When searching for a retirement community, it's hard not to focus all of your attentions on the fun amenities. Is there a pool or a spa? Do they serve five-star cuisine? But what matters more than tee times and tennis is whether the retirement community that you're eyeing is safe and sanitary, and can cater to your health care needs — now as well as in the future.
One would think most retirement communities would fit the bill. Think again. In the past year, there have been news reports of a fire that broke out at the Providence Retirement Home in New Albany, Ind. (eight residents were treated for smoke inhalation and two were sent to the hospital), of staff members spotted two deer running in the halls of an Adams County retirement home in Pennsylvania before they exited on their own will, and of unsanitary conditions (including maggots in a resident's leg wound) at the Armed Forces Retirement Home in Washington, D.C., surfaced during an investigation of 1,400 veteran's facilities nationwide. Before you choose your new residence, make sure to visit it at least once, and be prepared to do some detective work. Here are some tips on what to look for when shopping around for a retirement community.
Even if you're in good health, consider choosing a retirement community that has an on-staff nurse or a visiting practitioner, as well as health care services such as bathing assistance and medication reminders. Also, take a stroll around the health care facilities and pay particular attention to cleanliness, how the staff interacts with the residents, and odd smells — especially a lingering smell of urine, which is usually just one of many signs of unsanitary conditions, according to Barth Holohan, president of Continuum, a health care company based in St. Louis, that provides health and supportive services to seniors.
Continuing care retirement communities are probably the best prepared to deal with healthcare issues that arise as one gets further on in their golden years. This type of community hosts independent living quarters, assisted living facilities and nursing homes. That way, if a resident's health deteriorates, he or she could get the proper treatment without changing facilities. "There will come a day when [a patient] will need [in-house, health] services," says Holohan. "You don't want...to change homes three or four times."
The average cost of living in a not-for-profit continuing care retirement community is $2,672 per month or $32,064 annually, according to American Association of Homes and Services for the Aging's (AAHSA) 2005 Continuing Care Retirement Community Profile. To avoid being slammed with excessive fees down the road, make sure to assess your healthcare needs before you choose a particular package, says Holohan. Otherwise, if you ever need additional services like 24-hour-awake care — having a nurse's aid or a certified nursing assistant who's awake at all time — could cost you around $3,000 more a week, he says.
If you have fallen in love with a certain retirement community and they don't offer health services, be prepared to dole out a lot of extra cash. One of your few options should you get sick or require regular assistance is to contact an outside health care company, which will likely charge a monthly or per hour fee for private care. Setting up a resident's medicines, for example, costs around $100 per week or $18 per hour for a minimum of four hours with Continuum.
Even if a retirement community, assisted living facility, or nursing home appears well-run, it's important to do some extra digging. You can start out by eating at least one meal at the facility, and when you speak with residents ask them if they are happy living there. But don't stop there. Before you start loading the moving truck, contact the Better Business Bureau or Elder Care Locator. They can inform you of deficiencies, complaints, or legal actions that have been filed against a specific facility. In addition, Medicare's Nursing Home Compare offers information on nursing home quality measures, inspection results, and staff. Another option is to contact your state health care or licensing agency or ombudsman or you can ask the facility for its most recent state inspection, says David Kyllo, executive director at the National Center for Assisted Living (NCAL).
The Fine Print
Incoming residents often have to sign a binding contract with their retirement community before moving in. Ask an attorney specializing in elder care to review the terms of the contract, a service that typically costs $300 to $500, before you sign on the dotted line, says Debra Speyer, an elder care attorney with offices in Florida and Pennsylvania. Each retirement community and contract is different from the next one, so it's important to read the fine print, she says. Make sure you understand what services the base price includes, and if fixed costs are set to increase annually, then the contract should state the percentage at which the increases will be calculated.
"Keep in mind, that most of these contracts are a take it or leave it," says Speyer. If there's room to negotiate, have your attorney request that an exit clause be included in the contract, she says. That way, if you leave the community — say, because you just weren't comfortable there — then you'll be protected from any large financial damages, such as losing your entire deposit — a cost that can range from $60,000 to $120,000, according to AAHSA's 2005 profile. Negotiating this clause costs around $100 to $400 an hour, depending on where you live, says Speyer.
Chances are your monthly payments to your retirement community are, in part, determined by staffing levels. A retirement community that charges $3,000 per month might have a resident-to-staff ratio of eight-to-one, while a community that charges $2,000 might have a ratio of twenty-to-one, says Holohan. The extra money could be worth it if residents receive better care, he says.
Also, get a feel for the staff turnover rate. "If they've been there for two months, you're in trouble," says John Hehn, executive director of Florida Presbyterian Homes, a continuing care retirement community in Lakeland, Florida. "The longer they...know the residents, the better their care will be." To get an even more realistic sense of what life in the community is like, visit at night when there's less staff, says Holohan.
Sadly, security is a very big concern at retirement communities. Make sure to inquire about the number of security personnel that are on patrol 24 hours a day, seven days a week. Look for locks on all of the windows, barriers, like metal bars, on first-floor windows and an alarm system. Equally important is the interior security, says Dr. James Wood, clinical assistant professor of medicine at the University of Rochester. He suggests asking if call bells are easily accessible or if the facility has a Personal Emergency Response System (PERS) that outfits residents with bracelets or necklaces that can alert staff of falls or other emergencies. These aren't required, he says, "but it's something I'd expect of any facility where I place someone I love."
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