Retirement

Retirement housing options for older adults

During the 25 years between 2005 and 2030, the number of people over age 65 — the age typically viewed as the beginning of retirement — will grow to more than 78 million, according to the U.S. Census Bureau.  Well over half of that retirement age group will represent the baby boom generation, the obstinate, forward-thinking generation that blazed a trail of change during the second half of the last century. The sheer numbers, combined with the vigor and momentum of this generation will continue that change as retirement, retirement living and all aspects of aging will be transformed.

With a median age of 60, Presbyterians will be well represented in this growing group — entering retirement with all of the complexities and diversity, characteristics, gifts, economic fruits, education and experience, preferences and opinions, political leanings, health status, plans and intentions. With a million or more boomers reaching retirement each year, many with their own unique definition of retirement, blending into the current retirement landscape, infusing the current supply and definitions of retirement housing will simply not be possible.

Making the Retirement Community Decision:  One woman’s personal experience

Sue Mooney decided to sell the family house, downsize and move to a retirement community.  Sounds simple, right?  Not quite so much. [Read her story]

Current approaches to retirement housing for elders

Beginning with the acknowledgement that radical change to the array of retirement housing options must result as the boomer generation ages, current options are divided largely into two categories — aging in place or changing locations but aging independently of an age-related cohort and intentional retirement communities. 

While relocation to intentional retirement communities is viewed as the “gold standard” by some, because it holds the greatest possibility for providing the specific features designed to meet a variety of needs, as well as appealing to and pleasing old adults, not all retiring boomers will be able to afford this option nor will there be adequate numbers of retirement communities to serve them.   And importantly, a recent AARP publication, "Beyond 50.05," indicates that for virtually all age interval groups over age 50, more than 80 percent of older adults would prefer to remain in their own home, near friends, family and familiar places.

Aging In place

Aging in place can encompass a variety of situations ranging from individuals simply determining to remain in their home for life. Aging in place may or may not include specific retrofit of the home with modifications that will make it more accessible and safer for elders who may become more frail as they age and may or may not consider the availability of add-on health or support services. On an individual basis, it typically does not involve infrastructure change — transportation or community-wide safety elements. Some communities that are beginning to create what AARP calls livable communities have applied the phrase “aging in place” to a wide array of formal and informal program elements and services designed to meet the needs of older adults.

The Aging in Place Initiative is a collaboration between Partners for Livable Communities and the National Association of Area Agencies on Aging and seeks to help “home” communities become as livable as possible for older adults by providing them with safe and appropriate housing designs/redesigns, desired amenities and services with the added benefit of remaining within a community that is familiar and more likely to be near family members. The Aging in Place Initiative provides a more formal, yet adaptable program model that could be expected to have greater consistency and completeness as well as common program elements that could be described and evaluated.

Naturally occurring retirement communities

Another form of aging in place is the NORC — the naturally occurring retirement community.  A NORC typically refers to a community with a large proportion of older people within a specific geographic area and is different from intentional retirement communities in that the residents have typically aged in place together without a coordinated plan. Some NORCs have support services provided and others do not. NORCs may be located in urban neighborhoods or rural communities. A recent report by the U.S. Department of Health and Human Services extols this community plan as an efficient way to provide services to elders, yet acknowledges that “sustaining funding for the NORC services programs after the AoA (Administration Agency on Aging) grant funds run out is a challenge all sites will face. At the moment, most funding sources for the sites' programs are external to the NORC, including AoA, HUD and private foundations.” (U.S. Department of Health and Human Services, Supportive Services Programs in Naturally Occurring Retirement Communities, 2004)

Intentional retirement communities for healthy, active elders

The options for intentional retirement communities run the gamut from luxurious country club settings replete with amenities, activities and ambiance to utilitarian, mission centered, ecologically friendly developments of like-minded people. The continuum includes variations of:

• Senior living communities ranging from spartan to luxurious, but with age eligible communities, impose age limits on all residents.
• Age restricted apartments are those constrained by rules about resident age. These rules may be imposed by the leaders of the apartment dwellers or may be a condition of the funding that supported the construction or renovation of the building.
• Modular home communities are those that have been populated with homes that have manufactured components transported to the site and assembled. These homes may be available with adaptations suitable for an older population.
• Informal shared housing could include both group homes and two non-related individuals deciding to live together to share expenses.
• Continuing care or life care retirement communities combine all three levels of care — independent living, assisted living and nursing home care in a single setting. Traditionally, such communities required a sizeable entry fee, plus monthly maintenance fees, in exchange for a living unit, meals and eventual health care coverage up to the nursing home level. More recently, such communities have also begun to make their services available on a pure rental basis, rather than on the shared-risk basis of the traditional life care endowment. CCRCs provide residents with the independence of retirement home living and the security of long term care.
• Seasonal/vacation communities (AKA “Snowbird Communities”) have emerged as an alternative for permanently changing location and provide, for those who can afford them, the option of spending the coldest portion of the winter in warmer climes.  During times of the year not occupied by the owner, these properties may be converted to rentals, a source of investment income for elders on fixed incomes.
• Cohousing developments or congregate communities are a type of collaborative housing in which residents actively participate in the design and operation of their own neighborhoods. Cohousing residents are consciously committed to living as a community. The physical design encourages both social contact and individual space.
• Private homes contain all the features of conventional homes, but residents also have access to common facilities such as open space, courtyards, a playground and a common house. (Cohousing Association of the United States)

Housing options that include support services

As they begin to think about retirement, older adults have many options for housing, including staying in their own homes with home health services when needed. The following list is not intended to be a definitive description of the types of housing available — rather it is a starting point for understanding what different options might offer. Costs and state regulations vary greatly and services that can be offered in one type of facility in one state may not be allowed in others.

Independent living

Older adults who have no medical concerns may choose to live in a facility specifically designed for older individuals. Some of these facilities may cater to low-income individuals, while others are open to anyone who can afford to pay. In general, these facilities do not have extended care for residents. However, there may be home health care options for those who need care but can remain somewhat independent.

Shared housing or supportive group housing

In this type of arrangement, a small group of seniors live together and share the cost of housing and meals. A religious group or agency may sponsor this type of arrangement. There may be little in the way of extended care services, but home health care may be an option.

Continuing care retirement community (CCRC )

Continuing care retirement communities offer the full spectrum of care from independent living in houses or cottages, assisted living services and skilled nursing care. The residents move through the "continuum" of care as their health care needs increase. The services a person receives will depend on the level of care required. However, independent residents may qualify for a short-term stay in the CCRC's rehab area or receive additional services following an illness or surgery. They may then go back to their independent living arrangement. CCRC's can vary greatly in how resident care is managed.

Assisted living facilities

Assisted living facilities vary greatly in the services they provide. However, in general, the resident will receive some or all meals and assistance with activities of daily living such as getting dressed or showering if needed. There is staff available 24 hours a day and the resident is monitored regularly. Depending on state regulations, licensing requirements for services that are offered may vary.

Nursing home

Nursing homes provide 24-hour nursing care for residents that are unable to care for themselves. A nursing home may have different levels of care such as rehabilitative care or skilled nursing care. A nursing home may also provide care for those living with dementia but have few other medical conditions. Nursing homes must follow very strict federal and state licensing requirements, which can vary from state to state.

Helpful links

Presbyterian Association of Homes and Services for the Aging

Aging in Place Councils

The National Aging in Place Council, with growing numbers of chapters throughout the country, is bringing together entities from the private sector and service sector to work on a common goal of creating communities that are more liveable.  The mission of NAIPC includes: Increasing the level of knowledge and skills of persons from a wide variety of fields (e.g., remodeling, architecture, interior design, finance, product design and manufacturing, urban planning, social services, health and others) whose collaboration and involvement is essential to insuring greater public access to programs and support services that promote independent living.

Local chapters might not naturally look to churches as partners; however, since it is the church that often provides the most support to aging individuals, seeking out the chapter in your community might be helpful. NAIPC promotes universal design in building and remodeling. Universal design is great for homes, and might also be a consideration for kitchens and bathrooms in churches! 

The NAIPC Web site has a number of helpful resources and suggestions for making buildings and communities safer and more livable, as well as help in locating a council near you.

National Aging In Place Council Web site

AARP

AARP has a very useful website with many different types of information.  Of particular value is their listing of internet resources that includes a comprehensive listing of helpful websites covering a very broad range of topics.  It also includes a search engine for finding information on specific topics.

AARP Web site