Your decision about where to live as you age is likely influenced by these three factors:

1. Your tolerance for risk related to future health care needs
2. Your financial ability to pay for where you want to live
3. Your “ideal” community life

Your tolerance for risk related to
future health care needs

Many deny the risk involved with their current living situation if  future health needs increase. If a person needs extensive health care, and does not have family to provide it in the home, the prudent person may want to make a housing change ahead of time.  Decisions may be made in our 50’s, 60’s and 70’s to “hedge” against the housing and health care risk.  That is why individuals move to retirement communities, smaller homes, apartments or nearer to family members.

Your financial ability to pay for where
you want to live

Most people accept the reality that our finances limit the size and quality of our housing.  Americans have typically desired to “live large” in a dwelling and neighborhood beyond the means of the average person’s earning power.  One has experience in matching our housing desires to our financial realities.  The mortgage lenders and landlords have taught us this.

Throughout the United States, there is a growing movement to provide supportive services in your home.  However, this care does not provide 24-hour-a-day companionship or supervision, unless you contract for a “live in” or hire different individuals for 8-hour work shifts throughout the day and night.  Most advertised “companion home care” provides a few hours a day at most, and qualification for these services either from government agencies (like Medicare or Medicaid) or your long-term care insurance policy (if you have one) may take some effort.  Nonetheless, many people can benefit from these few hours a day, along with Meals on Wheels programs.  They will remain in their homes for many more months or years than they would without these services.

Estimated in 2007, the provision of 3-shift, around-the-clock home-care services will cost in excess of $150,000 annually—not including specialized medical visits from nurses, physicians or therapists.  It is no wonder that $200 per day for nursing home care ($73,000)—including nurses, physicians and therapists--seems like a relative bargain!

Contracting with a live-in caregiver can have many drawbacks, especially for the person with chronic illness, confined to a sedentary lifestyle.  There may be need for care anytime of the day or night.  Lack of stimulation or dementia makes it probable that the health-challenged person will confuse night and day.  A live-in caregiver cannot be expected to be “on call” all the time, and burn-out is common.  Also, live-in caregivers may have no other place to go if you decide to terminate the person’s employment, and some municipalities may require you as the provider of their housing to find another place for your ex live-in caregiver.

While most people over 80 years old (80%) live at home, increasing number are turning to more congregate living opportunities.  

Two types of institutions have arisen to respond to future health needs of persons now living in non-institutional home settings:

• Assisted Living which provides services and housing together at the onset of a person’s residency;
  
  
• Independent Housing with care options on the premises for future health needs.

Assisted Living is chosen by individuals and families usually at the point of a significant need or decline.  Most individuals in assisted living have a form of dementia, so these communities for a valuable service to those with these related disabilities, without the regulated and restrictive environment of a nursing home.

Independent Housing, CCRCs:  Continuing Care Retirement Communities, known as “CCRCs” require a significant up-front entry fee, which may or may not be refundable.  CCRCs are the primary example of independent housing with care options.  They provide an opportunity to “hedge” the value of your current cash or real estate against future health care costs. 

Independent Housing, “Active Adult,” “Market Rate,” “Affordable Housing:”  These age-restricted options provide support in community living, but do not usually offer extensive medical support, like a CCRC.
 
The disadvantage of Assisted Living, Market Rate or Affordable Housing is the “30 day letter.”  This is the communication to you, required by governmental regulation, if you fail to meet safety and/or health requirements. You can be evicted, and the next step would likely be a nursing home, or your daughter’s front yard.  To be fair, many of these staff work tirelessly to maintain individuals who could be “technically’ evicted—but there comes a point where long-term chronic diseases take their toll and round-the-clock care in a nursing home is required.

Active Adult Retirement Communities provide an environment where people over a certain age (usually 55) can live together in a neighborhood which optimizes the establishment of informal support networks.  These age-restricted communities are allowed by federal housing regulations to discriminate on the basis of age.  There have been many of these types of communities in “virtual” existence long before they were marketed as a strategy to keep noisy 30-somethings and car repairs off your street.  Some of these communities are developing health clinics, fitness centers and activities facilities “in the neighborhood.”  However, there are important questions to ask about these communities:

• What is the policy about visitors, children, live-ins?
  
  
• What is the history of monthly fee increases and likelihood of extraordinary raises?
  
  
• What rights do the owner of the development or the members of the association have to change the requirements of residency?  Remember, these are not regulated like Assisted living, CCRCs or government subsidized housing: buyer beware.
  
  
• Is there a healthy mix of ages, or will all the current residents age together to a point of disability, and perhaps unattractiveness to future buyers?
  
  
• What is the pet policy?
  
  
• How possible would it be to live here when you no longer drive a car?

           
Your “ideal” community life

Regardless of your age, planning for your second retirement is an opportunity to realize your “ideal” living circumstance.

Joys for Extroverts-- These are the dreams many realize in communal retirement living:

• If the 40 room-mansion with a staff never became a reality for you, it may be possible to live in a communal retirement setting with abundant public rooms and staff.
  
  
• If you value the freedom to leave your home and travel without worrying about your home
  
  
• If you cherish living with others on a day-to-day basis and working closely with new friends to volunteer or provide other public service
  
  
• If you want to be relieved of home repair, cooking, laundry and spend your time doing other things
  
  
• If you enjoy joining in activities and classes within walking distance.

Hope for Introverts--These are dreams many realize who do not prefer communal living, but receive the benefit of living in a community:

• If you prefer to spend your time alone, pursing your own interests, in your own space, many retirement communities offer spacious individual living areas, so hobbies, libraries, computers and other entertainments can be enjoyed;
  
  
• If you think it important that others are aware of your physical or emotional condition, but not be actively involved in it, it is comforting to know that if there is an emergency, there is a supportive group of people close at hand;
  
  
• If you wish to maintain your privacy and independence by being able to walk to most public services you need, without depending on others to transport you or deliver services to your home.

Freedom for Introverts and Extroverts.  Research has shown that fear of unknown, negative change affects the quality of our life more as we age, because disease and limitation are more closely associated with old age than youth.  Planning for retirement in this “second stage” (age 75+), is essential to make room in your imagination for new accomplishments, relationships and dreams to come true.