Boomers and their parents come face to face with need for support, care

Jan. 07--The holidays are a time for family gatherings, and it's a good bet that at many of them, a couple of the adult "kids" huddled together and asked, "Do you think it's time for mom and dad to live somewhere else?"

At others, those kids might have heard mom and dad announce they were selling the family home, ready to find something with fewer stairs, less yard work and more services.

The percentage of older residents in Thurston County is increasing. People age 65 and older made up 13 percent of the population in 2010, according to the Census. By 2015, that number was 15.9 percent, slightly higher than the statewide average.

As baby boomers enter or approach their own retirement, their parents need more and more support for their physical and cognitive needs.

They are the first generation to live long enough to need widespread, years-long care, and many haven't planned for it, said David Robinson, a geriatric care manager in Thurston County.

"It's the rare person who decides they want to get ahead of change," Robinson said. But making a change before it's a crisis is the goal, he said.

Stacy Johnson, community relations director at Olympics West Retirement Inn in Tumwater, said part of the problem is there are misconceptions about assisted living and other housing options. Olympics West offers a range from independent living to assisted living and into end of life, if possible.

"I'm most often contacted by adult children," Johnson said, adding it's very rare to be contacted by potential residents. "The population of 80-plus thinks assisted living is a nursing home. They're afraid to even consider it as an option."

It's the fear of the unknown, Johnson said. "It's like a new kid on the first day of school. Once they get here and realize 'I don't have to cook. I don't have to clean. I don't have to eat alone, I get driven to the store and the casino,' they settle in."

A triggering event

A number of circumstances can trigger a change of need, Robinson said.

On the physical side, a stroke or broken hip can suddenly make a home unusable. Or children may notice a parent having trouble keeping track of bills, appointments or medications, Robinson said.

"Most people prefer to age in their own homes, and every effort should be made to keep them there," Robinson said.

For the Hensley family of Olympia, the first sign that their father needed help was his reluctance to travel from his retirement home in Arizona.

"Dad traveled almost a third of the time for his work," his daughter, Stephanie Hurd, said. But he began making excuses for not coming back to the Northwest to visit.

In hindsight, she said, there was a lot of confusion about how to deal with situations he used to be able to handle, like traffic.

The four children persuaded their parents to return to the Olympia area and settled them into a condominium. The next step was convincing their mother to accept in-home help with their father.

After finding a caregiver whom both parents liked, the couple was able to manage in their smaller home for about 2 1/2 years.

"We became aware that it was time to look for a residential solution," Hurd said.

As their father's dementia increased, the family first moved him into a memory care center and then into an adult family home.

In addition to their father's increasing symptoms, their mother's health was declining.

"She still struggles with 'I should be able to take care of him,' " said daughter Stacia Hensley.

"We all miscalculated how hard it was going to be for mom physically and emotionally," Hurd said. "She's declined and depressed."

Their mother now has moved into residential housing. Brother Tim Hensley has taken on many responsibilities for his mother, including helping her manage her finances.

Between them, the Hensley children spend about 30 hours a week or more visiting, caregiving and supporting their parents.

The Hensely family found support through their close sibling relationship and the Lewis-Mason-Thurston Area Agency on Aging, which offers resources and support groups. The LMTAAA mission includes assisting "individuals and families in making the right choices for them when confronted with the realities of loss and change," according to its website. Caregiver newsletters offer information and a schedule of programs and training.

Stephanie Hurd said her advice is for people to reach out for resources.

"You need help," she said.

Making a change for yourself

For seniors who are making the decision on their own, options range from simple downsizing, to a spectrum of senior communities, to facilities that offer increasing levels of care.

Some developers offer smaller, accessible homes in active senior communities. Another option, continuum of care, is offered at communities such as Panorama in Lacey. There, people can purchase a home or apartment where they live independently, then add services or move into more assisted housing options in the community as they age.

"What we're finding the last 10 years is that residents are coming sooner and are younger and more active," said Howard Burton, director of marketing for Panorama.

Dale and Georgia Vincent of Olympia decided in their 60s that it was time to leave their two-level, five-bedroom house near Olympia High School. They'd lived there more than 30 years, moving in when their son was 5.

"We looked around, not very aggressively," Dale Vincent said. "Now and then we looked at condos. Surprisingly they were mostly two level."

They were at the nearby Fred Meyer to buy some Mariners tickets when they decided to drop by Panorama. After looking at more than 30 homes, they ended up with a two-bedroom, two-bath duplex. That was eight years ago.

Burton said that boomers and active older people seek experiences instead of things, and the community expresses that.

Panorama has buy-in fees starting at $80,000 for a one-bedroom unit, he said, with a monthly rent of about $1,125 that includes utilities and taxes. But at least 20 percent of residents fall below the community's low-income standard, Burton said.

People considering Panorama should be to the point of wanting to sell their home, and have a "decent pension or monthly income," he said. Residents pay for their own meals and other expenses. Costs increase with larger living units or moving into higher levels of care.

"If you look at the financial side, if you add up all of the things that you pay for (now) that you won't have to pay for at Panorama, I'm not sure it's any more expensive," Vincent said. "In the winter, it's wonderful not to have to pay for heat."

A step for many is assisted living, which is apartment living that includes housekeeping, meals and on-site nursing care.

Olympics West, for example, offers independent living for people who need very little assistance with daily activities, but want the security of quick emergency response and the convenience of communal meals. It also offers assisted living, which includes 24-hour access to assistance.

"It can be as simple as assistance with medications or intermittent assistance with bathing," Johnson said.

The cost starts at $3,000 a month and tops at $5,400, depending on level of care, Johnson said.

Factors to consider

At some point, families need to have a conversation about senior housing options and what is needed, Robinson said.

"If you're meeting with a lot of resistance, just plant some seeds," he said as advice to adult children. "The default position feels safe and predictable, even if it doesn't meet needs."

An easy entry point can be a short-term stay, or respite care, at a senior housing complex, Robinson said.

Johnson agrees. "I will regularly counsel people trying to convince mom or dad to come in, to talk to mom, see if you can get them in for 30 to 90 days." She said respite care rentals are month to month, and she recommends 60 to 90 days so the resident has a chance to settle in.

"In four years at this building, only one person left after 90 days," she said.

Some things to consider to determine the right fit:

-- Medical condition: Do you or your loved on have a condition that will worsen? Do you need daily help?

-- Location: If you are completely independent, it may not matter how far your home is from shopping, but for someone who can no longer drive, or may be limiting driving to short distances and daylight hours, consideration of how far it is to the store, doctor, church and social activities is important. Is public transit available?

-- Accessibility: Can your home be modified to accommodate a walker or wheelchair? Are there stairs to important parts of the house, or to get in and out of the house? Is the yard too much to maintain? According to the 2010-14 American Community Survey data, approximately 31,000 people in Thurston County -- about 12.3 percent of the total population -- had a disability. Of these disabled individuals, more than 40 percent were 65 years of age or older, according to the Thurston Regional Planning Council.

-- Social life: Do you like being around people? Are there hobbies you enjoy that you do outside the home?

-- Caregiving support: Do you have family nearby? Are family members available to help? If so, how much? Family support can be crucial, but is not always available, and family members may not be able to provide all the physical and medical support you may need.

-- Finances: Services in your home frequently cost considerably more than the same level of service in senior housing. If you have long-term care insurance, check what it provides, in what circumstances, how many hours a day and what the cap is on coverage.

-- Professional assessment: An objective assessment of your situation might be the best option. Geriatric care managers or agencies such as Area Agency on Aging can provide guidance and assist in placement.

Levels of care

Once you have a good idea of your needs, try to match them with the options available.

-- Senior retirement community: The first step from the family home might be a senior or retirement community where people own their homes. The community may offer amenities such as small yards, maybe with contracted maintenance, and a community hall with some organized activities.

Individuals must hire any housekeeping or caregiving, if it is wanted.

Residents are similar in age and income, and it's a place to develop friendships, Robinson said.

Costs per month depend on mortgage payment and contracted services.

-- Senior retirement living: This next step is generally rented apartments, with meals available (as well as kitchens), and often some planned activities. Small pets are often allowed. Personal care is still the responsibility of the individual.

Cost per month is about $2,500.

-- Assisted living: The biggest change between "retirement living" and "assisted living" is having a 24-hour caregiver present, a nurse on staff, and help managing medications and bathing. Meals are provided. Individuals may have the option of light cooking in their apartment or eating communally. Activities are available.

Cost ranges from $3,000 to $6,000 a month.

"In assisted living, care is good up to a point, if the need is predictable," Robinson said. "Once needs are unpredictable, assisted living is no longer sufficient."

-- Memory care: For people with dementia and other cognitive impairments, more supervision and higher staffing and services in a memory-care facility may be more appropriate, especially if they are mobile.

Costs are greater than assisted living.

-- Adult family home: State-licensed and privately owned, these homes meet much of the need that in the past would have been provided in a nursing home. They provide housing and care for about six residents and have a high staff-resident ratio. Some adult family homes are appropriate for people with dementia.

Cost is approximately the same as assisted living.

-- Nursing homes: These facilities are now used primarily for rehabilitation before patients move into another form of housing. They are set up to provide heavier care and more supervision and are covered to an extent by Medicare and Medicaid.

-- Continuum of care: Some retirement communities, such as Panorama in Lacey, provide a continuum, from independent living to nursing care. Residents pay their membership buy-in, and pay monthly rent for their homes or apartments. Residents who meet financial requirements are guaranteed to have their needs met as they age.

A different future

The next generation of retirees will likely be more proactive about planning their own living arrangements as they age, Robinson and Johnson agreed.

"If I had a nickel for every time an adult child said, 'Forget mom, I'm moving in,' " Johnson said.

One newer option is creating "villages" of like-minded people, who live in a neighborhood, share resources such as yard maintenance or caregiving, and have a common interest, like travel or art.

The village concept can be casual or very organized.

One example of senior co-housing is Silver Sage Village in Boulder, Colorado. There are 16 homes, each with a common dining area and guest rooms. It is not assisted living, but residents may opt to hire helpers. Residents also serve on committees to run the community.

Some senior living villages have an emphasis on pet ownership, with services that make it easier for residents to keep their dogs.

Another group is the Village Movement, which started in Boston more than 15 years ago. Villages are membership-based and self-governing to help the community address the challenges of aging.

There are 19 villages in various stages of development between Portland and Bellingham.

"It will definitely get easier, I think, as boomers continue to age and need this kind of setting," Johnson said.

Jerre Redecker: 360-754-5422, @jredecker

Resources

-- Lewis-Mason-Thurston Area Agency on Aging: Assistance to family caregiver, including respite care. lmtaaa.org/

-- AARP: Nonprofit, nonpartisan membership organization for people age 50 and older. A good source for insurance information. Lobbies on senior issues. aarp.org

-- Eldercare Resources of Olympia: Provides comprehensive services to older adults and their families in Thurston County. A geriatric care manager will help connect older adults to appropriate services that preserve their autonomy and dignity. olympiaeldercare.com/home

-- Medicaid: Offers programs for long-term care in home or within facilities. washingtonlawhelp.org/documents/1541615102EN. pdf?stateabbrev=/WA/

-- Caregiving information: caregiver.org/caregiver/jsp/home.jsp

-- Village to Village Network: Commit to helping their members age in a place of their choosing, closely connected to their communities and with the supports and tools they need to create successful aging of their own design. vtvnetwork.org

Senior

retirement

community

Senior retirement

living

Assisted living

Memory care

Adult family home

Nursing homes

Continuum of care*

Housekeeping

No

No

Yes

Yes

Yes

Yes

No

Yard work

Maybe

Yes

Yes

Yes

Yes

Yes

Yes

Meals

No

May be

available

Yes

Yes

Yes

Yes

No

Medication

No

No

Yes

Yes

Yes

Yes

No

Pets

Yes

Sometimes

Sometimes

Not usually

No

No

Yes

Personal Care

No

No

Some

Yes

Yes

Yes

No

On-site nurses

No

No

Yes

Yes

Yes

Yes

Yes

Accessibility

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Cost

Depends on mortgage/rent

About $2,500 month

$3,000- $6,000

Greater than assisted living

$3,000- $6,000+

Usually for rehab and often covered by Medicare and Medicaid

Buy-in and monthly rent

*Data for independent living; services are progressive as needs increase

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