The Senior Housing Boom

For years, NH has been building single-family houses, yet its two largest generations-the millennials and baby boomers-find themselves fighting for a small selection of apartments and condos. So even with a boom in senior housing, space is tight.

Many seniors now in NH want to stay here, some in their current homes and others in houses or housing communities more suited to their changing needs. The problem is little housing exists for them to do that. "Two populations, the elderly looking to downsize and the millennials, have a substantial interest in the same type of housing, apartments and condos, that doesn't exist in New Hampshire," says Steve Norton, executive director of the NH Center of Public Policy Studies in Concord. "There's lots of one type of housing: McMansions with five bedrooms and three bathrooms, but not much of the other."

That has led to a building boom in 55+ communities, assisted living facilities and other retirement communities to try and keep up with demand. Within two weeks of Webster at Rye opening 27 new assisted living apartments this past spring, 15 seniors moved in. The Morrison, a new senior living community in Whitefield, broke ground in the fall, and 28 people were on the waiting list once it opened. Less than six weeks after a major capital improvement project started at Birch Hill Terrace, a nonprofit Continuing Care Retirement Community (CCRC) in Manchester, there were deposits on 22 of the 31 units under renovation.

The question is whether even that additional capacity will be enough. New Hampshire has the second oldest population in the country behind Maine. "Baby boomers and the silent generation drive trends," from the demand for new schools to housing when raising their own families, says Brendan Williams, CEO of the NH Health Care Association. "Now that the demographic is aging and in need of additional senior housing, support and health care services, that's where the demand and growth is."

The state doesn't officially track investment in senior housing, but recent developments add up to tens of millions of dollars being spent to build new retirement and assisted living communities and to expand existing ones. There are currently 1,341 assisted living beds and 4,400 beds in supported residential care facilities in NH, according to the Department of Health and Human Services' Health Facilities Administration-Licensing. And it's only going up from there.

"In some respects right now we are in our economic prime," says Norton, since the state's average age is still below the typical retirement age. By 2030, nearly half a million Granite Staters will be over the age of 65, dubbed an approaching "silver tsunami," representing almost one-third of the population. "It doesn't matter whether it's a problem or not, it's going to happen, and we have to find ways to deal with it," Norton says. "I'd say it's a challenging situation."

The Cost of the Good Life

It used to be that senior housing was functional and simple. Not anymore. The facilities these baby boomers want are often nothing like the ones in which they placed their own parents and grandparents. "This is a generation that grew up with a lot of choices," Williams says. "Frankly, they have developed a certain level of entitlement through their lives, and they want things that are nice."

RiverWoods, a continuing care retirement community with more than 400 independent living apartments, 75 assisted living apartments and 75 nursing home beds in the Exeter area, is making sure it can meet those changing expectations. "What a 75-year-old wants today is different than what someone wanted in 1994. Our community's mission is to provide people with community and peace of mind and do what we have to so we're interesting to that population. Today that means things like organic food, farm-to-table, having a whole technology department and an optimal health and wellness program, not just an activities person," says CEO Justine Vogel.

Such amenities come with a price. The residents at Webster at Rye pay a minimum of $6,300 per month for assisted living, which includes meals, utilities, maintenance, nursing support, recreational activities and transportation. Base level in memory care at Rye starts at $7,300 per month. Webster at Rye's assisted living and memory care apartments all have access to secure as well as open outdoor spaces and gardens and all-inclusive packages with full-service dining, housekeeping, laundry services, daily activities, field trips, three levels of nursing support and an annual lobster lawn party.

"It's really important to be able to provide different levels of care, a continuum of care, under one roof, especially when caring for couples," says Tom Argue, CEO and administrator at Webster at Rye. "One person might require memory care, for instance, and for a spouse or loved one to be able to go down the hall and visit their partner on a cold snowy night instead of getting in a car and driving on icy roads is really an advantage."

At RiverWoods in Exeter, residents pay entrance fees ranging from $183,000 for a studio to $814,000 for a 2,300-square-foot cottage as well as monthly fees ranging from $2,200 for a studio to $6,700 for a large cottage. RiverWoods also recently affiliated with Birch Hill Terrace and has committed to a three-year, $9 million investment in that facility. At Birch Hill, entrance fees range from $156,000 to $282,000. Both RiverWoods and Birch Hill are nonprofit long-term care providers. They are unique in that they require hefty up-front entrance fees, but those fees are generally partly refundable when a person moves out or dies. At RiverWoods, 90 percent is refundable, while at Birch Hill, 50 percent is refundable,which can be paid to a person's estate. Insurance assures residents continue to pay a discounted monthly fee off the market rate for assisted living services, nursing home care or memory support care, whatever they might need down the road, Vogel says.

Access for All Seniors

Not everyone has the finances to pay hefty entrance fees and monthly fees, and others don't want or need the additional services that continuing care retirement communities and assisted living facilities offer. "I tend to think of them [seniors] as three differ- ent populations," Norton says. "One is folks who have sufficient resources that can live forever in their communities and another is low income individuals who would ultimately become eligible for Medicaid services and community-based services. Then there's that middle group that everyone is trying to focus on. How do you support those people? Anything you can do to minimize their costs and help them stay in their homes as long as they are able is important."

A North Country community-needs assessment and feasibility study conducted in 2013 by a Dartmouth College Tuck School of Business student determined it wouldn't be viable to build an affordable facility in that region based on the rates Coos County's senior residents could afford. Certainly the demand was there for a servicerich continuum of care, yet the area's population and income level wouldn't support the cost of building and operating such a facility. To make it work, the $25.6 million Morrison Senior Living Community was funded by two low-interest loans totaling $25 million from the U.S. Department of Agriculture along with a $144,216 invested by The Morrison, which already has a nursing home and assisted living facility in Whitefield. The new facility will have 83 units of housing for moderate income seniors ranging from independent living to assisted living and memory care.

"Little by little we were able to put the right people in the room, and we just didn't take 'no' for an answer," says Roxie Severance, CEO and project manager of The Morrison. "We challenged the government to change, and they did." The USDA agreed to a pilot program in which it would fund independent living and assisted living on the same campus, something Severance says "their rules said they couldn't do [before]." Though the exact cost for residents hasn't been set, Severance says it will be "Coos County priced for moderate income people."

For those not needing additional services, 55+ communities offer an alternative to freestanding houses and apartments, and the maintenance and/or loneliness that can come with them. The Grand Estate at Londonderry, a 55+ independent community, has a 40-seat movie theater, a library with a fireplace and community room, as well as apartments ranging from one bedroom, one bath to two bedrooms, two full baths.

No matter what, it's better to do research and have conversations earlier rather than later with family and loved ones. "It's hard to go out there and ask the questions when you really don't know the game," says Nancy Euchner, an Aging Life Care manager with AgeQuest LLC in Portsmouth, which works with seniors and their families to identify and find the housing and services needed. She notes that, for instance, "the contracts are varied especially for assisted living. Additional charges may be hard to figure out. We advise people to get a copy of an admission agreement so they can do an apples-to-apples comparison to make the best choice for their loved one and themselves."

Admittedly, Euchner says, "There is a huge shock when people find out the cost of paying for assisted living and care in New Hampshire." She notes the average cost for assisted living in NH is $5,500 to $8,500 a month, considerably higher than the national average and in places like Florida, where there are more facilities and more competitive pricing. In addition, families and individuals who meet with her for assessments are surprised that most independent living facilities have waiting lists. They are also surprised that a program like Medicaid will not automatically pay for assisted living. In fact, NH's Medicaid program is limited, and Euchner notes that if you have Medicaid in another state and move here, the benefits don't transfer.

"You owe it to yourself and your kids to figure out the plan for your future," Vogel says. "You've planned your education, your kids' education, your vacations. Don't quit now." *