Understanding assisted housing, Part I

Many who opt for assisted living facilities note that they didn’t want to ‘bother’ their children ‘with every little thing; They are busy, and have their own lives to lead.’

Retirement home (illustrative) (photo credit: INGIMAGE)
Retirement home (illustrative)
(photo credit: INGIMAGE)
Protected/assisted housing (diur mugan) is defined, as per the 2012 Protected Housing Law, as a group of apartments where residents (a single or with a life partner) of at least 60 years of age lead independent lives and pay for services over and above maintenance, cleaning or guards.
Sarit and her husband Gil, a couple in their early 80s, lived alone. For years, their children begged them to move into an assisted living facility. “I panic every time the phone rings,” their son told them. “I expect to hear that you have fallen, had a stroke, or worse.”
Finally, they agreed and moved. Soon afterward, Gil lunched with friends and returned to his apartment with a paralyzed mouth. Sarit took one look and called the reception desk. Lily, a medical student in her sixth year and on call for Shabbat, arrived in less than a minute.
Her first question after making sure that Gil’s heart and blood pressure were normal was: “What did you eat today?” When it turned out that Gil had tasted hot peppers for the very first time, Lily calmed the couple, returning to check up on Gil every hour until he was back to his old self.
“If we had been alone,” reported Sarit, “I would have had to take him to the hospital, or to urgent care. I am so grateful we were here!” After interviewing several dozen older people currently residing in different ALFs, I learned that their reasons for moving into them were vastly varied.
There was one couple in which the husband had a heart condition. He was afraid of leaving his wife on her own if he died and wanted her to be in a protected setting should that happen – and it did.
One woman, completely independent for years, fell while alone in her home.
The trauma motivated her to move into an ALF. In other cases, people were no longer able to climb the stairs in and outside their home; instead of moving to more accessible apartments they decided to enter an ALF.
In another case, friends dragged a widow to every ALF in the city until she found one she liked: she had barely left her house since her husband died six years previously and they believed she needed to be around other people.
Quite a few found that they wanted to have somewhere to go and something to do every day, and have it right at their fingertips. Others had become lonelier and lonelier as neighbors left to be closer to their children – and friends died.
All found their ALFs to be advantageous, offering both complete privacy and the option to talk to people when they felt like company or to wanted participate in activities.
There were people who wanted a place where they could feel safe from the outside world, and where there would always be someone near to call on for help. And almost everyone stressed that they didn’t want to “bother” their children “with every little thing. They are busy, and have their own lives to lead.”
While researching the subject of ALFs, I was astonished to discover how few older people lived in protected housing.
According to Julie Oz, the Social Affairs Ministry’s supervisor of older protected accommodation, there are only 90 ALFs in Israel, housing 15,000 people. Only 3% of the older population resides in an ALF.
One reason became clear during an interview with Kobi Yona, manager of the Golden Hill ALF in Jerusalem and blessed with decades of experience in the field. (Full disclosure – Golden Hill is where my parents spent the last 10 years of their lives.) When thinking about making the move into protected housing, states Yona, the first factor to consider is financial: It is far more expensive to live in protected housing than to reside at home, even with a caregiver. You have to think about the possibility that you will live for a very long time, and to calculate what this would mean to your resources.
Health is the second important factor to consider, he notes, for ALF’s are meant only for people who can run their households independently when they first make the move. Many an older person waits too long to apply for housing in an ALF, and when he does, he needs someone to assist him. By that time, it is too late.
Julie Oz explains that the Protected Housing Law, pushed through by the Residents’ Association, was born out of a need to safeguard the deposits residents handed over to the ALF when they moved in. Although today there are other systems of payment as well, until very recently you paid a very large deposit (sometimes millions of shekels) and the money remained with the ALF until you left or died. Each year the ALF withdrew a certain percentage of the deposit, and you or your heirs received only the remainder.
Unfortunately, says Oz, a system of protection for that money has yet to be perfected. But the law is important in itself, as it sets down standards that each ALF has to follow. For instance, the law requires ALFs to allow people to remain in their apartments, with specific exceptions, even after they are no longer independent. In another section, the law states that ALFs must offer a trial period during which the potential resident or the housing facility can change their mind.
Each ALF must offer at least three cultural activities each day. It is required to make contact daily with residents.
And – very importantly – well before you ever sign a contract, the ALF has to hand over a disclosure document detailing the services it offers, giving you the names of the ALF’s owner and manager, telling you who owns the land on which the ALF stands, describing the building and its public areas, stating the size of the apartment, laying out the payments you will be making and what they include, discussing parking spots, explaining conditions for acceptance into the ALF and more.
Oz notes that the document should at least contain answers to any question you would ask if you were purchasing a new apartment and that it must be valid for a minimum of 30 days. You need to gather all the facts necessary for a long-term commitment for, says Oz, no one knows how long he/she will live. At the moment, each ALF produces its own document; Oz promises that soon a standard document will allow potential residents to easily compare facilities.
The law also demands that the facilities be overseen and provides for that supervision. Oz is an accessible address for problems with an ALF, and there are area supervisors ascertaining that every ALF conforms to the law.
Different facilities have different systems of payment, states Yona. The most common are the one-time deposit that remains with the ALF until you no longer live in the facility, monthly rentals, or an entrance fee of several hundreds of thousands of shekels spread out over a few years – money which is not returned.
In most cases, and no matter the system, residents do not own their new homes. The apartments are not theirs to sell and they revert to the ALF once the resident no longer lives there. In all cases residents pay a monthly maintenance fee for the services they receive.
Under the monthly rent system, your maintenance fee includes your rent, and is – obviously – much higher than that of the resident who paid a one-time deposit which is eaten away each year. Golden Hill is unusual, at least in Jerusalem, for being the first to use the monthly rental system and the only one I know of who uses it exclusively; most other facilities offer this option only on specific apartments.
Assuming you can afford it, are you a person who will get the most out of protected housing – and if so, what is the right time to make the move? If you are thinking about it and decide to investigate, what questions should you ask each facility? What should you be looking for on your visits? For the answers and some extra tips, check out the follow- up column: Part 2 on protected/ assisted housing.
Note: Please continue to send letters with comments and general issues that you would me like to address in this column (consumerjpost@gmail.com).
However, for specific consumer problems please contact one of the numbers: 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 12 noon
Public Trust (emun hatzibur): (02) 539-6000 Sunday through Thursday 3 to 5 p.m.