Aging in place

As you know if you read Funny about Money off and on, one of my goals in life is to maintain my independence through my dotage. That is: to stay out of life-care communities.

Is there anything intrinsically wrong with a place where you fork over most of your life savings and cede your independence in exchange for shelter until the end of your life and a guaranteed place in a nursing home when you need it? Possibly not.

But from my point of view: yeah. Everything. The whole idea of a warehouse for old folks conflicts with my basic concept of a decent lifestyle. Understand: a life-care community is not a nursing home. It’s more like an age-restricted apartment complex with a built-in restaurant or two and a staff of keepers. And rules that constrict your behavior in much the same way that a dormitory’s rules do. In effect, it’s a dormitory for old people.

I hated living in the dorms during undergraduate school. And you may be sure I’m not going to spend the last few years of my life in another dorm!

But…as a practical matter, how can one avoid it? Or can one, in any safe and sane manner?

When you move into a life-care community, you fork over most of your life savings and cede your independence in exchange for shelter until the end of your life and for a guaranteed place in a nursing home when you need it. While you live there, you occupy a tiny apartment and are expected to take at least one meal a day in the institution’s “restaurant” (more like the chow line at the dorm), where you are treated to lots of processed, packaged, oversalted and oversugared foodoids. The reason you must show up for one meal a day is so that the proprietors can easily check to be sure you’re still alive and conscious.

There are some sterling benefits to moving into one of these places:

• You don’t have to prepare your meals every day. In some cases, as in the place where my father stayed, you wouldn’t be able to do so in any practical manner.
• You have lots of old people to make friends with.
• Usually a nursing home is attached to the life-care home, and you get first dibs on entry to it. Sometimes getting into a decent nursing home when you need it is extremely difficult.
• The level of security is very high.
• Some housekeeping services are provided.
• Various entertainments and amusements are provided: crafts rooms, a small library, musical performances, lectures, and the like
• Some of these places have a swimming pool, a hot tub, and an exercise room.
• Some also provide Alzheimer’s or other dementia care.
• You could in theory live there without ever having to drive a car or go to another grocery store.
• A doctor is usually on the staff or hired on contract.
• If you fall, have a heart attack, or suffer a stroke, someone is on the premises to help you, 24/7.

All of those are good things. However…I would argue that alternatives exist, and those alternatives cost a whole lot less than a life-care community and do not lock you into a prison for old folks. You can get most or all of those services on your own — without forking over your life savings for the privilege.

First, let’s take a closer look at the benefits and the downsides of moving into one of these places.

We have two sets of friends here who have made two contrasting life decisions. One has determined that she’s not going into a life-care community, come Hell or high water. At 95, she still lives on her own, in a freestanding house with a large yard and an irrigated lawn here in the ‘Hood. Let’s call her Margarita. The others, a couple exactly the same age as Margarita, decided to sell their patio home and move into a two-bedroom apartment at the Beatitudes, one of the two most prominent life-care communities in the city of Phoenix. Let’s call them Dick and Jane. Knowing these folks well gives us a chance to think about their choices and how they work.

Bear in mind, as you’re perusing the first two lists below, that Dick strongly resisted moving into the Beatitudes. However, Jane owned the house where they lived, and so it was her decision whether to sell or not to sell; also, Dick had some serious health challenges that were making him infirm. Additionally, Dick and Jane lived next door to a crazy woman who was constantly doing battle with the homeowner’s association and who had taken to threatening to run down the neighbors in her car. Jane saw this madwoman as a serious threat, and she surely was right. So, at her behest, it was off to the Beatitudes!

How, then, has this worked out for our friends?

As you can see at a glance, both householders face similar challenges: advancing frailty, growing risk of injury from falls or health problems, the difficulties of obtaining and preparing food and other necessities. Dick and Jane faced an additional challenge: a neighbor who was batshit crazy. This woman took to threatening to run down other members of the small patio-home HOA with her car, and she in fact did aim her car at Dick a couple of times. She also harassed him every time he rolled the trash barrel out to the curb for pickup, and sued them in a misguided attempt to engross part of their backyard into her own (she lost).

Margarita does not have the crazy neighbor problem, but all the other issues are similar. Her solutions, however, did not entail consigning herself to a warehouse for old folks.

As we make this comparison, we do so with several assumptions in mind:

• They all have enough money to handle whatever they need to handle.
• They have access to medical help.
• They retain all or most of their marbles.
• No one is trying to cheat or rob them.
• Dick and Jane’s kids are doing little to help them; Margarita’s husband and her only child are deceased.
• They have no hired representatives (except for the Beatitudes) to handle various financial, health, and custodial matters.

These are not necessarily givens, but rather are assumptions based on what I’ve observed.

Okay. So what are the pro’s and the cons of their respective decisions: to stay at home or to move into a custodial setting?

HOME

LIFE CARE INSTITUTION

What seems like an advantage or a disadvantage would certainly depend on your own disposition and experience. To me, the disadvantages of the life care setting so outweigh the disadvantages of living at home that there’s really no choice. But on the other hand… That’s because I value my aloneness. I like privacy, I like independence, I like quiet, and I don’t much like people in my face. And I’m used to those things: I’ve lived that way for years.

Thus we have the question of just how important is a given advantage or disadvantage, when it comes to thinking about where you’ll spend the last few years of your life. How much do these things really matter?

To figure this out, let’s assign a value to each advantage and disadvantage, on a scale of 1 to 10, where 1 is least important and 10 is most important. What do we get then?

Here we see the advantages of aging in place at home are almost a wash when compared to the disadvantages. There’s a very slight tilt in favor of the advantages, but the disadvantages are very serious, and in fact when they’re weighted in terms of their importance, the advantages just barely outweigh them.

How does this way of looking at things work when we apply it to life in the Beatitudes?

Now we see a much more significant difference. Whereas the total point value of the stay-at-home advantages (the total advantage factor) was only one point more than the Beatitudes’ advantages, the total point value of the Beatitudes disadvantages outstrips its advantages by 23 points. This is because there are more disadvantages than advantages to living in the Beatitudes. That was not the case for the stay-at-home scenario, which presented an equal number of advantages and disadvantages.

Nevertheless, when you calculate an average, you come up with figures in the same ball park. Except…here the disadvantages on average outweigh the advantages by more than 3/4 of a point. whereas the advantages of living at home just barely outweigh the disadvantages.

Parsing it out, we can make these observations:

1. There are more advantages to living at the Beatitudes than to living at home, but…
2. Some of the advantages are rather low in value. This is reflected in the fact that…
3. The average value of the advantages to home is higher than that of the Beatitudes.
4. There are many fewer disadvantages to living at home, but…
5. The overall weighted value of the disadvantages is about the same. That is, there are some major disadvantages to living at home, so that some advantages are outweighed by disadvantages.

Okay, so how did Margarita pull off the feat of living in an upscale home on the fringe of the tony North Central neighborhood, all the way into her dotage…all by her little self?

Well, in the first place, both her husband and her only child died some years ago. This means there’s no one that she feels bound and determined to leave her estate to. Thus that nine-point disadvantage posed by a reverse mortgage goes away.

That being a given, she had no impediment to taking out a reverse loan on her house. And if you believe Zillow, her house is currently worth $662,000. That puts a lot of cash in her pockets.

The house is in a fairly upscale section of the neighborhood, across the street from some mighty valuable horse property and nestled among well-maintained 1960s ranch houses on big lots. That suggests her husband made a good living and without a doubt left her a decent retirement fund. Plus of course as his widow she would be getting his full Social Security. The house is paid off. So all she has to do is pay the utility bills, pay the taxes on it, and hire people to maintain the place and assist her personally.

So: a major part of the plan could be to add the equity in your home to whatever you have in your life savings and to your Social Security income to support yourself in much the same style that you would enjoy at the Beatitudes. This would mean hiring housekeeping help, yard workers, and possibly a practical nurse to come in and help cope with your infirmities. It might include someone to chauffeur you around, if and when you reach the point when you ought not to be driving.

Given the value of Margarita’s home, she presumably would have plenty to cover those costs. If she added, say, $30,000/year to her Social Security income, which is probably around $16,000 or $17,000 a year, the cash in her savings and house equity would outlast her for many years,

My house’s value is nothing like hers — despite the influx of Californians and resulting inflation in real estate values, it’s presently worth about $461,000. But I have cash in savings. The result: there’s enough there to support me until I croak over, assuming I don’t live more than about another 20 years. That would put me at the end of the lifespan of my most long-lived relatives.

If you figure I spend, on average, around $30,000 a year on everything including taxes, insurance, medical care, house repair & maintenance, automobile costs, housekeeping help, yard guys, the pool guy: the equity in my house would support me for 12 years. The amount in savings would last for 22 years. Combine them, and they would keep me going for another 38 years in this house…and believe me, I ain’t a-gonna live for another 38 years! 😀

By “keep me going,” I mean provide most of the amenities one gets at a place like the Beatitudes: prepared meals, people coming in every day or two to check on you, transportation, home maintenance, medical & dental care, utilities, and whatnot. But you would get all that in the privacy in your own home, without having to give up much independence. Over time, you might become more dependent on certain kinds of helpers…but you would be the one who hired those people, not some institution’s management, which means you would be the boss.

So, what would be the drawbacks?

Assuming you weren’t incapacitated by a fall, the main things that would work against you would be cancer, stroke, or dementia. You could suffer cancer or stroke at any time of your life: my grandmother was in her 40s and my mother was 65 when they died of the Big C. If you evade cancer, a stroke or a heart attack are probably the likeliest wormholes into the other world. In that case, most of the cost for end-of-life care would supposedly be covered by Medicare plus my long-term care policy.

But dementia is the monster lurking behind the curtains… If you were demented, you truly could not take care of yourself and would die, slowly and expensively, in a nursing home — with, as far as I can tell, no way out. If on the other hand you suffered a disease that could be treated and staved off, you probably could return to independent living. This fact would be true, though, no matter where you lived: in a private home or in a warehouse for old folks.

Incidence of dementia in the US has fallen: at this time about  20-25% of over-65’s have “mild” cognitive decline. Furthermore, dementia rates in the US are continuing to drop as the population ages. Harvard University notes that dementia cases in this country are dropping at 15 percent per decade. The Alzheimer’s Association claims the numbers are growing…but then, it’s in their interest to do so. Additionally, the level of education a person attains is somehow associated with one’s likelihood of succumbing to dementia: the more education, the less likely you are to suffer senile dementia. I have a Ph.D. So presumably I’ll remain sharp as a tack no matter how superannuated I get!

The Alzheimer’s Association’s claim that the numbers are rising measures something different: their figures represent the fact that a huge bubble in the U.S. population — the baby boom — is advancing into old age, not that the percentage of people with Alzheimer’s in that population is increasing. In other words, if (let us say) 10% of people develop Alzheimer’s after age 65, and a city has a population of 100,000 people 65 and older in 2010 and 200,000 such people in 2020, obviously the city will see a lot more citizens with Alzheimer’s in 2020 than it did ten years earlier.

Gina Colata, writing in the November 21, 2016 issue of the New York Times, reported that “the dementia rate in Americans 65 and older fell by 24 percent over 12 years, to 8.8 percent in 2012 from 11.6 percent in 2000.” If this trend continues, then one’s likelihood of developing dementia drops accordingly.

It’s a crap shoot. If you can hang onto most of your marbles and you don’t develop a debilitating disease such as Parkinson’s or ALS, you should be able to maintain your freedom until close to the end of your life, if not until you’re all the way home. In my case, the peripheral neuritis surely could become debilitating. However, Margarita has it and says it’s not the reason for her crutches. It’s annoying, but apparently no more crippling for her than it is for me, which is…not at all.

Neither Jane nor Dick appears to suffer from dementia. Dick is ill because he has heart disease. Jane has suffered from hip pain, but a hip replacement seems to have resolved the problem.

The hip thing was one of Jane’s motivations…she was afraid she wouldn’t be able to continue caring for Dick much longer. But…she resisted having the surgery. After she went into the Beatitudes, someone finally persuaded her to do it. At 94, she came through it just fine and now is walking pain-free. Had they stayed in their home, she could have hired someone to come in and take care of Dick — or have rented a place for him at the Beatitudes for a month or three — until she recovered. After that, she probably would have been better able to cope, at least for awhile.

One powerful motivation for her decision to move them out of their perfectly manageable patio home was that a nut case lived next door, and this woman was threatening them with harm. So…let us say that you arrive at your dotage and find that you truly do need to move out of the home you’re living in, not so much because of infirmity but because of other issues.

Is there an alternative to the life-care community?

Well. Yes.

Check out this place.

This is an apartment in the high-rise where my friends and coreligionists Jack and Lou live. Personally, it’s not to my taste, mostly because I’m less than fond of apartment-house life. But…it’s one helluva lot better than the Beatitudes. $385,000 for 1261 modernistic square feet: that’s probably more than Dick and Jane paid to get in to the Beatitudes. But…

It’s not a prison. Also, Jack and Lou’s place is larger than Dick and Jane’s two-bedroom digs, I believe. Certainly the kitchen is vast, by comparison. The sitting areas are far more pleasant, and the master bedroom is large enough to accommodate…yes…a king-sized bed. One of those will not fit into Dick and Jane’s main bedroom.

Though it has no cafeteria in-house, it’s within walking distance of quite a few eateries. It’s also less than a mile from the beloved AJ’s gourmet grocery store. That shopping center has at least three restaurants.

It also has no monthly gouge, other than an HOA fee. At the Beatitudes, the monthly fee starts at just $2,815 with a one-time 90% refundable entrance fee starting at $144,800. The final pricing depends on the size of apartment you choose.  So they say. It’s impossible to get a straight story about their buy-ins and fees online — the only way you can get straight dope is to go down there and subject yourself to a ferocious sales pitch, and give them private information so they can keep hustling you til the end of time.

One site says the monthly fee starts at $2254 and is coy about the buy-in Another says the buy-in is $180,000, but that’s undoubtedly for a studio: Jane told me it took ALL of the proceeds from sale of their home to buy into the place…that would be around $350,000. Plus.

Here we have a more realistic claim of $350,000: “Residents in independent living pay a buyin fee. That price can range from two hundred and fifty to three hundred and fifty thousand dollars. They pay a monthly fee for services as well. We also have month to month rental units with no buy in requirement.” They claim 90% of this is reimbursed to family when the person dies — that has got to be BS. My understanding is it’s gone, once you move in. This article appeared in January 2017, over 4 years ago.

Dick and Jane’s place is supposedly 2 bedrooms, but it’s nothing like the size of Jack and Lou’s place. J&L’s kitchen is huge — probably bigger than mine. It’s three times the size of the Beatitudes’ kitchenette, which doesn’t even have room for a built-in microwave. It has a living & dining room, but so does the Beatitudes’ place, sorta: a large-ish room divided by a pony wall. It has a second bedroom — so does Jack and Lou’s. But the Beatitudes’ master bedroom isn’t large enough to accommodate a king-sized bed!

No kidding. Dick and Jane had to get rid of their marital bed and replace it with a queen-size bed, over Dick’s strenuous objections. Within a couple weeks, Dick fell out of the thing onto the floor! Only by sheer luck and the grace of God did he fail to break a hip.

Back at the Central Avenue high-rise, Jack and Lou’s place has a generously sized master bedroom and a normal-size second bedroom, both with astonishing views of the entire East Valley, the Superstitions, and the South Mountains. It has a dining room/living room suite that easily accommodates 15 or 20 guests for a party (I’ve been there!), and in addition it has another sitting area, a rather private alcove off the entry that could be used as an office or just a separate seating space. If you put a fold-out sofa there, you could use it for overnight guests. Or it could serve nicely as a small library.

The cost of a two-bedroom apartment at 1 Lexington (right on North Central — step out the front door and the light-rail will whisk you to AJ’s, to a Safeway, to any of half-a-jillion restaurants, the library, two nationally prominent museums, the baseball stadium, a live theatre, or your lawyer’s office downtown) is about the same as the buy-in for the Beatitudes, only without the exorbitant monthly fee and without the Big Mama constraints.

As for a chow line: it doesn’t cost anything like the Beatitudes’ monthly fee to order food from Instacart or meal delivery services. What’s to stop you from ordering seven meals from a restaurant at a time? Plus grocery stores sell rafts of prepared meals, which are the same damn thing you get at the Beatitudes’ dormitory-style eateries, only cheaper. But if you like real food, an in-the-wild apartment has no requirement to show up at the mess hall to be counted and assessed by your keepers while you eat institutional yuckum: you can cook your own meals.

We do have the fact that at the Orangewood institution, one of the office staff helped my father with his bank account bookkeeping when he no longer could cope. But again…for one helluva lot less than your entire life savings and a gigantic monthly fee, you could hire a bookkeeper to do that.

Obviously, a stylish high-rise apartment condo has no nursing or custodial care on site.

But it’s a five-minute drive (or less) by ambulance to not one but two major hospitals. And if necessary, you can hire people to come in and ride herd on you.

To my mind, the biggest drawback of this alternative is that it provides noplace for your dog. You’re allowed to keep a dog at the Beatitudes, but you have no yard space, so of course you have to take the dog out on a lead, meaning you have to stand there in the heat or the rain until the dog decides to do its business.

But we do have this thing coming up the pike: a plan to demolish a Paradise Valley ghost mall and replace it with an apartment/office/restaurant/retail complex.

Except for the dog problem, that could be ideal. And if you could get a unit on the ground floor, it would work: you could just step outside with the dog, rather than having to get it up and down an elevator and pray it doesn’t pee in there.

Other alternatives already exist.

For example, there are some older but very pleasant two-story garden condos down by the Phoenix Art Museum. These places also are close to Central Avenue — a short stroll to the light-rail line, minutes to the nearest hospital, across the street from a Safeway. They’re also within walking distance of the main city library, the Heard Museum, the Phoenix Little Theatre, and a variety of stylish restaurants.

Better yet: a patio home is your basic apartment…without anyone tromping around overhead.

The latter would give you some yard space for your dog.

Alternatively, you could re-home the dog and buy a suite on a cruise ship. Sail away into the sunset and never come back!

Or you could buy a room or a suite in a hotel. This would accomplish essentially the same objectives as moving yourself into an old-folkerie, only sans the age segregation, the bad food, and the officious supervision.

So…if there are better ways to get by without locking yourself in a prison for old folks — ways that cost no more and may cost less — why on earth do people do that? As I mentioned above, the sales tactics at these places are highly aggressive. I went in there one time with Jane, met a sales rep, and my mailbox still gets stuffed once a week with advertising junk for the Beatitudes. Too, I suspect peer pressure works its magic…my father was put on to lifecare communities by my great-aunt, who came into town looking at places when she wanted to move out of her (spectacular) place in Sausalito, California.  She ended up staying in the Bay Area, in a (very tony!) old-folkerie in the East Bay. But no matter how swell, the fact still remains: this is a prison to which the inmates deliberately sentence themselves.

Realistically, though, if you live as long as is theoretically possible, there’s going to be a point at which you will have to have help with daily living. How to get that remains a conundrum.