Journal of Financial Planning: March 2025
Alexandra Armstrong, CFP®, is founder and chairman emeritus of Armstrong, Fleming & Moore Inc. (https://afmfa.com). She was one of the first female CFP® practitioners in the United States as well as the first female president of the IAFP (precursor to FPA). She founded her financial planning firm in 1983 in Washington, D.C. Since then, she has focused on helping women achieve financial independence. She is the coauthor of Your Next Chapter: A Woman’s Guide to a Successful Retirement and the recently revised and updated sixth edition of On Your Own: A Widow’s Passage to Emotional and Financial Well-Being.
Recently, the FPA National Capital Area chapter (Washington, D.C.) offered their members a Zoom session conducted by Kristy Kennedy and Ginger Noce, the founders of Silver Bridges Consulting. These women work with individuals and financial planners, helping them select the right retirement community for their situation. I found this topic interesting since moving into a retirement community from their own home is a decision that many women face as they age in retirement.
In August 2021, I wrote a column about the various housing choices available to retirees, and I thought I was pretty knowledgeable in this area. After all, my husband and I had recently bought and moved into a continuing care retirement community (CCRC) in Florida since my husband was having health issues. We had put our names on a waiting list several years before, but when his health started to worsen, I told them we were ready to make the move. As is often typical in these cases with desirable properties, we still had to wait a year before an apartment we liked came available. This made me somewhat nervous because I was worried that his condition might deteriorate to the point that they wouldn’t admit us to the independent living portion of the residence before an apartment of our liking was open. So, lesson No. 1, move while you are still healthy enough to enjoy your new home and become a member of the community.
After we moved, my husband was in and out of the hospital for the next two years. I had the comfort that he could rehabilitate at the same facility where we lived. In fact, the rehab unit was two floors below our apartment. When my husband died last March, I was already established in the community and enjoying my new friends and the wide range of activities available. At the same time, I had the comfort that I was experiencing what I advised my clients to do for years, particularly my female clients—move in while you are healthy enough to enjoy all the facility has to offer.
While I realize moving into a retirement community isn’t the solution for everyone, I think they are particularly appropriate for women who have children who aren’t willing or able (financially and physically) to help them as they age. These residences are even more appropriate for single women who don’t have children or someone else they can count on to help them out.
Despite the fact that I thought I knew pretty much all I needed about choosing a retirement community, Kristy and Ginger expanded my knowledge. They told us:
- There are 30,600 senior living communities in the United States and more are being built every day, according to the American Health Care Association and the National Center for Assisted Living, the largest association in the U.S. representing long-term and post-acute care providers. I was amazed to learn most of these are rental properties with only 2,000 being CCRCs.
- By 2030, one in six people in the world will be 60 or older, according to the World Health Organization.
- By 2034, older adults (aged 65 and older) in the United States are projected to outnumber those under 18 years old for the first time in U.S. history, according to the Census Bureau.
Wanting to learn more, I interviewed Kristy and Ginger. They told me that CCRCs provide a tiered approach to the aging process, accommodating residents’ needs as they age. Health services, meals, personal care, housekeeping, transportation, and emergency help as well as social activities are included. In some communities, the resident might have her own cottage; in others, she might be living in an apartment.
There are different CCRC contracts, but typically the client is making an agreement with the CCRC to provide service and a place to live for the rest of her life. The resident pays an entrance fee (which may be partially refundable to her heirs) as well as a monthly fee. Part or both of these fees may be tax deductible. In other cases, the resident buys her apartment, which can be sold by her heirs, at either a predetermined price or current market price.
Since we had paid an entrance fee for our CCRC, I was not aware that individuals also had the option of moving into a rental community where you pay a lesser up-front fee and a monthly fee. However, as mentioned above, Silver Bridges Consulting informed me that there are many more rental communities available than CCRC communities.
Questions for Clients Considering Community Care
Kristy and Ginger provided us with a list of questions our clients should ask when touring senior living communities. When I interviewed them, I reviewed this list as it applies both to purchased and rental units.
What care options are available? CCRCs offer independent living, assisted living, or memory care, but not all retirement communities do. For instance, one of our local options offers independent living but if you need assisted living, you have to hire your own caregiver. The differentiator between CCRCs and other communities is whether skilled nursing is offered on-site.
What is the tenure or experience of staff, especially the executive director and director of wellness? Obviously, more experience is better, but you also need to know how long these individuals have been at the facility you are visiting. If not long, what is their prior experience?
In the case of rental communities, what were the results of the last state survey visit? Any citations? If so, what were they and how were they resolved? Every state has its own regulations and inspectors, so it’s important you know how the residence did. These state survey visits apply to all licensed rental assisted living and memory care communities across the country. CCRCs are different since they are inspected about every three years by the Bureau of Insurance in their state.
In assisted living or memory care units, what is the ratio of caregivers to residents? The desirable ratio in assisted living units is one caregiver to nine residents. For memory care units, it is one to seven residents.
In a CCRC, ask if they have a caregiver on-site that they partner with to provide home health. When communities have this in place, residents are not required to hire them for a minimum of 4 hours, which is typically required by most outside home health providers. For instance, when communities have an on-site caregiver, residents can hire them for 20 minutes five times a week to assist with putting on compression stockings, showering and dressing, etc.
Do they have any agency staff in the community? This means how many people work for an outside agency versus being part of the community staff. Obviously, agency staff is expensive. When it was difficult to find staff during the COVID-19 pandemic, it was common to have more agency staff, but now this situation has been corrected in most places.
How many and what type of activities are offered each day? Ideally, you would have a fully equipped wellness center with trainers. A full schedule of exercise classes should be available at various levels. (For instance, in addition to the regular menu of physical exercise like yoga, our CCRC even has a tap-dancing class!) You would expect regular late afternoon and early evening cultural lectures and concerts each week.
How frequently are outings offered? This would be trips to nearby museums and gardens as well as transportation to outside events such as concerts and plays.
What types of doctors visit the community and how often? Most communities have a primary care physician who visits the community regularly to see residents. You are not required to see this physician, but the majority of residents living there do. Many communities also bring other physicians on site, monthly or quarterly, like a podiatrist, audiologist, dermatologist, or dentist. You may have your own concierge doctor, so this may not be as important to you, but there should be a doctor who is assigned to the rehab, assisted living, and mental wellness areas who visits the facility regularly.
Do you have on-site physical, occupational, and speech therapy services? Obviously, it is more convenient to have these people available on-site rather than you having to go out to get these services.
What types of special diets do they provide? (low sodium, Kosher, mechanically soft)
What kind of special training does the staff receive? Obviously, this would vary with the department—dining, nursing, etc.—but it is good to ask. You want to make sure your community provides regular in-service training for their staff. This would include things like additional dementia care training for those working in memory care, and for those working in assisted living, training on how to safely transfer a resident from their wheelchair to a chair or bed. What you are looking for here is that the community is providing ongoing training for their staff to ensure they are keeping their skills both sharp and current.
What additional costs are involved? (hair salon, cable, phone, transportation to doctors, parking, gratuities etc.)
In a CCRC, under what circumstances might a resident be required to move out of independent living to assisted living or memory care facilities? This is usually spelled out in the original contract.
As for rental communities that offer assisted living and memory care, it’s important to know if they are staffed to provide two caregivers to support one resident with activities of daily living like bathing, dressing, and grooming. Some CCRCs and rental communities may require residents needing the support of two caregivers to move to skilled nursing.
May I have a copy of your disclosure agreement? This document includes financial information; however, not all states require that the facility provide one.
How have your occupancy rates changed over the past few years? If there are huge fluctuations, you should ask why. The industry occupancy average for rental communities is currently 84.2 percent. For entrance fee CCRCs, the rate is around 90 percent, according to the National Investment Center for Senior Housing and Care.
Conclusion
Getting answers to these questions is very helpful to your client, as is visiting the facilities in person, having a meal there, and talking to residents. The best approach of all is if you or she knows someone who has been living in the community for a few years who can give you additional insight. However, faced with too many choices, it may be best for you to consult an independent professional in your area to help you assist your client in making the best selection. After all, this is most likely the last move she will make, so it is important to get it right!