As it turns out, making that transition is anything but easy—at least physically— and residents strive to maintain their abilities to remain on the independent side with a somewhat fierce determination.
“If they need to move over there, they can,” says Cowen, pointing to the Maravilla’s assisted living wing as he strolls by the elegant indoor swimming pool on the independent side (while, appropriately, the muted strains of “Someone To Watch Over Me” waft through the overhead speakers). “But statistically, fewer than 4 percent will. The bulk of people moving in here will not move to assisted living.”
That’s partly because more CCRCs, which typically charge a hefty entrance or buy-in fee that covers the resident’s lifetime health care needs (often refundable to their estate at the end of that lifetime, either in whole or in part, depending on the contract), are moving to a “fee-for-service” model, where registered nurses and health care professionals are made available to care for residents as needed, right in their unit on the independent living side.
“It used to be, if you fell and broke your hip, they’d tell you, ‘You need to go over there to the health care building,’” Cowen says. “You had to go to where the care was. Now the trend in the industry is exactly the opposite. If I need care, it’s ‘Come to me, thank you very much.’”
Cowen says this model works especially well in North Scottsdale, where a cottage industry of third-party health care providers have sprung up to serve its ever- growing senior community.
“Within a short radius from here, there are between 40 and 50 home health care providers that will bill in one- to four-hour increments,” he says. Depending on the resident’s health needs, that care can become more costly than opting for assisted living coverage. But Cowen says most of the seniors he talks to (average age: low 70s) are willing to bet they won’t need it, and will happily opt for lower monthly payments on their apartment rather than pay for a stay in assisted living they hope won’t be necessary.
“Most other places will ‘front load’ your payment, charging $1,000 to $2,000 more per month, for the possibility that you might need to get care over there,” he says. “We do not front load our monthly fees for a lot of health care assistance that 97 percent of our residents are not going to use.”
If they do need it, they can get it—often without having to go “over there.”
“Between home care, home health agencies and concierge nurses, we’re keeping people living independently, as long as they want.”
The other side
There’s another reason many residents on the independent living side of a CCRC never move over to its assisted living facilities, says Angela Olea—and it’s not quite as sunny sounding.
“Often, people would rather move to an assisted living facility in another place than move over to the one in their own community,” she says. “I have seen so many times, when a person has a decline in their health and they cannot remain in independent living, they come to that choice between staying in their own community and going somewhere else. And many would rather go to an assisted living facility in a different community and start fresh than be shifted to that ‘other side.’”
That’s a term Olea has come to know during her over 10 years of servicing the senior living industry. “You hear residents in independent living talking around the community centers: ‘Oh my gosh, she went to the other side! She had to go to assisted living.’ Almost like it’s a bad word! And in some communities, it’s definitely a split. Once they’re in the assisted living system, they cannot go back to the independent side to join in on activities. They’ll see all their friends eating in the independent living dining room, and they truly cannot go join them. They need to stay in assisted living for their meals.”
That little-known segregation in the senior living world is the subject of a documentary short currently up for an Oscar titled “Kings Point,” named for a retirement community in Florida director Sari Gilman came to know upon multiple visits with her grandmother, who lived there for more than 30 years. At the film’s New York premier last summer, Gilman talked about the “almost Darwinian aspect of social life” that emerges around each resident’s relative condition.
“If you had your health, you were popular,” she said. “If not, people stopped coming by. At the pool, I heard the whispers: ‘Oh, Ida. Yeah, she’s going down.’”
“These communities have done a good job of sheltering their residents in the independent living units from the serious health care that goes on in the assisted side,” says Olea. “But we’re starting to see the negative consequences of creating that ‘great divide.’”
As combined living facilities age themselves, observers say the key to keeping them attractive may lie less in dressing the buildings up in distracting elegance and staffing the communities with people who can best address the whole mix of unique physical, mental and social needs that develop in all these age-segregated communities.
“Our mission every day is to make our residents feel safe, important, comfortable, respected and happy,” says Jay Beaird, marketing director of McDowell Village in Scottsdale, where the average age of the residents is around 82. “And that takes hiring people who have a passion for seniors. We have a multitude of exercise programs and activities that challenge their minds, bodies and souls. But ultimately, it’s about treating them with dignity and respect.
“Many of these residents have moved here for what is probably the last phase of their lives,” adds Beaird, vocalizing an uncomfortable fact about CCRCs never mentioned in the brochures. “Our job is to make that whole phase as wonderful as possible.”