Longevity Planning – Planning for Long Life and Likely Disability

 

denver elder law

Lucina’s Spring Blossom

As you have undoubtedly noticed, Americans are living longer than ever before.  One of the side effects of this longevity is a fairly strong likelihood that an incident or period of incapacity or disability will accompany that long life.  Yes, we baby boomers seem to think that if we just continue to exercise and eat right, somehow we will get a ticket to longevity that ensures our vital longevity.  After all, we boomers practically grew up with Jack LaLanne!  Long before Hans und Franz of SNL fame, there was the blue-jumpsuited “Godfather of Fitness” (I learned of this moniker this only as I did a bit of web research).  LaLanne died in 2011 at age 96, with nary a gray hair on his head!

So what about this longevity issue – I am thinking of it in the context of the death denial and youth glorification convergence . . .?  I’ve written about it before.  Death strikes fear in people’s minds, and even in our hearts.  For many it is a major anxiety producing thing to consider, let alone contemplate.  Ernest Becker wrote about this in The Denial of Death.  A favorite book of mine stands in contrast to this well-recognized fear, in Who Dies, authors Stephen and Ondrea Levine take a completely different approach to this fear and address it in the context of conscious living and conscious dying.

So how we view this life and death experience, in terms of what we fear and what we embrace, what we can know and what remains mystery, this is far from a “standard” human response.  I might be getting off-topic here, but let’s face it, with this kind of a topic it’s hard to know where things will lead!  I don’t think we’ve always lived like this – with such “faith” in medical science as something that will somehow protect us from the ravages of illness, old age and eventual death.  I am pretty certain that our scientific progress in understanding more of how our bodies function, age and eventually die, has brought about a thinking that we can somehow “manage” death.

And so we hold death at bay, we call it the enemy and we make our lives a struggle against the inevitable.  Well, if that is the sum of a life’s purpose . . .  I would say “that ain’t much!”  When many of us are ill and eventually die, we often employ that language of warfare.  Example: John Doe fought bravely in his struggle against metastatic prostate cancer.   On this topic of battlefield euphemisms, my friend Liz sent this excellent article to me from “The New Old Age.”  Bottom line is, the militaristic language, the fighting words we see so often and hear in conversation do nothing to empower our lives and our sense of purpose in our lives.  I would argue that this language and its approach rob us of our purpose, disempowering us by making us random and senseless victims of our lives in our death.  Remember the announcement of the war on cancer by President Nixon?  Most recently we have the war on Alzheimer’s announced by President Obama.

So back to the longevity planning theme and the fear of illness, frailty, disability . . . .  life on its own uncertain terms.  The fear of disability is more troubling in many respects than the fear of death.  Much of it springs from youth glorification, an extension of that anxiety around death which often includes processes, occurrences and diseases that often precede death.  Is the glorification of youth simply an extension of the denial of death?  I am not asserting that the American cultural obsession with the denial of death is a recent occurrence or produced by the baby boomer generation.  No, it goes back further than that.

I have written previously about the fear many of us have of getting Alzheimer’s or some form of dementia.  I think there is also plenty of evidence that people fear incapacity at least or perhaps more than the fear of dementia.  Of course, dementia is only one form of incapacity, so the questions may blur the distinctions. There are of course a myriad of other fears which surround aging.  Many of them don’t have to do with losing capacity so much as retaining it in our old age.  I enjoyed reading Roger Angell’s article “This Old Man” in The New Yorker.  It is a story about all those human needs and desires we carry with us into whatever age we find ourselves.  There is no handbook on how to behave when you find out that your 85 year old mother, who has been widowed for less than two years, has started dating on the internet.  And what about physical intimacy in the assisted living or nursing home?  I’ll write more about our cultural fear of aging soon.

©Barbara Cashman  2014   www.DenverElderLaw.org

What’s a Boomer to Do? A look at Continuing Care Retirement Communities

 

dad's gone fishing

dad’s gone fishing

A few months back I had some friends over for brunch.  They were all baby boomers coming up soon on retirement age.  One of them, Mark, encouraged me to write a post about all the continuing care retirement communities (CCRCs) that are sprouting up and what people might want to know about this type of living arrangement.  This is a broad topic, especially for us boomers who love to exercise our independence and self -expression.  Let’s face it, the medical-model of the nursing home, or SNF (skilled nursing facility) as folks in my line of work are prone to call it, is no longer the predominant model of infirm or old-age care.  Some would argue whether it ever occupied that status. This post is about considering options.

Many of us are by nature planners, and retirement planning and estate planning go hand-in-hand, just as does disability or life-care planning.  Maybe there are too many hands here. . . !  My point is that the disability aspect comes into play as a result of increased longevity in our country.  While we are lengthening our days considerably, we have no way of knowing whether our retirement savings will outlast us, nor do we know whether we will need any assistance from others – family members or hired professionals – to help us pay our bills and assist with our day-to-day living.  This topic is huge, so I am narrowing it to just the FAQs about CCRCs.

The American Association of Homes and Services for the Aging defines a Continuing Care Retirement Community (CCRC) as “an organization that offers a full range of housing, residential services, and health care in order to serve its older residents as their needs change over time.”  The focus is not on the medical needs of older persons but rather on helping people maintain a sense of independence and community.  There are still many people who cling to the idea that the only way to maintain their independent lifestyle is to live on their own is a house that may be difficult and even dangerous for an older person to maintain.  The growth of independent living, assisted living and CCRC-type communities attest to the relaxation of that otherwise inflexible approach to an independent lifestyle.

Well, these CCRC’s have been around for many years, even if many of them fell on some pretty lean times over the last decade or so.  Belt-tightening seems to be easing and optimism often appears less guarded these days.  Here’s a recent post about the market boom of a boomer market in assisted living developments.

Many families are undoubtedly going to continue with their multigenerational living arrangements, and you can read my blog post about that topic here.    In the Denver metro area of Colorado, there are several CCRCs.  Each one has different arrangements for how to enroll, pay rent, buy into, and generally become a member of the community.  For the vast majority of us who have little or no long term care insurance, these living arrangement can provide a certain amount of peace of mind.  Check out the AARP’s article about CCRCs here.

What is a CCRC?

A CCRC is a community which is designed for people aged 60+ (the age often varies) and provides a continuum of residence-based care.  Beginning with independent living, one can expect private, low-maintenance housing – as in an apartment or cottage home along with a built-in community.  The “continuing care” part comes into play in the event a person needs or wants additional services like housekeeping, transportation, and security.  You can expect community attracting spots like a fitness center, performing arts center, along with various dining venues.  There are also plenty of activities to keep people socially engaged like classes, field trips and the like.

What about the “care” in CCRC?

As far as the care part goes, this often encompasses on-site care that including assisted living, memory care, skilled nursing, and rehabilitation services.  It is by nature a continuum, designed to offer services in the event they are needed in a nearby setting.  These care include in-home services, assisted living, memory care, skilled nursing, and rehabilitation services.  This can simplify things especially for a spouse of life partner of a person who needs more care and services.

How does someone go about finding an appropriate CCRC?

CCRCs began to crop up as not-for-profit based communities, often sponsored by faith communities or other similar affiliations for people.  Many CCRCs have cropped up in more recent years that are for-profit institutions.  There is a listing of many of these types of communities under the guise of the Commission on Accreditation of Rehabilitation Facilities, and another acronym is CCAC for Continuing Care Accreditation Commission (in case you might have wondered about the nature of “rehabilitation” in the facility) along with important standards to consider.  Keep in mind that there are many types of CCRCs and many homes are not yet accredited and there are different types and levels of accreditation.

Why are the location and setting of a CCRC important?

CCRCs can offer a full-service lifestyle right on campus. This can be very important for a couple to maintain an independent lifestyle but still allow a spouse who may suffer from health challenges to receive care within the community while providing support for a caregiver spouse.  Many residents  appreciate having easy access to greater community amenities such as cultural, recreational, spiritual, and retail offerings. Additionally, residents often choose a location that allows them to maintain close ties with family and friends.

Do I have to rent or can I own a home at a CCRC?

Some CCRCs offer equity, but most do not involve a real estate transaction. If you are looking carefully at these options or considering them for another, read the contract very carefully.  There is no “standard” type of contract for these living arrangements. Many communities offer an entrance fee plan, guaranteed by a contract or residency agreement that entitles residents to occupy their chosen cottage or apartment and use the common area amenities, programs and services. The one-time entrance fee – which is usually partially or fully refundable – also assures residents access to the on-site continuum of health care.   I am familiar with one local facility that had a $10,000 “fee” chargeable to a resident’s move from a two-bedroom unit to a more affordable (from a monthly rent standpoint) one-bedroom unit after the spouse passed away.  Keep in mind there are typically monthly service fees that come into play as well, depending on one’s circumstances.  If you are considering a move to a CCRC, for yourself or a loved one, please take the time to carefully read the contract so that there are no surprises.

CCRCs are a relatively recent development in living arrangements that are designed to encompass different living arrangements in a single community, thereby obviating the need for someone to move to a different residence or facility as their care needs increase.  It will be interesting to see how they evolve in the coming years.

 ©Barbara Cashman     www.DenverElderLaw.org

A Sense of Place and Aging in Place

 

 

 

Isn’t this an amazing Saguaro cactus? A few weeks back I visited Scottsdale Arizona’s McDowell Sonoran Desert Preserve with a friend.  There were many types of cactus and other vegetation, along with plenty of birds.  The saguaro, especially one that gets “giant” status like this one – is truly a survivor of almost impossible odds.  It is nature’s way.  I also saw a couple smaller and younger saguaro cacti which benefitted from a “nurse plant” to a baby saguaro.  These plants or trees shelter the vulnerable saguaro during critical stages of development, and after making the ultimate sacrifice for the saguaro (the nurse plant takes less and less water and nutrients as the saguaro grows bigger and stronger), it stands for years as a tribute to its sacrifice.  Even in a harsh environment such as the desert, there is much cooperation and biological community.

 

On my drive down to Scottsdale, I travelled through the Monument Valley.  Here’s one of my pictures from the Navajo tribal park there.

Monument Valley

The Sentinel

I love this part of the country.  Along the way, I listened to Richard Rohr’s book “Falling Upward: A Spirituality for the Two Halves of Life.” Watch a YouTube with him here.     It is a wonderful book about aging growing and what we can do with the second half of our lives on a spiritual level.  This is a book about what we can come to understand with our aging, maturity and wisdom – as well as how we can come to terms with mortality and the meaning of our life.  The unprecedented number of people in their 80’s and 90’s has opportunities for meaningful elderhood that few of their forebears enjoyed.  The number will be even bigger as the huge wave of baby boomers gets older.  What will we do with this time in our later years?  Will we continue to enjoy retirement as a long vacation or as a chance to reconnect and engage with our community in meaningful ways?  Each of us has a choice to make about this to the extent we are given this opportunity of what to do with our longevity.

While I was listening to Father Richard (he is a Franciscan priest), I thought about the popular notion of “the bucket list” or some to-do list of things that many people agree they ought to see or visit before they die – as if life experiences, unique and personal – are somehow easily boiled down into some generic list of what a worthwhile human experience is. . . .  . !  Rohr’s chapter on the first half of life is about learning and practicing the rules, being a productive member of society and that sort of thing.  Sadly, many people get stuck there and seeing that there are many others in their company – may think that this place is the only destination.  Hence the “bucket list.”  Who writes their own bucket list – or is it a bucket list because it is agreed upon by a group that it is meaningful?  His reference to falling into the second half of life is a place where a person can be freed from the constraints – internal, external, community.  A journey of free fall that is like a remembering of who we are, what we came here to be and to do.

This reminds me of the lyrics of a favorite Enya song – “Pilgrim” (watch a beautiful video of the Hubbell Deep Field photos with the song as audio here ):

one way leads to diamonds,

one way leads to gold,

another leads you only to everything you’re told….

oh pilgrim it’s a long way to find out who you are.

It is a long journey, but as Father Richard explains and reiterates, the second half  is a beautiful journey of freedom which each of us must discover for ourselves.  I would say it is a pilgrimage of the heart, to remember.  So – where is that physical or emotional or spiritual place for “aging in place”?  Is it in a multigenerational home, is it with the support of or under the care of others, or is it with the “independence” we fancy that we have enjoyed throughout our lives?  That is up to each of us to decide – or not, depending on our own inclination.

 

Perhaps the whole journey of life is as a return from exile, the experience of exile – moving away from the known and its sense of belonging.  Redemption is possible when the way toward home is found, through some place of light, through the illuminated darkness.

Could this aging in place provide the opportunity to move beyond one’s constructed self, the identity of who we have become in our accomplishing phase of the the first half of life?  Might this resulting freedom allow one to consider the wholeness of or our sense of place in the world, to reassess our place in the community?  What about your place in the universe, and in the struggle to wake up?  More on this topic later……

 

©Barbara Cashman 2013     www.DenverElderLaw.org