more responsive to your father's needs".

Today Dad's in a memory care facility with eight patients per wing (individual rooms). He spends most of his day in his room (by choice) doing jigsaw puzzles or walking the grounds (alone but within view of the staff). He can no longer wander through unlocked doors and the common area is much quieter. He's able to avoid crowds and he rarely has to interact with anyone. He's off most of the medications and he's much mellower. Ironically the memory care facility is cheaper than his previous one, so not only is he likely to live longer but his finances should last longer.

My spouse and I are hoping for a better care experience than a CCRC. I've invested in Ho'okele Health Innovations, a tiny home-care tech company, and the industry has rapidly evolved over the last 10 years. (Some of this evolution is inspired by ACA legislation and Medicare incentives.) Sensor tech makes it much easier for an elder to live on their own. (Ironically the elders are usually the ones asking for the tech so that their adult children will stop pestering them about the dangers of living alone.) Healthcare (blood pressure, weight, cognition, mobility) is much more easily monitored by a tablet with Bluetooth-connected devices. (A caregiver's website collects data which is shared among the doctor, the visiting nurses/aides, and the family. No more black composition logbooks or Post-It notes or frantic phone calls.) The elder spends much less time going to medical appointments, and care staff spend much less time driving among their patients' homes. Care robots and exoskeletons are just beginning to augment the care staff.

Ridesharing has nearly eliminated the traditional family battle over elder driving, and the tablet makes it easy to order a movie or a pizza or a massage.

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Originally Posted by Marita40 Can anyone explain to me how owning a LTC policy (I do) works with a CCRC? If you move into the "independent" living of a CCRC, does the LTC kick in? Or, once you need to move from the "independent" side of the CCRC to the "assisted" side, does it then kick in? My questions are basic because I haven't investigated this yet. I think when I retire in a number of years I'll get serious about putting a deposit down somewhere. Thanks.

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Originally Posted by MichaelB As I understand LTC insurance, to qualify you will need assistance to carry out a minimum number of "activities of daily living". Nords documents well the battle he had with the insurer over his father's situation. Nords prevailed, but it was a battle.

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Originally Posted by nwsteve Assuming, of course, your provider is still in business and willing to pay in a timely manner. Note Nord's journey to get an A rated provider to cough up the benefits.

Long-term care insurance is considered a reimbursement. Most of the contracts are capped on the dollar amount, not necessarily the length of care. The same policy might pay out for three years at one facility in a lower-cost area but only two years in a higher-cost facility.

John Hancock's "reimbursements" were eventually higher than the previous month's invoice that I sent in for documentation, but by then I was afraid to ask questions for fear that they'd try to recoup the excess. Their lack of supervision (or downright incompetence) might have been why they paid out the policy faster than necessary, but I decided that I didn't care as long as the cap stayed the same.

If you're safely living independently then you generally don't meet the requirement for a LTC insurance claim until an incident occurs. This can be aggravating when someone with mild cognitive impairment is in a care facility for longer than Medicare's 100 days and they improve with therapy. When the LTC payout stops (because they're capable of living independently again) then they "go home" (or move in with other family) and the MCI becomes worse (possibly because they're out of the care facility environment). This boomeranging can happen several times over a few years before the MCI reaches permanent dementia.

By the way, this is much more stressful for the family (caregivers) than the insured. The person with dementia can't understand the LTC insurance problem and just stops worrying about it. Meanwhile the caregiver stress is amplified by the insurance company's claims manager.

Eventually the medical array of standard cognitive quizzes and brief clinical exams is supplemented by a full-blown interview (at least an hour) with a neuropsychologist. (In 2011 it cost us $3760.) The neuropsych's assessment was conclusive proof (to the LTC insurer) that while Dad could attempt the activities of daily living, and could still pass the Mini-Mental Status Exam with flying colors, he was no longer capable of the problem solving required to continue to live independently.

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Originally Posted by Amethyst One can only imagine the battle when one is on one's own, without a Nords to act as advocate.

Yeah, me too. I have high hopes for my daughter.

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Originally Posted by Amethyst True. In my experience, people will go on endlessly about their old parents ("Sigh...we had to fly to Florida, Mom fell again"), but resist any discussion of when it's going to be their turn. Or if the topic does happen to come up, some man will assert that he intends to shoot himself when the time comes (which is absurd - anybody know anyone who actually did that?) and the topic shuts down again.

Um, yeah, I've seen that story a lot and it happens with a discomforting number of military vets-- both older and younger than me. Middle-age suicide is on the rise (especially among middle-class Caucasians, https://afsp.org/about-suicide/suicide-statistics/) and a firearm is the method of choice. That's a favorite lead for the nightly news-- especially when the guy doesn't get the job done and ends up in a coma or (even worse) is conscious yet permanently and severely disabled.

The "just shoot me" conversation comes up every few months in our house, but my spouse has unrealistic expectations of the one-shot kill. Or maybe she just thinks I'm a better shot than I really am.

We've spent a lot of time talking about our options (or our narrowing array of options) and their perceived value. It boils down to the lifestyle perception that a Hawaii CCRC is an apartment with limited access to the outdoors through a lanai door. Even when that problem is solved, there's an entire staff and fellow residents with rules and boards and committees and a level of bureaucracy and intrusive administration that we'd hope to avoid by living in our own home (admittedly with a much bigger HOA). Today, at age 56, it's unattractive to me. In 20 years I might feel a lot differently. Judging from my personal research, in 30 years I'm unlikely to be surfing anymore-- but I'm holding out a lot of hope for that exoskeleton tech.

15 years ago, Admiral Nimitz committed suicide. (The son, not his WWII parent.) It was a big controversy not just because of the family, but also because their adult children understood the evidence that Mom & Dad were contemplating suicide. The "kids" elected not to interfere because they felt that it was their parents' right to choose.

One part of the media portrayed the incident as an elder couple who'd bravely fought the good fight as long as they could before finally executing their exit plan. After all, the guy's a submarine admiral who's accustomed to command of big decisions and knows how to get stuff done.

Another part of the media viewed this as a formerly impressive elder who might have tipped over into dementia and even paranoia, yet whose spouse chose to tolerate (and even encourage) his behavior. Or she may have been dealing with her own dementia, or she may have even been intimidated and coerced into going along with his suicide pact. In any case a control freak caused them to end their lives sooner (and more painfully) than necessary.

I don't share my spouse's "just shoot me" attitude. I'm pretty sure that I'll always be curious about the next sunrise, whether or not I'm physically able to see it. My spouse and I have enough assets (and enough pension income) to self-insure-- and we see ourselves aging independently in our own home(s). When we can no longer handle our current dream home (master bedroom on the 2nd floor, steep backyard slope, not a walkable neighborhood) then we'll revert to our rental property (single level, smaller lot, one block from the strip mall). If dementia rears its ugly head then I'll keep paddling out until I forget how to paddle back in move into a care facility while my spouse continues living in our home as long as she's able.

[mickeyd]

I recently attended a local CCRC information session and found it very interesting. BTW the CEO noted that "CCRC" was slowly being replaced with the term "Life Plan."

[Brat]

This may seem sexist but at least in my family the men with dementia were much more difficult to manage than the women. Disinhibition, aggression, need to be in control.

[Fedup]

I've read if you are violent with Alzheimer's, you can be kicked out at some places.

[audreyh1]

One issue with a CCRC that I will have to study carefully before making any commitment is the issue of gifting money once you are under contract. There are some limits - gifting could violate your CCRC contract, but I'm sure there must be some parameters.

As we age we intend to gift more and more to family members. By CCRC age we'll probably have a well funded DAF for charity. But as my siblings are a few years younger than me, I don't want them to have to wait until I pass before receiving a major inheritance.

So - I guess we'll have to try to figure out how much to gift before making a move to a CCRC, how much we can still gift while in the CCRC, and how much will have to wait until we pass.

Lots to figure out!

[bmcgonig]

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Originally Posted by audreyh1 One issue with a CCRC that I will have to study carefully before making any commitment is the issue of gifting money once you are under contract. There are some limits - gifting could violate your CCRC contract, but I'm sure there must be some parameters. As we age we intend to gift more and more to family members. By CCRC age we'll probably have a well funded DAF for charity. But as my siblings are a few years younger than me, I don't want them to have to wait until I pass before receiving a major inheritance. So - I guess we'll have to try to figure out how much to gift before making a move to a CCRC, how much we can still gift while in the CCRC, and how much will have to wait until we pass. Lots to figure out!

Now THATS a first world problem 🌻🌻🌻

[audreyh1]

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Originally Posted by bmcgonig Now THATS a first world problem ������

So are CCRCs! (a solution to a first world problem)

[imoldernu]

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So - I guess we'll have to try to figure out how much to gift before making a move to a CCRC, how much we can still gift while in the CCRC, and how much will have to wait until we pass. Lots to figure out!

Pretty sure this will depend on the contract, and the body that determines the admission requirements. Of course, if medicaid becomes involved, there will be a five year look back.

[ejman]

Just curious. I know we have a number of readers that live in Mexico/Central/South America or Asia since US SS and or pension income goes a lot further there. Are you contemplating coming back to the US when needed or are there local options that look promising? For example, I know there are probably one or two million + US expats living in various parts of Mexico. Do most people age in place, hire local help as they age, go to local facilities or what?

[growing_older]

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One thing that does lead to improved level of care, however, is a family member or friend that comes by regularly

This is true in my experience and perhaps the most important factor.

[explanade]

I don't understand.

If you pay the entry fee and can make the monthly payments, they have a say in what you can do with your money?

[audreyh1]

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Originally Posted by explanade I don't understand. If you pay the entry fee and can make the monthly payments, they have a say in what you can do with your money?

The issue is you running out of money while you stay there.

[Huston55]

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Originally Posted by explanade I don't understand. If you pay the entry fee and can make the monthly payments, they have a say in what you can do with your money?

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Originally Posted by audreyh1 The issue is you running out of money while you stay there.

My guess would be that if you've paid the entry fee & have guaranteed income streams that cover your monthly fee +, then there are less (no?) restrictions on the remainder of your portfolio. But, this is just a guess. Audrey raises a good question, which we will also have to check out when the time comes.

[audreyh1]

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Originally Posted by Huston55 My guess would be that if you've paid the entry fee & have guaranteed income streams that cover your monthly fee +, then there are less (no?) restrictions on the remainder of your portfolio. But, this is just a guess. Audrey raises a good question, which we will also have to check out when the time comes.

I just ran across this issue scanning a couple of articles. I haven't done any detailed research, and won't for a while until we get a bit older.

And maybe setting up some guaranteed income streams would be one way to handle it (but more expensive perhaps that what I would want to do?).

Obviously overall a complex series of decisions to make. Might take a while.

[Huston55]

In our continuing research to confirm that a CCRC (our current plan) is the right choice for us, I've found several advocacy organizations with very useful information; links to two are below. What I've learned so far is that, in California, there is a substantial body of law protecting CCRC residents' rights regarding: level of care transfer rights, CCRC financial disclosure/transparency, informing CCRC residents, CCRC resident participation, procedural & legal protections, etc.

Continuing Care Retirement Communities (CCRC) – CANHR

https://www.calcra.org

We're in California so, these are for our state but, I expect most states have similar advocacy organizations applicable to your location.

[audreyh1]

I'm really glad you are doing all that research Huston55!!! And sharing it!

[Walt34]

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Originally Posted by explanade I don't understand. If you pay the entry fee and can make the monthly payments, they have a say in what you can do with your money?

Yes/No/Maybe.

It depends on the contract with the CCRC. For example, you are allowed in with total assets of say $500k, and $100k of that goes to your admission fee. This may or may not be recoverable, but that's another discussion. Without spending down assets, your normal income will cover expenses in the independent living section.

Here's the issue; Many CCRC contracts stipulate that if, after showing you have the assets to fully self-pay full NH care to a year or two, and then you do so and your assets are fully exhausted, they will then accept what Medicaid pays and let you stay on there. The contract also says that you cannot "spend down" your assets to below that level.

Now, suppose Mr./Mrs. Foolish fails to note the bolded sentence and moves in to independent living, then gives most of their money to whoever, or goes on round-the-world trips, finally buys the new Maserati or whatever, and then has a stroke that means they're going to be in 27/7 nursing care for the foreseeable future.

In this scenario the nursing home would be fully justified in kicking the patient to the curb.

[Sirka]

+1
Lots of great info, thanks

[Marita40]

I've realized that there are several different types of contracts for CCRCs, and the names of the types seem to vary. For example, one type of CCRC I'm familiar with from my area (I just took a tour, in fact) has no "entrance" fee, you pay monthly rent for independent housing, and when you move to nursing or assisted living your monthly payment rises. Another type of CCRC has a "lifecare" contract where you pay a very large entrance fee, and then your monthly fee stays the same whether you are in the independent housing side or the nursing/assisted living side. In this type of contract, it appears that all care/nursing/etc in the nursing/assisted living side is covered by your monthly fee.
What I've been trying to understand is how my current LTC plan "works" at CCRCs of various types. If a CCRC has a "lifecare" contract such as the one I mention above, why would one need LTC insurance?
My LTC rate has just risen 26%, so I'm trying to figure out whether I want to drop it or renew it.

[REWahoo]

Some great info in this FAQ post: http://www.early-retirement.org/foru...aqs-86124.html