In home-based care programs, members live for years in their own homes and undergo regular physical examinations.
Carole Ann Basso had cared for years about her sick parents and disabled husband. At one point in time, all three were receiving hospice care in their home in northern New Jersey.
"It was so unimaginably stressful," recounted Ms. Basso, who is a retired high school history teacher. "I did not want my kids to feel that craziness."
When she relocated to the small coastal town of Lewes, Del., In 2012 after the death of her parents and husband, he became worried about her future. At 69, Ms. Basso had long-term care insurance and a modest pension, but only small savings was the reason why she moved to a lower-cost region.
She began asking herself, "How am I supposed to take care of myself?"
In Lewes, she heard about another long-term care option offered by some pioneering care retirement communities: a C.C.R.C. without walls.
However, in the home-based care programs, members spend their independent living years mainly in their own homes.
In 2015, Ms. Basso participated in a program called Springpoint Choice, which allowed her to stay in her comfortable ranch house with an equally aging English setter named Princess Leia. Diane Willoughby, her “care navigator,” monitors her needs on a daily basis.
With luck, Mrs. Basso, who is now 76 years old, can stay in her house for years - or forever. If at some point she needs help with bathing, dressing or other daily living activities, the program will provide domestic help.
If she is unable to live safely at home, Ms. Basso is free to move to The Moorings at Lewes, the affiliated care retirement community just blocks away. Her one-time entry fee and monthly fees cover the cost of long-term care at home or on campus, while Medicare and her insurance pay for medical care.
"It gives you a sense of security," said Mrs. Basso.
Most people want to age in place
Although some home programs date back to the 1990s, there are still very few. Almost 2,000 mainly nonprofit organizations serve approximately 745,000 residents throughout the country. Only 32 in about a dozen states have added at-home programs.
But more and more senior living organizations are considering this approach, which may solve the eternal conflict: Most older Americans need long-term care, but often despise the idea of leaving their homes.
"Most people want to successfully age in place. They do not want to move to a community, "said Kevin Ahmadi, who is head of Senior Choice at home and is linked to Gulf Coast Village, a C.C.R.C. in Cape Coral, Florida: "We believe that at-home programs have a strong future."
Applicants who want to enroll must submit years of medical records and large financial documents showing that they are healthy and can afford the fees. Progressive neurological disorders such as Parkinson’s or dementia disqualify the applicants.
"We expect them not to need any service for at least five years," said Cecily Laidman, executive director of Springpoint Choice. But this need could arise in 15 years or the next month.
Ms.Laidman said that such programs work financially, because many members enroll in their seventies, rather than waiting to move into a community in their eighties. They pay for the program for a longer period of time than if they were moved to a facility, which would allow the programs to invest for the later years of the members when they are more in need of care.
Traditional C.C.R.C’s operate under various contractual agreements. Some have high buy-in fees, which are refundable to varying degrees after the death of a resident, others are more like rentals. Depending on their luxury and geographic location, they are more for senior citizens who feel financially comfortable.
According to a report by LeadingAge, the nonprofit senior care professional association, residents often sell their homes to pay an average of $ 107,000 to $ 427,000 for entrance fees. (LeadingAge has renamed these companies "Life Partner Communities.") Monthly fees range from $ 2,100 to $ 4,200.
"It's a great solution for people who have sufficient funds or retirement savings and have built up some wealth," said Ruth Katz, senior vice president of public policy and advocacy at LeadingAge.
How much do at-home programs cost?
So far, at-home programs are less expensive, although members still pay for housing and other living costs. At Senior Choice at Home in Florida, Ahmadi said a 75-year-old would likely pay entrance fees ranging from $55,000 to $60,000 and about $525 a month.
Springpoint Choice, which has approximately 270 members in Delaware and New Jersey, has initial fees of $30,000 to $65,000 and monthly charges of $300 to $500. All fees are tax-deductible.
"If they experience an event that changes their lives in one year, they could pay $400 a month for skilled nursing, which usually costs $13,000 a month on the East Coast," said Ms. Laidman.
Ms. Basso has come to Springpoint Choice at a bargain rate. Since she has a good long-term care insurance, her entrance fee was a discounted $25,790 USD. She paid for it by selling her home in New Jersey and her parents' condo. Her $128 monthly fee has since increased to $146.
She needed help much sooner than anyone had thought. She underwent open-heart surgery on Johns Hopkins months after signing the contract, followed by two weeks in intensive care.
Ms. Basso then spent five weeks in rehabilitation at The Moorings, where she did physiotherapy twice a day, with daily visits from Mrs. Willoughby, her care navigator. Finally strong enough to go home, Ms. Basso needed an assistant for another three weeks to help her with shopping, preparing meals and doing laundry.
"They took great care of me, and I never had to pay a penny more than my monthly basic fee," said Mrs. Basso, returning to her independent life. "I'm not as mobile as I am, but goodness, I'm blessed."
Advantages to a C.C.R.C. without walls
She also discovered another advantage to a C.C.R.C. without walls: Members are encouraged to meet residents and staff, use campus gyms and pools, participate in activities and join community trips.
"They are connected," Ahmadi said of at-home members. In his program, a woman changed her mind and left home at 86 to move to the Gulf Coast Village with her newly found friends.
Although the number of elderly care communities is increasing again after a setback during the recession, it is unclear whether at-home options will become more popular. Some state regulations do not allow them, so lawyers are working to change the laws, as has happened in Florida.
And these communities need to explain to potential members how everything works. "Educating the public is probably the biggest challenge we have," said Ms. Laidman.
In addition, the at-home versions do not provide all the services that members would need if they moved to a campus like scheduled transportation, housekeeping and meals.
However, at-home arrangements may be more appealing to older adults, who vow that they will only leave their home after they die.
Given the aging population, "the bottom line is that we'll need a lot of options for long-term care," Katz said. "We have to experiment and find new models, and this is one more."
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