Planning for elder issues - best ideas/advice

[cascadiabound]

I have a lifetime of working in primary care and have had to navigate locating appropriate elder care for a half dozen relatives and have watched so many families struggle through this incredibly common need.

With all of this experience, I am beginning to think about how to have the most control possible and the best path to an option that would cover all of the usual needs in a non traditional way... face it, the options available are adequate at best and there are lots of compromises in them.

Have you see an option that you can imagine being happy in when you have such needs?
Have you seen people create/preplan an option outside of the typical options?
If cost were essentially not a problem, what would you want?

I have this idea... and it seems like someone must have done this already...
to purchase or build what I want for myself, join with 5-10 other people/couples who have similar values, funds and lack offspring that could be counted upon and create a small community of housing for elderly/dementia needs. Have a central gathering place that provides meals and common spaces for fitness, creativity, culture. Hire a chef, but have kitchen space enough to do for yourself if you are able and want. Hire a business administrator to handle business stuff and bills. Contract with a physician to be medical director and hire whatever other care staff might be needed. All independent of any larger organization.

Anyone ever hear of such a set up?
Inquiring minds want to know

 

[Dearelliot]

Is that like "assisted living " here in Jersey.

 

[twister947]

You are talking about a breathtaking amount of money. Subscribed.

 

[IrisAlthea]

I have a lifetime of working in primary care and have had to navigate locating appropriate elder care for a half dozen relatives and have watched so many families struggle through this incredibly common need.

With all of this experience, I am beginning to think about how to have the most control possible and the best path to an option that would cover all of the usual needs in a non traditional way... face it, the options available are adequate at best and there are lots of compromises in them.

Have you see an option that you can imagine being happy in when you have such needs?
Have you seen people create/preplan an option outside of the typical options?
If cost were essentially not a problem, what would you want?

I have this idea... and it seems like someone must have done this already...
to purchase or build what I want for myself, join with 5-10 other people/couples who have similar values, funds and lack offspring that could be counted upon and create a small community of housing for elderly/dementia needs. Have a central gathering place that provides meals and common spaces for fitness, creativity, culture. Hire a chef, but have kitchen space enough to do for yourself if you are able and want. Hire a business administrator to handle business stuff and bills. Contract with a physician to be medical director and hire whatever other care staff might be needed. All independent of any larger organization.

Anyone ever hear of such a set up?
Inquiring minds want to know

What you describe reminds me a bit of the 55+ communities here, in that they are providing for different levels when it comes to care needs and often have communal spaces and arranged activities.
They are usually pretty large though and run by either a company or the city.

There are care facilities run by cooperatives here, mostly as alternatives in northern Sweden, for those who want to stay where they are rather than move to the care facilities in the bigger cities.
They are usually not the fancy kind though and mostly for those with need for a lot of care.

The general idea here is that people should stay in their own homes as far as reasonably (and sometimes unreasonably) possible.
You can get home care and also alterations needed in your home, heavily subsidised and priced on a sliding scale depending on your means.
For some, that is what they want. For others it is a very lonley excistence.

 

[PersonalFavors]

Yep. My Mom lives in a community of Apartments, condos and villa's. It is much like a country club atmosphere. Fine dining each night or she can go to the 'bar'. Byob. And at 89 is still brown liquor with an ice cube. If I bring her home for lunch she asks for "some" beer but drinks a whole one. It is not cheap. It was ~175k to get in on a waiting list and the monthly has gone from 2800 to now 3200. There is a list of 5 health items. Once you lose a combination of those they move you to assisted living. She has us so we make sure she gets to the doctor and Mom still likes the grocery store or to visit the pharmacy instead of delivery. There is a bus for that or uber. But I like doing stuff with mom.
Since she could afford it this was the best thing for her. Big house big costs on keeping up the grounds and bills and non-sense really. And there is less chance she will be drinking alone. If she does have an emergency or fall they are well prepared for that. The community is pretty cool. Meaning they can move about and have friends. Many are hard liberal very political so some visits are like a mine field of hate without reason. She steers clear of that on her own and also avoids those that have their libido intact. I can see her avoiding men at this point but I think there are some ladies there that might have a nice touch. Old school, my Mom. I'm sure she will never go there. So arthritic not sure she can do much for another either. I mention it as if things continue for me mine will still work but I might not be able to self serve. Is there a service for that? What's an old guy to do? Could be a difference in life and death....
They 'facility' seems to be good handling others money. Fortunate for us there are Estate Planners in the family to manage/protect that.
Other family in Peru do not have it so lucky. Stay home and hope you have someone to look out for you. I hear from a neighbors that Medicaid is so jacked up here that their system for elder care is much better managed. Years ago when obama/pelosi eliminated health care in the US the medicare/medicade system was raided. It no longer provides as it did before. My Korean and Thai friends [neighbors] in that retired age phase are now trying to find their way back home as they will be much more comfortable in the later stages of life and age related illness. In other countries the government does not determine what is or is not funded. Like us citizens that worked and funded the health system the carpet has been pulled out from under. the imposed double standard is extremely difficult to navigate if one is not wealthy beyond the cost of living.

 

[cascadiabound]

Is that like "assisted living " here in Jersey.

Assisted living is generally one of 2 things -
fairly institutionalized elder care highly regulated by the state
Or
A assisted living home with a small number of residents. these vary widely in the level of care provided
Both are improvements over the nursing homes of the 70s and 80s, but still... I would prefer not to spend my last decade or so in either setting thank you very much.

 

[cascadiabound]

You are talking about a breathtaking amount of money. Subscribed.

Yes. I realize this.
I am definitely not talking about a budget conscious option.

 

[Dearelliot]

Assisted living is generally one of 2 things -
fairly institutionalized elder care highly regulated by the state
Or
A assisted living home with a small number of residents. these vary widely in the level of care provided
Both are improvements over the nursing homes of the 70s and 80s, but still... I would prefer not to spend my last decade or so in either setting thank you very much.

Know what you mean, I'm 88 and my wife is 85...so that day weighs heavily on our mind.

 

[twister947]

Yes. I realize this.
I am definitely not talking about a budget conscious option.

Understood. What do you envision here? Individual units or cottages that are individually owned and have discrete Deeds? Or something more communal? Apartments? Condos? Again the issue of individual ownership comes up. Would an LLC work? What about the model of a golf course/club where you buy membership and have a home on the golf course? I'm just spitballing here, obviously. It's a very interesting question you pose.

 

[DWW]

Yes. I realize this.
I am definitely not talking about a budget conscious option.

Some good ideas about a tough situation - been through it myself with my mother and now starting to think about myself and SO as we are aging fast.

So what’s the plan when someone runs out of money? Would the others all pick up the slack? Would you charge more to start in order to build up a reserve? What happens when 2 or 3 run low on money or some simply refuse to support the ones low on savings or income?

Sorry to ask tough questions but this happens all the time at expensive Continuing Care Communities - some kick you out, some transfer you to a cheaper place where you exist on welfare or Medicaid - and some (mostly the non-profits) let you stay and cover the cost with charitable fund-raising.

 

[Mrtenant]

Some good ideas about a tough situation - been through it myself with my mother and now starting to think about myself and SO as we are aging fast.

So what’s the plan when someone runs out of money? Would the others all pick up the slack? Would you charge more to start in order to build up a reserve? What happens when 2 or 3 run low on money or some simply refuse to support the ones low on savings or income?

Sorry to ask tough questions but this happens all the time at expensive Continuing Care Communities - some kick you out, some transfer you to a cheaper place where you exist on welfare or Medicaid - and some (mostly the non-profits) let you stay and cover the cost with charitable fund-raising.

I think that's where money management comes into play. A variety of investments and a fund to help the community for emergencies just as you describe. It also helps to limit how many members can be part of the group. Every family should particpate and contribute to the fund. Like an investment club. That is my field of specialty- retirement planning. There are models for how this works sustainably for the entire community. Setting up trusts for the community itself being the key operating piece. A sharp retirement planner and investment adviser working with estate planning attorneys can create this package. Again, limited membership is important for sustainability.

 

[Bramblethorn]

I have a lifetime of working in primary care and have had to navigate locating appropriate elder care for a half dozen relatives and have watched so many families struggle through this incredibly common need.

With all of this experience, I am beginning to think about how to have the most control possible and the best path to an option that would cover all of the usual needs in a non traditional way... face it, the options available are adequate at best and there are lots of compromises in them.

Have you see an option that you can imagine being happy in when you have such needs?
Have you seen people create/preplan an option outside of the typical options?
If cost were essentially not a problem, what would you want?

I have this idea... and it seems like someone must have done this already...
to purchase or build what I want for myself, join with 5-10 other people/couples who have similar values, funds and lack offspring that could be counted upon and create a small community of housing for elderly/dementia needs. Have a central gathering place that provides meals and common spaces for fitness, creativity, culture. Hire a chef, but have kitchen space enough to do for yourself if you are able and want. Hire a business administrator to handle business stuff and bills. Contract with a physician to be medical director and hire whatever other care staff might be needed. All independent of any larger organization.

Anyone ever hear of such a set up?
Inquiring minds want to know

I've heard "intentional community" used for arrangements where several households get together to organise something similar, with shared common spaces etc. The ones I've heard of didn't include that aged-care aspect, which is obviously very important, but searching on the term might still find something relevant.

I expect you'd want legal advice in formalising things in a way that protects residents when they no longer have the mental capacity to look out for their own interests, and planning out contingencies e.g. what happens when some of the original residents are no longer around, or if people can't get along.

 

[Gerilynn69]

LBGTQ folks have been working on this intentional living concept for years and years. Chosen families, chosen communities of like minded folks.

Building that community is a big part of the process. It does take money, but it takes finding your own chosen community that are willing to support each other. Good luck. It helps to have multiple generations so folks can assist each other.

 

[IrisAlthea]

I've heard "intentional community" used for arrangements where several households get together to organise something similar, with shared common spaces etc. The ones I've heard of didn't include that aged-care aspect, which is obviously very important, but searching on the term might still find something relevant.

I expect you'd want legal advice in formalising things in a way that protects residents when they no longer have the mental capacity to look out for their own interests, and planning out contingencies e.g. what happens when some of the original residents are no longer around, or if people can't get along.

Yes, I’ve seen several versions of communities like that, working out to different degrees.

The added factor of advanced ageing would complicate it further I think.
Especially with dementia, it can get really rough on those close to someone who just isn’t the same person any more.

 

[Dearelliot]

Something that, had one time interested us, my cousin and wife, maybe around when they were in their early sixties..(Maybe) Bought an insurance policy for senior care, monthly payments.. I dont know the particulars, he kept all of that to himself, I'm sure the policies vary a lot,
He passed when he was 81, and his wife of the same age wasn't in good health. With her policy she had a live in full time maid.. according to her, paid for thru the policy.
she was very happy with that.
I woulda, I coulda, I shoulda, looked into something like that....but we didn't.

 

[Beholders_Eye]

I live in a one bedroom apartment in a U.S. Texas senior community, somewhat like that which you describe. It is part of a corporation that serves the industry. I am in the independent living section of the complex, but there is an assisted living section and a memory care section. It is not cheap, but do have many amenities: 3 meals/day served in dining hall; 2x month maids; fitness center; full kitchen, washing machine/dryer, patio, TV, internet, courtesy van to appointments, etc. I am one of the fortunate ones, as many use walkers or wheelchairs, but I am ambulatory and still play golf. There are numerous activities for those who like them: outings, card games, bingo, etc. I am pretty much independent and still have my car (as long as I can be).

 

[cascadiabound]

Understood. What do you envision here? Individual units or cottages that are individually owned and have discrete Deeds? Or something more communal? Apartments? Condos? Again the issue of individual ownership comes up. Would an LLC work? What about the model of a golf course/club where you buy membership and have a home on the golf course? I'm just spitballing here, obviously. It's a very interesting question you pose.

I can see the possibilities in all of the above options except no golf course living for me.
I think an LLC would work.
I am thinking perhaps discreet cottages or condo type units with communal outdoor space. I imagine each participant would invest into the project with a significant amount of capital and ongoing contributions annually or something to fund salaries of staff, facility care and maintainence etc. Maybe it's a buy in or partnership kind of model. Because I am imaging this to provide for needs as my capacity diminishes there would have to be safeguards of several kinds. Perhaps a board of directors to provide oversight? Maybe each member gets to appoint someone to the board they have confidence in their ability to be an advocate?

 

[cascadiabound]

I've heard "intentional community" used for arrangements where several households get together to organise something similar, with shared common spaces etc. The ones I've heard of didn't include that aged-care aspect, which is obviously very important, but searching on the term might still find something relevant.

I expect you'd want legal advice in formalising things in a way that protects residents when they no longer have the mental capacity to look out for their own interests, and planning out contingencies e.g. what happens when some of the original residents are no longer around, or if people can't get along.

I am familiar with these. I think this is part of why I wonder if my idea about a more deliberate end of life/assisted care situation already exists.
In the US (and maybe other places?) these are called co-housing communities and there is an organization that helps people set these up and expectations/models for ongoing life and decision-making matrices. There are several I know of in the PNW and my mother lives in one in the Bay area CA.
Her co-ho has made some provisions for aging in place, but it has significant shortcomings and gaps imo for the likely needs of people in 80-90's

 

[cascadiabound]

LBGTQ folks have been working on this intentional living concept for years and years. Chosen families, chosen communities of like minded folks.

Building that community is a big part of the process. It does take money, but it takes finding your own chosen community that are willing to support each other. Good luck. It helps to have multiple generations so folks can assist each other.

Absolutely this
Like many LGBTQ folks, we have no offspring, so we either make a plan for ourselves or god only knows what will happen.
I have people in mind I'd like to do this with and we are beginning conversations. We have maybe 20 years lead time on it?

 

[cascadiabound]

Yes, I’ve seen several versions of communities like that, working out to different degrees.

The added factor of advanced ageing would complicate it further I think.
Especially with dementia, it can get really rough on those close to someone who just isn’t the same person any more.

Dementia and the need for memory care capacity is at top of mind for me. if we have 10-20 community members the likelyhood that several of us will have such needs is high. I've seen memory care pretty well done, it's always a compromise, but having beautiful outdoor (gated/locked) spaces that do not feel like a prison is of critical importance. Being able to continue to live is some amount of community with familiar people around is important, but equally important is to have the spouse be relieved of primary caretaking responsibilities.

 

[cascadiabound]

Something that, had one time interested us, my cousin and wife, maybe around when they were in their early sixties..(Maybe) Bought an insurance policy for senior care, monthly payments.. I dont know the particulars, he kept all of that to himself, I'm sure the policies vary a lot,
He passed when he was 81, and his wife of the same age wasn't in good health. With her policy she had a live in full time maid.. according to her, paid for thru the policy.
she was very happy with that.
I woulda, I coulda, I shoulda, looked into something like that....but we didn't.

Long term care policies are a useful tool. They are expensive and most affordable if you get one when you are still young (less than 50). They vary a lot in what kinds of care is covered. I am familiar with policies that cover 24/7 in home care.
But still... I would like to age in community... with and around people I love. To me this is a quality of life issue. Long life is a curse without quality of life

 

[cascadiabound]

I live in a one bedroom apartment in a U.S. Texas senior community, somewhat like that which you describe. It is part of a corporation that serves the industry. I am in the independent living section of the complex, but there is an assisted living section and a memory care section. It is not cheap, but do have many amenities: 3 meals/day served in dining hall; 2x month maids; fitness center; full kitchen, washing machine/dryer, patio, TV, internet, courtesy van to appointments, etc. I am one of the fortunate ones, as many use walkers or wheelchairs, but I am ambulatory and still play golf. There are numerous activities for those who like them: outings, card games, bingo, etc. I am pretty much independent and still have my car (as long as I can be).

This is an excellent sitiation. There are more of this type of facility these days and I am grateful for them. We moved my in laws to a very similar community in 2021. They both passed the same year, but they had significant health challenges. The staff was great, independent living to the extent residents were able and lots of activities. But in the time of covid the restrictions were draconian and a private self funded LLC might avoid what I know diminished the quality of life for the residents there.

 

[NC_Coastal]

The elderly couple (with no living relatives) that lived next door came up with a unique idea. They invited a couple into their home for assistance - rides, home repairs, keeping schedules etc. The wife died several years before the husband, who stayed in the house after her death. He died a couple years ago. The live-in couple inherited the house.

 

[cascadiabound]

The elderly couple (with no living relatives) that lived next door came up with a unique idea. They invited a couple into their home for assistance - rides, home repairs, keeping schedules etc. The wife died several years before the husband, who stayed in the house after her death. He died a couple years ago. The live-in couple inherited the house.

This is an excellent solution.
My great aunt and uncle in Texas did something similar. They had a live in caretaker who inherited the house and car when they passed.
I recall some family members being concerned the woman had taken advantage and coerced them into leaving their estate to her. I don't think that was the case, but if they had shared their plans for their estate before deaty there would have been less consternation

 

[twister947]

This really becomes complicated when I begin to consider what happens to shares in this organization upon the passing of residents. Their shares will, unless otherwise provided for, pass into their estates, and then what?