Most readers of this blog are residents of Continuing Care Retirement Communities (CCRCs). Traditional continuing care means that a person lives independently in the community for as long as they can, but if health or cognition deteriorate to a level where one is no longer able to perform the tasks of self-care they transition to a residence facility that provides the support needed. The progression over time might begin with visits from a home health aid, then move to a personal care wing, and eventually to a wing with skilled nursing.
CCRC residents choose their communities and pay substantial entrance fees so as not to burden their families, and also so as not to be forced to make wrenching moves away from their circle of friends and activities. When one is frail and unable to easily travel to a place a quarter-mile away, relocation means isolation and possible lonliness.
The CCRC concept originated with faith-based benevolent groups. Some were organized for retired clergy, many of whom lived in rectories and had never owned homes of their own. Others were founded by people who envisioned a community of caring people who pooled resources to live well among caring friends. These communities were benevolent – organized primarily by and for residents and dedicated to compassionate resident care for life.
Times change. Medicine has advanced, and people survive longer with expensive health issues. Some live on, though dementia has robbed them of their personalities and ability to function without continuous supervision and care. The business of housing seniors has attracted investors who form communities for profit. These businesses do not necessarily have benevolence as a priority.
Even the most benevolent of communities must be financially sustainable. As residents we face new challenges to preserve and improve the services our communities offer. We are faced with rising costs and conflicting wants. We want those who make a caregiving career in our communities to be well paid. Yet as individuals, many of us have fixed incomes and modest wealth.
The solutions to these challenges require a fresh look at being mortal and end-of-life issues.
“Being Mortal” is the title of Atul Gawande’s popular book. Here’s what the New York Times Book Review says about it: “In the first part of the book, Gawande explores different models of senior living — from multigenerational households to newfangled nursing homes. In the latter part, which is shorter, he shifts somewhat abruptly to end-of-life medicine, promoting hospice as a model of care. The two sections are anchored by two of Gawande’s most memorable New Yorker essays, which make up two of the book’s eight chapters — “Things Fall Apart” and “Letting Go.” Around them are rich stories from his own family.”
We can’t predict the future. However, it is clear that significant changes are going to be necessary in the model that CCRCs adopted in the early years.
As individuals, we need to consider our mortality and how we plan for it. As communities we need to look for different, more efficient ways to deliver the care we want. Innovations like congregate housing, Green Homes, visiting caregivers in-home, daycare for residents in need of supervision, and other innovations not yet imagined.
Legislative action will be needed for the regulatory environment to keep pace with change. Share your thoughts and feelings on our NaCCRA forums.