Continuing care homes offer peace of mind, but some loss of agency, for those who choose them
Oct. 09--When Jan Brown paid $810,000 to move into Vi at La Jolla Village, she thought the resort-like retirement home was a place she could spend her last years without fretting over the cooking and cleaning and, most of all, her health.
Then she broke her leg.
Within days, Brown said administrators learned of the accident and tried to move her from the 19th floor three-bedroom apartment she has lived in since 2011 to the care center nearby.
"I was afraid to go in there," she said. "I was afraid they wouldn't take good care of me."
Brown, who asked that her age not be published, is among a growing number of well-to-do seniors who have bought into continuing care retirement communities, or CCRCs, in recent years.
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The idea is to join a community in which residents can grow older without worrying as they transition from independent living to assisted living to memory care or to skilled-nursing situations.
Many welcome the peace of mind the CCRCs can provide. Others complain that after moving in, and paying an entrance fee up to $1 million, they lose too many rights. Administrators are often in charge of deciding when residents move to a higher -- and more costly -- level of care. The residents must eat what is served at the time it's served, or prepare and pay for outside food.
Brown, who is recovering at home after her doctor helped deter a move into the care center, has tried to get her entrance fee refunded so she can relocate but to no avail. Her monthly assessment has climbed past $7,500, paid on top of the up-front payment.
Among other grievances, Brown complained she was not given a copy of the home rules until after moving in. She said recommendations from the state-required residents council are regularly ignored. When she tried to organize residents to fight back, she said administrators refused to provide meeting space.
"I am victimized and powerless," said Brown, who said the meals offered at Vi do not meet her nutritional needs. "I have no control over my life. For pretty much the first time in my life, I awake every day anxious and stressed."
Company officials declined to be interviewed but issued a statement saying that the home is dedicated to providing quality environments, services and programs to enrich the lives of older adults.
"Our primary focus is our residents and Vi has been serving seniors for over 30 years at our 10 communities throughout the U.S.," the statement said. "Our resident satisfaction is strong. We remain committed to our residents, our core values and our mission."
Vi at La Jolla Village includes more than 400 apartments scattered across two high-rise towers. When residents can no longer manage alone, the care center has 60 beds and there are three dozen assisted-living units. The owners spare little expense in maintaining an attractive ambiance.
The grounds are dappled with lush landscaping, fountains, arches and walkways. There is marble and stained glass and a grand piano in the main seating area. There's a movie theater, artist studio, library and billiard room on site.
There is valet car service. Hotel-like rooms are available at reasonable rates for overnight guests. At 21, the top-floor dining alternative where jeans are not permitted and gentlemen are expected to wear sport coats, the meals covered by monthly fees include Delmonico steaks and parmesan-crusted European sea bass.
Many residents are grateful for the amenities and for the myriad activities at their disposal.
"They have 300-plus programs a month, if you can imagine -- things like yoga and exercise, musical entertainment," said Pat Delaney, a retired payroll company executive who moved into Vi with his wife, Mimi, almost five years ago.
"Is it perfect? No," he said. "Do they always have enough staffing in the dining room? No."
The need for senior housing has been growing steadily as the baby-boom generation ages.
According to the U.S. Census Bureau, the number of people 75 and over was 6.1 percent of the nation's population in 2012. By 2040, 11.7 percent of the population is expected to be 75 or older, some 45 million people.
The statistics underscore the escalating demand for housing for the nation's eldest residents.
In addition to thousands of stand-alone assisted-living homes and skilled-nursing facilities, the state of California licenses about 80 continuing care retirement communities like Vi at La Jolla Village.
Other centers in San Diego County include La Costa Glen in Carlsbad; Casa de Las Campanas in Rancho Bernardo; White Sands La Jolla; Mount Miguel Covenant Village in Spring Valley; Brookdale, with sites in Carlsbad and Carmel Valley; and Front Porch Communities, which operates four different homes.
The communities are regulated by the California Department of Social Services and, in cases in which they also operate skilled-nursing facilities, by the California Department of Public Health.
State officials say there is much to consider when choosing to move into a retirement home.
"It is important to remember that each community is unique and individuals should look for a provider that meets their needs," Michael Weston, the Social Services deputy director, wrote in an email. "Find a place that is right for you."
Weston said his office strongly encourages consumers to consider the risks and benefits of a continuing-care contract and to seek financial and legal advice before signing an agreement.
Like child-care centers and group homes, assisted-living and retirement communities are regularly inspected by state officials, sometimes during scheduled visits and at other times that are unannounced.
Inspectors check to see that the facilities comply with mandated staffing levels, criminal background checks for employees, insurance requirements and other safety regulations. The homes also must post annual reports detailing residency, assets, revenue and spending.
The written evaluations are published on state websites so consumers can review the providers' records, although the findings and penalties can be difficult to locate and are not always easy to understand.
Industry officials say continuing care retirement communities serve a vital function in the mix of housing opportunities available to aging seniors.
"These communities are popular because they meet needs now and well into the future," said Sally Michael of the California Assisted Living Association, which also represents the buy-in retirement communities. "Older adults and their families choosing a CCRC find this model of care to be both reassuring and practical."
Michael downplayed any conflict of interest between administrators charged with turning a profit and making decisions about when to move a resident into a higher level of care.
"Before a transfer is made, the CCRC conducts an assessment of the resident's needs, involves the residents and their responsible person in the assessment process, provides a clear explanation of the process and conducts a care conference with the resident and their responsible person to review the results of the assessment," she said. "If a dispute arises, it is reviewed by the Department of Social Services."
Only one request for review was filed last year, the state said.
Levels of care
By design, continuing care retirement communities serve senior citizens through almost every stage in the aging process.
At the independent-living phase, residents enjoy a variety of amenities at their own leisure and come and go from the community as they please. Many continue to own cars and travel off-site.
When residents can no longer live without help, the facilities offer what's called assisted living. Assisted living includes many of the same services and is generally reserved for residents with physical limitations or medical conditions that call for 24-hour monitoring.
As seniors require even more supervision, CCRCs place residents into what is known as skilled nursing. Under skilled-nursing care, seniors are treated by licensed nurses and certified nursing assistants, and have access to doctors and other medical professionals as need be.
Not all continuing-care communities charge an entrance fee to move in. Instead, many offer services on a month-to-month basis, with the costs to residents rising with the level of care.
Facilities that charge sizable entrance fees are usually marketed to seniors with financial means who want to avoid moving from place to place as their needs change. Most of the larger homes maintain professional sales teams that showcase the benefits of community living.
Chris Murphy of Consumer Advocates for RCFE Reform, a San Diego nonprofit group that takes its name from the acronym for residential care facilities for the elderly, said many clients she consults pay more attention to the appearance of homes than the terms of the agreement.
"It's a huge buy-in, and when residents are buying in they have scales on their eyes," she said. "They're looking at this beautiful place, but then they discover they are basically captive and no longer in control of what they would be if they were in their own home or in an apartment they were paying for month to month."
Elder law attorneys say the fact that so many CCRC contracts give administrators authority over when residents are placed into higher levels of care presents a significant conflict of interest.
San Diego lawyer Anthony Thompson said he regularly defends clients who have been transferred to higher-cost arrangements against their wishes so administrators can market the entry-level residence to a new customer.
"The contracts are pretty ironclad, however," he said. "They have a good legal team... When you have the administration and staff of a facility making the determinations of level of care, and they are clearly incentivized to increase that level, you can see how things could go wrong."
With vulnerable populations that can swell to 500 or more, many of the larger retirement communities have ended up in legal disputes with tenants.
In 2013, Casa de Las Campanas in Rancho Bernardo sought to cancel the life-care contract it signed with resident William Miller, in a dispute involving behavior that his family said was a medication mix-up in treating his Parkinson's disease. The dispute played out in several lawsuits over several years.
"It was a really traumatic few years," said David Kay, Miller's son-in-law and a San Diego attorney who co-litigated the dispute.
Kay, who said both of his in-laws have since passed away, said the life-care agreements like those his in-laws signed can work for both sides. His own parents lived at Casa de Las Campanas at the same time his father-in-law was being evicted.
"The marketing is all geared toward minimizing risk and taking care of everything upfront," he said. "My father and mother had that experience. That was the promise, and that's the way it worked out."
Kay said seniors and their families should understand that they give up some personal control when they invest in a continuing care retirement community.
"They can tell you where you're going to live. They can try and kick you out. They can control all the aspects of your life," he said. "Because you're invested there and can't go anywhere else, you are captive."
Thomas Dillard is in the same position. He feels cheated that administrators at Mount Miguel Covenant Village are trying to move his 86-year-old mother into assisted living.
"She's got a nice apartment that overlooks Sweetwater Reservoir and Mount Miguel," said Dillard, a disabled veteran from La Mesa. "If she gets moved out, they get to move another person into that apartment. Then they're going to double my mom's rent."
Dillard acknowledged his mother endured a difficult year, first with a dementia diagnosis and then a handful of falls. But he said his mother does yet not need a higher level of care, and said her doctor agreed. His family is still working with the home and has not filed a dispute with the state.
Officials at Mount Miguel acknowledged they can resell an independent-living apartment when vacancies occur, but said that is not the reason for transferring any resident to a higher level of care.
"The motivation is for CRC (Covenant Retirement Communities, which owns Mount Miguel) to manage and provide the resident's care at the appropriate place, with the appropriate staff and facilities available to provide care as contemplated in the contract," executive director Richard Miller said in a statement.
Do more than read
Jean Accius, an independent-living policy expert at AARP, said prospective residents need to do more than read the services agreement and write a check when deciding whether a continuing-care community is right for them.
"We know that oftentimes people are thinking about their current health needs and not taking into account their needs over time," he said in a telephone interview. "They should also take into account the facility's financial report, licensing records and any inspection reports."
Accius also said potential residents should interview current residents, read the facility's annual reports and investigate the occupancy and turnover rates.
"People want to be able to age with options and CCRCs are an option for those who can afford it," he said. "People want to be able to be in the driver's seat, dictating the type of care they need when they need it."
Jacques Peeters moved into Vi at La Jolla Village eight years ago.
A long-retired defense worker, Peeters spent 41 years in Poway before deciding he and his wife, Jennie Lea, should relocate into a senior community. They talked to friends and researched various places before investing in Vi at La Jolla Village.
"I like it," he said by telephone. "I'm here because I want to take care of my wife. I'm 83 years old. If something happens to me, she will be secure here."
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