Continuing Care

I EXPECTED TO SPEND early 2017 blogging about my fourth round-the-world trip, which I’d just completed, and planning my next journey. Instead, I spent much of the year on the couch with a heating pad, in between assorted medical appointments, everything from acupuncture to meeting with an infectious disease specialist.

Eventually, I got a definitive diagnosis—I had a form of rheumatoid arthritis—and, in early 2018, an effective medication. But I had been forcibly reminded of something I’d first learned 10 years earlier, when I broke my ankle. My house, as things currently stood, was not suitable for aging in place.

But was aging in place a good idea? During 2017, I learned just how debilitating persistent pain could be. I was 70, single (by choice), childless (by choice) and with no close relatives nearer than England. I already had a chronic, potentially disabling disease. What if I suffered a stroke or heart attack, or fell and broke a hip, or developed dementia? At a moment when I was least able to handle the decision, I’d have to find and fund in-home care, or move to an assisted living or skilled nursing facility.

In addition, I was thoroughly tired of the responsibility and cost of maintaining my house, not to mention preparing all my meals. Those of you thinking that your spouse could handle such things should bear in mind that, at some point, one of you will be a surviving spouse. Even if you have children close by, do you really want to burden them with your care?

I had friends living happily in continuing care retirement communities, and there were a number of CCRCs nearby. A CCRC typically offers a continuum of care from independent living to assisted living to skilled nursing. It was time to do my research. Ruth Alvarez’s guide to CCRCs proved invaluable. HumbleDollar readers can also get a good introduction to the four types of CCRC by reading Howard Rohleder’s 2022 article.

For me, the choice of type was straightforward. I wanted a place that promised not to throw me out if I ran out of money and preferably backed that promise with a benevolent fund. I wanted a nonprofit, because a good for-profit might too easily be taken over by a bad one. I wanted on-site assisted living and skilled nursing, which is pretty standard among CCRCs. I wanted a place that accepted Medicare and Medicaid, and had a good rating. I wanted a place that had been open for a while and had sound financials. And I wanted an on-site clinic, exercise facilities and plenty of activities. I started collecting brochures.

If a CCRC is regulated, it’s regulated by the state government. North Carolina requires CCRCs to give prospective residents a detailed financial and policy disclosure statement, and also post these documents online. That’s how I learned that one potential CCRC didn’t own its land and buildings, and another appeared to be operating at a loss. The brochures were fairly basic, although they usually included floor plans. Clearly, a visit was the acid test.

My first choice turned out to be an unexpected disappointment. It didn’t feel friendly and seemed rather isolated. Another promising prospect, offering plenty of continuing education opportunities in conjunction with one of the local universities, had ceilings so low that the apartments felt claustrophobic. It also seemed to be spending a lot of money on décor, and charged comparatively more for independent living so that it could charge less for assisted living. I preferred to gamble that I’d spend longer in independent living.

I ended up putting down a refundable deposit at a nonprofit CCRC with good-looking financials that had been operating for 30 years—long enough that some residents were second generation. It was walking distance to a library, cafes and restaurants, and was also on a bus line. Everyone I met there was friendly, plus it had the welcoming vibe I’d missed at my first choice. In early 2019, the wait for a one-bedroom apartment was four-plus years, but the next year I was able to switch to a two bedroom in a new building that should be completed this summer.

All the apartments in the new building are at least two bedrooms. Many, if not most, of the prospective residents are couples. The CCRC solution is attractive enough that some couples are moving to a one bedroom, while they wait for a two bedroom to become available. The wait list at my choice is now seven-plus years for a one bedroom, 10-plus for a two bedroom in the original building and 12-plus for a cottage. The CCRC’s wait list population is 65% couples and 35% single individuals. If you need a place with no wait list, probably your only hope—at least in my area—is a CCRC that’s just starting or possibly one that’s undertaking a major expansion. You also need to pass both a physical and financial check when moving in, another reason to plan ahead.

Before my expected move to the CCRC, I moved to an apartment and sold my house. I’ve been pleasantly surprised to find that I don’t miss the house, despite living there for more than 30 years. The move to a two-bedroom apartment meant I could keep my study, which certainly made the change easier. Another bonus: After paying the CCRC entry fee, I’ll qualify for a substantial medical deduction on this year’s taxes—which I’ll use to reduce the tax on a Roth conversion.

Kathy Wilhelm, who comments on HumbleDollar as mytimetotravel, is a former software engineer. She took early retirement so she could travel extensively. Born and educated in England, Kathy has lived in North Carolina since 1975.

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