Moving Mom & Dad – but to where?

With the over-5o population expected to grow from 100 million this year to 130 million in 2030, the question of how and where to house these older adults is one that’s not going away. And it is not just a question of quantity and variety — enough houses, apartments, retirement communities — it’s how to ensure that needed services will be accessible to all.

A new report just released by AARP’s Public Policy Institute and authored by the Center for Housing Policy offers a comprehensive look at a complicated picture. Insight on the Issues: Strategies to Meet the Housing Needs of Older Adults and is designed to help state and local policy makers understand the needs of this growing population segment.

All of these Boomers, who are now beginning to swell the ranks of the Seriously Senior, have specific wish lists: independence, security, and above all avoidance of the N-word — the dreaded nursing home. The wish lists change almost by the day, but some things stay the same.

“With the population of older adults on the rise, this report helps to identify the essential housing policy strategies that can help them to balance their increasing needs with a desire to continue to stay closely connected to their families, communities and society,” said Center for Housing Policy Chair John K. McIlwain, senior resident fellow and the J. Ronald Terwilliger chair for housing at the Urban Land Institute.

According to Susan Reinhard, AARP Senior Vice President and Director of the AARP Public Policy Institute, “These resources will be invaluable for policymakers at the state and local levels as they adapt to the changing needs of an aging population.”

If you, or your parents or grandparents, are over 50, chances are you have already had The Talk. Where in the world will Mom and Dad go, and how in the world will they stay there? What’s going to be comfortable? How will we afford it?

Nine fact sheets accompanying the newly released report are divided into three sections. It all makes the task of plowing through the talk a little easier, especially if local and state policy makers are paying attention at the same time.

This space will be looking at the different points over the coming weeks. Your comments and personal stories are welcome.

Moving Mom and Dad

The folks are getting on in years, the old house needs work, the Stuff is piling up everywhere — it’s time to look at moving. But the big question is, where to? Urban condo? Assisted living? Retirement village? LifeCare facility? Co-housing? Maybe even the dreaded Nursing home or dementia facility?

Making the decision to move into what is likely the last residence on this side of the hereafter can be daunting, sometimes devastating. Whether it involves oneself or one’s older family members, the Final Move often exhausts patience, finances and family resources. But good choices are out there, and good help (sometimes free, more often adding to the growing costs of this life event) can be found. In previous posts this space has offered glimpses of these choices and experiences: Helping Mom Die (10/16); Hanging in the ‘Hood (9/29); Justice Souter’s Retirement Housing (8/10.) What follows is a look into the LifeCare option. I should first insert a grateful nod to the source of this headline, a great book by Sarah Morse and Donna Quinn Robbins.

I have just returned from a visit with my sister Helen and her husband, newly installed in a spacious two-bedroom cottage at Kendal at Ithaca (NY), a Continuing Care Retirement Community. To do this necessitated cleaning out and selling (of course, the sale fell through when everything was on the moving vans, but last-minute calamity is to be expected) the far more spacious four-bedroom plus roof deck 1920s condominium in Boston they have called home for nearly 40 years. It was not pretty. Despite my earlier Boston visits to whittle down the Stuff factor and later urgings to connect Helen with the National Study Group on Chronic Disorganization, the job tested the limits of patience and strength of their four extraordinarily loving children.

Nonetheless the deed did get done, and Kendal at Ithaca is perfect for Helen and Clare, thanks to a confluence of happy circumstances: their physician daughter has relocated from Seattle to Ithaca; Manhattan is a comfortable Cornell bus trip away; desired features are in place. KAI includes a community center with a dining room in which their monthly fees entitle them to one meal per day, a fitness center, a large library, a van to take residents to doctors’ appointments etc. Best of all, says Clare, who has Parkinson’s, “they can’t throw me out.” The major appeal of LifeCare, or Continuing Care communities, for many seniors, is the inclusion of facilities for different levels of care which one may require in the future. (Worst of all, Clare adds, is the fact that “we have a lot of Parkinson’s, so I see myself 3 years down the road… 6 years down the road.”)

Continuing Care communities do not come cheap. But for seniors who have a chunk of change from a home sale or other source and a comfortable retirement income, they fortunately exist in growing numbers across the country.

For my own part, and I am certainly very senior, I was suffering anxieties and depression after one day. I need regular infusions of 30-somethings and 40-somethings for basic survival. Again, from what I’ve heard about co-housing — the perfect choice for many others as they age — that arrangement would feel crowded and disorderly. But there is the growing aging-in-place “Village” movement, which many would not choose but seems perfect to me.

Thank heaven for choices. It is seldom too early for Boomers, or Beyonders, to start considering them — and while you’re at it, you may want to clean out the attic.

Hanging in the 'hood – a good option for boomers and beyonders and the economy

Say you’re happy in your ‘hood. The sights are familiar, the neighbors are okay, the comfort level is high. Now say you’re 70-something or 80-something and you need a little help now and then, bringing in the papers, getting to doctors’ appointments, changing light bulbs. Do you really want to pull up roots and move to a totally new environment, re-learn where everything is, make new friends among people who never knew your children (or your parents)? The latter is being chosen every day for or by seniors in America; the former is spurring a movement with an interesting variety of formats under the general heading of Aging in Place. I really want an umbrella acronym for this category, but I don’t really want to be an AIP.

On her New Old Age blog for the New York Times a few days ago Paula Span wrote about her dad’s life in a NORC.

In my father’s apartment building in South Jersey, the older tenants start drifting into the small lobby each day around 1 p.m., taking up positions on chairs and couches. The ostensible reason: The mail is about to arrive. The real reason: They relish a chance to schmooze.

“There’s a lot of discussion about the economy,” Dad reports. “And what the president said about the police and that fellow in Massachusetts.” Lesser issues arise, too. Whose daughter is coming to visit. What is on sale at the ShopRite supermarket.

Twenty-five years ago, a University of Wisconsin professor coined a great term for this kind of residence. It is a naturally occurring retirement community, or NORC. The place wasn’t built for seniors; its tenants are all ages, infants through nonagenarians. But a substantial number of residents have been there long enough to grow old together.

Since he still drives, my father heads out each morning to buy the papers, which get passed from one apartment to another. (God forbid you should squander 50 cents for your own copy and read the headlines before suppertime.) He ferries friends to doctors’ appointments. He benefits, too: his pal Manny comes by several times a day to check on him, and neighbors stock his fridge with soup and strudel.

NORCs exist all over; probably half of Miami Beach, Fla., was a NORC at one time. Watching this little community cope with shopping and banking and constant medical visits, I have wondered why services can’t be brought to these residents. Wouldn’t it be more efficient to have a nurse visit weekly, instead of each person making a laborious trip to a doctor’s office? For the senior van to schedule regular excursions to ShopRite? For the high school orchestra to give concerts in the community room, since so few older residents go out after dark?

A number of NORCs do offer this kind of help. Twenty-five states have NORC supportive service programs, according to the queen of NORCs, Fredda Vladeck, who runs the United Hospital Fund’s Aging in Place Initiative. New York leads the list with 54 NORC programs operating in high-rises, garden apartment complexes and neighborhoods of single-family homes; Indiana comes in second. The common mission of the programs, Ms. Vladeck said, is “transforming communities into good places to grow old.”

NORC’s and their cousins the Village aging-in-place concepts are multiplying, but they’re nothing new. They’ve been around for more than a quarter of a century (if you discount the automatic NORCs that small towns and Native American communities offered in ancient America afforded. And they’re proven effective. “Numerous studies have documented the benefits and potential of NORCs, including a Senate report (PDF), a foundation grant report and a graduate thesis,” Span writes.

So why, after 25 years’ experience, are there not more support programs for the millions of older Americans already living in NORCs, and the millions more to come?

Ms. Vladeck, accustomed to lobbying and testifying and organizing, sounded philosophical. “It’s incubating,” she said. “Sometimes, innovation takes a long time.”

If you want to keep your parents out of nursing homes, or want to stay out of a nursing home yourself, learning about how these alternatives work isn’t a bad way to start the plan.  There may not be a long time left, at the rate America’s getting older.

When the Neighborhood Is the Retirement Village – The New Old Age Blog – NYTimes.com.

What to do about Mom?

My friend Joan is distressed about her mother.   Joan – that’s an alias, we both value her privacy – lives quite near her parents, visits regularly, helps out with finances, health issues and everyday needs. They are in their late eighties. Other siblings live in other states. Until recently everything was fine; now the parents are in separate areas of their assisted living residence, Joan’s mother is in frequent despair and need. What’s a daughter to do?

This story is being repeated thousands of times every day across the country. Only this story has a peculiar twist: Joan’s parents did everything right. They lived frugally, planned ahead, raised their children to be successful and independent, moved early into a retirement community which offers care through illnesses minor and terminal. With Joan’s help they kept their affairs in order, including updated advance directives. (You don’t have your advance directives done? Horrors. Let me know and I will be at your door, cyberspacially speaking, to walk you through them immediately.) Joan’s parents were among early advocates for advance planning and end-of-life choice.

Joan comments: “Frankly, Mother is tired of being alive.  She’s not depressed, just ‘finished’, especially as she sees these slow declines in her quality of life as a steady and inevitable progression.  Her greatest desire would be to have a massive stroke and not survive.  But then her greatest nightmare would be to have a stroke and live . . . Even with the best advanced directives reflecting her choices, that’s a fine line to navigate.”

The moral of this story is that no amount of planning and preparation can guarantee the kinds of last months and years we might want. My own mother died peacefully at home, followed 20 years later by my father, same story. But that was in 1967 and 1987, in the small town of Ashland, Virginia where they had lived since 1939. The town looked after them; their out-of-state daughters merely visited and counted their blessings. Towns and neighborhoods like Ashland are in diminishing supply.

But all is not gloom and doom; this writer is constitutionally unable to write doom and gloom. Joan is at least clear about her parents’ wishes, and her parents have good care plus all allowable precautions: DNR orders, POLST forms, understandings with their medical professionals. Most of these are possible for today’s Boomers and their Beyonder parents; if you can’t find them I’ll happily tell you how. Joan’s parents are also in housing of their choice. And those choices are many: co-housing, retirement communities, assisted living facilities, many of them available to middle and low income Americans. Anyone over 50 who thinks he or she should postpone considering all of these issues, documents and choices until next year is delusional. Essays re housing choices have appeared in earlier Boomers and Beyond posts; others will follow. The secondary moral of this story is that without planning, late years can quickly turn into hell for elderly parents and adult children alike.

What we don’t have, of course, is health care such as Joan’s parents still enjoy for others who need it. The thing is, we can.