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The Longwood at Home concept—a “CCRC without walls”—keeps making national news in the long-term care field. And right here in Southwestern PA, Longwood at Home is making a dramatic difference in the way people think about retirement living—giving them more control over their plans, more security in their own homes and more value over conventional long-term care insurance. Read about it here.

Aging in place: Seniors remodel to meet changing needs and remain in their homes

November 16, 2014

And it worked out well. The three women found a cozy home in Mt. Lebanon, the front door flanked by griffins. But steep, twisty staircases make the house a hard place to grow old. So the women are moving on.

They are doing so with unusual forethought, two renovating a condominium in Sarasota, Fla.: choosing levers instead of door knobs, push-button lights rather than switches, lower countertops, less slippery tiles, wheelchair-accessible showers, wider-than-usual doorways, grab bars that don’t look like grab bars and installing a Toto toilet (one that Ms. Machinist, 67, made sure “doesn’t look like an old person’s toilet”). The third is hoping to stay in Pittsburgh, searching for another co-householding arrangement.

Their experimentation is part of a growing trend across the United States: seniors increasingly opting to “age in place” rather than move into a full-service retirement community.

“Older folks are doing everything they can to stay in their houses,” said Carnegie Mellon University professor Stefani Danes, who has researched residential environments for the elderly.

In Pittsburgh, this takes a variety of forms: elderly couples and individuals finding ways to stay in neighborhoods across the city by renovating their homes, moving to one-story condominiums and often subscribing to aging services networks.

Longwood at Home, which claims to be one of only 17 “continuing care communities without walls” in the U.S., currently serves roughly 270 people in Allegheny, Beaver, Butler, Washington and Westmoreland counties.

The program, run under the umbrella of Presbyterian SeniorCare, aims to “make aging easier,” providing members with the same services they would receive at a typical residential retirement community — just at home. The monthly fee ranges from $300 to $625, and the service is founded on relationships between so-called “care coordinators” and clients. These care coordinators do not serve a “mother hen” role but check in depending on members’ needs, said Grace Smith, a retirement living specialist with the program. 

Joe Charny, 86, a retired psychiatrist who subscribes to Longwood at Home, said he enjoys the freedom his Squirrel Hill condominium gives him, including access to a bike trail, restaurants and the library. If, on a whim, one day he decides he wants to fly to Paris, all he has to do is walk out the door and catch a shuttle to the airport — no permission slip required. Residential retirement communities, on the other hand, he said, seem limiting, and conversations there focus on only two things: health and grandchildren.

“Everybody there is the same age, everybody is aging,” he said. “That’s somewhat different from life.”

One difficulty many seniors face is navigating hilly Pittsburgh once they lose the ability to drive.

Port Authority of Allegheny County runs a door-to-door paratransit service for seniors and those with disabilities called ACCESS but priority goes to medical appointments. And for those who can no longer drive, often it’s the peripheral activities that get left behind: things like church and lunch with friends. But these can often be just as important as hospital visits, said Jen Martcheck, a Southwestern Pennsylvania Partners on Aging board member. Isolation has been shown to shorten lives in a way similar to smoking, said Ms. Danes, the CMU professor.

This past spring, a new program of volunteer drivers called AgeWell Rides kicked off in Pittsburgh to supplement the transportation needs of older people. An initiative of the Jewish Family & Children’s Services, the program matches volunteer drivers using their own cars with senior citizens needing rides. So far this has been funded partly with United Way funds.

Another local “community without walls” aimed at providing seniors with transportation and community is Mt. Lebanon Village. For $400 a year ($600 for a couple), approximately 50 seniors are participating in the network, a branch of a national movement first founded in Boston. This provides rides to medical appointments, grocery stores and arranges social activities ranging from museum visits to luncheons. Around 27 volunteer drivers bring participating seniors to appointments weekly, said program coordinator Karen Jones, who manages the schedules in a master Google document. 

Though Pittsburgh is often lauded for having affordable housing, appropriate housing is a different beast, Ms. Martcheck said.

Lorraine Roberts, 71, said helping her mother-in-law navigate the 2-inch lip of her front door in a wheelchair was a challenge, prompting her to think about what aging at home would entail. 

So, she and her husband, Philip Roberts, 72, spent nearly three years and more money than they were willing to disclose renovating their Fox Chapel home: adding around 1,500 square feet, including an accessible entry and ADA-approved bathroom. Sitting in leather armchairs by a stone fireplace, looking out a two-story bay window at trees rustling in the breeze, they said enrolling in Longwood at Home provided relief and security.

Members are required to complete a physical every year, and care coordinators informally check up on members when they meet. If an emergency were to arise, their three children would not have to worry about logistics, Mr. Roberts said, adding that he was comforted knowing that their 14-year-old dog Hannah would be taken to a kennel.

Stephanie McFeeters, a senior at Dartmouth, was a summer intern at the Pittsburgh Post-Gazette.

SmartMoney -
Weighing Long-Term-Care Insurance Alternatives

September 24, 2012

Buyers of long-term-care coverage have a growing number of alternatives to traditional insurance. We weigh the options.

by CHARLES PASSY

Long-term-care insurance is the financial equivalent of gum surgery: something that is often seemingly necessary, but just as often avoided at all costs.

Now, to add to its unpopularity, soaring prices are prompting consumers to rethink how much coverage they need and to experiment with other types of policies.

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Long-term-care policies help pay for nursing-home, assisted-living and home care costs. In just the past year, premiums have risen by as much as 17%, according to the American Association for Long-Term Care Insurance, a trade organization for insurance agents.

In one recently publicized case, an Illinois couple, Bob and Cheryl Levy, saw their combined bill jump by 90% to more than $7,000 annually. Given the spiraling costs, Mr. Levy decided to keep the policy, but cut back on some of the coverage to hold the premium to the same amount.

"I was not about to double my payment," he says of the increase he and wife faced.

The increases help explain why the number of policy buyers has fallen, say experts who track the industry. Limra, an industry-funded research group, puts the decline at 38% since 2004.

Another reason for the decline: Insurers are pulling back. Five firms, citing higher-than-expected claims costs and lower-yielding investments as interest rates stay at low levels, have left the business or dialed back since 2010, including MetLife,(MET), Guardian Live, John Hancock, Unum Group (UNM) and Prudential Financial (PRU), according to Moody's Investors Service.

Yet the need for some kind of long-term-care planning remains greater than ever, experts say. Seventy percent of individuals over age 65 will require prolonged care at some point during their lives, according to the National Clearinghouse for Long Term Care Information website, which is maintained by the U.S. Department of Health and Human Services.

Fortunately for those who hope to buy long-term coverage, a growing number of alternatives to traditional insurance are gaining in popularity. Sales of hybrid products those that combine some type of life insurance with a long-term-care benefit, have been rising as traditional policies have faded. Limra says sales of such "life combination" products jumped 56% in 2011, the third consecutive year of double-digit gains.

Soaring Costs

With waves of baby boomers retiring, the number of long-term-care seekers is expected to rise to 15 million by 2020 50% more than in 2010, according to the federal Administration on Aging. Meanwhile, the cost of that care is also expected to soar and it is already plenty pricey for many Americans, with a year in a nursing home easily topping $80,000, according to some reports.

"A long-term care event is one of the few things that can completely derail your retirement plan," says Jeremy Kisner, president of SureVest Capital Management, a financial-advisory firm in Phoenix.

Typical of the new breed of policies is New York Life's Asset Preserver, a universal-life offering that allows money paid into the policy as a single upfront premium to be tapped for long-term care. (If you don't use the benefit in your lifetime, it is payable to your beneficiaries.)

Chris Blunt, president of New York Life's insurance group, credits the lack of a use-it-or-lose-it element a much-disliked facet of older policies for the fact that sales have tripled since 2007. "People hate paying for something they think they will never use," he says.

Reduce Benefits

Financial advisers are also increasingly telling clients to forget another aspect of the old policies: that they will cover everything you might need in terms of care. Now more consumers are eyeing policies in which the daily care benefit is dramatically reduced from standard rates often to as little as $100 which, say pros, should be enough to provide some hedge against inflation.

It isn't a perfect solution, says Ray Smith, an insurance broker who heads the Long Term Care Specialist Agency in Aurora, Colo. "Almost any long-term-care insurance is better than no long-term-care insurance," he says.

Still, the concept of self-insurance is getting attention these days. The idea is that instead of paying those increasingly higher premiums, would-be policyholders can simply increase their retirement nest eggs and use some of their savings for long-term care, if necessary.

The problem, say critics of approach, is that it requires more money than most Americans can afford to sock away. But those same skeptics acknowledge that many people with a sizable retirement kitty say, $2 million or more have already hit the mark where insurance is no longer absolutely necessary.

Reported in SmartMoney, September 24, 2012

Wall Street Journal -
Joining a Community By Staying at Home

April 9, 2012

Some continuing-care campuses are doing away with the requirement to buy a residence

By ANNE TERGESEN

Thinking about moving to a continuing-care retirement community? Perhaps you could stay in your home—and have the community come to you.

More in Next: The New Retirement

That is the idea behind a concept called "CCRCs without walls." Rather than requiring members to purchase a residence on a campus, these programs dispatch services—administered by aides, physical therapists, nurses and care coordinators—to members' homes as needed. By doing away with the residence requirement, they typically can charge less.

In the wake of the recession, the model is catching on. Currently, a dozen such at-home programs exist, up from five in 2007, says Sarah Spellman, who specializes in home and community-based services for older adults at consulting firm CliftonLarsonAllen LLP in Plymouth Meeting, Pa. An additional 10 such programs are under development, she says.

'Serious Look'

"A lot of our members are taking a serious look at the concept," says Steve Maag, director of residential communities at LeadingAge, an advocacy-and-research group representing approximately 1,200 nonprofit CCRCs, among other organizations that cater to older adults.

A traditional brick-and-mortar CCRC enables residents to move from independent living to assisted living to a nursing home if the need arises, all within a single community. Amenities often include fine dining and health clubs. They typically charge admission fees of $150,000 to $400,000 or more, plus monthly rates of $1,200 to $3,500 or more.

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By comparison, Longwood at Home—a nonprofit "CCRC without walls" in Oakmont, Pa., with 227 members—charges individuals a one-time entrance fee of $5,000 to $150,000, plus monthly fees of $190 to $584. Fees depend on the applicant's age and the plan selected.

'Form of Insurance'

Run by professional management typically affiliated with a conventional CCRC, these home-based care programs generally offer a variety of service packages, each covering at least a portion of the future cost of things like home health aides, visiting nurses and live-in companions. Most also cover some or all of stays in skilled-nursing and assisted-living facilities, with the most comprehensive—and expensive—packages defraying 100% of these costs. In that sense, they can be an alternative to long-term-care insurance, depending on the particulars of coverage. "It's a form of insurance," says Mr. Maag.

At-home CCRCs also typically provide discounted concierge-type services, such as transportation, that members may have to pay for out of pocket. (Rides to and from medical appointments are typically free.)

Most also seek to promote a sense of community. Kendal at Home, a 150-member nonprofit based in Westlake, Ohio, has three book clubs and regularly sponsors events on things like gardening, bird-watching and photography. Members also get together on their own. Last year, the at-home CCRC hosted a clambake and tour of Progressive Field, home of the Cleveland Indians. Like many of its peers, it sponsors nutrition, fitness and other wellness programs, including lectures, and social events throughout the year.

Covering the Bills

Members can use the fitness center and dining rooms at an affiliated CCRC. Kendal at Home sends a therapist to members' homes annually to recommend safety precautions, such as the installation of grab bars in bathrooms.

Elder-care experts say that like the traditional CCRCs, at-home programs are a significant investment and should be vetted carefully to determine if the benefits outweigh the risks.

For Diane and Howard Jernigan, who joined Longwood at Home about a year ago, the bet has paid off so far. The couple assumed they wouldn't need services for a while, but in October, Diane, 69, shattered her femur. The couple's care coordinator met them at the hospital and arranged for Ms. Jernigan to spend a month in the skilled-nursing unit of a local CCRC. When Ms. Jernigan was discharged, the CCRC sent physical therapists and health aides to her home.

Longwood at Home, which provided the same services again when Ms. Jernigan had follow-up surgery in January, has picked up the tab, says Mr. Jernigan.

Reported in The Wall Street Journal, April 9, 2012

To print the article click here...

Business Showcase Caregiver Magazine - Longwood at Home

December 1, 2010

Dr. Nancy Curry’s bright eyes sparkle behind her glasses as she quickly offers her thoughts on membership in Presbyterian SeniorCare’s Longwood at Home Community.

“It’s the best decision I’ve made,” remarks Dr. Curry, “The care is superlative and I’ve never had a fuss about anything.”

“Well, she’s not a ‘fusser,” gently teases Anna Scott, Dr. Curry’s care coordinator. The warm family-like friendship between the two women is clear as they share how Longwood at Home has allowed the spirited 79-year-old O’Hara Township resident to remain in the home that she loves as she’s weathered a variety of medical and care issues. Longwood at Home is western Pennsylvania’s first and only “at home” Continuing Care Retirement Community that enables healthy older adults to proactively plan for future long-term needs.

“I’ve risen above,” she comments. Dr. Curry became a member in 2004 after realizing that she wanted to remain in her home and yet not have any future care issues be “a burden” to her family. Her caregivers’ help has been tailored to her changing needs, be it 24-hour care after a major illness or the overnight care she now uses to help prevent falls. A nurse visits the former nursery school teacher and psychoanalyst weekly for a medication and blood pressure check. “It’s like a family,” Dr. Curry says, “I have a friendly network and I feel comfortable calling on Longwood at Home.”

Just across the river in Oakmont, Dr. Jim Snyder and his wife Ann use similar affectionate- albeit a bit more intense- language to describe their Care Coordinator Petrina Sichak.

“Petrina’s a warrior,” asserts Ann, 67, who first utilized her membership after an unexpected major back surgery several years ago. “Had I not had Longwood at Home, I don’t know what I would have done.” The Snyder’s also credit Petrina’s advocacy and the program’s portability with helping them to salvage a vacation and their peace of mind after Ann was hospitalized briefly for an injury during an extended trip to Florida.

“It wasn’t until I reflected back on what ‘might have been’,” comments Jim 69, “that I realized what we experienced was not all that bad, because we have coverage.”

Like Dr. Curry, the Snyder’s have family nearby, but felt it wouldn’t be fair to have their daughter help with their future health care needs while she’s busy raising her own children. They were familiar with Longwood’s reputation and were not disappointed when they made an inquiry about having care coordination at the ready.

“The staff has extraordinary sensitivity to the needs that we have- and they did so right from the first interview.” Jim says. “It was impressive.”

The home you made is precious to you, and it’s where you’re determined to stay.

Longwood at Home offers the long-term solution to support your decision. Enhance your quality of life and secure peace of mind through our range of care and services that will meet your changing needs while you continue to live in the home you love. A part of the Presbyterian SeniorCare family, Longwood at Home is backed by 80+ years of solid experience, ardent innovation… and the ability to keep pace with personalities as varied as yours.

For a life as unique as you.

Reported in Caregiver Magazine, December 2010

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