Home Improvement Emphasizing Privacy, Dignity And Independence, Assisted Living Bridges The Gap Between Retirement And Nursing Homes

The names sound like prestigious Eastern prep schools: Waterford, Park Place, The Academy.

The campuses sprawl grandly over large expanses of Inland Northwest real estate.

Inside, however, these new facilities house frail elders, not privileged teens. They are part of this region’s booming assisted living industry, bridging the gap between independent retirement communities and nursing homes.

Like prep schools, they carve out a distinct market: financially secure seniors.

Nationwide, American Demographics magazine estimates this industry is worth between $13 billion and $15 billion and likely to grow to $20 billion by the year 2020. In the Inland Northwest, more than two dozen assisted living facilities compete for the older population’s best customers.

“These are businesses,” says Dick Dauphin of Washington’s Home and Community Services office in Spokane. “You try to have as high functioning a population as you can and charge them as high a rate as you can. That’s the nature of capitalism.”

Inside the doors of these complexes, that entrepreneurial zeal often pays off for residents and their families.

Many residents say assisted living facilities provide privacy, dignity and independence - a happy alternative to life in a nursing home.

“The assisted living movement has swept this region,” says 73-year-old Lois J. Roach, a former community college speech instructor. “I feel so lucky, so fortunate, to be able to take advantage of that.”

Roach moved into Mission Ridge, a Spokane Valley assisted living center, because she has post-polio syndrome and no longer wanted to cook, shop for groceries or maintain her house. She knows assistance will be available when she needs it, and she hopes she never has to go to a nursing home.

Nursing homes originally were designed much like hospitals, with shared rooms, little privacy and an institutional philosophy that emphasized people’s disabilities rather than their social, emotional or spiritual needs.

Nursing home care costs an average of $3,376 per month, according to a Merrill Lynch report.

Assisted living facilities usually house residents in private studio apartments for an average monthly cost of $2,159. They offer more care than a retirement center, along with lots of social activities and personalized attention, which makes them well-suited for people who are still mentally active but physically declining.

According to Victor Regnier, a University of Southern California architecture and gerontology professor, the typical assisted living resident is a widow in her mid-80s.

Residents usually fall into one of two categories: The first includes those who are mentally alert but physically frail, with a disease such as arthritis, high blood pressure or diabetes. These residents typically need help with bathing, going to the bathroom, grooming, walking or eating.

They may need help remembering to take their medications, but they don’t need 24-hour nursing care.

The second category includes residents who are physically sound but suffering dementia or the early stages of Alzheimer’s disease, a progressive neurological disorder.

Assisted living residents have an average annual income of $28,000 and average financial assets of $192,000, according to a report from Coopers & Lybrand and the Assisted Living Federation of America.

Residents stay an average of 2-1/2 years, usually until they enter a hospital or nursing home for a higher level of care. Others die, move elsewhere or leave because they’ve run out of money.

An assisted living facility may be a wing of a retirement center, continuing care center or nursing home, or it may be free-standing. Residents bring their own furniture, stash their favorite treats in a small refrigerator, and sometimes even keep dogs or cats - as does Mission Ridge’s Velma McKibbin, 81, who lives with her toy poodle, Schotsie.

At most centers, residents can participate in a whirl of social activities: birthday parties, wine and cheese gatherings, exercise classes, day trips and chocolate-chip cookie baking sessions.

The happiest residents are those who feel they made the choice to move into assisted living themselves.

Eighty-year-old LaVerne Pettis lives at The Academy on Spokane’s North Side. She has a bright room overlooking Mission Park and is surrounded by Oriental furniture from her former South Hill home.

“The reason I live here is I need help,” Pettis says. “I’ve got a little Alzheimer’s and I forget things.”

On a day when Pettis forgets how to turn off the bath water, or raise the heat, she pulls a cord that hangs beside her bed for help.

Pettis likes The Academy’s chicken salads and homey, stylish atmosphere.

“This assisted living was perfect for me,” she says. “It suits me. It’s just right.”

On Spokane’s South Hill stands the Waterford, a huge complex that a competitor calls “The Love Boat.”

With its luxurious, multiwindowed design, this facility serving 241 residents does resemble a cruise liner. Here a manager in a navy blue suit, handsome as a ship’s captain, oversees the assisted living area.

In late August, 49 people lived in the complex’s assisted living rooms. Another 136 lived in the Waterford’s independent apartments and cottages, 21 in a locked Alzheimer’s unit, and 35 on a skilled nursing floor that resembles an upscale hospital wing. There were 45 rooms available.

At the Waterford, monthly assisted living costs range from $1,775 for a single studio apartment to $4,475 per month for the largest two-bedroom unit for a couple. Entrance fees, also based on room size, range from $5,200 to $18,000.

Visitors check in at the front desk. Overnight guests may sleep in quarters replicating hotel rooms, right down to the mint on the pillow.

Across town, near Gonzaga University, is The Academy. Located in the red-brick Holy Names Academy building, the main retirement community has the ambience of a hushed, European-style hotel. It has 75 rooms and is no longer affiliated with the Roman Catholic Church.

The Academy’s assisted living wing, the Catholic high school’s former music department, looks a bit plainer. It has a more institutional dining room, but 24 roomy apartments, and hallways lined with sofas, fish tanks and cages of tropical birds. Residents pay $1,998 per month, with no entrance fee.

The activities director lines up “pamper parties,” which feature neck rubs and manicures for each resident. There’s talk of adding a side-loading Jacuzzi.

“Our rule of thumb is, when you get to this point in life, you get anything you want,” says Charles Yeaton, administrator at The Academy. Here, every room is full.

In the Spokane Valley, Mission Ridge is more than half filled. It opened in June 1996. Monthly rent ranges from $1,650 to $1,950, with a $300 security deposit. A stroll through the 60-unit building feels like a home show tour, with a new construction smell and whimsically furnished model apartments.

In a room made up for a fictitious older woman, a box of pansy stationery spills out on the bed, and flowered slippers lie on the sand-colored carpet.

After a full day of touring these centers, a visitor begins to drown in visions of floral upholstery, golden chandeliers and two stylish shades of assisted living green: seafoam and spruce. They’re everywhere.

These complexes manage to blend the hospitality, health-care and construction industries. They feature trendy living spaces familiar to baby boomers: great rooms with high ceilings and fireplaces, intimate living rooms with overstuffed sofas, and small private dining rooms with cherrywood tables and silk flower arrangements.

Ralph Allen, a former Spokane nursing home administrator who now works in Hemet, Calif., explains that marketing-minded developers design these buildings not so much to attract potential residents but rather their guilt-laden children.

“I’m going to put in very nice foyer areas and very nice main living rooms,” he says. “I’m going to have it set up so when you come through, you’ll feel, ‘This is a nice, classy place.”’

Ten years ago, nursing homes were often depressing, institutional and outrageously expensive. They were also the only show in town.

Back then, says Ralph Smith, assistant secretary for Washington state’s Aging and Adult Services Administration, “There were just not many options.”

As Washington’s state agencies and its Legislature watched the costs of nursing home care mount in the 1980s, public policy began to shift.

Medicaid dollars, the federal funds that states tap to care for the elderly poor, were freed up. In-home services, such as those offered by visiting nurses and housekeepers, emerged. Adult family homes, with a maximum of six residents, grew.

At the same time, private industry began to copy Dutch and Scandinavian methods of elder care and named it “assisted living.” Developers started building luxurious complexes for middle- and upper-income seniors. Some of them applied for Medicaid contracts.

In Spokane, eight assisted living centers take Medicaid clients. In Coeur d’Alene, none do. So far Idaho won’t use Medicaid funds to pay for assisted living, partly because the definition of such care is so broad.

To qualify for Medicaid, a person generally is restricted to assets of no more than $2,000 and monthly income under $1,452.

Since 1993, Smith says, the number of Washington residents living in nursing homes has declined dramatically. The Medicaid caseload in nursing homes has dropped from a high of 17,700 in January 1993 to an expected 14,600 by the end of June this year.

“That’s the lowest we will have been in 20 years,” Smith said.

Judith Ross, the community education coordinator for Aging & Long Term Care of Eastern Washington, hopes to see the assisted living industry shift to serve those with lower incomes.

“I’d like to see these in the $1,000 (per month) range,” Ross says. “I don’t understand why they’re so expensive, to be quite honest.”

So many developers and corporations have rushed into the Inland Northwest market that insiders say the assisted living industry already is overbuilt.

According to a recent survey, 609 new assisted living apartments have been completed in Spokane during the last five years, bringing the total to 755. In late August, 113 were vacant. In North Idaho, an estimated 200 new assisted living beds have been added in the past three years, and half are empty.

“It’s gotten out of hand lately,” says Rick Colliton, chief operating officer of S.L. Start & Associates, which develops and manages retirement communities. Colliton’s company formerly managed Park Place, a Spokane Valley facility, which was recently sold.

“In our opinion, the market is oversaturated in Spokane, especially in the Valley,” Colliton says.

This new industry, fueled by money, politics and demographics, has that can’t-miss aura American entrepreneurs love most.

In Eastern Washington, the population of people age 85 and older is expected to grow by 49 percent between 1980 and 2005.

Kootenai County’s senior population - those 60 and over - grew 28 percent during the first half of the decade, faster than any other segment of the population. The group of people age 85 and older grew the fastest; that trend is expected to continue until 2006.

Nationally, the federal government estimates that, by 2000, almost 9 million older Americans will need long-term care, up from almost 7 million in 1988. Further out, the prospects look even better. The aging of the baby boom generation could make assisted living complexes as ubiquitous as 1950s ranchers.

Spokane rates for assisted living range from $800 to nearly $4,000 per month. Idaho’s range from $1,200 to $2,900 per month.

Most Spokane facilities simply charge rent; others also charge entrance fees as high as $18,000; and still others require residents to buy their rooms, at prices ranging from $20,000 to $150,000, a portion of which may be later refunded to the residents or their estates.

Prices, contracts and types of care vary widely. This complex, evolving new industry manages to confound the older people who decide to move and the younger relatives who help them shop.

“I equate it to buying a submarine,” says Yeaton, The Academy’s administrator. “I wouldn’t know what questions to ask and what to equate it to.”

Last fall 50-year-old Judi Flisakowski moved her father, James Haensly, into a Spokane Valley center. Haensly is a 76-year-old retired machinist with early symptoms of dementia.

She soon realized his $2,500-per-month unit wasn’t working out. The elevators confused him. Staff members called Flisakowski: Her father had been caught smoking in the bathroom. They confiscated his cigarette lighter.

With the help of consultants from Care Management Resources, she found Colonial Court in the Spokane Valley, where the service for clients with Alzheimer’s disease more closely matched her dad’s needs.

“I had a window of opportunity with my dad, and I kind of rushed into it,” Flisakowski says. “I should have gotten a little more information.”

Mary Metcalfe pauses before a slice of lemon chiffon pie at lunch to describe the Waterford’s assisted living facility.

“It’s a very beautiful place, and it’s kept so well,” she says with a delighted smile. “It’s like home. Everyone is so friendly and dear and nice.”

Metcalfe, 86, appears to possess a perpetually cheerful temperament. It resurfaced, she says, only after she began receiving excellent care at the Waterford.

“I couldn’t do anything when I came here,” she says. “I couldn’t get out of bed, and I was terribly depressed.”

For a time, Kemp Slaughter found life at the Waterford disheartening. He and his wife moved into an independent apartment after doctors discovered a blood clot in his wife’s leg and their children urged them to move to Spokane.

Slaughter, 84, is the former owner of Acme Machine Works in Spokane. He misses his waterfront home in Sandpoint, his pets and his freedom.

“I’d much rather be up there,” he says. “But after you sell your house … you’ve got no place to go back to.”

Slaughter completes an aerobics workout three times a week at Gold’s Gym. In the main Waterford complex, he disliked running into so many sick people in wheelchairs and walkers in the hallways. Recently, he and his wife moved into one of the Waterford’s separate cottages for more privacy and independence.

There are no guarantees that a move into seniors housing will be positive.

Consumers face confusing contracts, loose regulations and few avenues for resolving disputes. They may not receive the care they need; they may be asked to leave when their conditions worsen; they may simply dislike their new lifestyle.

As Ross Boreson, president of the Senior Legislative Coalition of Eastern Washington, says, “They become a captive customer.”

Older people may lack the physical or emotional stamina to fight back when problems arise. They also represent a more gracious era.

“We were brought up to be polite and not be nasty to people,” Boreson says.

Observers of retirement-complex living notice intriguing social dynamics. Healthier residents may resent seeing daily reminders of their own aging process and vote to ban wheelchairs, walkers or other assistive devices from common dining rooms or pool areas.

Others find that friendships that formed easily in an independent wing of a facility may become strained when one member moves into an assisted living area. Healthier friends may not want to cross the complex to visit.

The immediate concern for most consumers, however, is ensuring they’ll receive the care they need.

In Washington, assisted living centers are inspected annually by the Department of Health and receive a boarding home license with regulations less stringent than those of a nursing home’s license.

Idaho’s inspection process is similarly state-run. Facilities are licensed for residential care and regulated with a lighter hand than nursing homes.

Assisted living is not a state-regulated term. It can mean anything.

“If you’re lucky enough to have a daughter, and it almost always is a daughter, who comes in (to your home) and gives you a bath twice a week, you can call that assisted living,” says Ray Raschko, director of Spokane’s Elder Services.

While some centers advertise continuing care, with increasing levels of assistance, many consumers shop only for the help they need today.

A more proactive approach makes sense.

Raschko estimates that approximately half of the population over 80 winds up displaying symptoms of Alzheimer’s disease.

“Who of us really believes this is going to happen to us?” Raschko says. “We live in constant denial.”

Raschko advises consumers to check on staff training, an easily overlooked component.

“I think we all get seduced by how it looks, and some of these places look wonderful,” Raschko says. “The best-looking facility could hire an entire staff that knows nothing about Alzheimer’s, for example.”

Seniors worry most about outliving their resources.

Middle-class retirees typically set aside $60,000 to $100,000 in savings, supplemented by Social Security and retirement benefits, Raschko says.

Some experts recommend consumers choose private facilities that also accept Medicaid. That way, if residents run out of money, they won’t have to move.

Ed Gonyou, a 93-year-old resident of The Academy and the retired owner of Power Loan in Spokane, reads The Journal of Business regularly and keeps a sharp eye on the assisted living industry. Its rapid growth leaves him shaking his head.

“They’re investing millions of dollars in the things,” he says. “I think they’re overdoing it. … They’ll start cutting prices, and that will break them up in business. They’ll quit paying their bills.

“They’re pricing the old people out of the business now.”

Industry insiders say Gonyou may be right.

“This isn’t the field of dreams,” says Yeaton. “If you build it, they’re not going to come.”

Few predict price wars, however. In this industry, consumers appear more influenced by strong word-of-mouth and excellent service.

“For me,” Colliton says, “the acid test is, are you going to place your mom in a dump with a rotten reputation for $100 less a month?”

The best places have waiting lists, Colliton says.

“You can go around, and the really high-end providers will be full. The shaky ones won’t, and they can be right across the street from one another.”

High vacancies can be a warning sign.

“Some of these homes are going to be really troubled, and they’re going to be sold for discounts,” Colliton says. “It’s pretty tough to operate at the vacancy levels they’ve got.”

Still, two more assisted living facilities opened this spring.

Dr. Robert Shanewise, an orthopedic surgeon who couldn’t face a retirement filled with nothing but golf, runs Moran Vista with his family. It’s a 50-unit complex on the South Hill.

Heidi and Dave Bozett opened Fairview Assisted Living, licensed for 40 residents, near the Spokane Arena in June.

Both centers include Alzheimer’s units.

Next on the horizon are more choices for low-income seniors and residents with Alzheimer’s.

Harry A. Green, who developed The Academy, plans to build a 418-unit community called Clare House on the Palouse Highway south of ShopKo. It will be aimed at low- to moderate-income residents and will include 120 assisted living units and 48 Alzheimer’s units.

Two North Side centers - Aspen Meadows and Leisure Care - are also in the planning stages. They’ll include a mix of independent and assisted living apartments.

Construction in Kootenai County has stopped for now, which is a relief to Bill DePew, the associate ombudsman for Aging and Adult Services’ North Idaho office.

Throughout most of history, older people have lived and died at home.

Allen, the former Spokane nursing home administrator, thinks long-term institutional care has been American society’s grand experiment.

Assisted living, he believes, appears to be a good phase in this experiment.

“We don’t know how to take care of an aging population,” Allen says. “Nobody has ever told us how this is going to work.”

Colliton believes too many developers leaped into assisted living too early. It is inevitable that over the next 50 years the market will be huge.

But baby boomers won’t start turning 85 until 2030.

“The wave,” Colliton says, “is still 100 miles off shore. What you see now is only the beginning.”

, DataTimes ILLUSTRATION: 10 Color Photos; 2 Graphics: Spokane’s aging residents; Resident profiles

MEMO: These 3 sidebars appeared with the story:

1. WISH LIST Staff writers Susan English and Paul Turner asked some area seniors what services and amenities they would like in an assisted living setting. Here is their list: Good food (many mentioned buffet style with plenty of salads, fruits and healthy foods) Pool tables Massage therapist on-site Ongoing classes, from art to languages Book groups An organized social activity each evening A gathering place for social interaction A craft room Flowers but no elaborate landscaping Regular transportation to grocery stores, doctors and community events Transportation to a variety of churches Day trips in the area A security system Maid service Exercise classes A weight room A restaurant on-site, so residents can order meals at various times rather than being served at one specific time Amenities that people can use rather than ones that are just pretty A person who can help with various financial aspects of life A swimming pool A hot whirlpool or Jacuzzi

2. CHECKLIST When you buy a house, a reputable home inspector typically provides a worksheet with must-ask questions. If you’re shopping for an assisted living community, a similar kind of checklist is equally handy. After all, “The most obvious questions are the ones that go overlooked,” says Virginia Schomp, author of “The Aging Parent Handbook.” Once you have all the information you need, reviewing it with an adviser - even an attorney - is a good idea. But to start the process, here is a general list of things you need to know:

What are your most important concerns? Location? Price? Social structure? Range of care offered? Security? Comfort? Is the community licensed by the state? If so, are such facilities inspected regularly? What qualifications does the on-site staff possess? What training have staff members undergone? How often is training upgraded? Is an on-site manager available 24 hours a day? What social activities does the community regularly schedule? Which, if any, of these activities include family members (especially children and grandchildren) and other visitors? What restrictions are placed on visitors? How flexible is the dining schedule? What is the quality (and quantity) of the food served? What special provisions are made for special diets? Is courtesy transportation provided? If so, is it just for necessary functions (doctors’ appointments, shopping) or for fun activities, too? Does it run on a regular basis? What is the schedule? Does such transportation cost extra? How much? How disability-friendly is the community? For example, can someone using a wheelchair enjoy full use of the facilities? Is there a physician’s office or other health-care facility on the premises or nearby? Does the community have a convenience/sundry store? Does it offer a business center, with computers, copiers and fax machines? Does it cost extra? How much? Are pets allowed? If so, what kinds? Are there extra costs, such as cleaning deposits? Does the overall community feel comfortable and inviting? Does it provide 24-hour security? Is the security system accessible from each living unit? Is the community itself in a safe neighborhood? How does the facility provide for each individual’s need for privacy? Is there extra storage space? Does that cost extra? Are the heating and air conditioning systems individually controlled? Does the community provide a contract that specifically outlines each available service? Are there any hidden charges for laundry service, housekeeping, utilities, telephone or cable TV service, parking privileges? What guidelines does the community use for resolving disputes? If disputes can’t be worked out, can the resident leave without financial penalty? How does the community assess the level of daily care needed by potential residents? Can residents remain in the community if their care-giving needs increase? If not, can they transfer to a special unit, or do they have to leave? In case the resident does leave, is any of the initial fee refundable? If so, is that refund based on a set percentage or on a sliding scale that diminishes with each year of residence? Does the same apply when, or if, the resident dies? What is the full cost? Does the community contract with the state to accept residents who depend on Medicaid? If the resident runs out of money, will he or she be forced to leave? Compiled by Dan Webster

3. RESOURCES Housing options Considering a move? Gail Goeller of Mature Matters and Judith Ross of Aging & Long Term Care of Eastern Washington will present an educational program on the topic at the South Hill Senior Center Sept. 30. The free session, which starts at 12:30 p.m., will examine housing options such as retirement communities, assisted living and adapting one’s present home for changing needs. The program follows a noon lunch. To make reservations for the $3 lunch, call the senior center at 535-0803. It’s located at 2727 S. Mount Vernon. The Eastern Washington Long-Term Care Ombudsman, at the Spokane Neighborhood Action Program (SNAP), serves as a problem-solving agency for people who are having a disagreement with an assisted living facility. Call 456-7133. The Eastern Washington Chapter of the Alzheimer’s Association can help find placement for people with Alzheimer’s disease. Call them at 483-8456. Aging & Long Term Care of Eastern Washington: 458-2509 The Washington state Insurance Commissioner’s Office: (800) 562-6900 The Washington state Department of Health’s complaint hotline is 1-800-526-6297. The Department of Social and Health Services can be reached at 323-9400. Ken Wortley can help adult children in their search for alternative living places for their parents in the 300 Spokane-area homes that are not nursing homes and are less expensive than other alternatives. Wortley, who works with Adult Family Homes’ Sponsor Association and Referral Services, can be reached at 448-8019 or 328-5515. In Idaho, questions or concerns about assisted living facilities can be directed to the Department of Health and Welfare, (208) 334-6626.

Books A sample of related books in Spokane Public Library’s downtown branch: “American Guidance for Seniors and Their Caregivers - An Indispensable Guide to Social Security, Medicare and Other Vital Benefits, Services and Financial Assistance for Senior Americans,” by Ken Skala. “Mama Can’t Remember Anymore - Care Management of Elders and Their Families,” by Nancy Wexler, M.A., MFCC, with Wesley J. Smith, author of “The Senior Citizens Handbook.” “Care Giving - When Someone You Love Grows Old,” by John Gillies. “Helping Your Aging Parents - A Practical Guide for Adult Children,” by James Halpern, Ph.D. “How to Care for Your Parents - A Handbook for Adult Children,” by Norma Jean Levin.

Magazines Answers - This Birmingham, Ala.-based, bimonthly periodical carries the subtitle “The Magazine for Adult Children of Aging Parents.” A typical issue covers such topics as health insurance, legal affairs, nutrition, emotional difficulties. For a one-year subscription, send $21.95 to Answers, P.O. Box 9889, Birmingham, AL 35220-0889.

On the Web Perhaps the most up-to-date source of elder-care information, the Internet is a prime research tool. Here are three sites that are comprehensive, current and easy to use: AARP Webplace (www.aarp.org) - The official Web site of the American Association of Retired Persons offers a full range of resource sites with information about family, health, work, money, legal and consumer issues, and housing. Of particular value is the Guide to Retirement Living, which can help you in “navigating the senior and caregiver service network.” ElderConnect (www.elderconnect.com) - This database provides information on more than 33,000 retirement communities and elder-care service providers. Set up on a state-by-state basis, the directory is particularly useful because it has names, addresses and brief descriptions for all assisted-living communities in Spokane and Kootenai counties. SeniorCom (www.senior.com) - Set up as an easily accessible site for the computer-challenged, SeniorCom offers a communitylike “town square” pathway to resources concerning health and fitness, travel, volunteer opportunities and chat rooms, as well as a search operation designed to list community care centers.