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Where to move when the knees give out

Where to move when the knees give out

From the Retirement: how to prepare for the rest of your life series

If the stairs seem to be getting higher, the laundry basket heavier, and your knees ache when you mow the lawn, you may be thinking of moving somewhere designed more for older people.

Older folks in good physical shape might just get an apartment in a building with an elevator.

Those more wobbly might look for a place with a label such as “independent living,” “assisted living,” “catered living community,” “senior living center” or “life plan center.” They are the old folks homes of the new millennium.

The good ones provide more than an elevator. They provide muscle or a meal when a resident needs it.

They also provide a busy community of people to help chase away the loneliness that can come with age and the loss of a spouse. They have exercise classes, book clubs, volunteer projects, and vans to take residents out for shopping, ball games or movies.

There are dozens of options around St. Louis.

The housing comes in two levels; “Independent living” is for people who can take care of themselves, but often get a little help anyway.

“They call it independent living, but the reality is that most people in it are not living independently,” said Brad Breeding, a certified financial planner and author of “What’s the Deal with Retirement Communities?” They get help cleaning or cooking, or with a ride to the doctor.

“Assisted living” is for people who can live in an apartment of their own but need help with things such as getting dressed or showering, or remembering to take their medicine.

Some centers around the St. Louis area are designed to take you from gray to grave. They have independent apartments for the still-spry, assisted living and nursing homes in the same development.

These used to be called “continuous care retirement communities.” Marketers ditched that mouthful last year in favor of “life plan centers.” Most are run by nonprofit groups, often church-based. There are more than a dozen life plan centers in the area.

The good places aren’t cheap. Bethesda Health, a nonprofit that runs seven senior living centers here, rents a one-bedroom independent-living apartment for $1,500 to $2,500 a month. Rents at other places can run $5,000 a month for a large apartment.

For that, residents get free meals in the dining hall, apartment cleaning, rides around town and a recreation program.

Assisted living is more expensive. At Bethesda, rates range from $4,000 to $18,000, with the average about $5,700. There may be an extra charge if the resident needs “memory support.”

There is limited help for the poor and near-poor. “The biggest divider of all is income,” says Arthur “Buz” Zeman, who runs the nonprofit Housing Options Provided for the Elderly, or HOPE for short.

People at least 62 and earning under about $1,800 a month, after deducting medical expenses, are eligible for a subsidized apartment in a building for the elderly. They’ll pay 30 percent of their income in rent.

Many buildings have waiting lists, and quality varies. “There are not enough to go around,” says Zeman. “Some are well-managed. Some are not.”

Those earning a little more may find a place at a development built for the elderly using tax credits. The owners must keep rents affordable, which means about $500 to $600 a month, says Zeman.

Those that need more than a little help may be out of luck. Assisted living is very hard to find on what Missouri pays, says Zeman. “Missouri is very bad compared to Illinois in assisted living,” he says.

People in Missouri who earn less than $1,281 a month can get state-funded in-home help, which can keep them in an apartment instead of a nursing home.

If money is less of a problem, the decision of where to move becomes a lifestyle choice. You’re choosing a community – and a price.

“You live in an apartment – full kitchen, bedroom, living room – but you live with other seniors. You have a built-in social life,” says David Franta, director of the foundation at Nazareth Living Center in south St. Louis County. “There are book clubs, gym classes. Twice a week you go to grocery stores, to church. You’re buying into a community.”

But the financial decision isn’t always easy. The centers operate on different financial models.

Some demand a big up-front fee – often $200,000 or more – but give a break on the monthly rent. Entry fees of $1 million aren’t unheard of in St. Louis at “life plan centers” that follow the gray-to-grave model. Other centers live only on the rent. Some vary the rent by the size of the upfront fee.

Some centers will return the up-front fee – or part of it – when you leave the center or die. Others won’t.

Ask a very important question: “A big one. What does the monthly fee include?” says Breeding. Just how much help will you get in the apartment before you have to pay extra, and what might that extra help cost? Is there a fee for the gym? For van rides?

Many life plan centers — which offer independent, assisted and nursing home care — want an upfront fee. Before paying it, check on the center’s finances, said Breeding, founder of, an advice site for choosing high-end retirement communities.

Ask to see an audited financial statement. If you’re not financially savvy, take it to an accountant for an explanation. You want to make sure your new home will last as long as you do.

Many such centers have bond ratings, generally done by Fitch Ratings. In Missouri, centers following the lifetime model have to file financial and actuarial reports with the state. Ask to see the filing.

Look for liquidity — the cushion of cash, and how big it is compared to operating expenses. Check the level of debt as well as operating profit, says Breeding. Look at occupancy levels. It should be at least in the high 80 percent range, and the best ones often have a waiting list. If they’re having trouble filling up, ask why.

The good news is that centers rarely fail, says Breeding, who knows of only one instance in which residents lost their entry fee in a financial failure.

Breeding recommends visiting several. Talk to residents and make sure to see the nursing home unit. “Is it clean? Does it smell good?” he asks.

Also ask what happens if your money runs out before you die. Will they promise to keep you on, or boot you to the street? Most life plan centers are run by religious-based charities, and some promise to keep residents on if they outlive their money.

Life plan centers usually offer automatic admission to the next tier when you need it, be it assisted living or nursing home. So they usually want people to be fairly healthy when they first enter. They’ll lose money if you move to expensive nursing care too quickly.

There is an advantage to the tiered life-plan-center approach. “If you make the right choice, you never have to move again,” says Breeding. And that means something. “The older you are, the more difficult it is to move,” he says, “psychologically, physically, sometimes financially.”

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