Join CJM Wealth Advisers and Silver Bridges Consulting for an in-depth discussion on senior living options, from life plan communities (CCRCs) to rental and memory care communities. Learn what to expect, how to compare costs, and how to plan ahead for yourself or aging parents. Experts Kristy Kennedy and Ginger Noce share valuable insights, key questions to ask when touring communities, and guidance on financial planning for senior living.
This video is a replay of our webinar on October 16, 2025.
Introduction to Senior Living Webinar
Parker G. Trasborg:
Hello everyone. Thank you for joining us. My name is Parker Trasborg. I’m a Senior Vice President here at CJM. Today we are very happy to welcome Kristy Kennedy and Ginger Noce from Silver Bridges Consulting to talk about senior living options. Kristy is dedicated to service and has over 20 years of expertise in the senior living industry. She spent a decade as a leader for one of the nation’s top senior living organizations, and Ginger has over 25 years of corporate leadership experience and is able to combine that with the personal experience, maybe unfortunate experience of being a long distance caregiver for her mother who has memory impairment. They’ll spend a little bit of time today talking about the various options in senior living. I really do think this presentation touches a large number of people, whether you’re planning for yourself to move to a senior living home or planning for aging parents at some point in the future. If you have any questions throughout the presentation, please utilize the Q and A function at the bottom of the Zoom screen and we’ll try to make sure we get all those answered for you. Ginger and Kristy will do a great job kind of monitoring that and answering questions as we go along and maybe saving some for the very end as well. Again, Ginger and Kristy, thank you very much for being here today and you guys can take it away.
Ginger Noce:
Thank you, Parker, and thank you all for being on the call today. We really, really appreciate it. Knowledge is power and so today our goal is to infuse you with a lot of knowledge about senior living and the landscape we are located. By the way, I’m Ginger and I’m Kristy. We’re located here in the Washington DC area along with many of you, although we do work across the country, we’ll explain a little bit more about that. As Parker said, we love questions, and so if you have any at all, please do post them and we’ll answer them and sort of weave them into what we’re talking about. So they’ll come up, they’re going to perk up. Please whenever you have ’em, just pop ’em in there and we’ll get to them. Anything else? I forgot.
Kristy Kennedy:
I think that’s it.
Ginger Noce:
Okay, great. We’re going to get here going. Give me a second to, let’s see, slideshow and, all right, Parker, if I, you’re not seeing my screen, let me know.
Parker G. Trasborg:
You’re good.
Ginger Noce:
All right, great. Very good.
About Silver Bridges Consulting
Kristy Kennedy:
Alright, well thank you. As Ginger said, really appreciate you all be in here and hopefully this is going to be valuable for you. The most important thing with this is really beginning to have a plan and that’s what we’re going to talk about to give you some information to really help you understand what the various options are. So before we dive into that, I just want to share briefly a little bit about who we are. So as Parker mentioned, I’ve been in senior living for 20 plus years. Long time in this business. Ginger and I have actually both been caregivers for our aging parents. So we know how difficult that job is if you are a caregiver on the call. And we know also as far as this decision goes, the emotional how emotionally taxing this can be for many people. So we are a concierge consulting firm and really our goal is to educate and empower our clients with all the information they need in order to make the best decision either for themselves or for a loved one.
Senior Living Industry Overview
We spend about 45 hours with every family that we help. So we’re very high touch, very hands-on, really supporting folks from start to finish. So not only identifying and evaluating communities, but also helping you with all those steps that come after you make that decision about what do you do with your stuff, how do you move in, how do you get yourself there? So we’ve got folks who can help with that as well. So without further ado, we will dive into this and start talking about some senior living options and how these work. So with regard to senior living, I want to just share with you an overview of what’s happening in this entire landscape. So as of today, and if you’re in northwest or in the DC metro area, you’ve probably seen a number of senior living communities being built. You will continue to see that for the next several years.
So it’s a little bit scary, but senior living is saying as far as when you look at the industry statistics that as a nation we’re going to be about 800,000 apartment short of what’s going to be needed to take care of folks as the baby boomers continue to age. So when a senior living community is being built, it takes about three years from when they identify the site to when they actually open the doors. So unless they’re able to figure out a way to speed up that timeline, that’s what we’re looking at is there’s going to be a gap with not having enough residents for seniors. So the important thing to know about that is there are some waiting lists right now, more so with the life plan communities, which we’re going to talk about today, but you’re probably going to start to see waiting list increase as time goes on.
Now, another interesting thing I want to share with you is that beginning the end of this year and going through the end of 2027, about 12,000 people a day are turning 65. So that’s why we’re seeing this wave and this number of people that are coming in so quickly. This isn’t only happening in the United States, it’s actually happening globally as well. So by 2031 in six people in the world are going to be over the age of 60. It’s first time that’s ever happened. Now if you put a, we’re in northwest DC and if you put a pin in where we are and you drew a circle that was about 30 miles in circumference, within that catchment area, there are over a hundred senior living communities. So we always tell people the good news is if you live in this market, you have a lot of options and the bad news is you have a lot of options.
The number of options makes it more complex. It makes it not a little bit a lot more complicated because senior living communities are not all created equally. And so really being able to identify those that meet your budget, your preferences, your geography, your wants, your needs, it can become a little bit more difficult. So just to give you context, that’s what’s happening in the world of senior living. Now, the options that we’re going to talk about today, there are essentially two different types of senior living models. So one model is what is called life plan communities. Many of you may have heard that referred to as CRCs Continuing care retirement communities. Those names are interchangeable. It’s the same thing. The other option that you have is what is called a rental community. So rental communities, life plan communities are going to offer very similar services.
Life plan communities are going to be the largest of all options where you’re going to have more residents living there. And the other big difference is that life plan communities have skilled nursing on site and rental communities do not. So in a life plan community, you’ve got buildings for independent living, assisted living, memory care, and skilled nursing rental communities can be configured a little bit differently. So there are rental communities that offer the continuum from independent living to assisted living to memory care. There are others that are simply assisted living in memory care. There are some standalone memory care communities where that is, all they do is memory care. And then another option that falls under this sort of rental umbrella is what are called group homes. Now group homes are residential homes. You’ve probably driven by them in neighborhoods and didn’t even know it. They are licensed by the state and they’re allowed to have eight residents that live there max. So that’s another option that falls under this rental communities option. And as we go through these, we’re going to talk about some other differentiators with what distinguishes these two. The last thing we’re going to spend a little time on today is skilled nursing and long-term care. So just to give you sort of a high level overview, that’s where we’re going over this next hour.
Ginger Noce:
Yeah, there was a question about North Carolina. We knew we have some folks on the phone that may be out of the area. So what Kristy described about the opportunity slash complexity in this DC metro area, same, same. We work most of our 75% of our businesses here, the balance is across the country. So yes, we help folks in North Carolina. Well, you were just there two weeks
Kristy Kennedy:
Ago. Yeah, I was just down in North Carolina
Ginger Noce:
Going back
Kristy Kennedy:
In about a week.
Ginger Noce:
Yeah, so no matter where you are in the country, it’s the same. That said, everything that we’re going to talk about today and the pricing is really going to be what you’ll see in most major metro areas. So it won’t be that different no matter where you are.
Kristy Kennedy:
Absolutely.
Ginger Noce:
Yep, absolutely. But that answered the
Life Plan Communities (CCRCs) Explained
Kristy Kennedy:
Question. Alright, so we’re going to start out and dive into life plan communities here. So life plan community, CCRC, same thing. CCRC stands for Continuing Care retirement Community. These are campus models. So as I mentioned before, they’re the largest of all options. They’re sprawling a number of acres on that campus with different buildings in many cases dedicated to the different service lines. You do have to be 62 years or older to qualify to live there. If you are looking at this option, they’re going to have many different styles of apartments. So there is a one bedroom option, often all the way to a two bedroom plus 10 or sometimes even a three bedroom. So square footage can range from about 800 square feet up to 2,600 plus. There are some in this market that are larger than that, and I was just actually in North Carolina and they had options down there that were larger than that 2,600 square feet.
So lots of variety there. These communities are going to offer onsite physical, occupational and speech therapy. So even if you don’t need it when you move in, it’s great to have it because you never know when you might and it’s a nice convenience. Most of these communities are also going to have primary care physicians that see the residents. Sometimes in a life plan community, those primary care physicians are only dedicated to assisted living and memory care residents. Sometimes the independent living residents can access them also. So that is community dependent. Now, in addition to primary care, they are going to bring in other physicians. So they will bring in audiology, podiatry, dentistry, dermatology, and sometimes psychiatry as well. So lots of physicians coming in to see residents. The amenities you’re going to see at these communities are going to be larger than they are at rental communities just because the volume of residents.
So you may see indoor and outdoor swimming pools, fitness centers, excuse me, bocce ball courts, pickleball, tennis courts. Many will have a lot of clubs. We were at one community not long ago and they had about 150 to 200 different clubs. So they had everything from birdwatching to knitting to speaking Spanish to photography, you name it. But clubs are all resonant driven. So if you’re moving into a community and there’s something that you really have an interest in, there is a good chance the community could start a club like that as long as there’s enough interest. They’re going to offer on average five to eight organized activities a day. That’s on the low side at most of these communities. And then many of them are pet friendly. So if you have a dog or a cat or some other animal, some communities have a weight limit, 25 to 35 pounds. Some do not. So again, that just depends on the community. And then most of them are going to provide free transportation, and that is within five to 10 miles of the community. That five to 10 mile radius really depends on if they’re more urban or more suburban. If they’re in a high urban area, it’s usually about a five mile radius. If they’re in a more suburban location, it’s a 10 mile radius. And that’s true across the country
Ginger Noce:
For folks on the phone on the webinar that are from this area. Okay, I’ll give a couple examples just so you can understand when we’re talking about life plan communities, some in the area that are those type.
Kristy Kennedy:
Yeah, so some life plan communities would be places like any of the Ingleside communities or life plan communities, any of the Erickson communities like Green Spring Village, the new one you may have seen, Grandview is another Erickson community. That’s a life plan community. Ashby Ponds, which is out in Virginia. That’s another life plan community,
Ginger Noce:
The Mather and
Kristy Kennedy:
Tysons, the Mather in Tysons. Yep.
Ginger Noce:
So
Kristy Kennedy:
I will tell you of that 30,600 number we talked about in the beginning how many senior living communities, there are only 2200 of those fall into this category, this life plan community category. So it’s a much smaller subset. But the interesting thing is people tend to be more familiar with life plan communities than they are with rental communities simply because life plan starts marketing to folks when they’re 62. So they’re seeing this much more frequently, much more often.
Ginger Noce:
Cool, thank you.
Financial Considerations for Life Plan Communities
Kristy Kennedy:
Yes. All right, so this is where these two models, the life plan and the rental model really differ. So with a life plan community, this is private pay unless you have to go into skilled nursing where if you have three nights in the hospital, which equals a qualifying stay for skilled nursing, skilled nursing will pay for the first 20, or I’m sorry, your Medicare will pay for those first 20 days. With this model, if you’re moving into independent living, often you have to move into independent living. Start there and then go through the continuum, then you can move to assisted living, then you can move to memory care. In some cases, if a life plan community has availability, you could move into assisted living, but that is not always the case. And often you have to also qualify physically and qua medically and qualify financially. So that’s something as well that you need to need to be aware of.
The monthly service fee. So let me back up. The entrance fee, the way this works is you’re going to have a one-time entrance fee. So that entrance fee, you’re not physically buying the real estate in most cases. There are some what are called equity co-op models where you own the real estate, but in most cases with life plan communities, you’re paying an entrance fee. This entrance fee is essentially like a country club enrollment membership fee. It ranges anywhere from about $200,000 and this is nationwide. There are some that are $150,000, but about $200,000 to $5 million. So really quite a range there. In that entrance fee, depending on the community, a portion of that entrance fee will be refunded to your estate. When you either move out or pass away, we’ll go back to you or go back to your estate. The portion that is refundable is often predetermined by the community.
There are some communities that will give you a choice of whether you want it to be 50%, 70%, 90% others. It is one option. So important to look at that and really understand what that means. Some communities will have what is cloud. Basically it’s like a declining balance. So you’ll pay the entrance fee and then over the next so many months it depreciates. And then at the end of about a three year to four year period, that number is zero. So lots of different options with how that entrance fee is handled. In addition to the entrance fee, you’re going to have what’s called a monthly service fee. That monthly service fee is going to range from about $3,000 to $7,500. Again, those numbers are true across the country. You can expect a five to 6% cost of living increase no matter where you are. That’s going to vary obviously, by market.
I will share with you that during COVID we saw that number be substantially higher. It was like 12, 13, 14%. We haven’t seen those numbers since, and hopefully we won’t. There is, if you’re moving in as a couple, there is going to be with a life plan community, typically the way that it works for a couple, there’s the entrance fee for one person. There is a lower entrance fee for the second person. That can range from $50,000 to a hundred thousand dollars. It really depends on the community. It also depends on the size of apartment that you’re looking at. That’s going to dictate a lot of the pricing. In addition to that entrance fee, you’re going to have a second person monthly fee that’s going to range from about a thousand dollars a month to $2,500 a month for that second person. So just something for you to be aware of.
Now, there are lots of different contract types with life plan communities and the contract type often depends on how much you’re paying upfront and what happens when you move from independent living to assisted living or to memory care. So we’re not going to spend a lot of time on this today because it really could be another full hour webinar. But just make sure that if you’re looking at a life plan community, you know what contract you’re signing, you know what that means before you actually sign it. Alright, so included in your base rate, we talked about having that monthly rate. That is going to include some kind of meal plan. So all communities in independent living will have a meal plan. It’s typically 20 to 30 meals per month is sort of how it balances out. Some communities are a bit more flexible. Most you cannot roll that over.
We have been in several communities where you can roll that over or some where it goes quarterly. But important to find out with meal plans how that works. If you tend to travel and go out of the country for six months out of the year, see if there’s any kind of credit that comes back to you with regard to that. And then if you move to, and this is true nationwide, anytime you move to assisted living or to memory care, it is a state regulation that they must provide three meals a day, daily housekeeping where they’ll come in, take out the trash, make up the bed, weekly house cleaning, which is the deeper clean. They will do laundry typically once a week. If you want that done more often, you can pay a fee for that. And then it includes access to activities as well as that scheduled transportation. So the scheduled transportation is typically to doctor’s appointments. It’s also they will have specific days where they’re going to different grocery stores or going to different big box stores. And then if you wanted to go to a museum, you wanted to go to a performance, you can typically arrange that through the concierge as long as you give them enough lead time.
Alright. All right. So in assisted living and memory care, depending again on the contract type you’re going to have, this is where you start to have what are called care charges. So care charges come into play when folks need help with what are called activities of daily living. The acronym is ADLs. And essentially what activities of daily living include are bathing, dressing, grooming, toileting, and potentially feeding. So that’s what falls under this care level bucket. When someone moves into assisted living or memory care, the nurse at the community does an assessment. That assessment will determine how much care that that person needs, what that care level is going to be. And then after they’ve been in the community for about 30 days, they’re going to reassess to make sure they have that care level, right? The care level is fluid. It doesn’t continue to go up.
Sometimes folks move in, they’re coming out of rehab, they tend to then need a little bit more time and then start doing better. So the care level can fluctuate, but anytime there’s a change in condition or a hospitalization, that care level is evaluated. The other piece of this puzzle is what’s called medication management. So in some communities they are going to combine your care level, your medication management will be one fee. In other communities, it’s two separate fees. So what I mean by medication management is if you’re in independent living, you are able to administer your own medications. By definition, you’re fully independent When you move to assisted living and memory care. If you are unable to answer questions like, and this is during the assessment process with that nurse, if you’re unable to answer questions like what’s the medication I take? What do I take it for?
How often do I take it? And what happens if I happen to miss a dose? If you cannot answer those questions, you go onto the community’s medication management program. So this is where the community is responsible for managing the medications. They come to your apartment, they make sure folks are getting those at the right time in the right dose. They also manage the refills. So just so you know, in any kind of a senior living environment where medications are involved, if it’s not independent living, you either have to be able to self-medicate and answering those questions. Or you go on the management program, you can’t bring in pill boxes for a loved one and fill those up weekly and have them take ’em. That is not something that’s allowed. And then last but not least, there is a continence management program for folks that are incontinent.
The one thing I do want to share with you too is around state licensing and how this works. So life plan communities, the independent living portion, only that one is licensed differently than anything else across the senior living landscape, the Bureau of Insurance in that state is the one who licenses the independent living portion. Basically what that means is an inspector comes in, usually it’s once every three years to make sure the community’s doing what they should be doing, check the financial viability of it to make sure things are above board. When you go to either assisted living or memory care, those are actually inspected by separate entities. And it depends on states. States have their own licensing, they have their own licensing agency. Unlike skilled nursing, which is regulated by Medicare, they’re regulated nationally. Assisted living memory care across the country is all regulated by state and independent living on the rental side.
Rental Senior Living Communities
So in that case, they’re inspected on a more regular basis. Usually it’s once every year they come in spend about three days on site at that community, they can give that community what are called deficiencies. So that means that they found something that was happening outside of state regulations. If that’s the case, they can cite them and they either, sometimes, depending on how severe that is, they may have to pay a fee or they give them a certain period of time to correct that. Important takeaway from this is if you’re looking at a community, you want to know how they did on their last state survey. It is public knowledge. The reality with this is it’s hard to find. Number one, you need to know who the regulating body is in your state. And then number two, once you find it, it can be hard to read just because there’s so much information and it’s usually written in very either skilled nursing or medical type terms. But please, if you’re looking at communities, ask how they did on their last state survey. Many times they have it posted. If you can’t find it, they can certainly tell you how they did. Alright, we are going to move on now to rental communities. And people often ask us, well, if it’s a rental community, is it less, is it less than? Is it not as good as a CCRC because people are more familiar with CCRCs. That is not true at all. These communities are both great. Did you have a question?
Ginger Noce:
Give folks an example of some rental communities in the area.
Kristy Kennedy:
Yeah, absolutely. So some of the rental communities would be, let’s see if you’ve ever heard of BrightView, BrightView, senior Living. Those are rental communities in Tysons. There’s one they’re called the Trillium. There’s one in Fairfax called the Providence. Any of the Sunrise communities are rental communities.
Ginger Noce:
If you’re in DC, the Fitzgerald,
Kristy Kennedy:
Fitzgerald,
Ginger Noce:
Many of them. But just to give me an idea of
Kristy Kennedy:
Inspire, which is a new one. So lots and lots of rental communities in this market
Ginger Noce:
Far more than in CCRC,
Kristy Kennedy:
Yes, far more than the CCRC side. So as I mentioned before, these communities can include independent living, assisted living and memory care and independent living where you’ve got the full kitchen, you’ve got the washer dryer in the apartment, all of that. Others are going to only cater to assisted living and memory care. And then some are memory care only. So various room styles with this option as well, you can have a studio all the way up to a two or three bedroom apartment, about 400 square feet to 2200 plus square feet. These communities, just like those life plan communities are going to offer onsite physical, occupational and speech therapy. Many of them do. You want to make sure that they do because if they don’t or if they say we have home care that comes in and does that, that is a very different animal. If they have a vendor on site that rents space from them, that is called outpatient and it means that the person who needs therapy is getting about 55 minutes of therapy. If they have someone from home health come in to provide that service, they don’t have the equipment on site. Folks are bringing that in and they’re only getting about 20 minutes with that therapist.
Ginger Noce:
This would be like if you were at your own home and bringing in physical therapy.
Kristy Kennedy:
Exactly. So very different. So just sort of figure out, ask them, do you have a vendor on site that leases space from you or is somebody coming in from the outside? These communities are also going to have visiting physicians. The primary care physician. You can keep your own physician residents. It’s not mandatory that you go to that physician on site, but about 70 to 80% of residents end up doing that just because it is so much easier and it improves continuity of care. They’re going to have the same types of visiting physicians, the audiology, podiatry and dentistry that come on. Now with the amenities, you’re going to have great amenities at rental communities. They’re just not going to be as large. The size of rental communities varies anywhere from about a hundred residents up to about 250 residents, sometimes 300,
But they’re going to be smaller in size. So you’re going to have your onsite hair salons, spa services. Some will have swimming pools, art studios, movie theaters, state-of-the-art fitness centers, all those types of things. They’re going to offer the same number of activities, that five to eight activities. They’re also going to have clubs, but they’re not going to have 200 clubs. They may have 25 clubs that they offer. These communities are also pet friendly, some with the weight limit, some without, and then they’re going to provide the free transportation as well to within five to 10 miles of the community. Now here’s where they really differ. Aside from rental communities not having skilled nursing, which isn’t necessarily a negative because there are some life plan communities that have skilled nursing that when you look at their Medicare star rating with how they do, it’s not great. So Medicare uses a five star rating system, a one to five, five is the best, one is the worst.
Some of them are not so great. So plenty of skilled nursing options should you ever need that. But this is the other place. These two options really vary. So this model is also private pay. Instead of having that huge entrance fee that we talked about before, in this model you have what’s called a community fee. Now this is a one-time fee. Think about it as a security deposit. It’s just not refundable. You don’t get it back when you move out. That money essentially goes to refurbish that apartment when a resident moves out. So your community fee is going to range from about $3,000 on the low side to about $80,000. On the high side, the average that we see across the country is between 10 and 15. That’s about what you’re looking at. Room rates are going to vary based off of apartment size, based off of location.
This is true in the CCRC model as well. Your monthly rate is going to be anywhere between 4,000 to $12,000 per month. So your entrance fee or your community fee is going to be substantially less. Your monthly fee is going to be a little bit higher. There is typically if a couple is moving into a rental community, there’s only one community fee. You don’t pay that for two people. It’s per apartment, not per person. And then there is going to be a second person monthly fee that’s anywhere from a thousand to $2,500. This model as well is going to have an annual cost of living increase. And you can ask what has your cost of living increase been over the last three years, just to get a gauge of how they’re projecting. And then in assisted living and memory care, as I mentioned before, this is where those care levels start to kick in depending on how much care your loved one needs or your client needs. This is, and here’s the other interesting part of this is care levels vary greatly by community. Some communities may have three care levels, some may have eight or nine. That’s the other part of this that makes it so confusing is they’re not the same care level. Pricing is very different. And then the medication management piece, again with this model, some will bundle those two prices, care management and medication. Others will have two separate rates. So just something for you to be aware of.
Alright, in your monthly service sphere, that base rate we talked about there is going to be a meal plan for independent living. Independent living residents. That is usually about one to two meals, meals a day. What we’re finding is that many of these communities do a continental breakfast, which often isn’t just pastries. They usually have eggs and bacon and things like that. And then they give you access to a second meal a day, which most folks choose dinner because it’s the more social meal at the community. So one to two meals a day are going to be included in assisted living. As we mentioned before, a memory care, all meals are included. Laundry, housekeeping, all of those things. Assisted living and memory care obviously is where the care levels are going to kick into play. And then one thing to make you aware of that rental communities offer that life plan communities do not is something called a respite stay.
So in most communities offer this. So if you are caring for a loved one and you just need a break, it is one of the hardest jobs out there. This is a great way for your loved one to get the care that they need and for you to get the rest that you need. So your loved one can move into a community for a minimum of, usually it’s 30 days, some communities will do two weeks, but usually it’s a minimum of 30 days up to a max of 60 days. But they can be well cared for, you can get the rest that you need. The other option with respite stays is it’s a great way for people to sort of try out the community and understand what it’s like to really live there as a resident. They can move in for 30 days for 60 days and experience it firsthand and then decide at the end of that period of time if they want to become a permanent resident. So that’s something a lot of folks do as well.
Understanding Memory Care Options
There are couple conditions that would prohibit someone from moving into an assisted living community. So these are not mandated by the community. These are actually state mandates and these are consistent to across the country. All of these conditions you see listed here have to be managed in a skilled nursing setting. So if someone’s on a ventilator, if they have a skin wound that is considered a stage three or stage four, meaning it’s more severe if they’re on IVs or getting injections directly into the vein versus subcutaneously or if they’re on a feeding tube. Those conditions need to be handled in skilled nursing. Alright, want to share a little bit with you about memory care because we get a lot of questions around this and folks often think because their loved one has a diagnosis of memory impairment or mild cognitive impairment that they need to be in a memory care setting and that is not the case.
There are lots and lots of residents that live in assisted living that are pleasantly confused. So you don’t have to have, if you have someone you love, has that diagnosis, they don’t have to live in memory care unless a few things are true. So this is a secure neighborhood. There is a keypad to enter and exit. You also have to have the approval of a physician in order to live here. So the reason people would move into a memory care setting, there are really three primary reasons. The first is if someone is doing what is called exit seeking, meaning they’re constantly trying to leave that community to get outside in an area they shouldn’t be in that can put them in harm’s way. So that would be one reason if they’re trying to physically leave the building. Another reason folks would move to memory care is if they simply become overwhelmed in a assisted living environment.
Sometimes that environment can be too much stimulus. It’s usually larger than a memory care setting. So folks tend to do better if they’re in that memory care neighborhood. And then the third reason is if sometimes with memory, memory impairment is the disease progresses, people will develop what are called repetitive behaviors. So they may vocalize and make the same sound over and over and over again or say the same thing over and over again. Or they may tap or do things that could be seen as distracting to other residents in the memory care setting. They have more staff and they’re better able to redirect residents and help manage those types of behaviors. So those are really the reasons people move into memory care. It doesn’t mean that you have a diagnosis that you have to move into memory care. And then in some communities, and this is unfortunately not a lot, but some communities have what is called a bridge program. So it’s for those folks that are, they’re not really doing well in thriving in assisted living, but they’re not really yet ready for memory care either. They’re sort of at that in-between space. So it’s called a bridge program. And actually your mom was in one, why don’t you talk?
Ginger Noce:
Yeah, thank you. My mom had early stage dementia, so she was very still able to engage in conversations, participate in activities, social interaction, still super important when she was being taken care of by my father when he was alive at their home, he did, he was committed to taking care of and he did the best that he could in that situation. And at that point she wasn’t as engaged, I would say would be how I would think about it. When we moved her to this area and she went into a community with a bridge program, it was like pouring water on a wilting flower. I kid you not, she just came alive from the programming, which is very, very specific to trying to stimulate the brain, create engagement, and the goal of which is to help minimize slow the decline, if you will. We saw an actual improvement. I don’t know that it was necessarily that you’re always going to see an improvement, but certainly she was able for at least over a year or more, take a very, very high level of engagement despite the disease. So it was a wonderful for her, wonderful for me. And when it came to visiting her and just something that we really believed a lot in these programs so that if communities have them, that’s a very good thing.
Kristy Kennedy:
Yeah. The other thing you’ll notice sometimes when folks have dementia and they’ve been cared for at home and the loved one doing the very best they can, it can be hard to fix three nutritious meals a day to make sure medication is delivered every day on time and getting into a setting where those things are happening easily and people are getting the right nutrition, they’re getting their medications exactly when they should, their proper dose. Those things too, in addition to, as Ginger mentioned, just the programming and the way this is done, you can sometimes see residents actually do better.
Ginger Noce:
About a month after my mom got to this program, and it was about a month later, my dad had just died a month before and I was not expecting her to be doing so well, and I looked at her and said, mom, are you doing okay? And she said, Ginger, she said, I’m living my best life now. My dad gave her a real good life. I’ll tell you that. The fact that she was just to really come alive with these kind of programs, it’s special. We see it all the time.
Kristy Kennedy:
And this is a woman who wasn’t really communicating prior to that. So it was pretty remarkable for us to see.
Ginger Noce:
Yeah.
Skilled Nursing and Long-Term Care
Kristy Kennedy:
Alright. So real quickly, I want to just share a little bit with you about skilled nursing. So should someone need skilled nursing? Every skilled nursing or almost every skilled nursing facility has two types of beds. They have a certain number of beds allocated for what are called short-term stays. That’s for people who’ve been in the hospital who are coming out after a surgery or an illness and need more time before they can go back to whatever home is. The other option is what is called long-term beds. Long-term beds are really for those folks who have chronic and complex health needs that need that 24 7 skilled nursing oversight. So as I mentioned before, Medicaid is going to cover a cost of this depending on if you’ve been in the hospital and had those qualifying stays. If you have to pay for skilled nursing out of pocket, and this again is across the country, if you’re looking at a semi-private room, it’s usually about $8,500 a month. If you’re looking for a private room, it’s going to run you about $10,000 a month. So just something to keep in mind there.
Ginger Noce:
Right.
Kristy Kennedy:
Alright.
Ginger Noce:
CCRC question, let’s get to it. Major considerations around choosing 90% entrance fee versus declining balances. Do you have any thoughts about that?
Kristy Kennedy:
Yeah, so this really depends on,
Ginger Noce:
I’m going to repeat the question.
Kristy Kennedy:
Yeah, I’m sorry. So the question is if they wanted us to address the major consideration around choosing the 90% entrance fee option versus the declining balance option, so the declining balance option, you’re usually paying less upfront. So the difference, it depends on how much money upfront do you want to give the community, and this is really a decision if you’re looking at CCRC versus rental communities. The biggest question is what do you want to do with your money?
Do you want to give your money to an entity and have them invest it where you’re not making money on it, or do you want to keep that money and invest it on your own? Because many people, if they’re moving into a CCRC are having to sell a home in order to do that because of the large entrance fee. So the declining balance is typically going to be a lesser amount you’re paying upfront than if you’re doing a 90% refundable, usually a 90% refundable, you’re paying a lot more upfront. So you have to really determine financially what is going to be the best option. That’s why we always, always refer people back to their financial planner to say, help them model this out for you as to what’s going to be the best option based off of your entire portfolio and what makes sense.
Funding and Financial Planning for Senior Living
Ginger Noce:
Which leads us to our next slide. Yes, it does. All right. So I want to talk a little bit about funding senior living because it’s important for us as consultants to stay in our lane and as Kristy said that the most important resource, and you guys are in wonderful hands, it’s CJM is your financial planner when it comes to decisions around ensuring that your money doesn’t run out, if you will, which is sometimes a concern for folks or the best way to use it, depending upon what you want to leave your state as an example, most folks, this is the most, if they are moving into a life plan community, need to sell a home. Okay? So that’s something to consider. If you have long-term care insurance, long-term care insurance is a wonderful thing when it comes to deferring the cost at assisted living or memory care.
Look at your policy. Every policy is different, but in general, it kicks in whenever there’s a need for covering two activities of daily living, that bathing, dressing, grooming, toileting, standby assistance could be in there. Feeding memory impairment can be in there as well. And so you want to check. Now that can also pay for in-home care, but if you’re in a community, communities are used to working with long-term care insurance providers. So they’re really good about providing the documentation is everything, the documents that you’re going to need to provide your long-term care insurance provider. Okay, so good. Your pensions, your investments, all the wonderful things. You have your social security. There is a benefit. We’re not going to talk about it today just from a time standpoint, but it’s called aid and attendance. It’s a veterans benefit that provides between 1,520 800, somewhere in there.
Dollars worth of benefit, monthly benefit. If you were a veteran at a time of war or married to a veteran, reach out to us. You’ll have our information. We can tell you more about that if that’s the case. And of course, you always have family members. But again, number one takeaway here is when it comes to that final decision about which way do I go, this life plan, these rentals, the big apartment, small apartment, how do I need to be thinking about my money as it relates to these decisions? Your financial advisors will be able to model that for you. So you’re in good hands. All right, lower cost models. There are some options in this market and many markets that are lower cost, but they’re not enough. But to give you an idea how this works is within a community is being built within any certain jurisdiction that the government says, okay, and you can build this community, but based on a size of it, you need to dedicate so many of your apartments to folks for lower income or supplemental income.
There’s not a list. So there’s not a list that you can go to anywhere. It says where in this area or any area of the country can I find those communities with apartments that they have and that are available. And availability is typically really hard because they’re often used for folks who have been with them and living in the community for a while, but they do exist. If you want to know, you just have to make phone calls. There are some moderate and low income housing in this area as well as other areas of the country. So it’s going to be determined by income. Not always assets, but it definitely is level of income and a number of other criteria. But they’re there. Adult day centers, when we talked a little bit about respite and respite and the need for caregivers to really have a break, that there are non-residential facilities that support both health, nutrition, social interaction, et cetera, in an area where it’s professionally staffed and a setting that’s a very highly social model.
There’s one in this area though, there are several that are for folks with memory impairment. I’m on the board of one called Insight Memory Care. It’s a Fairfax Virginia program. There’s some in DC as well. And they’re great because if your loved one has any sort of memory impairment, whether it’s early stage or all the way to late stage, it can go in a day setting. It’s certainly less expensive option, and then come back to you in the evening. And they’re well taken care of in a really positive way. So those exist folks often say, well, what if I just want to age in place? Who doesn’t? Right? And so the things that we want to talk to you here about just the financially, how to think about this. If you want to live at home and you want to bring in care and the way of companion care, and we talk about companion care, this is someone to help you with those activities of daily living, go to the grocery store, fix dinners, whatever is you need someone to do that.
They’re not a nurse by training. There are organizations or agencies that provide this type of support when you engage them. There are the requirements of typically a four hour minimum shift, two to three days a week. So it’s not like you can say, I just need somebody for an hour to become do blank. The average price is going to be 35 to $38 an hour. When you need someone that’s a nurse, as an example. So for wound care or some other reason that you would need a licensed nurse, think about that. 80 to $90 an hour. And when we’re looking at this for our clients, and oftentimes we’ll be brought in to look at exactly this. Let’s find the right communities first that meet their criteria and they’re the best fit for them. What are those costs, but how much does it also going to cost if they want to age in place?
We see this a lot when older children are bringing in, their adult children are bringing in their parents to discuss this as a topic. And so the cutoff that we see, if you did the math and made a grid of it once, you need more than 20 hours or more per week of care from a companion care standpoint, it’s really financially speaking, going to make more sense to move to a community assisted living community. So something just to keep in mind, there’s a wonderful service called a neighborhood village. If you’re not familiar with them, there are nonprofit organizations. They’re in neighborhoods across the country, over 280. Within our DMV area, there are 90, 80. Okay? So what it is, is the concept. It’s neighbors helping neighbors. You can volunteer to be part of a village and to help as a resource, or you can actually join if you need support. You can also join if you want to have social activities around. So it’s a volunteer driven, driven nonprofit. You need help changing a light bulb. You can contact your village that you’re a member of. They will then find someone who’s a volunteer who will do that for you. Okay? So it’s a really great way to, if you want to age in place or you’re in that in between stage where you just may need some help to find a local village, the cost, it’s less than a thousand dollars, I think. $500 a year.
Kristy Kennedy:
About 500
Ginger Noce:
A year. Yeah. It depends on the village and most around our area, there are many, many, many. To find a village near you, go to the Washington Area Village Exchange.
Kristy Kennedy:
If you live in this area,
Ginger Noce:
If you live in this area, if you are outside of the Washington area, it’s a village to village network. Do org. Yeah, or reach out to us. We can certainly get that to you. All right? Want to get to something? I think you’re going to find really, really useful. And the goal here is to arm you with questions that you should ask when you’re touring communities. Now, after we’re done with this presentation, Parker will be sending out to all, I’ll giving you a copy of this document. I’m going to give him a one page document that’s going to summarize all these questions. You can copy it, take it with you wherever you go. So let’s go through a few of those that we think are really super important. Tenure and experience of staff, very, very important at the level of the executive director, who’s the general manager of that community and the director of wellness or often called the head of clinical.
It’s a nursing function that manages all of the individuals providing care throughout the community. If you don’t have folks in those two roles that are steeped in this business, have the background and understanding of the requirements of what it’s like living and working in a community and aren’t great leaders. So they tend to have a lot of staff attrition, if you will. Then you’re going to have a community that’s always fighting fires. We see this all the time when you have, and it can be a beautiful building. Beautiful buildings don’t provide excellent care. Not necessarily many can and many do. But the real key is here in leadership. And when you have great leaders here, you’re going to have staff that want to stay. We have some wonderful examples in this area of communities that really highly invest, not only pay well, but they invest heavily into upleveling skills of their team members across the organization.
And you’ll see folks staying for years and years and years, which is really important, especially when you’re delivering on care side. It’s really important to have the same folks and there’s not constant turnover. So really that’s a big one to dig into when you’re doing your tours. You want to ask about the last state surveys. Kristy said, if you ask that question and you get crickets, that’s a sign. Every community should be able to tell you what the results were of their last date survey. Regardless of whether you’ve looked it up or not, they should be able to tell you. And if there were any citations and deficiencies. So they’re going to know you’re very serious when you ask this question. So know that you should get an answer. Agency staff within the community, that’s something that happened during COVID when agencies were in the situation where they needed to have more caregivers because many people were out. They had to get help from outside agencies to come in and provide care. Today, that should not be the case. Okay, so you were at a community week ago, right?
Kristy Kennedy:
Yeah. And I asked this exact question, and the answer that the team member gave me was, yeah, we’ve got about 20 to 30% of agency staff. And I was taken aback because that’s a really high number. And I said, why is that? And she said, well, it’s because of COVID. Now, COVID, as you all know, didn’t happen a year ago. And the fact that they still hadn’t figured that out and had that level of turnover was a huge red flag. So something that you want to make sure that you ask. And if they have agency staff, you want to find out why. But that in and of itself is a red flag.
Ginger Noce:
Should be the exception to the rule. Sure, for sure. Other questions? The number one on this particular slide is a big one. It’s call bell response time. So that means if you’re in assisted living as an example, typically you’re given either a pendant to wear or a watch or something that you can press. Yeah, sorry, pull cord. In apartments, you’ll have those around that. If you were to push or pull those devices, that a message would go out to the staff to say that you need help. Okay? That’s called call bell response time. How long does it take for when that message is received by the community to where you get someone to the room? Now, the magic number here, what does great look like? It’s seven minutes or less. Okay. So seven minutes or less is the number we’re looking for. Communities monitor this daily. If a community says, well, yesterday it was 10 minutes, here’s what we did to work through it. The fact that they’re monitoring, it’s great. We’ve seen a community where they actually post it on their website, which is amazing. And know that sometimes folks who lose their remote will pass the call bill. So there can be a little bit of a mix in there, but it’s a general indication of how fast are people responding when you’re needed, if you’re on the floor because you’ve tripped and you fell and you need help, and it takes 20 minutes for someone to come to, that’s not good. So call bill response time is a really big one to ask seven minutes or less.
Kristy Kennedy:
And again, if they don’t know, ask ’em to find out and let you know.
Ginger Noce:
Yeah, yeah. Big one. Kristy, you talked about the onsite physical therapy, the occupational speech therapy as well. If you have a special diet, most communities will offer accommodations for that. You want to dig in. So we haven’t seen too many lately, in fact, that don’t have something that’s available. You definitely want to dig in because this is a big one. Food is a big deal. The kind of training that staff receives, we talked about that. When it comes to retention, you want to ask, what was their annual increase last year? So Kristy, you talked about the average across the country is five to 6%, even in brand new communities that may not have a history. Right? And communities usually raise them in January. Usually sometimes it’s at the anniversary of your agreement. It just depends. But you want to ask what it is or if they’re brand new, has it been in their other communities?
So you should get a sense of that. They should be able to tell you any special pricing and promotions. A lot of folks don’t know that senior living can be negotiable. Alright, this is important. Now the caveat is if a community has a waiting list, there is no need for them to negotiate. So that’s tough. But there are a lot of communities and there’s a lot of capacity in the market right now. And so you need to ask the question because if you don’t ask the question, then you may not get what is really the best option available for you. So you want to ask, that could be three months. That could be rate locks, that could be lots of things, but ask if there are any special promotions.
Kristy Kennedy:
We negotiate that on behalf of our clients, and we usually get what our clients pay us plus more by how we do that. The other question I just want to point out real quick on here is you want to make sure that you ask, under what circumstances might a resident be required to move out?
Ginger Noce:
Yes.
Kristy Kennedy:
Because not all communities, as I said earlier, are created equally. There are some that cannot do. In other states, they don’t have what is called an enhanced license. Licensing, remember is by state, and it’s all different. In some states or some communities, they cannot do what is called a two person assist. So essentially that means they could not move me from this chair to this bed if I needed the help of two people. We usually see this happen with folks that have memory impairment because their brain and their body just don’t communicate. And so Ginger’s mom was a prime example. She was the size. We are not a big lady at all, but she just was completely dead weight in trying to move her. So in some cases, if that happens with the resident they have to leave and go to skilled nursing. Or if you’re in that CCRC environment, in some cases, if you become a two person assist, you’re moving out of assisted living into skilled nursing. So really, really important question to
Ginger Noce:
Ask. Yeah, yeah, that’s a big one. Thank you.
Kristy Kennedy:
Yeah.
How Silver Bridges Consulting Helps Families
Ginger Noce:
All right. Questions ask. Those will be coming to you. Please take them with you when you go. We get questions all the time. Okay. What do you do? Silver Bridges and want to do a real quick review of what we do and how we work. For those that may need support, we charge a rate. If you’re in the DMV, it’s $7,500. If you’re outside months, if you’re outside this area, it’s $9,500. So if you’re North Carolina’s example, Maryland, and that includes 12 months of our services, flat fee, unlimited time. We spend, as Kristy said, about 45 hours plus with every client. It’s very, very much of from beginning to end is what we’re providing in terms of service. We are your consultants and your advocates here. You want to talk to us just to say, explain your situation, find out more about what we do for the potential of an engagement, initial consultation, no charge.
So happy to set up an hour call with you, reach out to us, we’ll give you our information, and Parker will as well on our website or directly if you decide you’re going to engage us, we do a deep diver needs analysis to go into whatever your want to haves, nice to haves, have to haves if you will, your needs, preferences, budgets, your absolutes, all the things that are going to go into. What I’m going to look for, lack of a better word I’m going to use is just a checklist of what should we be looking for when we go into markets, either this one or across the country, to find the best options for you. With so many options, our goal is to bring it down to no more than five to six options. We can certainly provide more. We certainly can do less, too many, too much.
Okay? You’re paying for expertise. Once we get that needs analysis, and on top of that, we’re looking at communities that are operationally sound, we’re looking at the staffing and as we talked about those important parts, the licensing, we’re doing all of that on your behalf to make sure that we’re covering it all. We’re going to go and research those communities. We’re going to go end market. If you’re outside of the DC area, we’re in these communities all the time here locally as well first, and then we’re going to come back to you with a recommendations report with those communities that we’ve selected for you based upon those criteria. And we’ll also talk about those we didn’t select and why in that information. And what’s really important about this step in our process is not only were you going to have data and information and floor plans based upon what you wanted, et cetera, but we’re going to have a page that shows what is the pricing today.
Let’s say you’re independent. What is the pricing at independent living? What is the pricing at assisted living? What is the pricing if I move into memory care? And you take this back to the CJM team and your advisor and say, help me with this now because this now provides them with what they need to do. Modeling of your investments. So that helps in that collaboration with your financial advisor. We’ll then set up tours. We’re going to go with you, we’re going to go with you if you are out of this market. We’re going to go with you if you’re in this market. On those tours, we are your second eyes and ears. We’re not only going to get to the table, those folks, the sales folks that you meet, but also that senior leadership executive director, the director of clinical, et cetera. We’re going to go and then negotiate pricing when it comes to your final choices, we’re going to help you with transition coordination. We’re going to be there on a regular basis for if you need support for care, plan reviews, and then we’re an ongoing resource for you throughout our relationship. So that’s a little bit about our process, how we work. If we can be of help, we’ll have our information for you here at the end. But last slide, and this is one, this is Kristy’s favorite one. So I let her do this.
Final Thoughts on Senior Living Planning
Kristy Kennedy:
This is my favorite slide. I think it just brings home everything we’ve talked about today and sort of encapsulates it here. So again, thank you all for being here. The key is really about being proactive and having a plan. This is one area of life we do a terrible job planning for. We plan for weddings. We plan for having kids. We plan for buying a house. We don’t plan for. What are we going to do when I can’t or shouldn’t be living at home by myself anymore or with my spouse. Everything is okay until it isn’t and things can change very quickly. So sure you have that plan in place because you don’t want to make this decision when you’re sitting in an emergency room being told that you or your loved one cannot go back home. If you don’t have a plan, you really forfeit your agency.
You forfeit the ability to have agency in the decision. So the decision gets made for you. If you want to age in place at home, just know that research is showing, and this is so clear that isolation is the enemy of the brain. Make sure you surround yourself with community. You surround yourself or your loved one with people that are seeing them outside of just those caregivers. In our market, and in many markets, life plan communities are going to have a wait list for independent living one to three years in this market. In North Carolina, when I was down there and in Texas and some other markets, they had five and 10 year waiting lists for independent living.
Figure out what community you want to be at and get on that waiting list. It’s usually a thousand dollars refundable deposit to do that, but great idea. And then the last thing we’ll leave you with is we hear people tell us this every day is we wish we had made this decision sooner. So many people are afraid of this decision. They fear this decision because it’s a change. But it absolutely can be a wonderful next chapter for people. And it’s not something to be afraid of, but it’s an opportunity for you to just thrive in different ways.
Ginger Noce:
Awesome. Thank you. So Silver Bridges Consulting is who we are. Just go to our website and you can get access to us or at this email here and turning it back over to you, Parker. Let me stop. She, there we go.
Parker G. Trasborg:
Thank you. Thanks Kristy and Ginger, thank you so much for all of your insight today. Certainly a lot of information about all the various options. Very helpful. And we only really just scratched the surface. So like they said, if you need other information, please feel free to reach out to them. And if you’d like a copy of the presentation, please send me an email or your planner an email and we’ll make sure we get that to you. And we’ll try to send out all the questions that they had mentioned in an email to everyone that was viewing today. Viewers both live and that view us later recorded thank you so much for joining us. That concludes today’s presentation and we wish you all a very happy and healthy upcoming holiday season. Thank you very much.
Ginger Noce:
Thank you guys. Bye-bye.
Parker G. Trasborg:
Bye-bye.
Silver Bridges Consulting: https://www.silverbridgesconsulting.com/
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