NaCCRA Forum: General

Susan,

To help you, and anyone else interested, answer your question for yourself/themselves, I have added a number of documents to the DOCUMENTS section under "Actuarial Information." I have also created two new subfolders entitled "Skilled Nursing" and "SN Length of Stay/Where We Die" and populated these subfolders with documents that you might find helpful.

Gerard Hyland

President Elect

Thanks, Gerard. Two good articles.

I have yet to find a financial planner who can do forecasting to include assumptions about care needed in later years (based on actuarial tables) or assess reliably the financial soundness of a CCRC.

As a contribution to the discussion, two papers are offered:

Money Management for the Elderly is an article I drafted in response to a request by a resident for help in managing her checkbook. It's not a completely satisfactory discussion of the subject.

Who Will Care for You is Consumer Reports article on elder care.

Ann, thanks for the attachment. I am sure many people didn't do the listed homework.

I happen to be a volunteer for our local Village, so I am most familiar with how villages work. Just like CCRCs, if you have seen one, you have seen one. They are very different based on what they can afford to do. However, the focus for most is enabling seniors to socialize, providing a list of vetted vendors for "work around the house", providing help done by volunteers for minor work in one's house, some transportation and maybe some support for those who need someone to go with them to a doctor, or are coming home from the hospital, etc. They do not provide any level of ongoing custodial care or health related care, as volunteers are not qualified to do that and they also deal with liability issues. Some villages are considering maybe offering a list of professional providers (not referrals, just a plain old list). While Villages are great for a while, unfortunately they are not enabling truly aging at home as one would hope. When they will be partnering with those who can provide services needed to continue aging at home, then they might fulfill their mission.

There is a lot more to aging at home than what most people think about, obviously also depending on each person's unique family, health, financial situation and luck. At this time, there is no "ideal" solution for "aging in place" with dignity and proper, quality support in any setting (a facility like a CCRC, an ALF or at home, etc.).

You raise interesting questions. You are correct that when living in a CCRC there may be a social worker, home health support available and levels of care.

If one is thinking about aging in place in the community, I would explore the Village to Village Network. https://www.vtvnetwork.org.

One of the Charlestown residents shared a list of items to consider for End of Life Planning. It is a comprehensive list of information to compile which we have done for our executor. Ironically, he died suddenly a few years ago.

I have been reading an excellent book for planning for one's senior years, "Who Will Take Care of me When I'm Old", by Joy Loverde. Very informative, with actionable plans, great references, very well researched and organized. I found one piece of advice that confound me. The author recommends: "Putting your paperwork in order and making caregiver and advocate arrangements ahead of time will make all the difference in your quality of life - in sickness and in health". 

No questions about the paperwork, enough information about that. But how do you make caregiver and advocate arrangements ahead of time? If one is a CCRC resident, maybe there is no need to make caregiver decisions, although in today's world when many CCRCs discontinue their long term nursing and skilled nursing care, one doesn't know. Some of us NaCCRC members are CCRC prospects who are also looking at alternatives such as aging in place for as long as possible. In this context planning for caregivers makes theoretical sense. But how do you make that happen ahead of time, particularly if you do not have family willing to become your caregivers? 

One's support team is supposed to include a variety of professionals, some of them practicing without any formal training or licensing requirements. The team is assumed to include an elder law attorney, a geriatric case (or life care) manager, patient representatives, medical social workers, an occupational therapist, patient advocate, fiduciary, etc. 

If any of you built a team including some or all of these professionals/advocates, I would like to know how you did it in practical terms, what worked, what not, how did you decide who is trustworthy, dependable, and will be around when needed, etc. Did you sign any contracts ahead of time? I am familiar with the respective organizations that represent or license some of them and with obvious approaches such as asking for references, doing a background check, etc. 

Sharing information and experiences can be invaluable and this is what Forums like this one are for. I will add two resources. I did not use them, so this is not a recommendation.

https://accountableaging.com/what-we-do/care-management-services/   Care management in different locations in Texas

https://www.beaconpatientsolutions.com/about  Patient advocate; resides in Massachusetts but offers some aspects of services remotely too

Should you have any other ones, please add them with some comments about what you know about them.