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With the arrival of seasonably cold November weather, many senior citizens in the Mid-Hudson region are gazing out through their fogged-up windows at the bleak prospect of a landscape of un-raked leaves finally fallen from newly bare trees. Already high gasoline prices seem to have jumped another 15 cents a gallon almost overnight. Heating-oil futures are following the same jagged upward pattern. People living on a fixed income will have a hard time this winter. Some seniors are stapling plastic on all their windows or closing off unessential rooms until things warm up again. Others are coping by re-examining their budgets for fresh food and social activities.
It may not seem so, judging from all of the senior housing going up of late, but three-quarters of upstate seniors live in their own homes. Of those, four out of five have been living in the same home for more than 20 years. According to the census data, moreover, nearly seven out of every 10 senior-occupied homes were built before 1960.
Indeed, the vast majority of older people want to stay in their own homes for as long as possible as they themselves age. The strategy even has a title: “aging in place.” Most seniors bought their current homes when they were young adults, with a far different set of priorities. As the latest issue of the Federal Reserve Bank’s Upstate New York Regional Review sagely points out: “Housing characteristics once valued, such as a big house and yard for raising a family, can turn into impediments as homeowners grow older.” Physical access within the home can become increasingly challenging. Furthermore, an older housing stock and longer length of residence are highly correlated with greater maintenance and repair needs. And many rural seniors are experiencing increasing difficulty getting to the shopping and the services they need. Aging in place may be desirable, but it’s no picnic, especially as sub-zero temperatures approach.
So what to do while you’ve still got your wits about you and some semblance of health? Some who can afford to do so, opt to evade winter rather than to confront it. Long vacations or visits to friends and relatives in Florida for the cold season are one strategy, which often leads to a permanent move south for those whose blood starts to thin out. But a growing segment of seniors are thinking about how, even in a depressed market for real estate, they might trade in assets that are no longer serving their needs for something less onerous, for the right to stay right here where they live.
This last class of people has a relatively new option to consider: Continuing Care Retirement Communities (CCRCs) allow seniors to age in place, with flexible accommodations designed to meet their health and housing needs as these requirements change over time. Residents entering a CCRC normally sign a long-term contract that provides them housing, services and nursing care, usually all in one location, for the rest of their lives. A reasonably well-heeled senior citizen – for a fat, often tax-deductible entrance fee of somewhere between $100,000 and half a million, depending on the market rate of similar dwellings in the area, the plan selected and how much of a care package is opted for up front – gets to live in a nicely appointed home in a familiar area surrounded by all the help, camaraderie and health care he or she will ever need until the final curtain closes.
The first two CCRCs in this neck of the Hudson Valley, Arbor Ridge in Rhinebeck and Woodland Pond in New Paltz, are currently under construction. Both broke ground in the past couple of months, and like to boast that they are the first such facility in the area (neither is: the first in the Mid-Hudson region – and the state, if you go by when it was approved – was technically Glen Arden Life Care Community in Goshen, run by Elant, a regional nonprofit that manages nursing homes throughout this area). Arbor Ridge is expected to be occupied next year, and the much bigger Woodland Pond in 2009.
Rhinebeck dachas
Arbor Ridge shares a 75-acre campus with its parental entity, the Baptist Home at Brookmeade, which moved upstate from its Brooklyn birthplace in 1977. The project represents a departure from the large 200-plus residential scale of most CCRCs including Woodland Pond, Arbor Ridge is planning to build just 54 independent living apartments and 26 assisted living suites, to be called The Terraces, all designed for the 30 percent of the local population aged 62 and over who might not want to leave beautiful northern Dutchess just because they’ve outlived the usefulness of their big, drafty country homes. Residents will trade all those unwanted chores, cares and woes for a nice, roomy, well-equipped apartment just minutes from the Village of Rhinebeck with a wealth of onsite amenities including a dining room and café, an indoor swimming pool, walking trails, a fitness and wellness center, a craft and hobby workshop, a library, a card room and a hair salon.
Residents who live long enough to require a more intense sort of care can move almost seamlessly into the well-regarded Baptist Home for the final chapter of their lives. The Arbor Ridge deal involves a straight entrance fee (toward the lower end of the above scale, because it doesn’t involve a life-care) that gets you in, with long-term insurance your responsibility. You pay a la carte fees for additional services, and a monthly maintenance fee of around $2,000.
The Arbor Ridge Web site pretty much sums up the attraction of a CCRC and the aging-in-place philosophy. “Designed with the needs of active older adults in mind, Arbor Ridge offers 54 apartment residences and a combination of lifestyle, services and amenities unmatched in the area,” the pitch goes. “What’s more, the affiliation of the Baptist Home assures high standards of quality and integrity in all aspects of life at Arbor Ridge.”
People are signing up. At a catered picnic in a white tent adjacent to the site last month, a few dozen spry seniors were updated on where things stood as bulldozers chugged in the distance and trucks rumbled in to pick up and haul away the last of the big lumber that had been cleared. Three no-nonsense members of Lecesse Construction of Rochester, the project contractor, took turns going over the whirlwind of construction, set to be completed by spring. “By Dec. 17 we will be starting the roof of the first wing,” drawled project manager Matt Keyser, who detailed the assembly-line precision of the project phase. “And then the framing of the second wing will start as soon as the roof is going on. And the first wing, we’ll be starting the second wing and so on and so forth. We like to refer to it as ‘the train,’ and once we get the train going, everything just follows; we just kind of hop and skip right from one spot to the next. So that by on Dec. 27, the first wing of the building will be enclosed, with windows, so that the mechanical trades – your plumber, your electrician, the heating and cooling guys – can get in and start running their ductwork.”
Into the woods, to grandmother’s house
Woodland Pond may be a CCRC and provide a similarly upscale setting and menu of amenities, but it is an entirely different animal from Arbor Ridge. For one thing, it’s set to pack many more seniors into its 83 wooded acres on North Putt Corners Road; the site plan approved by the Village of New Paltz Planning Board includes 201 independent living units, 60 assisted living units (now apparently called “enriched housing” units in nursing home industry-speak) and a 40-bed nursing home. It’s an economy of scale that makes possible a real soup-to-nuts, golden twilight-to-grave operation possible. The plan offered to residents is the top-of-the-line Type A, or extensive, life-care agreement, which is the one where enrollees pony up a steep ($200,000 to $400,000) fee up front, along with money to go with a life-care contract for assisted living if needed ($52,500). After that, the maintenance on the apartment is about $2,000 a month, and doesn’t change depending on level of ser vices. When you leave or pass on, you or your estate gets back the entrance fee – which, by the way, is tax-deductible; it’s like self-insurance.
Woodland Pond is structurally different from Arbor Ridge as well. It is a nonprofit, run in conjunction with its own for-profit consultant, New Life Management & Development, Inc., of Mt. Laurel, N.J., in suburban Philadelphia. The essential nonprofit entity in the puzzle, and the eventual driver of the bus, is the Kingston Regional Health Care System, the biggest piece of which is Kingston Hospital, and all of which is undergoing a complicated restructuring and merger with Benedictine Hospital under the rubric of the newly formed Health Alliance Planning Incorporated.
Cynthia Rozenberg, vice president of strategic planning for the Kingston Regional Health Care System, is COO of Woodland Pond. “We still have the excitement and enthusiasm for this project that we had in 2001, and I am thrilled that we have achieved this milestone,” she said at the long-awaited post-groundbreaking ceremony last month before more than 175 future residents and supporters, which took place after the logjam of local opposition to the project had finally broken. “This day represents the beginning of the construction phase for Woodland Pond as we begin the process of building the kind of retirement community we would want for our parents and ourselves.”
A changing demographic
Surveys by AARP have shown that four out of five persons 50 years old and over want to continue living in their own homes – aging in place – as long as possible, even if they need assistance in doing so. And they’re getting public support to do just that. Medicaid, the primary public provider of long-term care for seniors, spent $6 billion on home- and community-based services in 1992. In 2005, that amount had increased to $35 billion.
At the same time, the proportion of seniors living in nursing homes has declined. According to the federal Department of Health and Human Services, the proportion of those 85 and over living in nursing homes has dropped almost 40 percent from its level in the 1980s.
“A mismatch between the existing housing and the changing needs of the population may be especially great in upstate New York,” says the Federal Reserve article, “where most seniors are homeowners and the housing stock is dominated by older single-family homes.”
One important response to this mismatch has been provided by rent-controlled senior housing projects. The majority of Ulster County townships now have such projects, which allow seniors of limited means to continue to live in the communities of which they are a part. Long waiting lists for entry are common. In recent years, one or two new projects of this kind have added to the county housing supply.
One solution does not fit all, however. For Anne Cardinale, director of Ulster County’s Office for the Aging, “putting up a building” is just a first step. “Don’t show me a building without the services,” she says.
An expensive idea whose time has come
Aging in place in a Continuing Care Retirement Community: it seems like a good idea, at least for those with a few hundred thou in equity burning a hole in their pockets that they can trade in for a life of stress-free, secure and at least somewhat familiar comfort. Why did it take so long?
The CCRC concept has been around since the 1960s, when life-care retirement communities began popping up in Florida, Pennsylvania, Ohio and California among other places, but it is relatively new in New York State. Until 1989, in fact, life-care was expressly forbidden by state law. The Legislature, aghast at scams through which people were exhorted to place their life savings in non-refundable, prepaid 10-year nursing home contracts and unwittingly dispossessing their heirs when they died, passed a flurry of laws that forbade prepayment of nursing home care more than two years in advance of need. In 1989, however, legislators realized the state was losing out on all that retirement money and found a way to allow a highly regulated form of life-care.
According to the CPA Journal, CCRCs in their earliest incarnation were church-run affairs that cared for aging ministers without families. Over time, the facilities have broadened their horizons and opened their doors to individuals, both single and married, from diverse ethnic and religious backgrounds.
The other thing holding up CCRCs has been that they’re expensive to get built, up and running. According to the CPA Journal, a recent study of CCRCs conducted by the Institute of Health Planning in Madison, Wis., indicated that the cost of building a CCRC for more than 200 residents averages $33.7 million. In fact, New York’s first two CCRCs – Glen Arden Life Care Community in Goshen and Kendal at Ithaca, run by the Kendal Communities Development Company, a Quaker-run nonprofit insurance company – didn’t get their financing together until 1994, five years after the change in state law cleared the deck.
How CCRCs work
Many seniors enter into a CCRC contract while they are healthy and active, knowing they will be able to stay in the same community and receive nursing care should this become necessary. Seniors who invest in a CCRC have adequately planned for housing and care for the remainder of their lives, and have the financial means to support their decision - no small consideration.
CCRC packages allow access to independent living, assisted living, and skilled nursing facilities. Seniors in independent living may occupy a single-family home, apartment or condominium within the CCRC retirement complex. If they begin to need help with activities of daily living (e.g., bathing, dressing, eating, etc.), seniors may be transferred to an assisted living or skilled nursing facility on the same site. Their long-term care needs will be met without the need to relocate.
New York State regulates CCRCs. The state insurance and health departments are in charge of regulating so-called Article 46 enterprises such as Woodland Pond, and the state attorney general keeps an eye on Arbor Ridge.
Planning authorities at the county level seem to like the CCRC concept as well.
Dutchess County Planning Commissioner Roger Akeley is supportive of Arbor Ridge. He says it’s a useful extension to what the Baptist Home has been offering, reasonably compact, and well-sited in terms of land use. He also says that seniors selling their homes to some degree free up housing opportunities for younger families.
Ulster County Planning Director Dennis Doyle praised the way the planning process involving Woodland Pond worked, saying the project helped add to the New Paltz community’s housing mix. And it was reviewed carefully and well. “The community went though a complex review process that was deliberate, open, long, somewhat contentious and thorough,” said Doyle. “There was a participative climate that persisted right through to the end.”
