Understanding assisted housing, Part II

It takes a lot of money to live in dignity as you get old. But you need even more to do so within the shelter of protected housing.

Nursing home (illustrative) (photo credit: ING IMAGE/ASAP)
Nursing home (illustrative)
(photo credit: ING IMAGE/ASAP)
True story: A 95-year old woman was advised that she should move into a retirement home, also known as protected/assisted housing – diur mugan in Hebrew. She found one that looked promising, walked inside, took a look around, and declared that protected housing wasn’t for her because “everyone here is old.” She then turned on her heels and exited the building.
Aside from the legal definition of protected housing, there is a different way to describe the phenomenon. Kobi Yona, manager of Jerusalem’s Golden Hill assisted living facility (ALF), explains that residents in an assisted living facility have everything they need at their fingertips: physical security, medical care, food, activities, intellectual stimulation, privacy if they want it and social opportunities if they don’t.
But, says Yona, more and more people are waiting until they have reached their 80s before making the move. That’s because these days we live longer and are more independent at a later age than we were even a decade ago – probably because we take better care of ourselves!
This becomes clear to anyone participating in classes like Tai Chi, and even Zumba. When I joined an “osteoporosis prevention” class, I was astonished to find that, at 69, I was 20 years younger than some of the participants – all of whom were still living at home.
One woman I interviewed for this article was 77 and had resided in the same house for more than 40 years.
“As long as I am independent and feel well why would I leave?” she asks. “I exercise at the community center twice a week, and I belong to a group that hears lectures several times a month. My family comes for dinner on Friday nights and on holidays and my grandchildren often sleep over. I don’t plan to move out unless I become disabled.”
There’s the rub. You can’t enter protected housing unless you are completely independent. People who wait until they cannot take care of themselves anymore miss the chance to enjoy the security, comfort and other benefits of assisted living. Others I spoke to, who entered when independent at age 80 or beyond, wished that they had done so earlier, and had additional healthy years in which to take advantage of what an ALF has to offer.
Of course, some people are simply not suited to life in an ALF. Julie Oz, the Social Affairs Ministry’s Supervisor of Older Protected Accommodation, tells of a man in an assisted living facility that grew up on a kibbutz and complained that if he had known protected housing was so similar, he would never have made the move.
In my previous column I talked about some of the reasons for moving into protected housing, such as physical or emotional trauma, loss of a spouse, safety concerns, loneliness – especially after friends have moved away or passed on. Yet there is a lot to think about. Moving to a smaller place – and it will almost always be smaller than where you live now – is a huge step, whether you have decided to downsize to somewhere other than protected housing or move into an ALF. But, as Yona says, do you really need all of those clothes in the back of your cupboard? These days, do you really cook with those pots and pans on your top shelves?
If you are thinking about making the move, are independent and can afford it, what should you look for when checking out different facilities? You may want to begin with considering whatever exists in your neighborhood, so that you can continue frequenting the grocery store, pharmacy and bank to which you are accustomed. However, everyone I talked to agreed that this should not be the deciding factor.
What kind of person are you? Do you like being around people? Would you prefer the relative anonymity of a large facility or the family-like atmosphere of a smaller one? Would you prefer a place in the country or in the city?
When checking out facilities in the area where you want to live, you first need to find out if there is an age limit (many ALF’s have one) and if your current medical situation is acceptable. One very important question concerns a possible deterioration in your health: in such a case, does the facility encourage you to remain there in your home, with help, or do they expect you to move out, into a room or apartment with nursing care. How do they feel about 24-hour caregivers in your home? No less important, are people who have become disabled allowed free access to the entire facility (there are some places that do not – so other residents don’t feel “uncomfortable”).
When you enter the lobby, what kind of feeling do you get? Could it someday become your home? Does the manager greet you, or do you sit down with a marketer? Does the place seem run more like a business – not necessarily a bad thing – or does the residents’ welfare seem to be the main concern? Are the lobby, dining room and restrooms clean? Are the public areas inviting?
When you take a look at apartments, are the hallways cheerful and well-maintained or does everything seem a bit worn? What kind of activities does the facility offer? Take a look at the monthly plan; do the activities interest you? Is there a parking area for your car and for guests?
Staff members almost always speak English. But unless you understand Hebrew, you will not be able to enjoy the lectures the facility offers – unless there are programs in English. Find out how often there are lectures and get-togethers in English!
If the system is a one-time deposit, how much will the facility deduct each year – and for how many years? This varies from place to place. What does the monthly maintenance fee include or not include and how much would it be? Would you be paying more than you would in another facility because you are offered meals you don’t want or a pool when you don’t enjoy swimming?
If you do like to swim or to work out in a gym, find out if the ALF has its own pool and health club or access to these facilities nearby. If you don’t drive, and there is always the possibility that you may stop driving in future, how close are you to a bus or – in Jerusalem – to the light rail? Are there shops and restaurants within walking distance?
What happens on Shabbat? Are there any activities on Friday night and Saturday? Is there any possibility of food on Shabbat? If you are observant, does the ALF have the kashrut certification that is right for you? On Shabbat, will residents playing bridge, listening to music or talking on cell phones etc. in public areas upset you?
How close is the nearest hospital or urgent care facility? Who will be there to help with medical issues, urgent or otherwise? Is there someone to assist with bureaucratic tangles, with repairs, with emergencies?
How many resident committees, and which ones, operate in the facility and what powers or influence do they have? If you have a pet, you need to find out the policy on keeping animals in the facility.
It may be difficult, at first, to make new friends. Do people at the facility reach out to newcomers? Are the people you meet warm and friendly? What do they say about the facility when you are not with someone from management or marketing?
Don’t forget, advises Yona, that while you are checking out an ALF, the facility is also trying to decide if you would be compatible. A place that encourages people to take an active part in activities may find a prospective resident interested only in a place to hang his hat unsuitable. It might also reject someone who is completely anti-social or who feels superior to the “old people” he sees at the facility. Of course, your level of religious observance plays a part as well, he adds. Certain facilities cater more to haredim than others – and vice versa.
When it comes time to sign a contract with an ALF, it is crucial that you go over it first with a lawyer – not just any lawyer, insists Oz, but one who specializes in protected housing. She stresses that even if you get a contract in English and are sure you understand everything – get a lawyer! In fact, she suggests that you look at this as carefully as you would if you were buying a new house. And, she adds, listen to what your lawyer says. People who don’t, or their heirs, end up complaining to Oz about terms in the contract that they don’t like or agree with. All she can say in response is: you – or whoever lived in the house – signed it!
There is a reason why 97% of the population remains at home when it can. After all, says Oz, it takes a lot of money to live in dignity as you get old. But you need even more to do so within the shelter of protected housing.
In a future article I will explore the idea of living at home until the very end – and what your community can offer you when you choose to do so!
Please keep writing to me with issues you would like me to discuss (consumerjpost@gmail.com). However, for consumer problems, please call one of the organizations below:
SHIL (Consumer Advice Bureau) in Jerusalem: (02) 629-7028/ 629-7144 Sunday through Thursday 9 a.m. to 3 p.m. Elsewhere in the country call 1-800-50-60-60 and you will be directed to your area office.
Consumer Protection Authority: (02) 539-6000 Sundays and Wednesdays 10 a.m. to noon.
Public Trust (Emun Hatzibur) (03) 539-6000 Sunday through Thursday 3 p.m. to 5 p.m.