To Move or Not to Move? A Helpful Guide for Seniors Considering Their Residential Options
If you are a senior who has been wondering lately whether you should consider moving, either because you ﬁnd the maintenance of your current home more difﬁcult due to diminishing ability or energy, or you simply want a lifestyle that allows you more freedom and less responsibility, then this is the book that will help you ask the important questions and ﬁnd the solution that is right for you. For some, the right decision might be to stay right where you are, but downsize your possessions, and look at acquiring support services to ﬁll whatever need arises — such as help with shopping, preparing meals, household chores, personal care, or getting around. Others may determine that the responsibility of looking after their current residence is too great and they would like to move to a place where they still have a high degree of independence but access to staff to take care of the things that are proving to be a bit of a headache. There are yet others whose health and safety is enough of a concern to them that they want to live in a place that has all the supports and services necessary to give them the peace of mind they are currently lacking — like would be found in an Assisted Living residence. Just how to manage any of these scenarios, is what this book offers. It will give you insight into what each option looks like, what pros and cons to expect, and how to navigate through the process of going from where you are now, to where you want to be. For seniors, or families of seniors, this book is the ideal place to start asking the questions and discovering the answers.
$9.95 in Canada Published by Senior Living magazine, a division of Stratis Publishing Inc. 2
To Move Or Not to Move?
British Columbia edition Copyright © 2009 ISBN 978-0-9783948-3-7 Published by Senior Living magazine (a division of Stratis Publishing Ltd.) 153, 1581-H Hillside Ave., Victoria BC V8T 2C1 (250) 479-4705 ofﬁce@seniorlivingmag.com www.seniorlivingmag.com Compiled and edited by Barbara Risto
Feedback from our ﬁrst edition publishing in November 2007 indicated an exceptional need for this information, not just on Vancouver Island but right across British Columbia. We have, therefore, expanded this edition to include information and resources available throughout the province. We have tried to be as accurate as possible while trying, at the same time, to make the information easy to read and understand. As time passes, programs change, and ofﬁces and websites relocate. We have indicated resources and contact numbers to assist you in getting additional information, or verifying that the information provided is still accurate and up to date. If we have erred in some way, we apologize, and would appreciate it if you would be kind enough to forward us any information that will help us do a better job in the future. If you have any suggestions for improvement, we would like to hear from you. Please email us at ofﬁce@seniorlivingmag.com Copies of this book can be ordered through our website. Please go to www. seniorlivingmag.com The price is $9.95 (plus shipping and GST). Or use the order form in our monthly Senior Living magazine. We will also be providing a list of businesses and bookstores in the magazine where you can purchase the book in person. Discounts are available on bulk orders over 25 copies. Made in Canada To Move Or Not to Move?
No Place Like Home
Deﬁne Your Situation – What’s Right For You?
Consider The Options
Age In Place In Your Own Home
Aging in Place – Deﬁned Age In Place – Products & Services Needed
15 15 17
Independent Living Residences
Assisted Living Residences
21 24 26 26 26 27 28 29 30 31 31 32 33 34 34
Complex Care Residences
Begin Your Search For The Right Residence Examine Your Finances Shop Around Visit All The Residences In Your Chosen Region Compare The Residences You’ve Visited The Assisted Living Registrar Moving Into An Assisted Living Residence What To Bring To Your New Home Moving Day Help Making The Emotional Transition Entry and Exit Policies for Assisted Living Advice For Friends And Family Members Suggested Do’s For Friends And Family Members Suggested Don’ts For Friends And Family Members The Application Process For Complex Care Residences
Moving Into A Complex Care Residence Planning Ahead Tell The Residence Staff About The Resident Paperwork Management Of Finances Personal Belongings Communicate! Who Makes The Decisions? Getting Cold Feet First Day At The New Residence On-going Involvement Of Family Members Or Friends Tips For Visiting Friends And Relatives The First Month
36 36 37 38 38 39 39 40 40 41 42 42 43
Campuses Of Care Residences
Shared Housing By Seniors
Shared Housing In Exchange For Rent Or Services
Shared Housing Offered By Homeowners
Co-habiting With A Family Member
Living With A Family Member â€“ Issues To Consider Your Contributions To The Family Involving Others In Your Decision Make Your Plans Ahead Of Time
45 46 51 51 52
What About Finances?
What Is Your Current Financial Situation?
How Much Money Will You Need?
Who Can You Turn To For Help?
56 56 57
Funding Sources Available To Seniors
60 60 61
Financial Planners Accountants
Long Term Care Insurance Equity And Investments
Reverse Mortgages Tax Deductions For Care Giving Services Independent Living BC (ILBC) Program Choice In Supports For Independent Living (CSIL) BC Palliative Care BeneďŹ ts Program Funding For Home Adaptations Shelter Aid For Elderly Renters (SAFER) Property Tax Grants For Seniors Aboriginal Housing Initiative The Veterans Independence Program (VIP) Aids To Independent Living (AIL) Red Cross Medical Equipment Loan Program
62 64 64 65 66 67 68 69 70 70 71 72
The Moving Process
Selling Your Home
75 75 76 79 80 81
Taking The First Steps To Downsize What Will You Do With Your Extra Things? What Will Fit In The New Space? Ask Questions As You Go Through Each Room Pack As You Go Through Each Room Be Kind To Yourself Hiring A Relocation Specialist What Services Can A Relocation Company Provide?
84 86 87 88 88 89 90 91 92
Age In Place
Staying Active And Strong As You Age
Home Care Supports
How To Find The Right Realtor The Psychology Of Moving Senior-Focused Realtors Services To Assist Your Move Ways To Move
Home Care Services
Adapting Your Home Adapting Your Rental Unit
Age In Place - Financial Assistance
Security â€“ Home And Medical
101 101 103
Aids To Daily Living
Securing Care Services
Do You Need Home Care Services? Home Care Services Available Hire Privately Or Through An Agency? Where Do You Find Home Care Agencies? General Questions To Ask A Home Care Agency
106 106 108 110 114 115
Rate the Residence Checklist
Home Security Medical Security Home Lifts
To Move or Not to Move? Introduction The seniors’ population in British Columbia is increasing at almost twice the rate of the general population. Right now there are more than halfa-million people over the age of 65, but that will increase to nearly 1.4 million people, almost one-quarter of BC’s population, in the next 25 years. Not only is the seniors’ population growing quickly, but seniors today are more healthy and active than ever before – and they want to remain independent for as long as possible. Past expectations of housing and care needs are also changing. The seniors of today are not destined for traditional nursing homes – the vast majority do not want or need round-the-clock care, as most report their health as good to excellent, with one-third of people over age 65 participating in daily physical activity. But what happens when your home becomes too difﬁcult to maintain, or mobility becomes a problem? What happens when your home starts contributing more to your isolation than your community involvement? What are the options? Today, a continuum of housing options are available, ranging from aging-in-place (your home or a residence that provides various levels of care allowing you to stay in the same place despite changes in your level of care) to continuing care (residences that provide total medical care to people with greatly diminished abilities). For most, staying in their own home is their ﬁrst choice. But there are numerous reasons to consider other options. When adaptations to the home no longer meet the mobility needs of the individual, safety becomes an issue. At this point, a look at other housing options becomes a necessity. The main advantage of living in some type of congregate housing is security. The presence of other seniors and competent staff means there’s someone around 24/7. If you need some assistance, help monitoring your health needs, and just desire stimulating social interaction, congregate housing can provide all these and more. But for some, it’s not an issue of safety, but of socialization. Living
by oneself can involve a great degree of isolation. Seniors often ﬁnd that becoming a part of a larger community brings them new friends and a full social life again. Research shows that social activity increases satisfaction with life and has a positive impact on physical health. Residences today are being built with more comforts and greater esthetic qualities than ever before. In some, the surroundings and service almost rival a luxury resort hotel. Others are just tired of the upkeep of a home and yard and of the responsibilities associated with daily living. They yearn for the opportunity to put these problems in someone else’s hands so they can just enjoy life - a much deserved reward after years of responsibility. For these and other reasons, seniors often choose to move to residences designed for seniors. The services and ﬂexibility these residences offer give seniors peace of mind. As their needs change, and depending on the type of residence they have chosen, seniors can often move from independent living to assisted living to full-care nursing within the same complex. This is of paramount importance to couples because it enables the healthier one to reside in an independent living apartment while the other moves into fullcare nursing. Not all senior residences, however, offer this option under the same roof, so it’s important to check this out before making your decision about where to move. Seniors and their families are faced with some very important decisions as they ask the question “Should I move, or not?” Weighing the advantages of congregate housing against the independence offered by a single family home can be difﬁcult. There are numerous factors to consider. Finding the answers can be an exhausting ordeal. To sort through these issues, this book has compiled information to help make sense of the process. We will attempt to describe the options available, and provide information that will, hopefully, help you navigate through what can be a very complicated and challenging process. We will pose questions to stimulate you to think about factors you may not have considered. The more thought that goes into your planning, the happier you should be with the results. We encourage you to read this book from the perspective of creating a better life for yourself or your family member, not just ﬁnding a “solution.” There’s a vast array of housing choices in British Columbia. Many seniors are surprised at how quickly a new address begins to feel like home. Some people simply opt to downsize to a smaller house, condomini
No Place Like Home There really is no place like home. Regardless of whether you stay in your own home, move in with family, move to a congregate housing residence, or some other option, people want to feel like they belong and that they are safe. They want to maintain their familiar social activities and know that they are capable of meeting the ďŹ nancial commitments associated with their preferred lifestyle. They also want to maintain their independence to the greatest degree possible. Fortunately, there is a wide selection of housing options. Unlike in times past when the options were only to move in with oneâ€™s children or move to a nursing home, todayâ€™s senior has numerous options. Sorting through them for the best solution takes time and the ability to do a considerable amount of research. To assist you with this process, this book will attempt to describe each option and its features.
To Move Or Not to Move?
Deﬁne Your Situation – What’s Right For You? Begin the process of determining what type of housing and care you require by seriously thinking about your personal situation. Be realistic in deﬁning your housing needs and desires. Take a moment to consider the following items:
- Are you a social person? - Do you prefer living in a private or community setting? - Do you prefer a large or small living space? - Do you require any special housing arrangements due to physical or mental limitations? - Is there a particular community, neighbourhood or type of neighbourhood you would like to live in?
- What type of care or assistance do you need? How often do you need it? - Do you have health problems, or any physical or mental disabilities? How may they impact your health care in the future? - Would you like to age in place or are you comfortable with moving if required?
- Do you have the ﬁnancial resources in place to accommodate your current or future housing and care requirements? - How much money can you afford to invest in housing and personal care? For how long? - Have you spoken with or do you need to speak with a ﬁnancial advisor? - Can you afford a private care residence? Do you need ﬁnancial assistance? Be open and honest with yourself about what your basic needs and desires are. Write a list or description of the type of accommodation and services you are looking for. Prioritize your needs and outline what you are willing to compromise on and what you must have in your new place of residence. Compare your needs with the housing options that follow. To Move Or Not to Move?
Consider The Options • Age In Place In Your Own Home • Accessory Housing • Senior Oriented Apartments • Retirement Communities • Independent Living Residences • Assisted Living Residences • Complex Care Residences • Campus Of Care Residences • Shared Housing By Seniors • Shared Housing In Exchange For Rent Or Services • Shared Housing Offered By Home Owners • Co-habiting With A Family Member
To Move Or Not to Move?
Age In Place In Your Own Home Aging In Place Deﬁned If you are in or nearing your retirement years you’ve probably heard the term “aging in place” being used in a number of different contexts. We hear the term being used by family members, news reporters and healthcare professionals on a regular basis, but what exactly does the phrase “aging in place” mean? In its original context the term “aging in place” was developed in reference to living in your home, or the place or community you have resided for many years, (i.e. a non-healthcare environment) as you continue to grow older. Aging in place in this context implies that there are products, services and conveniences that you will need to bring into your home to allow you to continue living comfortably, as your circumstances begin to change. In essence, aging in place means not having to move from your present residence in order to secure the necessary support services in response to your changing needs. More recently, the term has become a marketing term used by both the private and public entities in the seniors housing industry. In this new context, aging in place refers to the ability to have most of your care needs addressed in one location as you age. For example, more and more seniors housing accommodations provide independent, assisted living and continuing care options all under the same roof. It usually requires, though, having to move within the residence. For example, one part of the complex may contain suites for residents that are independent, another area may have suites reserved for residents needing some level of assistance. As your care needs change from independence to requiring assistance, you would move to the suite corresponding to that level of care. It does require a physical move, but you stay within the same complex, allowing you to maintain your established and familiar social structure. Regardless of how the term aging in place is used, the concept of living your life in a comfortable, familiar environment free from the stresses of uprooting and moving as your health declines is very appealing to many people. The key to successfully age in place in your home, or in a seniors housing community, is thoughtful planning. Determining which aging in place option is best for you – living in your home or moving to a seniors’ community – will depend on your personal desires, your ﬁnancial situation and your healthcare needs. To Move Or Not to Move?
If you wish to remain in your own personal residence, you will need to ensure that your home can be adapted to meet your health needs, you are ﬁnancially secure enough to afford the assistance you need, and your support network is in place to help you in your home. If you wish to move to a seniors’ housing community that offers aging in place, you will need to do your research to ﬁnd the most appropriate location for your needs. Many senior communities have long wait-lists, and you will sometimes need to sign up and begin downsizing a few years before you actually move into the new residence.
Age In Place - Products And Services Needed If you wish to live in your own home, you should familiarize yourself with the variety of products and services you may need to have in place in order to successfully age-in-place. • Personal Care Assistance – may range from bathing and grooming to cooking, shopping and excursions • Home & Yard Maintenance – grass and garden maintenance, painting, window washing, etc. • Aids to Daily Living – devices that can assist with reaching, grasping, personal care, communication, etc. • Mobility Products – canes, walkers, scooters, bath transfer chairs, wheelchairs, lift chairs, stair lifts, handrails, and ramps can assist with getting around. • Transportation Solutions – van conversions, hoists and lifts for scooters or wheelchairs, wheelchair/scooter accessible buses and cabs, and Handi-dart are some of the possibilities. • Bathroom Apparatus – walk in baths and showers, bath chairs, handheld shower heads, grab bars, raised toilet seats, non-slip ﬂooring, easy to grip faucets, etc. • Adaptations – The structure of your home can be adapted to make mobility easier, as well as safer. E.g. widening doorways, removing loose carpets, installing rolling shelves, increased lighting, easy to grip door handles, lighter doors, intercoms or ﬂashing lights to replace doorbell, lowered or raised counters, electrical outlets and taps and faucents relocated to within easy reach, ramps, additional handrails, etc. • Safety – Medical alert devices and enrolling in programs that provide daily calls or regular visits. 14
To Move Or Not to Move?
• Security – Outﬁtting your home to decrease the risk of trespassers • Meal delivery – ensuring regular nutritions meals are readily available (See Aging in Place Section for more information)
Accessory Housing Under the “granny-ﬂat” concept, family caregivers may consider erecting a small, self-contained housing unit on their property for an elderly person. Before building such a unit, however, the property owner needs to check zoning laws with the planning department in their municipality to obtain the necessary permits. Most standard city lots do not allow for this kind of addition to the property, but a large lot or acreage may, in fact, permit this type of building. Remodeling the caregiver’s home to provide separate living quarters for a senior is another option to consider. Again, before starting any renovations, be sure to contact your municipal hall for information about bylaws, permits, etc. The type of access to the suite, and who will reside in the suite can all be factors in the granting of a permit for what is commonly called an “inlaw suite.” Whether the resident is a family member or not can determine whether a permit will be granted. A bylaw ofﬁcer or building inspector can tell you about zoning, tax implications, and other regulations affecting the addition of an inlaw suite. A variation to the above, is to remodel the elderly person’s home to provide separate living quarters for a caregiver or renter. Again, the bylaws of your municipality will dictate whether a suite is permitted. Don’t start tearing down the walls until you’ve checked out all the rules and regulations.
Senior-Oriented Apartments Apartment complexes that cater to senior tenants typically do not feature any services. They may be advertised as adult-oriented, or seniorfriendly – mature adults may be the preferred tenant, but age usually cannot be legally used as a discriminating factor. The complex may have a common room where activities can be held by residents on a regular or scheduled basis, and sometimes amenities such as a pool, gym or workTo Move Or Not to Move?
shop are included. But rarely would you ﬁnd meals, cleaning, transportation or entertainment planning provided, unless the residents organize this themselves.
Retirement Communities Housing in this type of community might be comprised of singlefamily homes, town houses, mobile homes or apartments. Typical services include recreational activities, yard maintenance, on-site security, guarded or gated access, club memberships, etc. Fee arrangements vary. Residents, who are required to be 55+, might buy, lease or rent, depending on the individual project. Keeping the price down is often one of the goals of the community. Residences differ widely in basic concept, atmosphere, amenities and services. 55+ communities are often attractive for their security features, location, social activities and recreational amenities. Homes are low-maintenance, usually with a single level ﬂoor plan. Entry is controlled by gates, entry codes, key cards or security guards. The more exclusive the property, the higher the price tag as a rule. Residents often join for the beneﬁt of having less responsibility as they grow older. Travel, for lengthy periods of time, becomes an easier proposition without the worry of who will look after the house to make sure the property is secure, the lawn cut or snow shoveled, etc. Although young friends and grandkids are allowed to visit, residents of 55+ communities sometimes ﬁnd they miss the on-going presence of young people. Some welcome the opportunity to be among peers. Others miss the youthful shenanigans of the “kids next-door”. This is deﬁnitely a feature of the community that should be explored carefully before making the move. An interesting statistic in many established 55+ communities is that the median age of the residents has increased the longer the community has been in operation. Residents who became part of the community 15 years ago when the property was newly developed, are now 70+ and experiencing the aging related challenges normal to that demographic. Administrators are faced with ﬁguring out how to deal with an aging community of people that are less active, and now require home care services, assisted living supports, and ability-appropriate activities. 16
To Move Or Not to Move?
Community Residences Community-based senior residences generally fall into four categories, depending on the level of services and/or care provided. 1) Independent Living refers to retirement housing that provides meals, activities, house-keeping and maintenance to active seniors who can manage their own personal care. 2) Assisted Living refers to housing that, along with the services mentioned above, also provides supportive services such as assistance with personal care or medication. 3) Complex Care (often referred to as Residential or Continuing Care) is housing that provides a full range of nursing care services for those who become temporarily ill or who require long term health care. 4) Campus of Care residences provide a combination of all the above so that, having become a resident, the person can stay at the same site and have access to all levels of care.
Independent Living Residences Over the last 20 years, the face of retirement living has changed dramatically. Today, more and more private and public care residences are re-directing their programs to support an active, aging population. If you have good health, but are tiring of the day-to-day chores, a multitude of Independent Living housing residences are springing up all over North America, offering a wide range of accommodation, and hospitality services such as meals and housekeeping, as required. Independent Living residences provide seniors with a lifestyle that can often be compared with a stay in a luxury hotel. The difference is that the stay doesn’t end after a few days or weeks. Elegant décor, ﬁne dining and regularly planned activities make this the ideal “getaway”. Residences will often host an in-house convenience store, library, pool, billiards room, craft room, exercise studio, lounge, and rooms for private functions. They may even have a guest suite that can be booked by residents for out-of-town visitors. Shuttle buses take those residents who don’t drive to malls or on short outings. Although they are very similar, there is a difference between Independent Living and Assisted Living. Independent Living residences welcome retired To Move Or Not to Move?
adults who are totally capable of managing their own personal care. They do not have the operator-provided services that Assisted Living residents have - such as assistance with grooming, dressing, bathing or taking medications. Independent Living residents may choose, however, to purchase their own personal assistant services independent of the operator. In physical structure and basic amenities there is often no visible difference between an Independent Living residence and an Assisted Living residence. Independent Living housing units typically provide a combination of private living space with a lockable door, monitoring and emergency support, optional meal services, housekeeping, laundry, and social and recreational opportunities. Housing units may be large or small in scale and may include rented, owned or life-leased options. Residents with deteriorating health are candidates for Assisted Living, not Independent Living. Often a residence will have a combination of both assisted living and Independent Living suites. A resident who no longer ďŹ ts the criteria of Independent Living will move to an Assisted Living suite but stay within the same residence.
To Move Or Not to Move?
Assisted Living Residences Assisted Living residences combine private accommodation with support services and social activities to help seniors who may require regular help with daily activities to continue living as independently as they can. It often provides the bridge between home support and residential care. Often residents are people who no longer want or are able to live totally independently in their own homes, but they aren’t candidates yet for the total care provided by Residential Care (also called continuing care or complex care) residences. Health authorities require that assisted Living residents need to be mobile or at least able to transfer on their own. Services you may expect at an Assisted Living residence include: • Housing (rooms with lockable doors in a home to an apartmentstyle building with private self-contained suites, usually with their own bathrooms and cooking facilities) • One to three meals and snacks • Housekeeping • Laundry • Social and recreational opportunities • 24-hour emergency response system • Assistance with activities of daily living, if needed, such as bathing, dressing, toileting, hygiene and grooming, eating, and walking • Assistance with medications. Residences can be subsidized by government, offering seniors a comfortable home for 70 per cent of their after-tax income, or privately funded, providing accommodation at market rates. An increasing number of private residences are partnering with provincial health authorities to provide units at subsidized costs. To qualify for subsidized services, you must be assessed by a case worker from your local Health Authority. Because health and safety is important to seniors, legislation introduced by the provincial government Community Care and Assisted Living Act, requires all Assisted Living residences in British Columbia to be registered and meet health and safety standards. Any health or safety complaints will be investigated by the province’s Assisted Living Registrar. The standards cover everything from safe building design To Move Or Not to Move?