Welcome to RTD Financial’s Aging Well Webinar Series. The third installment in our series features Metta Johnson of Metta Johnson and Associates, presenting “Housing Options for an Aging Population”.
Overview
- Dynamics of aging
- Housing options
- Range of costs
- What to expect with each housing option
Housing Options for an Aging Population
- Continuing Care Retirement Community
- Independent Living
- Assisted Living
- Skilled Nursing Facility – Long Term Care
- Staying in one’s own home
- Home Health
- Hospice
- Home Care
- Adult Day Care
Full Transcript
Roberta Goldbaugh (00:03):
Hello everyone. And thank you for joining us for this third installment in RTDs aging well webinar series. My name is Roberta Goldbaugh and I’m a financial planner here at RTD. This series was created to address some of the challenges our clients may face as they themselves or their loved ones enter the later years in their lives. Joining us today is Metta Johnson, CEO and founder of Metta Johnson and associates. Metta is a certified aging life care manager and founded her company in 2002 to serve seniors and those with special needs in coordinating and overseeing care. Metta is founder and CEO of Metta Johnson and associates. As an RN, Metta has served those with chronic and aging illness for over 30 years. After working in oncology many years, she founded the first inpatient hospice in Metro Atlanta growing the program to one of the largest and most respected in the city. She’s nationally certified in oncology, hospice and palliative care. She’s a certified care manager. Seeing the need for guidance for seniors in all areas of aging, Metta, and her husband, Clyde founded Metta Johnson and associates in 2002.
Metta Johnson and associates provides comprehensive oversight and coordination of overall needs for seniors and those with special needs, especially as it relates to healthcare and living arrangements. Mehta Johnson and associates provides comprehensive care management services, coordinating medical care, medication, emotional and psychosocial support, living arrangements and care arrangements. Their mission is to offer extraordinary guidance, support, and expertise to seniors, and those special needs as well as to their loved ones. Mehta will present an overview of the various living arrangements available to us as we age, a range of costs for each and considerations to keep in mind as we evaluate the best regiment for ourselves or for our loved ones. Please note that this presentation is educational in nature. We appreciate Metta taking the time to share information pertaining to our aging wealth series. RTD and Metta Johnson and associates are not affiliated in any way formally or informally. RTD’s sole purpose in offering this webinar is to provide a means to share information that we feel may be useful to you from other professionals and specialists. Feel free to type in any questions you may have throughout the presentation and we will address them at the end. With that I’ll pass things off to Metta for today’s presentation.
Metta Johnson (02:39):
Thank you very much, Roberta and RTD for having me here today. I’m here for the chronically ill. For seniors that are well in planning for aging has been my life’s work and passion. And today we are specifically going to look at at aging, at healthcare and housing options. You know, we all hear a lot of statistics for people that are 65 and over that in 2000 the percent of our population was 12.4%. And 2030, it’s going to be 19%, which is 72 million people, 10,000 people turn 65 a day. You know, those are interesting statistics, but I can’t really relate to 72 million people, but these are some statistics that I can relate to. The life expectancy of a man in this country is 76 years old. And for a woman is 78, but those statistics are from birth to death. If you actually start at age 65, a 65 year old woman can expect to live to an average age of 85 and a 65 year old man can expect to live to the age of 83. And if a woman reaches the age of 85, she can expect to live another seven years, which puts her well into her nineties and a man can expect to live another six years.
Metta Johnson (04:38):
So these are things that need to be planned for a 65 year old woman can expect to live 14 of the next 20 years independently and the last six dependently. A 65 year old man can expect 13 of his next 17 years to be lived independently with the last four living dependently. So what are those dependencies? As an aside, you need to qualify for at least two of these dependencies to initiate your long-term care policy. And those dependencies are grooming, dressing, eating toileting, ambulation and transfers, and bathing. Cognitive impairment automatically meets the criteria for implementing the benefit of your long-term care insurance policy.
Metta Johnson (05:54):
I like to look at four areas in particular to plan for aging and a really commend you all for being at this webinar today, because we seem to plan for everything in our lives when we’re going to get married, when we’re going to have children, the education of our children, when we’re going to retire, but we don’t look at these dynamics of after we retire. Those four areas I consider are legal, which includes your wills, your power of attorney, your durable, medical power of attorney. Financial. In those of you listening to this seminar today are already addressing that by working with RTD financial. Health care medical advocacy, which I will discuss and housing options, which I will discuss as well.
Metta Johnson (07:05):
So in healthcare medical advocacy care management, which is the area of aging that my company and I work in. There are certified aging life care managers to coordinate and oversee issues for aging. We have a national organization, the aging life care association, that we are members of, and as individuals can become certified as an aging life care manager. We do an assessment of the senior in areas of psychosocial, medical, medications, functional level, safety, legal, financial. From that, we create a plan of care that maximizes each client’s independence and maintaining their dignity. The services provided includes evaluation and recommendation of living arrangement, health care evaluation, and accompaniment to healthcare providers. And we provide the healthcare provider with a written assessment of our professional evaluation of what is going on with the client.
Patient advocacy, in whatever setting the senior is in. They may have a crisis and be in the hospital. They may be in a rehab or nursing facility or in an assisted living. Care managers function as your advocate. We provide medication management and oversight, which is very important because we take into consideration the interactions of the medications, that you are taking them appropriately, your reaction to and effectiveness of the medication. Many seniors simply stop taking the medications because they are having an adverse effect to the medication, but they don’t call it the doctor and inform them what their reaction to the medication is so they can get on another medication that is appropriate. We provide daily money management, which is certainly not financial planning. It is just simply bill paying and the basics of money management.
We provide emotional and social support to the clients and the families. This is really important because the whole paradigm shift and dynamics of aging change the relationship between the client and the family and we support them in this. Coordination and management of care in whatever setting the client is in as I said. Home, hospital, assisted living, independent living, a nursing home. We’re there to coordinate and manage the care. Crisis intervention. Often our calls are dad had a heart attack. He’s the caregiver for mom. What are we going to do with dad after or do for dad is the better wording after this crisis. And how were we going to assist in taking care of mother? And referrals to legal and financial resources such as RTD financial.
Metta Johnson (11:18):
So that is what certified aging life care managers to today. The main focus is going to be on housing options. We are going to look at the following housing options as well as assistance in those housing options. Continuing care, retirement communities, independent living, assisted living, skilled nursing facility, or long-term care, home health, hospice, home care, and adult daycare. And most of all, we’re going to look at staying in one’s own home that 75 to 80% of people say that they want to do, but it is good to take a hard look at what the other options are. One of the deterrent to moving from ones own home is it is overwhelming to think of the move, but with the assistance of a certified aging aging life care manager, we all, we often use a senior move manager and there is the national association of senior move managers. And they manage the relocation of older adults from where they are to where they are going to age in place. And that is very helpful.
Metta Johnson (12:59):
The first living option that we’re going to look at is continuing care retirement communities. These are called CCRC, and they provide all levels of care. Independent living, assisted living, as well as nursing home. There are many activities, many dining options, movie theaters, exercise rooms, activities outside the community. In these types of communities, they charge an initiation or an entry fee that ranges anywhere from 250,000 to over a million dollars. Some of these arrangements allow for the return of a portion of the fee to the senior if they leave the CCRC or to their heirs. And in addition to the initiation or entry fee, there is a monthly fee that ranges from $4,500 to $7,000 a month. The nursing home portion or area of the CCRC, except Medicare for rehabilitation. They do not accept Medicaid usually, but they do in Pennsylvania.
Long-term care, which is the nursing home care usually run about $330 a day or $119,000 a year. There are three types of that are provided. One is type a, which is life care. And that goes from covers all of your services that you will ever need. All of the levels of care, independent, assisted living and nursing home. That generally that monthly fee runs is higher, is the highest costs in a CCRC, but you’re completely covered for whatever you’re going to use while you are living there. Type B is a modified contract that it provides your independent living. But as far as assisted living in nursing home, that has like a 30 day or 60 day or a 90 day coverage. And then after that, you’re paying for that assisted living or nursing home fee. And type C are fee for service fees. Many CCRC have people that enter at the assisted living and even at the nursing home level of care. And so they pay a fee for service rate. The range of cost for these facilities as mentioned above there is a wide range with your entry fee and your monthly rental fee. The payers for this are private pay and long-term care insurance would cover assisted living or the nursing home.
Metta Johnson (16:35):
The next That we’re going to talk about is independent living. Independent living communities now that are freestanding buildings also have an assisted living section. But what we’re going to cover right here is what the independent living offers themselves. These are communities with like aging people with common interests that kind of live in an apartment building for people like this. They are full apartments with full kitchens and the amenities in these independent living spheres. They prepare three meals a day, but in your monthly fee, there’s usually one meal that is included and you can pay for the other two meals. If you wish. Generally there is no entry fee or initiation fee into any of the other types of living communities we are discussing.
Many of the independent livings provide what is known as shared services. This is where a licensed home care company has a service that is provided for many of the people in the independent living for short period of time increments. 15 minute increment up to the four hours. We’ll discuss private home care in a few minutes. Social and cultural outings and activities are provided there. They have a weekly trip to Kroger or Publix and target. And then also take you out to some cultural activities. The range of costs for independent living is 3,500 to around 6,000. And the payer for this is private pay. Long-term care insurance would cover for shared services that are providing some of those activities of daily living that we mentioned earlier.
Metta Johnson (19:09):
Assisted living memory care, personal care are communities that provide caregivers to assist with activities of daily living. They are there 24 seven for the whole community, but they do not provide one-to-one care for a senior. So do not, you know, understand that these caregivers are there that may be assigned to seven or 10 other residents that need assistance with eating dressing, grooming transfers, ambulation toileting, and they provide medication assistance. They also provide activities and social and cultural outings. Most of their activities are provided in the assisted living. They have something almost every hour of the day that is there in the community because these are people that do need assistance and are not as independent as those in independent living. The range of costs is 3,500 to about 8,000. Assisted livings have levels of care. So if you are there with just the basic assisted living assistance, that’s $3,500 around. But as you need more assistance and go to a higher level of care, and each owner of the communities do this in a different way, but then your care can be up to $8,000 a month with your individualized care plan. The payer for this is private pay and long-term care insurance.
Metta Johnson (21:16):
The dreaded word, nursing home, or skilled nursing facilities. Nursing homes are not what they were 30 years ago. And so we do need to get past that. Patients go to skilled nursing facilities for rehabilitation and additional nursing care that Medicare will pay for after you have had a three day stay in the hospital. Medicare pays for up to 100 days of rehabilitation. If, and that’s the operative word here. If the patient continues to progress, Medicare pays 100% for the first 20 days. And then it pays 80% from days 21 to 100 days with the remaining 20% being the responsibility of the patient. His or her Medicare supplement policy will cover that 21 to a hundred days. So often people say, Oh, Medicare pays 21 days and I have to get mom out of there. That’s not true. Medicare pays 100% the first 20 days. And then it pays 80%. When one is no longer qualified for skilled nursing or rehabilitation, they become eligible for long-term care and to stay in this community this nursing home. And at this point, the payer becomes private pay or Medicaid. The range of cost, if you are in long-term care is $80,000 a year to $120,000 a year for semi private room. The payer is private pay long-term care insurance or Medicaid.
Metta Johnson (23:37):
So if you are at home or if you are in an independent living or in assisted living, you may qualify for home health care. And this is a Medicare covered and insurance coverage service that provides nursing service and physical occupational, and speech therapies to those who are home bound. Meaning that you’re not going out to your bridge club, or it means that you’d go out to doctor’s appointments and church. The important thing about this, no matter where you are living is that it provides these therapies. You may be getting out of the hospital and you do not want to go to rehab in a nursing home, or you may have had some falls recently. And so a skilled therapist comes in and provides care for you for a set number of visits and number of weeks. Again, the participation in therapy is needed in order to continue the therapy, as well as making progress is required. The range of costs is paid for by insurance and Medicare and Medicare advantage programs. Typically you do not private pay for these services.
Metta Johnson (25:19):
The next service that we’re going to talk about is hospice care, which is again, a Medicare covered and insurance coverage service when one gets to the last six months or less of their lives. And they want to, to focus on symptom management rather than aggressive care. This is a wonderful service. We do not like to think of the end of our life in uur culture, but it’s an important thing to think about. The services include a RN on call, 24 hours a day, seven days a week for the family to call. They make weekly visits. You have a home health, aid for short periods of time, persistence. You have the social worker for emotional and social support. There is a chaplain and a medical director. This is not giving up. As you heard, I have a lot of experience in hospice. It is near and dear to my heart, and it is actually taking control over the end of your life. Medicare and insurance pays for this. Hospices cannot private charge you for private pay
Metta Johnson (26:47):
Other services available to you in any of these living options is private home care. These are licensed through your state. These are licensed agencies providing caregivers and companions for you in the home. These typically have a minimum shift of four to six hours or eight to 12 hour shifts can be provided all the way up to 24 hours a day. Live in care can be provided. You need to have in mind that the caregiver must have a room of their own and be allowed at least eight hours of uninterrupted sleep. These home care caregivers provide assistance with your activities of daily living like housekeeping, cooking, errands, transportation companionship, sometimes on the weekends and evenings and holidays there is a surcharge. The cost is 20 to $23 an hour. So if you need care, wherever you are, for 24 hours a day, that is $175,000 a year. For an live in caregiver it ranges 95 to $110,000 a year. It is paid for by private pay and long-term care.
Metta Johnson (28:28):
There is daycare available at a licensed daycare facilities where you can take your loved one and they will have assistance with their activities of daily living. They have snacks and meals that are provided and activities. They are provided medication administration and the cost of daycare ranges about 75 to a hundred dollars a day. And the payers for this are insurance, private pay and the Medicaid waiver program.
Speaker 2 (29:12):
So staying at home, which is what most people say that they want to do. So do take into account the costs that we have discussed before. The cost of your care if you have private daycare, if you have private home care, as we said, if you need that 24 hours a day, it’s about $175,000 a year. So the other costs that you need to consider are mortgage. And some people are like, my mortgage is paid for. So to stay at home is free, but there are fees or rent that you have. There are taxes, there is insurance, there are utilities, there are home and maintenance repairs that need to be done. There are groceries and supplies. There are transportation issues that come up. There are remodeling that needs to be done. And there is care when needed. I think many people think staying at home is what I want to do because the want to continue to see my friends that are staying at home and we’d go to dinner every now and then I may have a bridge club or a Marshawn.
But you have to remember, most of your friends may be electing to live in one of these other types of communities as well. And even if you live in one of these other aging communities, you can still go out with your friends for dinner and you can still meet them for bridge or book club whatever your get togethers are. But as you age, it becomes more difficult to stay in your own home. There’s small things that matters to. Who will do the meal planning, who will do the grocery shopping, who will prepare the meals? These are really important issues with the food because we find most people that stay in their home without assistance become malnourished. They just simply do not have the interest or the wherewithal to plan the meals, hop the meals, prepare the meals. Most seniors that move to a senior community put on 10 to 15 pounds like we did, like we were in college, the freshman 15. So keep that in mind.
Now you are in the home and you have home care. If you have an aging life care manager, they can help you with the meal planning and your caregiver can help you with the grocery shopping and preparing the meals. There are also wonderful services now that either send meals already prepared, all you have to do is microwave them, either directly to your home or that are picked up at a pickup point a couple of times a week. There are also personal chefs that can come in and prepare meals for you once or twice a week. Who will do the housekeeping? The light housekeeping and the heavy housekeeping. I have so many seniors. I go into their homes and they’re like, well, I do that. But when you look around the home there are cobwebs is not kept up the way that it needs to be kept up for one’s own health. Who will do the laundry? As we age, we may need a walker. We may have balance problems that comes with aging. That becomes dangerous to carry a laundry basket or to carry a laundry basket up and downstairs. Who’s gonna run those errands to the dry cleaners, to the grocery store? Who’s going to take you to the dentist once you elect not to drive anymore? Who’s going to change those light bulbs that are up high, and who’s going to reach those high shelves?
My husband and I live at home. We right now have two ceiling lights that need to be changed. I really do not like my husband getting on the ladder. I think even over 55 years old, we shouldn’t do that anymore. I bought a new office chair two weeks ago that is slowly making its way up to my upstairs office because we needed assistance in carrying the big box up the stairs. So these are just some things to continue to look at as we are staying at home and we age. I tried to leave plenty of time for questions there. And we want to look at the seminars that are coming up next, but let’s take some questions from the audience or from Roberta who is working with me on this seminar, webinar.
Roberta Goldbaugh (35:48):
I’m checking our questions section and I don’t see any listed. If there, if there are no questions, know that you, if you think of questions later, know, that you can certainly get in touch with your RTD rep and ask them. We will track that and answer for you.
Metta Johnson (36:10):
Well, I can certainly give you some questions that I often have asked of me. Many of the people that come to us as certified aging life care managers are aging children themselves. They’re in their late fifties, early sixties. And they are part of what I call the club sandwich generation, which is even thicker than the sandwich generation. You have your aging parents that are in their late seventies, eighties that need to consider the things that we’ve discussed here today. As we age and I have people call me every day, my mother is 84 and she is great. But our health as we age is very delicately balanced. I like to say it is like a mobile that when you pull one thing out of whack, other things seem to go out as well. So these plans need to be made before that part of the mobile gets sent, where we have other things go out of whack.
Then you have your child in their late fifties, sixties. They are more than likely still working. Most people are working into their seventies now. So they are working. They have children that are in their forties and they, those children or working perhaps, and they have children as well, that are the grandchildren and great-grandchildren. So you have to look at quality of life issues. Do these people in the late fifties and sixties, any time they take off work to take the senior to a doctor’s appointment, which is generally seven or eight times a year, at least. They, that is going cut into their pay days off, their quality of life with their spouse or significant other with their children and with their grandchildren. So those are some things to consider as you as children age. Have we had some other questions come in Roberta?
Roberta Goldbaugh (38:56):
We do have a question and I think this goes back to the, the stay in a skilled nursing facility that is paid for by Medicare. The question is, do you happen to know, Metta, what the average length of stay is at at a skilled nursing facility that actually gets paid? So the first 20 days, and then another 80 days, do you happen to know what the, what the typical.
Metta Johnson (39:22):
Average length of stay for rehab is, is really the question being asked. I, I do not have a hard and fast number on that I can tell you from my years and years of experience in this field, it is generally longer than the 20 days that Medicare pays at a hundred percent. My experience is that it is anywhere from four to six weeks. The plan of care in a skilled nursing facility for rehab itself, there’s skills services. We discussed physical therapy, occupational therapy, and speech therapy. That plan of care is created by the therapist. And generally they plan that for four to six weeks of care. So that would be my estimate that it would be four to six weeks and Medicare would pay for the first 20 days, which is about three weeks and the rest needs to be paid for by your Medicare supplement, which we highly recommend that you have.
Roberta Goldbaugh (40:47):
We have a couple of other questions. Will we provide these PowerPoint to the attendees by email? Yes, we will. And it will also be posted on our website under the blog section. You’ll be able to listen to and watch this entire presentation again. And would you can you provide the name and contact information for the presenter? Yes. her company’s name is at the end of the, at the bottom of each slide, and we will be sure to include all contact information from Metta with all of the, when we, when we email the presentation to all of you. Right.
Metta Johnson (41:26):
And so my name is Mehta Johnson. Metta Johnson and associates. Our website is Metta Johnson, M E T T a J O H N S O n.com. And our phone number is four Oh four, four Oh two six oh two seven. And we would love to talk with any of you. Are there any more questions coming in? I have more questions that I can a gift that I’m often asked.
Roberta Goldbaugh (42:06):
There’s no more questions. Let’s take one more of your questions.
Roberta Goldbaugh (42:09):
Okay. All right. All right. So often ask, gosh, mother is at home. We know she has some dementia. She said that she is perfectly fine. She does not want any help. And so how do we get help for her? How do we get someone like an aging life care manager in there when she doesn’t want anyone? And I say to that, you know, respond in a very caring, loving way. She does think that she is independent and she may be functioning well now. I feel in this country, our, our commitment to independence is our best trait and our Achilles heel. So people stay independent far longer than they really are functionally independent. And I would say, mother, we care about you. We want to feel assured that we are doing whatever is possible to provide for you. What is needed. We all have professionals that work with us. Our accountants, our CPAs, financial advisors. This is just another professional to work with you. So he or she you know, just talk with them. And the assessment is very informal, but professional. And honestly, once we have gone to the door, I never, in our 18 years of being in business, had it closed on us. So that is what I would recommend.
The other question that we get asked a lot is how do I take away the keys? There, again, that gets into our love of our independence. There are a number of ways to address this in my experience with a large family, we have simply simply met with the loved ones and presented our concern and our love for them. And oftentimes if they will give us the keys. If you give them the option of how are they getting to the grocery store, how are they getting their hair done? How are they going to the doctor? How are they seeing their friends? If you can solve that for them in that conversation, they are very open to often to giving the keys up. If not, there are senior driving assessments that are specific for seniors. They’re not just giving them a driving test. They’re giving them a perception test, a functional test. Many seniors cannot even turn their head to see where the traffic is coming in to get the direction. And they, they give them cognitive testing. They write the report, they send it to the doctor that is ordered it. If they don’t find the person competent to drive, the doctor will then send it to the motor vehicle department or the family member will have that report to send that to officially tell the senior that they can no longer drive.
Speaker 2 (46:10):
Well, thank you to Metta and thank to thanks to all of you for participating today, we will provide a recorded copy of today’s presentation to you. Please keep an eye out for the invitations for the remaining two presentations on our aging wealth series and have a good day. Thank you.