I am 72. I graduated college 50 years ago and am a quintessential baby boomer. I studied seniors housing and care as a real estate market and stock analyst for more than 20 years. I spent several years raising capital and advising companies in the seniors housing and care space and served on the board of Quality Care Properties, a health care REIT.
The holy grail of seniors housing and care throughout the last 20 to 25 years has been the arrival of baby boomers as senior housing residents. Despite a series of ups and downs driven by overbuilding, varying economic conditions, and a pandemic, the arrival of the baby boomers at the front door of seniors housing properties nationwide continues to be seen as spurring huge investment upside for the seniors housing and care industry.
The problem with this thinking is boomers have not moved in mass to seniors housing in their 60s or so far in their 70s. There is a rethink going on among some in seniors housing considering if boomers may abandon traditional seniors housing offerings altogether and, instead, seek out active adult communities, both large ones like the Villages and Del Webb and smaller scale active adult options. In these scenarios, boomers use home health care to avoid traditional independent, assisted living, memory care and CCRC properties altogether.
A funny thing happened this past week. Two baby boomer couples we have known for many years, who are our age or just a few years older, independently started touring CCRC communities around Baltimore, where I live. These same boomers, until very recently, could not picture themselves ever living in a CCRC. It is too soon to call this a trend, much less a wave of baby boomer demand, but it appears to me that after three years of pandemic, on and off masking, and much reduced social interaction more boomers are ready to consider communities that offer a wide range of education, entertainment and social activities, even if these properties are full of “old people”. Another couple we know is selling their condo near the water in a hip Baltimore neighborhood to rent in a 55 plus community in the suburbs with pickleball courts, educational and social programs.
I am curious if other senior housing industry professionals and other baby boomers are seeing evidence that boomer attitudes toward at least CCRCs are beginning to change and the holy grail of increased boomer demand for seniors housing may yet remake the industry. Please respond with your comments on this post.
I thought a letter to the editor published in the Wall Street Journal on November 11, 2021 from Jane Shaw Stroup contained a number of good insights on retirement center living from someone whose husband had recently died after the couple spent five years in a community. Jane Shaw Stroup is a retired nonprofit executive and her husband, Richard L. Stroup, was an economist. The couple moved into a retirement community in Raleigh, N.C. in 2017.
Key points in Mrs. Stroup’s letter include:
Experience was mixed but generally a good one.
Your friends are close by, with was important during the depths of COVID pandemic. A small group of us met once week for wine and snacks during the pandemic.
A retirement center has some resemblance to a college dorm, but that a good thing. You are able to meet people at meals, exercise classes, lectures and clubs.
Having gym and a restaurant downstairs makes life easier.
Retirement centers are full of people who have experienced long, interesting lives – lots of opportunities for good conversation.
Emptying the contents of one’s home and selling it are poignant experience but leaving the process to one’s children may not be the right approach.
A retirement community can only succeed if it has caring staff who tolerate the foibles of older people. We were never reprimanded or chided by the staff even though we did some stupid things, like forgetting to push the button each morning to let staff know you are okay.
A retirement center is a place where you don’t have to be smarter or younger than you are. And a place where many friends can ease the loss of a spouse.
I will turn 70 next month. I have been semi-retired for five years and fully retired from my last full-time employer for three years. I find a number of my close friends, who elected to keep working after age 65, are now shifting to full or partial retirement at age 70 and I thought I would share with readers of this blog some of the advice I have been informally providing to friends.
For high achieving Baby Boomers with well established careers, it is scary to think of giving up a career in which you are still investing more than 40 hours per week, which provides status and professional recognition, and which is the nexus for many of your social relationships. A number of my friends are very concerned about how they will fill their time post-retirement.
I was fortunate in being able to cut back with my full-time employer, from working 50+ hours per week as a stock analyst covering seniors housing and care stocks and healthcare REITs to working 20 hours per week in investment banking focusing on business development and providing input on industry trends and corporate strategy for M&A transactions and capital raises. This step-down in time, together with a shift in my responsibilities, kept me productively engaged while allowing me to ease into retirement. I believe employers today are more open to these types of arrangements but, based on feedback from friends, this seems to work less well for law firms and other employers that bill by the hour.
When I ceased working as an investment banker part-time for my long-time employer – Stifel Nicolaus, it was my choice to end the relationship. I was spurred to retire by my older brother’s death, which increased my desire to enjoy more of life while I was still healthy. However, I still wanted to remain professionally engaged post-retirement, so I set up Robust Retirement, LLC as a vehicle though which I could provide consulting services with a liability shield and set up this blog to allow me a platform from which to comment on industry issues. Setting up and maintaining an LLC and a web blog is not very difficult. In the years since I fully retired, I have done a number of consulting assignments through my LLC and served on the Board of Directors at the publicly traded healthcare REIT – Quality Care Properties.
My advice to pending retirees or those contemplating retirement.
Don’t do too much pre-planning of your time in retirement or make a lot of commitments.
Take some time to clear your head and reflect on what’s really important to you.
Observe and talk with friends and neighbors about how they transitioned to retirement and what they like and dislike.
Dabble – take some courses, try some organizations and see what you like before you commit.
Avoid getting over committed to too many volunteer organizations or projects. It’s okay to say no – my own rule is no more than one board or major volunteer assignment at a time.
Free, unstructured time is okay.
Commit to an exercise regime. Vigorous exercise is one of the few things that can extend your good health. My current program includes boxing/intensive cardio twice a week, yoga and tai chi each once a week, weight training once or twice a week and golf once or twice a week now that the weather is turning warm.
Consider a move to a condo before or shortly after you retire unless you really enjoy yard work. My wife and I moved to a high rise condo with a doorman and valet parking. One story living with someone to help with deliveries will allow us to stay in our current home for many more years and, if you are looking for more than two bedrooms in a well-located condo, these can be relatively hard to find.
Stay connected with professional colleagues – I belong to one professional association with a local chapter that keeps me connected and make a point of connecting to former colleagues for lunch or drinks from time to time.
Notice some things not included in the above list – buying a second home, relocating to a warming climate or lower tax state. These reflect my personal preferences. I don’t want the added work of maintaining two homes and prefer to remain in a location where we are closer to family and long-time friends.
We do travel a lot but that is not for everyone. This past winter, we traveled a week a month to someplace warm (Hilton Head, SC and the Caribbean) and over the last several years have traveled to Scandinavia, Israel, Northern Italy, Costa Rica, the Galapagos and more. A planned Spring trip to Japan was just cancelled by our tour operator but eventually the virus will pass and we will be on the road again.
It has been several months since I updated my blog because I have gotten busy serving on the Board of Quality Care Properties (QCP) and with some consulting work. I am also just back from a vacation in Costa Rica about which I hope to soon do a post.
An article in today’s (January 23, 2018) Wall Street Journal prompted me to do this post. The WSJ article is entitled “How Immigration Could Affect Grandma’s Care” and is in the “Capital Journal” commentary by Gerald F. Seib. Key points include:
American is getting older. A fifth of the population will be over 65 by 2050 and 4% will be over 85, both records in terms of absolute numbers and as a percentage of the population.
A study by PHI, an organization that works with the long term care and home care industry, estimates there are 860,000 immigrants holding “direct care” giving jobs in senior care and perhaps as many as one million when workers providing care independently for families are included.
The largest share of these workers come from Mexico, the Philippines, Jamaica, Haiti and the Dominican Republic; the very countries in the crosshairs of the immigration debate.
Restrictions on immigration may drive up wages for what are often low paying jobs providing direct care to seniors and this may draw more people into the industry.
But forcing dedicated, qualified people from other countries to leave, many of who have lived in the U.S. for years, will be a blow to many including seniors who rely on these immigrants for care.
As you consider you position on immigration policy, you should also consider who will care for your parents and eventually yourself and your peers as you age.
I continue to find the Wall Street Journal one of the best sources of financial advice for seniors. In the “Ask Encore” column on Monday, October 31, 1017, Glenn Ruffenach recommends that retirees retain a financial advisor, despite fees that can run to 1% of assets. While some retirees have the skills and time to manage their finances late in life, Mr. Ruffenach recommends an advisor to:
Keep you from doing something stupid, like investing in a business opportunity offered by a relative or selling aggressively in a market pullback.
Establish and maintain a good allocation among asset classes.
Efficiently manage your tax liabilities including required distributions from retirement accounts.
Assist the surviving spouse, who may be less familiar with financial matters, with the support needed to maintain the nest egg you have built together.
If fees are a sticking point for you, Mr. Ruffenach notes major funds families, such as Vanguard Group (and I would add T. Rowe Price and Fidelity) and some financial service companies like Charles Schwab, Betterment and Wealthfront are now competing to be your advisor with fees considerably lower than 1%. I still see an experienced financial advisor offering more personalized advice than that available from the less seasoned staffers or automated advisory services available at some of the firms noted above. But, the key advice for retirees is that there is value in having an outside advisor and you should shop for one that offers a combination of services and fees with which you are comfortable.
On the page “What Is Retirement” (see link above on the banner of this blog) I propose a new definition for retirement as “The period of one’s life when one shifts from working primarily for the means of earning income to working primarily for the satisfaction of producing a purpose or result while devoting additional time to recreation, education and leisure activities.” to replace the current Oxford English Dictionary definition of ”The period of one’s life after leaving one’s job and ceasing to work.”
While ultimately concluding that the scientific evidence is inconclusive about whether working longer benefits your health, TheNew York Times article says the answer tends toward yes and asserts this is true not just for more highly educated, healthier adults in more fulfilling jobs but for many types of jobs that keep the mind active and provide networks for social interactions.
The headline of The New York Times article seems to imply a choice between working full-time and full-time retirement but most of those cited in the article as working past retirement age have shifted from full-time to some type of part-time employment or consulting. My experience, and that of many well-educated friends, shows them most satisfied in a partial retirement lifestyle where part-time work, consulting or a challenging volunteer position offers the mental stimulation and social networking opportunities that The New York Times article asserts benefit seniors’ health. I believe seniors, their employers and society in general all benefit from meaningful part-time, consulting and volunteer experiences and that we will see more and more baby-boomer seniors in these partially-retired positions going forward.
Most seniors and their families see the monthly cost of a senior housing facility as much higher than the monthly cost of living at home with family care, or even with part-time or full-time home healthcare. But the math that most seniors and families use to make this comparison assumes no implied cost for occupying a home without a mortgage, much less paid care than is provided in a seniors housing facility and places no value on the companionship and social interaction that a seniors housing community can provide.
This analysis, using data from a variety of sources, attempts to make a fair apples-to-apples comparison, before and after taxes, of the cost for a senior living at-home without care, living at-home with a modest amount of paid care and living in an independent living, assisted living or memory care facility.
The chart below shows the comparison on a pre-tax basis of living at home with a modest level of care to the cost of various types of seniors housing communities. Bottom Line – The cost of living in a $150,000 home with even a modest level of home healthcare can easily exceed the cost of an independent living community and approaches the cost of assisted living. In addition, a senior living at home with part-time care does not get the companionship and social interaction that a seniors housing community can provide and which many studies show are beneficial for a senior’s mental acuity and well being.
Please read below for details and I welcome your comments and questions.
THE COST OF A SENIOR HOUSING COMMUNITY
The cost of various seniors housing settings is easy for seniors and their families to see because most facilities charge a monthly fee for housing and care. The average monthly cost for this care according to a recent survey by the National Investment Center for the Senior Housing and Care Industry (NIC) is as follows:
Independent Living – $3,076 per month
Assisted Living – $4,722 per month
Memory Care – $6,082 per month
To these costs, we need to add some additional expenses for a senior living in a seniors housing community for social and entertainment activities, transportation and non-housing living expenses. I have estimated these at half the estimated cost of someone living at home based on data from the “A Place for Mom.com” website, at a total of $475 per month. I assume half the cost of a senior living at home for someone living in seniors housing because many of these services are provided in a typical seniors housing facility and are included in the monthly rate. I add another $183 per month for a senior living in a seniors housing community for utilities, cable television, wifi and phone and renters insurance. Adding a combined $658 per month for things like phone, cable TV, some outside meals, transportation and other living expenses to the monthly fee for seniors housing communities brings the total monthly cost for living in senior housing rounded to the nearest $100 to:
Independent Living – $3,700 per month
Assisted Living – $5,400 per month
Memory Care – $6,700 per month
AT HOME LIVING AND HOME OPERATING COSTS
When the total monthly cost for senior housing and care at the above settings are compared to the out-of-pocket costs for a senior living in a $150,000 home without a mortgage they certainly appear formidable. A Place for Mom estimates the monthly out-of-pocket cost for a average senior living at home (in a home we assume is worth about $150,000) without a mortgage to be approximately $2,400, broken down as follows.
Utilities including phone and cable
Three meals per day
Emergency alarm system
Social and entertainment
It is this $2,400 figure (or something lower because the senior in question has curtailed her social, entertainment and transportation expenses) that most seniors and their families compare to the $3,700 to $6,700 monthly cost of facility-based senior housing and care. Therefore,seniors and their families generally see facility-based care as 50% to 275% more expensive than having a senior live at home.
But the above comparison ignores the value of the house in which a senior is living and ignores the cost of caregiving and the socialization benefits that a senior would receive if she were living in a seniors housing facility. Let’s deal with each of these separately.
ESTIMATED HOUSING COSTS FOR $150,000 HOME
To account for the value of the home itself, I estimate implied rent (essentially an estimate of the amount you could earn from renting the house) using a 7% cap rate on the assumed $150,000 value of the home, at $875 per month ($150,000 x .07 / 12), which seems very modest for many U.S. housing markets.
When you combine the above monthly costs for home maintenance, taxes and operation and living expenses of $2,400 per month with the implied rent, we get an estimated monthly housing and living cost for a senior living in a $150,000 home of $3,275 (approximately $2,400 for living and home operational expenses, plus $875 in implied rent).
From the above analysis you can see that the cost of living expenses, home maintenance and operation and implied rent/housing costs for a senior living on one’s own $150,000 home, calculated in what I believe is a conservative fashion, is nearly 90% of the average cost of a senior living in an independent living facility. And in the independent living facility the senior is getting much more interaction with other people, much more socialization and mental stimulation than most seniors get when living at home alone.
ESTIMATED HOUSING COSTS FOR $500,000 CONDOMINIUM
Doing the same math for a senior living in a $500,000 condominium yields estimated monthly living and home operating expenses of $4,449 broken down as follows:
Utilities including phone and cable
Three meals per day
Emergency alarm system
Social and entertainment
The implied rent calculation for a $500,000 condo is $2,917 per month ($500,000 x 7% / 12). Combining monthly living and home operating expenses with the implied rent for a $500,000 condo indicates a total monthly cost of living at home, including implied rent, without care at approximately $7,400.
When the above figure is compared to the cost of seniors housing, you can see that the estimated monthly cost of a senior living in a $500,000 condo is almost twice the cost of independent living and 36% higher than the cost of assisted living. You can argue that comparing the cost of a $500,000 condo with the average cost of seniors housing is an unfair comparison because these facilities would cost more in an expensive real estate market. But I believe the calculation on a $500,000 condo is fair for the Baltimore market, where I Iive, and I believe it is fair to say that when a true apples-to-apples comparison of housing, home operation and living costs for senior is made to the cost of living in a seniors housing facility, the difference is smaller than most seniors and families realize before even taking into account the cost of care.
HOME CARE COSTS
From the above analysis, we see that the cost of a senior remaining at home is less than the cost of any type of seniors housing community, even independent living, for a senior in a modest $150,000 home. However, as soon as any degree of paid home healthcare is provided the cost advantages of living at home disappear.
According to A Place For Mom and other surveys conducted by insurance companies offering long term care insurance, the cost of in-home care ranges from $14 – $24 per hour. Certainly at the lower end of this range we are talking about a companion or an aid, not a trained nursing. If you assume only four hours of care per day and only five days per week with family providing care on weekend, the monthly cost of this much home healthcare would range from $1,120 ($14 x 4 hours x 5 days x 4 weeks) to $1,920 per month ($24 x 4 hours x 5 days x 4 weeks). If we use the average of these two figures, the monthly cost for four hours of home healthcare five days a week is $1,520.
When you add the cost of four hours of home care during the week to the cost of housing noted above, the monthly cost of housing plus a modest level of home health would be approximately:
No cost is assumed for family care on weekends.
As the chart at the beginning of this post indicates, as soon as a modest level of home care, in this case four hours per day five days a week, is added to the cost of a home, home operation and living expenses, the cost of living at home with home care, even for a modestly priced home, easily exceeds the cost of independent living and is nearly 90% of the cost of an assisted living facility.
In general terms, healthcare costs exceeding 7.5% of income of a senior’s income are deductible. This includes long term care costs if the senior is chronically ill and is is being cared for pursuant to a plan of care prescribed by a licensed health care practitioner.
If a family member younger than age 65 is paying for care, healthcare costs exceeding 10% of the income of the family member paying for care are deductible. This can apply to home care prescribed by a licensed health care practitioner but not a senior’s housing costs while living at home.
In a seniors housing facility the cost of healthcare provided in assisted living or a memory care facility that exceeds 7.5% of income may be deductible if required by a senior’s medical condition and it is possible that the full cost of facility-based care including housing component may be deductible if living in such a facility is considered essential for medical reasons. See IRS Publication 502 https://www.irs.gov/publications/p502/ar02.html for more information and consult with an accounting professional for more complete information.
AVAILABILITY OF GOVERNMENT ASSISTANCE
While many people believe it does, Medicare does not pay for long-term custodial care at home or in a seniors housing facility. It may pay for short-term home health, therapy or nursing care at-home or in a facility if is prescribed by a physician in response to a particular medical need.
Medicaid will pay for long-term custodial care in skilled nursing facility but only after all other resources are exhausted. Some states have waiver programs that allow Medicaid to be used for assisted living and memory care or at-home community-based care, but as is the case with nursing home care, Medicaid will pay only after all other resources are exhausted. In addition, the last proposed Republican repeal and replace of the Affordable Care Act included significant cuts to Medicaid that could potentially reduce the availability of Medicaid funds for long term care for seniors.
Veteran’s benefits include increased Veteran’s Aids and Attendance Pensions payment for care in a seniors housing or long term care facility under certain circumstances and seniors who qualify for Veteran’s benefits should investigate this option.
A Wall Street Journal article on Tuesday, July 26, 2016 entitled “Can This Brain Exercise Put Off Dementia?” hitp://on.wsj.com/2arSPfA reported on the results of a new study, called “ACTIVE” for Advanced Cognitive Training in Vital Elderly, that were presented the previous Sunday at the Alzheimer’s Association International Conference in Toronto, the world’s largest gathering of Alzheimer’s researchers. The article immediately attracted attention within a group of my close Baby Boomer friends who have known each other since elementary school. The New Yorker also published an article on the same study on July 24, 2016 http://www.newyorker.com/tech/elements/could-brain-training-prevent-dementia.
According the Journal “The study results showed that speed training—computer exercises that get users to visually process information more quickly—beat out memory and reasoning exercises, two other popular brain-training techniques sometimes suggested for improving cognitive function and reducing dementia. Researchers found that a total of 11 to 14 hours of speed training has the potential to cut by as much as 48% the risk of developing dementia 10 years later.”
As reported by the WSJ, the ACTIVE study, which was funded by the National Institute on Aging and the National Institute of Nursing Research, included 2,832 healthy subjects, ages 65 to 94, at six study sites around the U.S. Participants were randomized to get one of the three cognitive-training programs or be in a control group. Since 1998 the study has received a total of $33.8M in funding and is still in touch with all but 4o of the original participants.
Prior to release of the ACTIVE results there was no evidence that computerized brain training had any effect on cognitive ability or dementia prevention. TheNew Yorker cites a consensus statement by more than 70 academics in 2014 that “playing brain games has been shown to improve little more than the ability to play brain games.” And in January of this year the Federal Trade Commission fined Luminosity, the largest and best known provider of brain games, two million dollars for making unsubstantiated claims of cognitive improvement for its games. Thus, the large and well-funded ACTIVE study is likely to provide a big credibility boost for the use of computer mind stimulation games to combat cognitive decline and dementia.
The speed training component of the ACTIVE study used a computer game in which, for the briefest instant, two images appear, one in the middle and one on the periphery of the screen (see below). The computer then prompts you to identify whether the central image is a little car or little truck along with which edge the second image appeared. The more accurate you get, the more quickly the images appear and the more complex the background becomes.
Double Decision is a more user friendly version of the speed training game used in the ACTIVE research that was acquired by Posit Science, of San Francisco, in 2007 and is now part of the company’s BrainHQ online service, a cognitive-training program. A monthly subscription, which includes access to Double Decision, is $14 a month, or $96 a year. Posit Science says the company intends to file a medical-device application to the Food and Drug Administration based on the recent clinical trial findings.
After reading the WSJ article my friends and I were immediately tempted to purchase Double Decision through the Brain IQ service, as would any Boomers concerned about their future cognitive abilities. However, our group of friends includes Mitchell Clionsky, Ph.D. who is a clinical neuropsychologist and has worked extensively on dementia testing and evaluation. Dr. Clionsky, or Mitch as we know him, pointed out that, unfortunately, these kinds of stories hit the news with some regularity, always look really great, but sometimes aren’t.
Mitch points out that the ACTIVE research was presented at AAIC as a talk. It has never been subjected to peer review or published in a journal, which the WSJ and The New Yorker also mention. In other words, lotsa sizzle, maybe not so much steak. It also defies reason that 10 sessions of training would impact cognitive functioning 10 years later. Finally, the 48% difference in the frequency of dementia in the ACTIVE study is the calculation of decline from a conversion rate after 1o years of 14% for healthy adults with an average initial age of 73 to a conversion rate of 8% for the subgroup undergoing computerized speed brain training for 10 hours and receiving just four more hours of training. In a large group this is statistically significant. However, it may be less meaningful when applied to individuals.
Mitch is hoping that there is something to the ACTIVE research and looks forward to a replicated study, with a more varied dosing schedule of exposure to training, and better measures of cognitive functioning 1, 2, 3, 5, and 10 years later. In the meantime, he thinks it the impact of using computerized speed training exercises on dementia are way overblown.
Mitch believes it would be better for us Boomers to take home the message: Don’t retire entirely or, if you do, stay mentally and physically active (by writing a blog, playing golf and exercising for example). Get yourself a cool gaming station and play some intense shoot em up games or other video games that require lots of visual processing and reaction time. That way, at least you will be having fun. Control your diet, keep your BMI at about 25, don’t drink too many margaritas at one sitting, take a 30 minute walk every day.
On Monday June 6, 2016, The “Ask Encore” column by Glenn Ruffenach in the Wall Street Journal responded to a question from a reader about “what features, at a minimum, should be added to our current home or incorporated in a new home so that we can stay in our home as we get older.” The columnist’s response identified three resources to make a home accessible and adaptable for seniors. These included:
These all appear to be useful resources and the Wall Street Journal column cites the Harvard Study as saying five features, in particular, that make for safe and acceptable homes are: no-step entries; single-floor living; switches and outlets reachable at any height; extra-wide hallways and doors and lever-style door and faucet handles. The Harvard Study indicates that 90% of existing homes have one of these features but that only 57% have more than one.
Research (AARP United States of Aging Survey, 2012) indicates that 90% of seniors would prefer to stay in their own home vs. moving to a seniors housing community and I have no doubt that for some seniors making adaptations to an existing home or buying a new home with adaptable feature may allow them to defer a move to seniors housing for some period of time. However, because of most seniors’ strong bias toward staying in an existing home, I see far too many seniors resisting a move to seniors housing even when this would be more beneficial for their health, their finances and their families.
I believe it is important for a senior and her or his family to also consider other issues when considering whether to modify an existing home vs. moving to a seniors housing community. Chief among these are (1) the location of one’s existing home, (2) the age and medical conditions of the residents, (3) access to companions and support services, and (4) the cost of maintaining a home. The key points I want to make are:
seniors and their families need to think through how making accessibility improvements to a home will meet a senior’s physical and mental health needs over time, not just at a single point in time, and
staying vs. moving should be considered in light of the full occupancy and care costs for each alternative.
Location is important for the resident, her or his family and other formal or informal caregivers. Too often, seniors of advancing age become increasingly isolated in their homes because they are not located where public transportation, taxi or Uber-like services are readily available. If this is the case, as a senior’s ability to drive diminishes, which it invariably does, a senior’s ability to visit friends, see medical professionals, attend social, educational and civic events will be restricted with negative implications for their physical and mental health. If they are living alone, studies have show poor diet and social isolation can take a heavy toll. Technology may be able to reduce these isolating effects in the future but is not yet able to overcome all the location issues noted here.
Location is also important for family members and other formal and informal caregivers. If you live hundreds of miles from your children or if your home is not readily accessible in good and bad weather to formal and informal caregivers, a home modified to be accessible for a senior may still prove unable to meet a senior’s needs over time as their physical or mental health deteriorates and caregivers are needed.
Age and Medical Condition
The age and medical condition of residents is also important to consider when thinking about whether to modify one’s home or move to a retirement community. Physical limitations, such as needing a walker, shower grab bars, lever door handles can help extend the ability of an existing home to accommodate a senior. But, if a senior is 85 or older or has medical conditions that will escalate over time, the benefit of these types of improvements may be short lived and fully modifying a home for a wheelchair equipped senior – completely flat floors, wider doorways, larger baths with turning radius for a wheelchair can get very expensive. In addition, if a senior has early signs of dementia, this condition too is likely to deteriorate over time and may require a more secure setting with full time care at some point, which an individual’s home cannot provide.
Access to Companions and Support Services
The cost to bring qualified caregivers and other support services into one home can quickly exceed the cost of a seniors housing community if care is required on a 24/7 basis. It can also be difficult for a senior or their family to manage care and home maintenance services and to monitor the quality of care delivered in a senior’s home, particularly if the family does not live nearby. The availability of qualified caregivers varies with geography, with access to public transportation and with population density tending to improve the availability of care.
Cost of Maintaining A Home
When comparing the costs of staying in one’s home vs. moving to a senior housing community, seniors and their families too often view the cost of staying in one’s home as only including the cost of making accessibility modifications and do not fully consider the cost of part-time or full-item care, the cost of taxes and maintenance, or the income that can be generated from investing proceeds from the sale of a home. This sticker shock of a $2,500 to $6,000 per month fee for seniors housing may seem a lot less daunting when one makes a accurate assessment of the costs of staying at home. It is also important to understand that the average length of stay for an 85 + senior in assisted living is about two years, so $150,000 in home sales proceeds is usually sufficient to fund an average stay.
There is some additional discussion of housing options and issues to consider when moving to seniors housing on this blog www.robustretirement.com. The American Seniors Housing Association also has a new website Where You Live Matters with a lot of information for seniors considering whether to stay in their existing homes or move to a retirement community, including cost calculators. Specific posts on this website that may be of interest include:
Earlier this month I toured The Stories at Congressional Plaza, a new type of “seniors housing” project designed to appeal to seniors as well as those of other ages looking for a high-tech, high-service environment in an urban mixed use setting. The Stories opened in February 2016 and is a joint effort of Federal Realty Investment Trust and Ryan Frederick’s Smart Living 360.
Federal Realty is a publicly traded REIT (NYSE: FRT) that specializes in the ownership, operation, and redevelopment of high quality retail real estate in the country’s best markets and is increasingly developing mixed-use projects in connection with its retail holdings. Ryan Frederick has long been known as one of the leading thinkers on the future of seniors housing through his Point Forward Solutions consulting company. Ryan has now created a new company, Smart Living 360, to work with a retail/mixed use developer, rather than a seniors housing company or health care REIT, to bring us his vision of the future of “seniors housing” in a property designed to appeal to seniors but open to those of all ages.
The Stories is a new 48 units apartment building located at 1628 E. Jefferson Street in Rockville, Maryland. It is part of Federal Realty’s Congressional Plaza redevelopment that includes a high-end shopping center, Federal’s corporate headquarters and an existing 150+/- unit apartment building with structured parking (The Crest), now about 10 years old. The Stories was developed on a site long designated for residential use as phase 2 of the Crest. According to Ryan, Federal became interested in consciously designing The Stories to appeal to the seniors market because they wanted a way to differentiate the projection from other high-end rental projects in the same area of the Rockville Pike, northwest of Washington and Bethesda.
The Stories is designed to appeal to the baby boomer market, now passing age 67, and other seniors with a “younger” outlook, unlikely to consider independent or assisted living or even a continuing care retirement community (CCRC). This market is large and rapidly growing and not well served by well served by conventional seniors housing. While those 75 and up are considered part of the senior housing markets in many market studies, the average entrance age for most dedicated senior housing communities is now closer to 85 than 75 (See Slow 80+ Pop Growth, Elevated Construction Spark Concern For Seniors Housing on this blog – https://robustretirement.com/?p=209.
Ryan and Smart Living 360’s vision for The Stories is derived from a view of what “younger” seniors want in a living environment to enhance their wellbeing and tries to anticipate the growing role of technology for enhancing seniors’ lifestyle and delivering the services they want and need. It is also purposefully designed to be flexible so it can adapt to the needs of its target market as they are discovered over time.
To understand what Federal and Smart Living 360 have created at The Stories, you need to think outside the traditional seniors housing box regarding design, services and technology.
Physically, The Stories is a attractive 5-story modern apartment community located in high-income, high-wealth, high-education zip code with a unit mix favoring larger 2 and 3 bedroom units (75% 2 bdrms) over one level of structured parking. With rents from $2,500 to $4,000, The Stories is priced at about half the cost per square foot of traditional IL properties in its market. But unlike conventional IL properties, The Stories does not bundle food service and activity programs into its rent. It is part of a mixed-use project including retail, office and other residential uses in a nice residential area a block off a heavily travel arterial street, the Rockville Pike, MD 355. The property faces other residential uses and fronts on a relatively quiet suburban street.
Units within The Stories look like high-end non-age-targeted residential rental units with small balconies that are designed with largely invisible accommodations for an aging senior market – wider doorways and master baths able to accommodate a wheel chair with higher toilets, easy entry showers, modest grab bars in the bath with studs behind the wall to allow more to be installed, roll out lower shelves in cabinets, electrical outlets further up on the wall, etc. These are accessible units that intentionally look like conventional units.
Common areas include a large fitness room with some specialized equipment for seniors that could also be used by personal trainers or rehab therapists, a central lounge with a refrigerator and cooking equipment and a self-serve coffee bar. There is a small conference room that is designed so that it can also be used for a visit by a health professional or for telemedicine care. The entire building is pre-wired for high speed Verizon Fios internet with pre-installed routers; and service providers are available to install Sonos wireless speaker systems and other electronic amenities in the units. The electronics designed into the building are intended to accommodate increased use of patient self-monitoring and wellness devices that Ryan believes will become increasingly prevalent, sophisticated and integrated over time.
The building offers a secure electronic entry system, with an enhanced concierge called a Lifestyle Ambassador (services described below) manning the front desk during the day. The building is monitored in the evening by management personnel from the larger Crest Apartment building that is located at the other end of the block, across a parking lot from The Stories. The number and length of coverage by on-site personnel is partly limited by the buildings relatively small size, only 48 units.
What really sets The Stories apart as a community that will appeal to seniors is its use of a Lifestyle Ambassador, in this case a hotel industry trained and certified concierge cross-trained in seniors housing design and services. The role of the Lifestyle Ambassador is threefold – 1. Help residents connect with one another and with the outside community, 2. Provide access to any needed services, and 3. Simplify resident’s lives by taking care of pets and plants while residents are traveling and providing other services. Smart Living 360 makes use of many off-the-shelf on-demand services, has prearranged for a wide range of additional services to be available to residents of The Stories and will provide referrals to providers, including:
The goal at The Stories is to offer attractive housing, location and services to enhance the well being of baby boomers and other “younger”, generally healthy seniors without the stigma of a traditional seniors housing community with a large percentage of very old, frail people; and to do it in a flexible way that allows it residents to order in any services they may need and to adapt to rapidly evolving technology for medical monitoring and wellness.
Smart Living 360 hopes to monitor residents of The Stories over time to see if the building’s design and the flexible services it offers will enhance residents’ well being compared to those living in other residential settings. This will be done using the Gallup-Healthways Well-Being Index that measures five factors:
Purpose – Liking what you do each day and being motivated to achieve goals
Social – Having supportive relationships in your life
Financial – Managing your economic life to reduce stress and increase security
Community – Liking where you live and having pride in your community
Physical – Having good health and enough energy to get things done.
What is interesting to me about Smart Living 360’s approach compared to a traditional senior housing facility is that Smart Living 360’s Life Style Ambassador begins with the residents’ wishes and customizes activities and services the resident desires while a traditional senior housing facility has a menu of services into which it tries to fit a resident. I see the Smart Living 360 approach as more resident centric, more personalized and more adaptable over time.
The Stories occupies an interesting place somewhere between non-age-restricted market rate apartments and conventional seniors housing. Interestingly, the project was voluntarily described as 55+ housing in pre-opening marketing material but the developers have now decided to market its advantages for seniors but without the age restriction, which they believe may be a turn-off for their primary but not only target market. Of the first several residents moving in, two are seniors and one is age 29 but liked the amenities.
It remains to be seen whether The Stories will be successful in attracting baby boomers and other seniors with a “younger” outlook and how Ryan Frederick’s vision of meeting residents’ needs and increased use of electronic devices to monitor and enhance health and wellness will come to pass. But I believe, even at this stage, The Stories has some interesting lessons for seniors housing and multi-family developer/operators and institutional real estate investors. These include:
Non-age restricted housing and un-senior “seniors housing”, as I categorize the Stories, may be more appealing to under 80s seniors, and even those over 80 in good health with younger outlook, than more conventional seniors housing projects. For a significant portion of the senior population today and I believe for even a larger portion of the baby boomers, living in mixed aged neighborhoods or even in mixed age buildings like The Stories may be preferable to living in a senior ghetto or in an isolated age-restricted community.
We have already seen obsolescence in seniors housing communities, such as IL projects without sufficient provisions for handicapped residents, IL and CCRC projects without AL and memory care units, AL communities with insufficient common space for gyms or rehab care and IL and AL buildings with too many small units. This history suggests that building flexible design into seniors housing communities, which The Stories has very deliberately tried to do, may be an advantage for the community over time.
Seniors housing located in mixed use projects or higher density urban areas, where services and amenities are close-by, while often more difficult and more expensive to develop than stand-alone conventional IL or AL communities, would seem to offer a lot of appeal for the baby boomer age cohort and other active seniors.
In an age of on-demand services, such as Uber and Foodler, planning seniors housing around services delivered by outside vendors may prove both cost effective and better able to meet seniors desires and needs than the service packages typically available in seniors housing communities.
Seniors, particularly the baby boomer age cohort, are increasingly tech-savvy and should be able to adapt to electronic delivery of health and wellness services, as well as other on-demand services, and may see projects designed to accommodate more high-tech amenities as more appealing than conventional care models.
The resident centric and holistic approach to meeting resident’s needs built into the Lifestyle Ambassador approach that incorporates both social and care needs, seems to offer some advantages over the way conventional seniors housing services are organized with responsibility fragmented between healthcare, activities, dining and caregiving personnel, each of whom may only see themselves responsible for a slice of a senior’s needs. While the staff in any well managed seniors housing project should get to know the “whole resident”, making resident on-demand centric services the organizing principal of your care delivery system appears to offer some advantages and a have a better chance of assuring a residents need are met.