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November 16 update (original post -September 27) — Today the Times reported that congressional hearings are looking into charges that nursing homes. It reported that “Members of the House Ways and Means Health Subcommittee and the Senate Special Committee on Aging proposed measures to require nursing homes to disclose ownership and to require regulators to release information about poorly managed homes.”

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September 27 — The New York Times reported this week that investor-owned nursing homes tend to have fewer staff and experience more serious deficiencies and other problems than the national average. The article examined more than 1,200 nursing homes purchased in recent years by large investment groups. The acquired homes scored worse on 12 of 14 indicators used by regulators to assess the well-being of long-term residents.

One of the phenomenons reported is that private homes are more likely to reduce staff headcount, particularly of their nursing professionals. Investor-owned facilities have an average of 20 residents per clinical registered nurse, compared to 13 for the national average.

The active adults who tend to be Topretirements.com visitors might not be in the market for a nursing or continuing care facility for themselves - yet. But they well might be shopping for one for a parent or relative. If you are looking, keep these considerations in mind:
- Ask for the current ratio of residents to clinical registered nurses (the national average is 13)
- Ask to see records of serious health deficiencies found by nursing home inspectors. Compare those to national averages at the Department of Health and Human Services.
- Find out who owns the facility. If the ownership scheme is tangled web, be cautious. The Times reports that some investors have retreated to very complex ownership schemes to protect themselves against patient lawsuits.
- Use Medicare’s “Nursing Home Compare” Tool. The primary purpose of this tool is to provide detailed information about the past performance of every Medicare and Medicaid certified nursing home in the country.
- Use Medline Plus to help find a good facility near you.
- Visit the facility and ask for references. There is no substitute for your instincts and observations.

For further study: How to Persuade Your Elderly Relative It Might Be Time to Move

August 25 - More than 9 out of 10 people over 65 would prefer to stay in their own homes as they grow older, according to a survey by the AARP. The desire to live where they feel comfortable amidst familiar surroundings is powerful and understandable. Unfortunately, as medical needs increase and life skills like driving decline, it often becomes more and more difficult to continue living independently. Aging adults face more than their own frailties as well, because their adult children often pressure them to move to a retirement community or Continuing Care Retirement Center (CCRC). Enter the “villages” movement, as in “it takes a village”, to the rescue.

More and more people, according to a recent New York Times article, are starting to form cooperatives with the goal of making it possible to age in place. Cooperatives are springing up in Cambridge Mass., Palo Alto, Calif., Washington, D.C., and New Canaan, CT. The organization in New Canaan is called Staying Put in New Canaan. Aging in place allows participants to live in mixed communities, rather than just with other elderly people.

Proponents of the cooperative movement say that small problems, such as inability to shop or minor health issues, sometimes lead to a premature decision to leave one’s comfortable surroundings for an independent living facility. Those in the cooperatives believe that with a modest level of support those disrupting moves could be postponed.

In the most common form associations are formed to provide cooperative services. Beacon Hill Village in Boston is considered to be a prototype. Individual members of that organization pay dues of about $580 per year, couples pay a bit more. In exchange they get pre-screened access to a variety of service providers they might have difficulty finding on their own, such as a home health aide. Sometimes members barter their services such as home repairs or computer skills to other members in exchange for a future ride to a medical appointment or the like.

In some communities these “villages” are set up by existing social service organizations, in others they are formed by community residents. Successful aging at home associations result in NORCs, Naturally Occurring Retirement Communities, places where many retirees are settled without a developer or other outside source.

Links:
New York Times - Aging at Home with Dignity
How to Persuade Your Elderly Relative it Might Be Time

Topretirements is gearing up to publish an expanded article for our “Tips and Picks” section on how to persuade aging parents that it is time to move to some type of retirement home. We are very interested in hearing “war stories” from our readers’ experiences in trying to persuade their relatives to move from their private homes to a facility where they can get the care they need (independent living, assisted living, retirement home, continuing care retirement community, or nursing home). Please send your comments to editor@topretirements.com; we will try to share as many as we can.

Along with many people we know, we have struggled unsuccessfully with this issue. It is extremely difficult to persuade the elderly that they need more care. The reasons why relatives and friends don’t want to move out of their homes are certainly understandable - loss of independence and privacy being 2 really good ones. Whatever the reason, it seems like the majority of older people refuse to move until it is too late. The most serious ramification of waiting too long is that a serious health event occurs. That usually means disqualification for admittance to the most attractive facilities, or admittance only at a much higher cost. There are many other negatives associated with waiting too long, which we will explore in the Tips and Picks article. Please send us your experiences, and keep checking on this site for the new article.

Update May 2007: Use this link to find the completed article on Helping Elders Move, and this one to discuss your own war stories on helping to manage elder moves