Transcript Senior Living Options “Finding Your Place” Thursday

Senior Living Options
“Finding Your Place”
Thursday, October 9, 2014 – The Quechee Club
4:00- 5:30
AGENDA
•
•
•
•
•
A confusing system
Finding your Place on the continuum
CCRC an in depth conversation
What does it Cost
Q&A
Independent
Living
Assisted
Living
Nursing
Intermediate
Care
Skilled Care
Demenita
Care
A confusing system
The focus this afternoon will be to discuss a segment of the
housing and senior services sector:
Retirement Communities
10/09/14
Senior Living Options - Finding Your Place
2
SENIOR LIVING OPTIONS ... FINDING YOUR PLACE
Want Driven
Need Driven
Preventative
Long-Term Care
H
O
S
P
I
T
A
L
TRENDS ACROSS THE CONTINUUM
H
O
M
E
Continuing Care Retirem ent Com m unities
Assisted
Case Managem ent
Living
Senior
Catered
Respite
Interm ediate
Dem entia
Centers
Living
Care
Nursing
Nursing
Rehab
Sub-Acute
Wellness
Program
Specialty Units
Independent Living
Com m unity Based
Services
10/09/14
Acute
Skilled
Hom e Care
Hospice
Nursing
Adult Day Services
Senior Living Options - Finding Your Place
3
Regulations, rules, statutes
(each state is a bit different)
Dept of
Insurance (DOI)
Oversight
With broad
powers
________
In most
jurisdictions the
DOI… oversee
Independent
Living Contracts
Health and
Human Services
(HHS)
________
Generally
oversee assisted
living and
nursing units
AG
Attorney
General’s office
________
Oversees
non-profits
NH
Statutes (RSA 420-D): http://www.gencourt.state.nh.us/rsa/html/xxxvii/420-D/420-D-mrg.htm
Regulations (Ins 1800): http://www.gencourt.state.nh.us/rules/state_agencies/ins1800.html
VT
Regulations:
10/09/14
http://www/leg.state/vt.us/statutues/sections.cfm?Title=08&Chapter=151
Senior Living Options - Finding Your Place
4
Terms = I will focus on six terms that some of you are
familiar with…or you may begin to learn about them
today as you think about this topic in more depth.

Active Adult Communities

Rest Homes

Intermediate Care (ICF)

Assisted Living

Continuing Care Retirement Communities
(CCRC)

Skilled Nursing Faculties
The grid will now be easier to focus on.
10/09/14
Senior Living Options - Finding Your Place
5
POSITIONING AND FINDING YOUR PLACE ON THE CONTINUUM
Want Driven
Need Driven
Preventative
Long-Term Care
H
O
M
E
H
O
S
P
I
T
A
L
The Continuum in a CCRC
Continuing Care Retirement Communities
Independent
Living
Assisted
Living
Intermediate Care
Nursing
Skilled
Nursing
Rest Homes
Active Adult Communities
Continuing Care at Home CCAC
10/09/14
Senior Living Options - Finding Your Place
6
Definitions
• Active Adult Communities
An active adult community is targeted towards people 55 years of age or older.
Each is designed differently and may include single-family homes, condominiums,
town homes, multi-family dwellings, or manufactured housing units.
•
Rest homes
These homes were actually the forerunner to senior housing as we think of it.
Homes for the Aged (Taylor Community 106-years old), Westboro House in
Lebanon and Outreach House in Hanover.
10/09/14
Senior Living Options - Finding Your Place
7
• Assisted Living Communities (ALCs)
ALCs provide services to residents who need assistance with personal care,
medication management, and/or home management but do not require skilled
health care. ALCs range in size from studio units, one bedroom and 2 bedroom
units. Typically include a wide-variety of community spaces and activities.
• Continuing Care Retirement Community (CCRC)
CCRCs provide 3 levels of accommodations: independent living, personal
care/assisted living, and skilled nursing/rehab. Services vary by level of
accommodation.
10/09/14
Senior Living Options - Finding Your Place
8
• Intermediate Care Facility (ICF)
A nursing home, recognized under the Medicaid /Medicare program that provides
health-related care and services to individuals who do not require acute or skilled
nursing care, but who, because of their mental or physical condition, require care
and services above the assisted care level.
• Skilled Nursing Facility (SNF)
Skilled Nursing Facilities (also called Skilled Nursing Homes/Rehab) offer two levels
of skilled nursing care: long-term care and short-term rehab. Upon discharge from
rehab, patients often need follow-up care in their homes.
10/09/14
Senior Living Options - Finding Your Place
9
The Continuum within a CCRC
Independent
Living
Assisted
Living
Nursing
Intermediate
Care
Skilled Care
Demenita
Care
Coming up you will hear me talk about “life care” and in this
context it means that regardless of your ability to pay, the
community will cover your costs….for life.
10/09/14
Senior Living Options - Finding Your Place
10
Drill Down a bit on the pieces
Independent = Do what you want, join in activities.
Often meal plans are offered, but most often you are
on your own, everything is a la carte.
Assisted Living = Typically 3 meals a day, scheduled
and planned activities, some level of personal care
assistance and medication management.
Nursing Care = Nursing care generally includes
intermediate care and memory care/dementia care but
specifics vary. NH CCRCs cannot provide skilled care on
campus unless grandfathered.
10/09/14
Senior Living Options - Finding Your Place
11
Continuing Care Retirement Communities (CCRCs)
Samples – Contract Types
TYPE A
•
•
TYPE B
•
•
•
TYPE C
•
•
•
•
Contracts typically amortize down to zero in return for life time
guarantee (life care) … If you leave during the first 60 months you
might get pro-rated share back.
Monthly fees are usually the same regardless of the level of care
Entrance fee required (amortization differs by project)
Monthly fees are fixed for a limited period of time (no life care)
Refunding of entrance fee varies
Entrance fee required (a variety of refund options)
No Life care
Monthly fees are different depending on level of care
A complete a la carte model for services, activities, etc.
Rental Model:
10/09/14
No entrance fee….”pay as you go”
Senior Living Options - Finding Your Place
12
What does it Cost ?
Entrance Fees:
$44,000 up to $1.5 Million
Some entrance fees are refundable based on amortization schedule, often 5-7
years. Here is where it is important to understand contract…life-lease.
Recent trends offer refunds between 50%, 75% or even 90% mostly due upon
re-occupancy. These have changed based on market and macro-economic
influences.
Monthly Fees:
$ 1,500 to 5,000 per month single occupancy
Second person fees do apply. Increases are customarily based on COLAadjustment and most organizations do not cap annual increases.
10/09/14
Senior Living Options - Finding Your Place
13
The latest model on the Scene Continuing Care at Home – Two NH examples
•
Hunt at Home offers you a confident choice. It is the first program regulated by
the New Hampshire Department of Insurance as a Continuing Care at Home
(CCAH) program. Simply put, the Hunt at Home program allows an eligible person
to live in their existing home and still receive many of the services of a Continuing
Care Retirement Community. Entrance fee is required….and services paid for on an
a la carte basis.
•
Taylor Connection:
Like Hunt, the program creates a synergy between the main campus and the home
owner by requiring an entrance fee. Few services are offered BUT you have a
guarantee to be admitted under a Life Care contract when ready to move to the
campus.
10/09/14
Senior Living Options - Finding Your Place
14
Contracts and Disclosure Statements/Legal
Get an attorney:
Most providers encourage the consumer to have contracts
reviewed by an attorney – of course you should!
Specific disclosure statements are usually required by the
regulator in each state.
Documents, regulations, statutes and idiosyncrasies by
provider-type make every community different. There
used to be one model, but providers have to make
changes based on occupancy challenges, economic
pressures and market conditions.
10/09/14
Senior Living Options - Finding Your Place
15
Contracts and Disclosure
Statements/Finance/Accounting
Talk with your financial advisor or
accountant:
Review your finances, make sure you
have enough money.
10/09/14
Senior Living Options - Finding Your Place
16
CONCLUSION and THOUGHTS
•
Do your homework and don’t wait, move when you can, not when you HAVE to.
•
Of the 1900+ retirement communities in the US only 400+ are for profit. The nonprofits focus more on mission versus profit and are governed by people like you
and are always community-based 501(c)3 tax exempt. Many systems are faithbased.
•
Use resources, my favorite is LeadingAge, the national association of non-profits,
with over 5,000 members and an affiliate in each state. www.leadingage.org
•
Retirement Living Information Center: http://www.retirementliving.com
10/09/14
Senior Living Options - Finding Your Place
17
Questions and Answers
10/09/14
Senior Living Options - Finding Your Place
18