Senior Living Options “Finding Your Place” Thursday, October 9, 2014 – The Quechee Club 4:00- 5:30 AGENDA A confusing system Finding your Place on the continuum CCRC an in depth conversation What does it Cost Q & A

A confusing system The focus this afternoon will be to discuss a segment of the housing and senior services sector: Retirement Communities 10/09/14Senior Living Options - Finding Your Place2

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Regulations, rules, statutes (each state is a bit different) 10/09/14Senior Living Options - Finding Your Place4 Dept of Insurance (DOI) Oversight With broad powers ________ In most jurisdictions the DOI… oversee Independent Living Contracts Health and Human Services (HHS) ________ Generally oversee assisted living and nursing units AG Attorney General’s office ________ Oversees non-profits Statutes (RSA 420-D): Regulations (Ins 1800): NH VT

Terms = I will focus on six terms that some of you are familiar with…or you may begin to learn about them today as you think about this topic in more depth. 10/09/14Senior Living Options - Finding Your Place5  Active Adult Communities  Assisted Living  Rest Homes  Continuing Care Retirement Communities (CCRC)  Intermediate Care (ICF)  Skilled Nursing Faculties The grid will now be easier to focus on.

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Definitions Senior Living Options - Finding Your Place710/09/14 Active Adult Communities An active adult community is targeted towards people 55 years of age or older. Each is designed differently and may include single-family homes, condominiums, town homes, multi-family dwellings, or manufactured housing units. Rest homes These homes were actually the forerunner to senior housing as we think of it. Homes for the Aged (Taylor Community 106-years old), Westboro House in Lebanon and Outreach House in Hanover.

Assisted Living Communities (ALCs) ALCs provide services to residents who need assistance with personal care, medication management, and/or home management but do not require skilled health care. ALCs range in size from studio units, one bedroom and 2 bedroom units. Typically include a wide-variety of community spaces and activities. Continuing Care Retirement Community (CCRC) CCRCs provide 3 levels of accommodations: independent living, personal care/assisted living, and skilled nursing/rehab. Services vary by level of accommodation. 10/09/14Senior Living Options - Finding Your Place8

Intermediate Care Facility (ICF) A nursing home, recognized under the Medicaid /Medicare program that provides health-related care and services to individuals who do not require acute or skilled nursing care, but who, because of their mental or physical condition, require care and services above the assisted care level. Skilled Nursing Facility (SNF) Skilled Nursing Facilities (also called Skilled Nursing Homes/Rehab) offer two levels of skilled nursing care: long-term care and short-term rehab. Upon discharge from rehab, patients often need follow-up care in their homes. 10/09/14Senior Living Options - Finding Your Place9

The Continuum within a CCRC 10/09/14Senior Living Options - Finding Your Place10 Coming up you will hear me talk about “life care” and in this context it means that regardless of your ability to pay, the community will cover your costs….for life.

Drill Down a bit on the pieces 10/09/14Senior Living Options - Finding Your Place11 Independent = Do what you want, join in activities. Often meal plans are offered, but most often you are on your own, everything is a la carte. Assisted Living = Typically 3 meals a day, scheduled and planned activities, some level of personal care assistance and medication management. Nursing Care = Nursing care generally includes intermediate care and memory care/dementia care but specifics vary. NH CCRCs cannot provide skilled care on campus unless grandfathered.

Continuing Care Retirement Communities (CCRCs) Samples – Contract Types 10/09/14Senior Living Options - Finding Your Place12 TYPE A Contracts typically amortize down to zero in return for life time guarantee (life care) … If you leave during the first 60 months you might get pro-rated share back. Monthly fees are usually the same regardless of the level of care TYPE B Entrance fee required (amortization differs by project) Monthly fees are fixed for a limited period of time (no life care) Refunding of entrance fee varies TYPE C Entrance fee required (a variety of refund options) No Life care Monthly fees are different depending on level of care A complete a la carte model for services, activities, etc. Rental Model:No entrance fee….”pay as you go”

What does it Cost ? 10/09/14Senior Living Options - Finding Your Place13 Entrance Fees: $44,000 up to $1.5 Million Some entrance fees are refundable based on amortization schedule, often 5-7 years. Here is where it is important to understand contract…life-lease. Recent trends offer refunds between 50%, 75% or even 90% mostly due upon re-occupancy. These have changed based on market and macro-economic influences. Monthly Fees:$ 1,500 to 5,000 per month single occupancy Second person fees do apply. Increases are customarily based on COLA- adjustment and most organizations do not cap annual increases.

The latest model on the Scene - Continuing Care at Home – Two NH examples Hunt at Home offers you a confident choice. It is the first program regulated by the New Hampshire Department of Insurance as a Continuing Care at Home (CCAH) program. Simply put, the Hunt at Home program allows an eligible person to live in their existing home and still receive many of the services of a Continuing Care Retirement Community. Entrance fee is required….and services paid for on an a la carte basis. Taylor Connection: Like Hunt, the program creates a synergy between the main campus and the home owner by requiring an entrance fee. Few services are offered BUT you have a guarantee to be admitted under a Life Care contract when ready to move to the campus. 10/09/14Senior Living Options - Finding Your Place14

Contracts and Disclosure Statements/Legal 10/09/14Senior Living Options - Finding Your Place15 Get an attorney: Most providers encourage the consumer to have contracts reviewed by an attorney – of course you should! Specific disclosure statements are usually required by the regulator in each state. Documents, regulations, statutes and idiosyncrasies by provider-type make every community different. There used to be one model, but providers have to make changes based on occupancy challenges, economic pressures and market conditions.

Contracts and Disclosure Statements/Finance/Accounting 10/09/14Senior Living Options - Finding Your Place16 Talk with your financial advisor or accountant: Review your finances, make sure you have enough money.

CONCLUSION and THOUGHTS Do your homework and don’t wait, move when you can, not when you HAVE to. Of the retirement communities in the US only 400+ are for profit. The non- profits focus more on mission versus profit and are governed by people like you and are always community-based 501(c)3 tax exempt. Many systems are faith- based. Use resources, my favorite is LeadingAge, the national association of non-profits, with over 5,000 members and an affiliate in each state. Retirement Living Information Center: 10/09/14Senior Living Options - Finding Your Place17

Questions and Answers 10/09/14Senior Living Options - Finding Your Place18