By Paula Span
In theory, the continuing care retirement community, or C.C.R.C., makes great sense: build different types of senior housing on a single campus, or even in a single building, so that as residents need more care, they can transfer within the facility — from independent living apartments to assisted living units to a nursing home — instead of being uprooted from familiar surroundings. More than a half-million older Americans find this an attractive idea and have moved into such a retirement community.
Yet ever since reporting a few years ago in an assisted living facility in Bethesda, Md., and hearing about a resident who pushed the wrong elevator button and then screamed in horror when the doors opened onto the nursing home floor, I have wondered how these transitions work in practice.
Tetyana Shippee, a research associate at the Center on Aging and the Life Course at Purdue University, chose an unorthodox way to learn more. Ms. Shippee, then 21, moved into a C.C.R.C. in a Midwestern town and, for two years, observed, ate with, got to know and interviewed its residents.
Ms. Shippee’s findings, recently published in The Gerontologist, show how elusive the aging-in-place ideal remains, even in a facility expressly set up to foster it.
People liked their independent living apartments just fine, Ms. Shippee discovered, but were often reluctant to move to assisted living when their health and mobility declined. “There was a certain level of stigma involved,” she said. It was not that the assisted living units and nursing home, with their separate dining room, were particularly far away; they were just a seven-minute walk from the independent living apartments. “Mostly,” she explained, “there are social boundaries.”
In Ms. Shippee’s facility, where introductory tours often bypassed the assisted living/nursing wing altogether, the health and vigor required for independent living had become an important source of status. To leave an independent living apartment meant not only losing one’s home and social network, but also a part of one’s identity. Friendships often did not survive the move; visits became more like duties or favors than part of reciprocal relationships. Small wonder, then, that Ms. Shippee observed anger, stress and a keen sense of loss when residents were faced with moving.
It is possibly different in other facilities. At least, said Steve Maag of the American Association of Homes and Services for the Aging, a C.C.R.C. allows for the possibility of continuing social connections, so much harder to maintain across geographic distances. Mr. Maag pointed out, too, that C.C.R.C.’s were adapting to these unexpected social wrinkles, adding home care programs to accommodate residents who did not want to move.
But wasn’t the ability to move within the facility — with the assurance that as one needed more help one could remain socially connected — the whole point of selecting a continuing care community?
The prospect of an involuntary move led Sally Herriot, who cherished her cozy independent-living apartment in Palo Alto, Calif., to make a federal case of the issue — literally. Mrs. Herriot already employed private aides and had agreed to increase their hours, but in 2006, when C.C.R.C. administrators told her she would have to move into assisted living anyway, she filed suit in federal court and charged that forcing her to move was a violation of the Fair Housing Act. “It amounted to a loss of control, a lack of privacy and dignity,” her son Robert Herriot said.
A judge sympathized but ruled that state law permitted the C.C.R.C. to make such decisions. Mrs. Herriot, represented by AARP lawyers and by Relman & Dane, a civil rights firm in Washington, has appealed the verdict; meanwhile, Mrs. Herriot, 91 and very frail, remains in her apartment with her helpers.
Could C.C.R.C.’s improve the situation by promoting more interaction, with less physical and social separatism, among residents who require different levels of care?
“Independent living residents don’t like that,” Ms. Shippee pointed out. “They view themselves as healthy and active. If you try to integrate them with people in wheelchairs who have problems, they will object.”
In the dining room, she added, “they want to feel like they’re in a nice restaurant, conversing with friends; they don’t want to be faced with those in declining health.”
Mr. Herriot has heard of residents who have gone so far as to conceal their health problems, fearing that they will be the next ones moved.
So much for theory. Most C.C.R.C. residents who are told to move will comply, but having to leave a home is disruptive and distressing, it seems, whether you are moving 7 minutes or 70 miles away.
Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”
Verlia Caldwell, Pres.
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