Sunday, January 15, 2006

Lifecare (continuing care, life-care centers)

"Lifecare" is a rapidly growing living arrangement for older people, increasing more than 50 percent in the past 15 years, from about 200 to over 700 residences nationwide. Enrollment in a lifecare facility requires a substantial one-time down-payment and subsequent monthly payments, similar to rent, to the facility operator (many centers are church-related or run by fraternal organizations like the Masons). In return for these payments, residents are assured of a lifetime of housing and service in a small house or apartment, with grounds and building maintenance provided, along with the possibility of moving to a hotel-like facility, for an intermediate level of personal care or to a full-scale nursing home residence if required. Some centers do not guarantee all of these services, but provide for variations under differing contractual arrangements. Residents who contract for these life-long services often begin by living independently in a small house, apartment, or condominium-like structure, on the life-care facility grounds. Here they do their own shopping, cooking, cleaning, and continue all the usual routines of life except building and grounds maintenance. In the event that they become somewhat disabled and need moderate levels of assistance-as with meal preparation or help with bathing-they can move to the hotel-like area of the facility where intermediate levels of personal service are provided. Should they later need nursing home care, they can move to a skilled nursing unit that is often a part of property run by the center, or that may be an independently operated nursing home.
Some life-care centers are small multibuilding facilities arranged in various configurations around landscaped grounds. Others are high-rise apartment buildings located in cities, suburbs, or small towns, which include all levels of service in different floors of the structure. Whatever the type of facility, the environment and surrounding grounds are usually well designed and very attractive. Although the initial admission fee to many life-care facilities is high (ranging from a low of about $40,000 to well over $200,000), and the monthly maintenance rates may run from $400 to $1500 or more, it is estimated that over half of today's elderly population could afford a life-care facility if they chose. Because there are many variations to contractual arrangements and services provided under life-care contracts, applicants should examine these in detail, with professional advice if possible, and assure themselves of the financial solvency of the operator before concluding any agreement. Studies have shown people who live in well-run life-care facilities enjoy better health and are hospitalized less frequently than older people of comparable age.
Residents of life-care facilities acquire no equity interest in these facilities, which has created an unfortunate climate for fraud and mismanagement in some cases. Eleven states have enacted laws aimed specifically at these institutions. These laws cover certification and financial regulation, including escrow and reserve fund projections and provisions for monitoring facilities and administering the statutes. A community-based life-care system, known as a social health maintenance organization, is being tested in four areas around the nation. Developed by Brandeis University under a federal grant, social health maintenance organizations seek to integrate services and funding sources for people who live in the community and as an alternative to institutionalization. Elderly participants would receive services such as case management, home health, chore services, drugs, congregate or delivered meals, and transportation from a single provider.
A prepaid fee covered by Medicare, Medicaid, and Title XX social service funds would fund much of these services; enrollees would pay premiums of $25 to $40 per month. The social health maintenance organization would be at risk financially for excess costs, with an annual dollar limit between $6,000 and $12,000 for services. These organizations would save Medicaid dollars without increasing Medicare costs. For a list of accredited life-care facilities, contact:
American Association of Homes for the Aging
1129 20th Street N. W. Suite 400
Washington, DC 20036

Carlin, V. F., and Mansberg, R. If I Live to Be 100: Congregate Housing for Later Life. West Nyock, N.Y.: Parker Publishing Co., 1984.
Millard, S. "Lifecare," in Aging, Goldstein, E. C., ed. Vol. 2, Art. 64. Boca Raton, Fl.: Social Issues Resource Series, Inc., 1981.

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