We have all been through this decision-making process, of whether to move to a CCRC. And many of us have tried to advise friends on important considerations when shopping around. We were doing that again today when I recalled a memo on the subject that I had written in 2011, the night after we signed the big check. It is at http://williamcalvin.com/deciding/.
It is outdated. It is also just our singular experience, not something that others have expanded. I am posting it now to encourage WACCRA and SRA committees to modernize it and make sure it can be found on a web search. This will need a leader, and not me (climate, alas).
2011 sample, numbers are not ours but a random example.
• You wouldn’t be here if you hadn’t progressed beyond Why.
• When?
• Similarly, you’ve already figured out that you can’t just “Wait until I need it.”
• Move before you lose your energy or it will be twice as hard on your spouse.
• Where?
• Avoid having to move yet again, should you need more services.
• Don’t want to lose your new friends.
Healthcare Considerations
• Is there “Medicare A” Skilled Nursing for post-op care? (Not at Horizon House.)
• Is there a nurse on call 24/7 to make urgent house calls, not just a Day Clinic? (Horizon House has 24/7 RN to call; Skyline just calls 911 and lets the medics sort it out.)
• Do physicians keep office hours on-site an afternoon a week? Dentists? Social Workers? (Horizon House does.)
So you will need to spend time talking to residents. Go visit, over and over.
• Ask them for stories of something that didn’t work out well for someone.
• Ask them how the healthcare works in practice. Any disappointed expectations?
• Ask them how responsive the Administration is. Do they just respond to problems by making more rules?
The Residents tend to be boosters….
• If they like you, they will hope that you will move in.
• They’ve made their big decision and may be justifying it to themselves.
• Since that’s true no matter where you visit, it doesn’t give you differences to go on.
• You have to dig for the differences, the ones you can’t just tabulate in a comparison table.
Getting Past the Stock Answers
It’s not that you can’t get a straight answer from a resident or marketing person.
• But they do tend to talk in generalities suitable for visitors. They will tell you Policy when what you need to know is the Practice.
• You have to convince them that you need to know where the problems are, in order to do a fair comparison.
Dig for the Differences
• So ask the officers of the Residents’ Council what issues they have been taking up with the powers-that-be.
• Were they put off? Told the Board of Trustees would never buy it?
• Do they describe the Administration as eager to please, willing to be flexible?
Bundling can be hard to unbundle.
• Difference between 90% Refundableand Amortize in five yearsshould be about what a life insurance policy costs for the 90%.
• Long-term care insurance, similarly.
• Cost comparisons are hindered by different bundling for phone, housecleaning, and meal allowance.
A few weeks ago an astonishingly healthy and vigorous local centenarian “died peacefully after a brief illness,” in her home. She and I once met with others to plan a presentation on aging. Previous presentations touched on long term care living but cursorily. She told us of a project she had led comparing nursing homes in Seattle. Our planning meeting shut down when one of the members insisted that to choose a nursing home one need only visit several.
Or, we can plan to die at home. Mr Calvin’s decision-making speaks to yet another access point to long term care: Continuing Care Residential Communities.
The conceit of Continuing Care Residential Communities, compared to other options, is that, should we need it, our transition to increased medical services will be eased across three or more stages: independent living, assisted living, memory care and nursing home. These arrangements come at a cost of course. The alternative living arrangements can cost either much less or yet more than a ccrc.
Leaving aside cost considerations, those who are looking at ccrc’s risk falling into a most appealing trap. For those prospective residents who have little need of assistance with their daily activities, life in a ccrc’s “independent living” wing is marketed to look stylin’ – like in a grand hotel. Or, perhaps like a sentimental journey trip to the convivial dormitory of their college years. To be sure, the very term CCRC is a metaphor for that possible future life style we’d rather not even contemplate.
If residents are relatively active, their comfort level is likely to be found in a proscribed set of friends and acquaintances from among the hundreds of residents, staff, and visitors. Most residents eschew any involvement in the governance of their home. It is safer that way. Or, there’s their blood pressure to consider. Or, or, or. Their life in this place is either ‘Fine!’, or it’s…kvetch, kvetch!
So why expand on Mr. Calvin’s generous friendly assistance to those making a big decision? Because there is so much more to know and to share. And it is only by “expanding” on this brief introduction that both residents and prospective residents of ccrc’s will experience the shut-off lives of these ccrc’s most vulnerable residents: Those who lack this bully pulpit.
Let the wild rumpus of bully pulpit expansions start! Daily? Weekly? I’ll do my part, having spent so much of my life in ccrc’s, their resident councils and their surveyors’ exit conferences, both as a representative and as a community ombudsperson.
Early one morning, a dining room employee, identifiable by his uniform with cap, lay slumped over the driver’s wheel of a car in the ccrc parking lot. A witness to this unusual scene alerted the dining room’s head hostess. Hours later, the witness was doing her mom’s laundry in the facility’s basement laundry room. A staff member she’d known for years entered and stood there not saying anything. One of several laundry rooms, each with only two washer-dryers, and the only one available at the time, this one was also the furnace room.
Not to be intimidated by their isolation and this peculiar male presence, the daughter/visitor got animated: “I’m so glad to see you! I was just on the phone with the d.r. hostess because a guy was passed out or something in the parking lot. She (the hostess) wasn’t going to do anything to help him until she could talk to the director.” The staff member: “Well, he must have been alive because he left here in an ambulance.”
Playing it over in my mind, and with the increased media attention to drug overdoses, I’d have skipped the middleperson. It’s so unlikely that a person would take a nap bent over the wheel that I would call 911 directly myself. We know that time is of the essence in the much likelier event of a heart attack, stroke or drug overdose.
Yesterday it was announced that all willing Seattle public librarians will be trained in how to administer the lifesaving inhalant naloxone. The People’s Harm Reduction Alliance and the public health department say that having a naloxone kit is like having a fire extinguisher. We never know when we might need it.
Do the CCRC’s listed in Mr. Calvin’s comparison offer naloxone training? If residents, visitors and employees don’t need it for themselves, they might witness someone who does.
I like big words, I cannot lie. But “proscribed”? I certainly did not mean to say in a previous post that a resident’s friends are outlawed. ‘Circumscribed’ might work. Or ‘associates by propinquity’! Proximity?
I remind myself that a geriatrician says that our brains benefit from social interaction. That it’s the formulation of our verbal responses in conversation with others that improves cognition.
And what a luxury a blog provides by allowing us to edit before sending. Now to indulge in that gift to our gab.
SP
Thanks. SP
Thanks for this Mr. Calvin. I have so much to add and it may take some time to get it in writing but I’ll try for this week.
Sylvia Peterson
Jim: Please edit this for me!!!
Please add Mr. to William’s last name.
A few weeks ago an astonishingly healthy and vigorous local centenarian “died peacefully after a brief illness,” in her home. She and I once met with others to plan a presentation on aging. Previous presentations touched on long term care living but cursorily. She told us of a project she had led comparing nursing homes in Seattle. Our planning meeting shut down when one of the members insisted that to choose a nursing home one need only visit several.
Or, we can plan to die at home. Mr Calvin’s decision-making speaks to yet another access point to long term care: Continuing Care Residential Communities.
The conceit of Continuing Care Residential Communities, compared to other options, is that, should we need it, our transition to increased medical services will be eased across three or more stages: independent living, assisted living, memory care and nursing home. These arrangements come at a cost of course. The alternative living arrangements can cost either much less or yet more than a ccrc.
Leaving aside cost considerations, those who are looking at ccrc’s risk falling into a most appealing trap. For those prospective residents who have little need of assistance with their daily activities, life in a ccrc’s “independent living” wing is marketed to look stylin’ – like in a grand hotel. Or, perhaps like a sentimental journey trip to the convivial dormitory of their college years. To be sure, the very term CCRC is a metaphor for that possible future life style we’d rather not even contemplate.
If residents are relatively active, their comfort level is likely to be found in a proscribed set of friends and acquaintances from among the hundreds of residents, staff, and visitors. Most residents eschew any involvement in the governance of their home. It is safer that way. Or, there’s their blood pressure to consider. Or, or, or. Their life in this place is either ‘Fine!’, or it’s…kvetch, kvetch!
So why expand on Mr. Calvin’s generous friendly assistance to those making a big decision? Because there is so much more to know and to share. And it is only by “expanding” on this brief introduction that both residents and prospective residents of ccrc’s will experience the shut-off lives of these ccrc’s most vulnerable residents: Those who lack this bully pulpit.
Let the wild rumpus of bully pulpit expansions start! Daily? Weekly? I’ll do my part, having spent so much of my life in ccrc’s, their resident councils and their surveyors’ exit conferences, both as a representative and as a community ombudsperson.
Early one morning, a dining room employee, identifiable by his uniform with cap, lay slumped over the driver’s wheel of a car in the ccrc parking lot. A witness to this unusual scene alerted the dining room’s head hostess. Hours later, the witness was doing her mom’s laundry in the facility’s basement laundry room. A staff member she’d known for years entered and stood there not saying anything. One of several laundry rooms, each with only two washer-dryers, and the only one available at the time, this one was also the furnace room.
Not to be intimidated by their isolation and this peculiar male presence, the daughter/visitor got animated: “I’m so glad to see you! I was just on the phone with the d.r. hostess because a guy was passed out or something in the parking lot. She (the hostess) wasn’t going to do anything to help him until she could talk to the director.” The staff member: “Well, he must have been alive because he left here in an ambulance.”
Playing it over in my mind, and with the increased media attention to drug overdoses, I’d have skipped the middleperson. It’s so unlikely that a person would take a nap bent over the wheel that I would call 911 directly myself. We know that time is of the essence in the much likelier event of a heart attack, stroke or drug overdose.
Yesterday it was announced that all willing Seattle public librarians will be trained in how to administer the lifesaving inhalant naloxone. The People’s Harm Reduction Alliance and the public health department say that having a naloxone kit is like having a fire extinguisher. We never know when we might need it.
Do the CCRC’s listed in Mr. Calvin’s comparison offer naloxone training? If residents, visitors and employees don’t need it for themselves, they might witness someone who does.
And the work of these folks may last even into October as well 🙂
https://ths-wa.org/general/september-is-national-recovery-month/
(I cannot attest to the work of this organization, but it sounds good.)
I like big words, I cannot lie. But “proscribed”? I certainly did not mean to say in a previous post that a resident’s friends are outlawed. ‘Circumscribed’ might work. Or ‘associates by propinquity’! Proximity?
I remind myself that a geriatrician says that our brains benefit from social interaction. That it’s the formulation of our verbal responses in conversation with others that improves cognition.
And what a luxury a blog provides by allowing us to edit before sending. Now to indulge in that gift to our gab.
SP
Thanks. SP