Will independent living become the new middle class assisted living?
Several weeks ago I dropped into a Holiday Retirement independent living community. For a variety of reasons I ended up never writing about the visit, even though I was treated very well.
Today, Easter Sunday, my wife and I joined our daughter-in-law’s family for Easter Brunch at the Del Web Sun City community in Roseville, California. I considered writing about that experience. It is a beautiful community, but by the time we left I didn’t feel like I had a good enough feel for what they do to write a credible article.
Driving home we passed a senior living community and, rather than going out again, I decided to stop. Holiday Retirement, Mistywood They were in the middle of serving Easter lunch when I walked into the community. Paul and Leslie Platner were the co-managers on duty. Paul was busy interacting with residents in the dining room but came over to talk to me and was very helpful. The first thing he wanted to know was if I wanted lunch, an offer that was repeated even after I explained who I was and why I was there (and how much I had eaten at brunch). It was the perfect kind of reception to an unexpected visit.
The Big Question
There is no question in my mind that Holiday Retirement has the entire independent senior living experience dialed in. As an enterprise scale senior living company they have been doing this longer than anyone else. They have developed some unique management practices, such as live-in co-managers, that optimize resources and create a genuine relational style of management. What I keep wondering, though, is if the independent living model is sustainable. We know that seniors are waiting longer and are more frail when they finally move into a senior living community. We know that independent living communities have been able to attack this problem by aggressively allowing private duty care givers to contract directly with residents which, in effect, creates an “assisted living-like” experience. And yet, is this sufficient to sustain the model?
On one hand when I look at the current senior living market there does not seem to be much interest in the freestanding independent living model and yet . . . I can’t help but thinking that creating an “assisted living like” experience where the services are unbundled could see a significant resurgence as a way to control costs. I envision a time where a senior moves into a Holiday Retirement or Holiday style community and family members provide much of the ADL support which is then supplemented by outside agencies creating a much more affordable experience. Your thoughts? Steve Moran
The need for senior care – in home, outside of home and in a facility – continues to grow. All types of options are important. I was visiting a CCRC that has an interesting model for their IL residents. All IL beds are AL licensed so IL residents may get ADL support as needed. When they need true AL care, they don’t even have to move out of their room as the all the IL and AL rooms are in the same wing.
For free standing IL’s, this could mean offering access to ADL support and maintaining good relationships with nearby AL/LTC facilities so they can help transition the resident when that time comes.
For IL’s to do this well, being connected with the families is crucial. Families that have a window into the daily life of their loved ones can help as needed, especially with the often difficult decision to transition to AL or other LTC option.
My take on this is similar to my previous posts. In discussions with lenders, I have found more willing to finance IL rather than AL or MC. They seem to like the model and believe that AL and MC are getting saturated. That being said, I think there is a market for well designed and well placed IL
It has been my impression that “independent living” facilities that offer 1 to 3 meals per day tend to attract the older and frailer resident and, if not immediately, soon look more and more like an assisted living facility. The median age in most independent living facilities is now in the high eighties, very close to the median age in assisted living. I think folks choose these facilities because of cost and choice even if they need assistance.
This industry needs to find a product for the healthy 65 to 85 year old. Home builders are going after this active adult market with separate homes or condos often without any age restriction.
I agree — many independent living communities appear to have older and more frail residents than in the past — with about the same mean age as A/L. Having worked in I/L, A/L and long term care — acuity is rising in each model. Finding an Independent Living environment with a true “active” senior component seems to be more and more rare. Seniors want choice, but they don’t want to feel like they are in assisted living. There will also be the “them” and “us” mentality in I/L with more able residents discriminating against the more frail. I think providing in-apartment services merely delays necessary moves to assisted living — many times endangering their well-being as well. it should be about what is best for them — not just what they want.
Let me first identify from whence I comment: I am a leading edge babyboomer who moved my parents into a slight Type B, more of a Type C, CCRC in the year 2000. I am a CCRC IL resident now, choosing to go in early to beat the babyboomer rush. More on that in a minute.
In 2000, for my parents, a CCRC had the “power” to say that my mother could live in IL but that my father could not, due to blindness (macular degeneration) and mobility issues. So, he went directly into the SNF. It’s quite possible that only Type A CCRCs can mandate that “no IL for you” circumstances these days, due to court cases in which a plaintiff claimed discrimination under the Fair Housing Act. This arrangement was actually better for my mother who could transfer the primary care responsibilities of my father to the professionals in the SNF. The quality of her life improved as she enjoyed IL. She lamented that “they waited too late — your father would have loved the community dining experience.” To me, as their adult offspring, I quickly saw how easy it was for my mother to visit Dad, without getting out in the weather or behind the wheel of a car. A HUGE selling point.
I’m not sure when the rollator was invented, but I don’t recall seeing any fourteen years ago. It was rare to see a non-wheeled walker in her community’s dining room. But rollators changed the landscape of IL. Rollators, as well as motorized scooters, have helped revolutionize IL. Before, faced with a long hallway walk to get to the dining room, someone on a traditional non-wheeled walker might think, “I’d better move into AL, as I can’t make the trek any longer and have run out of steam.” Rollators allow one to rest on its special seat anywhere along the way. Dining rooms have to create parking spaces for rollators and scooters. While hardier IL residents might prefer it otherwise, that might be their situation some day.
The Marketing Department has asked IL management to somehow keep wheelchairs, scooters, and rollators from being left in the front foyer as residents are picked up by vehicles for an outing. The Marketing people say it conveys a negative image of what it is to live in IL. I don’t know of a reasonable “compromise” on this one.
I know of a Catch 22 to the Life Care contract (Type A) if private duty help is utilized in IL — it’s on a fee-for-service basis, meaning it’s out of pocket for the resident, even if provided by the in-house private duty home staff. The Life Care kicks in only if the resident moves to AL or IL. If an outside service is used, there is usually a 4-hour minimum. If in-house services are available (hopefully with the right license to allow Long Term Care Insurance to pay off), there may not be that long minimum time, if at all — maybe 15 or 30 minutes — enough to assist someone with dressing for the day, etc.
I’m sure the Home Health (not “Medicare Home Health, but private duty) agencies love it when they have a client in IL — the aide goes and fetches the food from the dining room, minimizing the food prep needed throughout the rest of the day…. the key: bring back enough for leftovers.
Some states (I’ve heard California, for example) license the IL as also AL, permitting the Marketing Department to fill the units either way, especially if they can tout an in-house private duty service. If people have the financial status to enter a CCRC in IL, then this probably indicates they have the means to stay in IL with private duty help. Sometimes going directly into AL may fall to “outsiders” who do not get there via living in IL first. This may be the name of the game.
Let’s talk about baby-boomers. Naturally in this land of rollators and scooters will make it a tougher sell to get non-infirm, younger residents into IL …. UNLESS there are enough “country-club” type of amenities on campus and enough residents to partake of the facilities. They’ll have to garner interest from those who have tired of yardwork or have had a security “issue” in their private residence.
Getting the baby-boomer generation “in” will be an education for all concerned. The baby-boomers need to work longer to get full Social Security benefits. They see the need to work longer because they didn’t save. The government is emphasizing that “aging in place, at home” is a more economical model than nursing homes. This is music to the ears of the baby-boomers are still attached to their homes, which probably have a 2nd mortgage or a reverse mortgage anyway. This is a generation of “consume now,” so they didn’t save. They may have counted on Mom/Dad’s house being an inheritable asset, until they find out that Mom/Dad put a reverse mortgage on it. They didn’t count on widowed Mom remarrying and having to pay her new husband’s nursing home bills because pre-nup agreements don’t shelter her assets from that requirement.
Liking their own home, they cannot see how boring the same 4 walls will become with no outside stimulation other than the health aide, their TV or a radio. No visiting choirs, musicians; no Halloween “parties,” no bingo on Saturdays.
The babyboomer rush I mentioned at the top of this piece is not the rush to live in IL. For me, the rush will be for the SNF as people really need help. There may not be enough brick-and-mortar places when the “pig in the python” hits the system. With almost all CCRCs, (Type A, B, C), the PRIORITY ACCESS to that custodial health care is the reason for present-day “buy in.” This is tough for Marketing to get across without appearing to be using scare tactics. Hint: use the babyboomers you aleady have in your resident population to get this point across subtly. Turn the more dominant appearance of infirmity in IL (really AL with private duty) into a positive …. saying that “this means one can enjoy their stimulating life in IL longer, since people make such good friends and enjoy the activities.”
I have been helping people with LTC planning solutions for 16 years. My own mother has been receiving care from a private caregiver at home for 6 years. Since we are in California, the long term care insurance company cannot require that we use an agency or licensed caregiver.
All this issues you speak about are of great interest and concern to me, personally and professionally. Thank you!
As a professional in the industry from a sales and marketing perspective, I have watched changes over the years. The independent living resident has changed to include more veterans, (Vietnam vets) and those with LTC policies. I worked with a company more than once on having a private duty home care agency in the the non-licensed independent living building to provide care and support for residents aging in place, who start to need care. Overall, initially, this saves money for the resident because they can hire care and not have to leave the living situation in independent living. The challenge is when the care needs outweigh the safety concerns and a move to assisted living is more cost effective then paying for private duty care at large time blocks. The independent living communities appreciate the support to help their residents stay as long as they can.
I think that a relationship of private duty care in independent living is a good idea for a resident who needs minimal care needs. But if there are concerns of diabetic management, fall risks, or a history of falls, then nurse management or oversight is preferred.
A question that I feel independent living managers should consider is how well these residents adjust to the care needs that change. Are they still socially appropriate ? Are they changing the culture of the community? Sometimes this can be hard for other residents to watch their peers have care needs, and those residents may feel like they “didn’t sign up for that” when they moved to an Independent living community.
Ultimately, if a community has a sales culture that does what is in the best interest of the resident, then things go well. Unfortunately, with census challenges that is not always an easy task.
I am a firm believer in the model of independent living. It was an honor to serve seniors and see all the positive and wonderful advantages independent living brings for a senior. In many instances, this brings on a whole new chapter and life that families would have never imagined. Socially, being able to appreciate new opportunities and make time for favorite things. The social benefits of senior housing is the biggest little secret in the industry. I am just glad I was able to experience it and live it daily. 🙂
I know that I am partial to Holiday’s IL model as my husband and I manage a community in Ohio. I wanted to comment on two items you mention:
1. Live in managers become extended family members to both the residents and their families. I liken it to neighborhoods where people know and look out for each other. It gives us all a sense of community that is often no longer available if the senior stays at home.
2. From a value stand point I think our model is a very strong one–residents and their families can off set any additional service expenses as needed, including by having family members being involved–giving them all the opportunity for continued contact and involvement.
And yes, we do often hear that our residents comment about others increasing needs but generally they appreciate that they too will have the opportunity to “age in place” and recognize that having the type of safety net available in our communities allows greater peace of mind for themselves and their loved ones.
From LinkedIn Groups
Independent living definetly has its place in the aging journey, I recently helped a couple into independent living. It worked out perfectly. This particular independent had a continium of care and was not a life care community where you had to buy in. The husband had alzheimer’s . He was able to go to day care at their memory center in the Alf and enjoy the evening with his wife back in thier independent apartment.The wife was totally independent. I believe some seniors are just not ready to make the leap into assisted living. A baby step into independent offers a wonderful alternative. If meals, socialization, housecleaning and transportation is the “care ” level that is needed why not make the move. Its less regimented than many assisted living communities and the only thing the senior is probably really “giving up” is space. Always Best Care Specializes in helping seniors remain as independent as possible by offering in home care and free independent and assisted living placement help. If you get a chance visit another independent living and speak with as many residents as you can to get their feed back
By Lesley J Vestrich-Hudanish
Could you clarify what you meant by “not a life care community where you had to buy in”??
Are you saying the community was Type D? And when you say “buy in” are you referring to an entrance fee? Entrance fees exist in Type A, B, and C communities. Some Type D (rentals) tend to have a non-refundable and much lower “move-in” fee — say, $5,000.
From LinkeIn Groups
Not everyone can afford retirement communities. In our area, low income senior housing is scattered rather than clustered around core services. Service providers drive all over town, being less efficient and more costly. And, we need to teach seniors how to help each other more. Formal help will become scarcer as the senior population grows.
By Larry Shoemaker
From LinkedIn Groups
I think they are needed to give resident choices, also for those who can afford them, it can be a positive thing.These facilities are structured and regulate, also they have routine, that allows transition prior to assisted leaving.
By Edith Okeyo Otieno RN BSN
From LinkedIn Groups
IL as part of a CCRC environment is a reasonable entry point into this “lifestyle” choice for folks who are attracted to this option for retirement as a continuum of needed or anticipated services due to the decline of one spouse or other contributing factors. For IL to exist independent of other, more progressive levels of care, doesn’t make much sense to me. Paying a premium for meal/housekeeping service, in essence, doesn’t seem sustainable in light of other options for otherwise healthy retirees.
By James H. Wesp, MPH MBA
From LinkedIn Groups
Why not just stay in your home if family is going to provide the care. I think independent living makes more sense within the continuing care context. What do you think?
By Lorie Eber
From LinkedIn Groups
I agree that this is a very good question. With prospects coming to us much older and frailer, independent living no longer looks or feels like the independent living of years ago. And with more home care agencies setting up shop within IL communities, people are aging in place rather than transferring to higher levels of care. It’s a concern that we need to address.
By Jackie Stone
From LinkedIn Groups
I see a continued need, we discharge from SNF to them all the time here in Florida. The CCRC’s fill all of the needs of our senior citizens
By Helen Elaine Conley, RN
From LinkedIn Groups
I think the hybrid IL approach you discussed is the future, but the completely independent concept is slowly dying. (Or maybe better put, looking less attractive to the end user) Assisted living still has state regulations that aren’t an issue for independent living properties. My company currently operates in 7 different independent communities (Including a holiday community) and it seems to be the best option for everyone. Even communities that said years ago “Oh no we don’t want your services, we are independently living not an assisted living community” have literally now called us back to get our services. At the end of the day, anyone who has been in the senior living industry long enough knows it isn’t good for a senior to move once they’ve settle into their “home”. This to me is one of the largest reasons to create a hybrid environment in an IL setting.
By Chuckie Snider
From LinkedIn Groups
Not to sound too politically correct, but I agree with all the comments above. ILF’s are still needed and will be in the future. However, it is imperative that an Operator address “acuity creep,” because the average age for residents in ILF’s is nearly identical to the average age in ALF’s and Skilled Nursing Facilities, around 84 years of age. At this age, a resident will likely experience some form of serious illness or physical challenge, relating to mobility, dressing, dementia, or other factor(s). By providing services that address the ever increasing need of the resident, the facility will attract and retain clientele. Of course, there needs to be a balance and positioning of residents in the facility; so the “go-go” seniors don’t feel like they are hanging around the very frail, sickly residents. Those who are well like to think of themselves as independent and not “one of those who need help.”
By Mark Myers
From LinkedIn Groups
In Houston so many people have moved here because they work in the oil industry. Their aging parents are far away and though they may not need assisted living the families are not comfortable leaving them 1000 miles away with no family close by. Independent Living fills that gap. Most of the IL’s have a home care company on site so as the situation changes help can be easily and inexpensively brought in.
That said the average age is about 82, a far cry from the 70 year old senior that many facilities envisioned. I do not see 70 year old’s in good health or even 78 year old’s moving into an Independent Living community. A 55 + apartment is usually where that crowd goes.
By Kathryn Watson
Motivated in part by a realigned economy, I entered Senior Living after nearly 20 years in luxury, master planned community sales and marketing, and found a dilemma: here was an industry designing and developing “facilities” that inherently repelled their intended market….
Since I had become proficient at attracting Boomers to emerging markets, and I suspected that most of the 77 million would continue to age, I became determined to find a group that was willing to reinvent the Senior Living model and create community that attracts discerning Boomers.
A year removed from finding a willing sponsor, we’ve crafted a vision that is speaking to younger seniors. Residents as young as 59 have signed-up for a Type C fee structure that truly promotes Vitality. (A genuine Vitality Model is far more complex than the marketing-speak too many companies use mask their broken care and entertainment models.) Overall average age: 74
The vision of assisted living is complex on many attractions and has also seen many drawbacks due to the economy woes. Assisted living provides for the middle upper class (if they can provide) whether they pay privately or with insurance which may be a draw back to. The care can be optimal or can be jaded hopefully with no foreseen problems.
Turn over is with management and caregivers. Most are signed on with a contract.
As a provider and caregiver for economically deprived usually on MEDI CAL who can remain at home as long as they are capable. I work for a non profit, the State of CA
IHSS program and self pay. There is a gap in between both IHSS and Assisted
Living folks who rely on such services if needed. Agencies are very expensive
and always do not accept insurance due to the written contract of those who
may have signed up. Assisted Living is not covered by MEDICARE or MEDI
CAL. MEDICARE and MEDI CAL budgets are cut back to OMBAMA CARE.
I don’t know how families and loved ones can face reality of inflation and
rely on those who can take care of them when they have to maintain
a lifestyle of middle class America. Families need to work and baby
boomers like myself are faced with lay offs, need to retire early to
take care of loved ones, etc.. Its definitely a problem we all face
to take care of our loved ones.
I found it interesting that many of the comments assumed that the resident would have families that live nearby. I live in Tucson and my family members live in CA, TX and IL. There does need to be a new model as we age… those who can still walk, hike, etc. but are approaching 70 or 80 do not want to be sequestered with others who are on walkers or in wheelchairs. In researching my book, almost everyone I interview wants to stay in their home. What they haven’t realized is that the number of available caretakers will decrease dramatically in the next 35 years. I’m looking forward to the industry coming up with some innovative solutions… do you have a Steve Jobs in this industry?