Looking for the Perfect Retirement Community

Most people don’t think about finances and other details. Make sure to do your research and ask the most important questions.

Most people don’t think about finances and other details. Make sure to do your research and ask the most important questions.

When Peter and Laurie Olsen decided, in their early 80s, that it was time to give up the burden of taking care of their home and yard—shoveling snow, mowing the lawn, cleaning out gutters—they found a retirement community that seemed perfect. Their large apartment overlooked a lake, the complex had a beautiful swimming pool, the dining hall was elegant and the people were friendly.

There was just one issue that they didn’t consider: that as they got older, they would need more medical care. Beyond the two doctors that visited once a week, their perfect retirement community provided nothing in terms of long-term care options such as a nursing care unit. After Peter was diagnosed with Alzheimer’s, they had to move, in their late 80s, into a Continuing Care Retirement Center (CCRC). “Life plan community” is another and more recent name for this kind of care.

CCRCs are becoming increasingly popular, especially with older seniors, because they provide different levels of care at different stages of your life without having to move to a different facility. Generally, CCRCs include units for independent living, assisted living, nursing care and memory care. Newer models have one type of apartment and bring in “assisted services” as clients need different levels of care, thus allowing them to age in place. Different levels of care also help couples, because it is likely one will need more care at some point, so spouses can remain in the same community, if not under the same roof.

Planning Ahead

Many seniors can’t imagine or don’t want to plan for failing health or injuries in their later years, but experts warn that people need to be prepared. Having to uproot yourself when you’re older, after a serious diagnosis or injury, is not as easy as when you’re younger. Finding the right CCRC takes time. It’s a complicated process involving a spectrum of issues: What community is best for you (or your parents)? What kind of medical care does it provide? How financially stable is it?

Perhaps because CCRCs are designed to meet different levels of care, they can be expensive. Typically, they require an entrance fee as well as monthly charges. Entrance fees can range from $100,000 to $1 million, and monthly charges can range from $3,000 to $5,000, according to AARP, and these costs can increase as residents’ needs change. However, some CCRCs are more affordable, and many are beginning to offer rental contracts with no entrance fees. Financial experts say to prepare for yearly fee increases, at minimum of around 4 percent.

Financial Issues

Many CCRCs lure prospective clients with their expensive appearances and impressive amenities: beautiful landscaping with ponds, chandeliers in the entryway and a fireplace in the community area, for example, plus activities that include field trips, movie nights and musical entertainment. But beyond the visuals and all the activities are serious issues that need to be checked.

One major concern is the company’s financial viability. Although infrequent, CCRCs, or the companies that manage them, can have financial difficulties, or even go bankrupt, and residents may never see their entrance fees again. Experts recommend due diligence before parting with your money and signing a contract.

• Review the company’s annual financial report and look for potential problems such as expenses greater than operating income, liabilities that exceed assets or occupancy rates below 85 percent.
• Check the facility’s licensing survey, which indicates how state regulators assess compliance with licensing requirements and complaint investigations.
• Ask how long the CCRC has been in business.
• Find out the number of fee increases over the years.
• If the CCRC is for-profit and could be sold at some point, ask how that would affect a resident’s contract.
• Determine the CCRC’s policy for refunds if you leave.

Because the skilled nursing unit is regulated by Medicare, use the website Medicare.gov to find ratings.

Before you sign any contract, have a lawyer or financial adviser review it, and talk to yourCertified Senior Advisor. For more suggested questions to ask the CCRC, see sidebar.

Different Kinds of Contracts

Once you decide on a CCRC, a big decision is the kind of payment plan. CCRCs have three basic contract and payment-plan options, although others may be available.

Additional Questions to Ask

Care Patrol, a free senior housing placement service that helps families find independent living, assisted living, memory care and in-home care options, offers its own checklist of questions to ask when assessing CCRCs. Here are a few questions from its list.

• Does the community require an application fee? Is it refundable?
• Does the community require a fee upon move in or move out? Is it refundable?
• What is included in the basic monthly fee?
• Are rates based on an all-inclusive level of care?
• Are rates based on fee for service?
• What are other fees for other services?
• Are advanced payments returned if the resident leaves the residence?
• Does the community accept Medicaid payment without additional contribution from an outside source/family member?

Life care or extended contract: The most expensive option, this gives unlimited assisted living, medical treatment and skilled nursing care without additional charges, and with little or no increase in the monthly maintenance fee.

Modified contract: For a lower fee, this contract offers a set of limited services provided for a set length of time. If you need more services, you pay a higher monthly fee that will still be below the average cost of a stay in other skilled nursing facilities in the area.

Fee-for-service contract: You pay for all healthcare costs separately, after paying either no fee or a low fee. Although initially the least expensive contract, costs can add up for those who have a lot of healthcare issues.

What About Medicaid?

No matter how good your finances are now, you may want to prepare for a time when you can no longer pay for your care and need to use government-funded Medicaid. Many people have been forced to move out of their CCRC (or move a spouse or parent) to a place that accepts Medicaid clients.

You’ll want to find out if the CCRC you’ve chosen will accept Medicaid. Many CCRCs limit the number of Medicaid clients because Medicaid pays less than most CCRCs can charge residents. Some CCRCs agree to accept Medicaid down the line if you can show you have enough funds to live in the community for a set amount of time. Also, different states have different requirements. For example, Ohio and Nevada offer Medicaid for assisted living, but Kentucky does not.

Lack of Oversight

One of the big problems when choosing a CCRC is the lack of independent information. While Medicare oversees nursing homes, states are responsible for managing CCRCs and licensing their assisted living components. Only 38 states regulate CCRCs through divisions such as insurance, financial services, aging or elder services, or social services. Twelve states have no regulation, and some only require CCRCs to submit paperwork.

To further complicate the matter, most states don’t make it easy to find the agency in charge of CCRCs, or don’t post inspection records online. To locate your state’s oversight agency, search online for “(the name of your state) CCRC licensing.” Better yet, contact your local Area Agency on Aging.

One state, Washington, just passed a bill that should increase CCRCs’ transparency and oversight. The bill becomes a law on July 1, 2017.

Where to Get Help

Currently, the only independent organization that analyzes and accredits the entire operation of a CCRC, including financial management and healthcare, is the nonprofit accreditation commission CARF International. But the CCRC must initiate the process of getting CARF-CCAC accreditation and go through a lengthy process that requires renewal every five years, so not many places opt to do so. CARF also provides a consumer guide about CCRCs.

Many people turn for help to senior living placement services such as A Place for Mom or Care Patrol. These services, which generally don’t charge for their assistance in helping you find the right community, have their own inventory and grading of CCRCs.

The website MyLifeSite offers a database of information about each CCRC, including contract details. It’s free for basic information, but $35 and up for more exhaustive information.

Helping Your Child Buy a Home

Make sure you don’t jeopardize your own retirement, experts warn, and be aware of all the options for gifting or loaning.

Make sure you don’t jeopardize your own retirement, experts warn, and be aware of all the options for gifting or loaning.

You watch as your adult child struggles to make a living. He’s paying a lot of money to rent what seems like a crummy apartment but can’t afford more because of his big student loan debt. His career is promising, but he’s still on the bottom rung of the corporate ladder. When he marries, he and his wife start looking for a home in which to raise a family, but housing prices are high. You want to help, especially while mortgage rates are low, but is it a good idea, and what are your options for lending a financial hand?

Financial experts say to first consider whether you can afford to help. That is, do you have enough for your retirement, or will giving or loaning your child the down payment on a house delay your own retirement plans? While your children will have time to accrue money over their lifetimes, whether with their investments, jobs or home equity, you don’t have the luxury of time. Studies show that parents 65 and older who financially support their kids are much less likely to be retired than those who don’t.

Before making a decision, talk to your financial adviser about whether you can afford to make a sizeable gift to your children. Also, either gifting or loaning money for a house can have serious tax consequences. Your Certified Senior Advisor can also provide advice. Before you decide to help your son or daughter, make sure you are aware of all the different options for doing so.

As a Gift

The easiest way to help is to give money as a gift, usually in the form of paying for the mortgage deposit (usually 20 percent of the home price) or closing expenses. But whether this is the best route depends on several factors. Experts talk about the responsibility aspect. Has your child asked you for money every time a problem came up in their life? Or is she someone who has worked hard and taken responsibility for herself, but just needs a boost to get to the next stage of life? Giving money to someone who has been irresponsible most of their life may only contribute to that pattern and won’t help either of you in the long run.

Make Sure to Protect Yourself

Mortgageloan.com suggests a few basic rules for parents to follow when helping their adult children buy a home:

• Don’t borrow against your home or retirement funds.
• Use cash accounts. Don’t liquidate your investments.
• Don’t establish a joint account with a child.
• Avoid cosigning for a credit card or a loan with a child. If the child defaults, your credit score is damaged and the bank comes after you.
• If you do end up cosigning, at least take the title to the property as well. That way you own the house if the child defaults and you can recoup the investment by selling or renting it.
• Keep the process as businesslike as possible and set up realistic payback terms from the start. Spell out your expectations and your child’s responsibilities ahead of time to avoid ugly misunderstandings later.

Besides the emotional issues are the financial consequences. The Internal Revenue Service (IRS) allows an annual gift tax exclusion of $14,000 per recipient per year. However, a married couple could each give $14,000 to a child and a child’s spouse, for a maximum of $56,000 in four separate gift checks. Be aware that gifts of more than $14,000 per parent to one child in a given year could count against the parents’ lifetime gift-tax exemption of $5.45 million, resulting in higher taxes on the eventual inheritance of large estates. On the other hand, giving the maximum or less allows parents to give away some of their estate while they are living, which can reduce estate taxes later.

A lender needs to make sure that your gift isn’t a loan, which might disqualify your child for the mortgage loan (because it would add more debt to the mortgage holder). Therefore, you need to provide a letter signed by you and your child, listing the amount and transfer date of the gift and stating that you don’t expect repayment.

An online retirement calculator (such asBankrate) can help you estimate how a gift would affect your retirement savings.

As a Loan

Although lending your child money to buy a house might seem the best choice if you need to preserve your retirement funds, a loan can come with messy emotional costs. You’ll need to sign documents coming up with a repayment plan (for the IRS as well), which means at some point your children will need to pay you back. When that time comes, especially if your children are unwilling to pay, are you willing to take your children to court? On the other hand, parents who don’t want to give their children the money outright, because they worry that it would encourage financial irresponsibility, can provide the loan and later forgive the debt if their children are making all the payments on time. It can be a way for parents to ensure that their children are taking some responsibility. A loan, rather than a gift, can also quell any sibling resentment over unfair treatment.

One advantage of loaning money is that parents can charge a higher interest rate than they would get on a CD, but less than it would cost their child to get a mortgage. Financial experts warn that when lending your child money, consider first whether you can afford to lose that money forever, in case your child can’t pay it back.

Because IRS deems the interest payments as income, the tax agency will require you to charge a minimum interest rate, with ensuing penalties if you don’t. In any case, you should discuss the tax and financial consequences of this option with a financial adviser or lawyer before entering into a loan agreement with your child.

As a Shared Deal

A good alternative to either giving or lending the money to your child is to share the home cost. In a shared-equity deal, the parent and child jointly purchase a home and decide on splitting the title 50-50 or a different percentage, depending on each party’s needs. While both contribute to the home’s cost, upkeep and taxes, one advantage is that your son or daughter gets a bigger home than they would have qualified for on their own. Your child could rent out bedrooms in a larger home, providing you both with rental income. Another benefit of this deal is that the child doesn’t need to use all their money for the down payment, while the parent can profit when the property sells. And because a shared-equity deal is classified as a residential loan, it has a lower interest rate than a rental property.

Other Alternatives

Cosign the mortgage. While some adult children may have enough money for a deposit on a home, a bad credit history may make them ineligible for a mortgage. In this case, parents could cosign the loan, thus guaranteeing that they will make the payments if their son or daughter can’t. But many financial experts advise against this because of the danger of parents taking on a huge debt burden in or close to their retirement years. Only do this if you are confident your child will be able to make the payments.

Buy the home. If you can afford to pay for the home outright, you can either give it to your child or have them pay rent. This could be a good option if your son or daughter is not currently prepared to take on a mortgage but may be more able later down the road—after they graduate, for example, or become more established in their career. This has the advantage of locking in a good deal on a home while mortgage rates are low, especially if you believe housing prices may increase in your area. The rent you charge would likely be less than what your child is paying to their landlord.

However, because of IRS rules, you would likely need to pay the 35 percent gift tax, although there may be tax strategies to get around this. As a landlord, parents can deduct property tax payments, maintenance and repair costs, depreciation expenses and mortgage interest.

Immunotherapy Cancer Treatments Show Promise

However, using the body’s own immune system to fight the number two cause of death in the United States is still in early stages.

However, using the body’s own immune system to fight the No. 2 cause of death in the United States is still in early stages.

Artificially boosting the body’s immune response to cancer has been called the most exciting advance in the treatment of tumors in the past couple of years. Cancer is the No. 2 cause of death in the United States. While good news for everyone, immunotherapy could be even better news for seniors, who have a higher chance of getting cancer than younger people. Many cancers in adults are not genetic, but are linked to environmental factors or lifestyle-related risk factors that accumulate over time, such as smoking or being overweight or obese.

Most recently, researchers at University of St. George’s in London treated patients who had pancreatic cancer, one of the deadliest forms of cancer, with immunotherapy as well as chemotherapy. Patients who received both treatments lived significantly longer (years) than expected, while the overall median survival increased by 59 percent (2.6 months) (Science Daily). Normally, life expectancy following a diagnosis for pancreatic cancer is short, with median survival about six to 11 months.

In another study, scientists from the Fred Hutchinson Cancer Research Center used immunotherapy on 32 people with otherwise untreatable non-Hodgkin lymphoma, a blood cancer. After the treatment, seven people went into complete remission, while another four saw their disease progress more slowly (Time.com).

How Immunotherapy Works

Although more than 100 types of cancer exist, they all work the same way. The disease starts when some of the body’s cells begin to divide without stopping and spread into surrounding tissues, forming growths called tumors. This uncontrolled growth is caused by changes to genes that control the way our cells function, especially how they grow and divide. We can inherit these genetic changes, but they can also result from damage to our DNA caused by environmental factors, such as tobacco smoke, radiation exposure, UV exposure and alcohol (see sidebar, “Examining the Alcohol-Cancer Link”).

Our immune system helps us fight infection, so if we get the flu, for example, our immune system works to get rid of foreign substances, such as the bacteria or viruses that are causing the flu. Similarly, the immune system tries to eliminate cancer cells, which are damaged and abnormal cells, but it doesn’t always succeed, partly because cells can mutate over time. When cells mutate, the immune system doesn’t always recognize them as foreign, or the response might not be strong enough to eliminate the cancer.

Unlike chemotherapy, which kills cancer cells, immunotherapy artificially boosts the immune system to help it attack the cancer. For certain cancers, the combination of immunotherapy and chemotherapy works best. Although still in the early stage, research is finding that immunotherapy works better for some types of cancer than for others.

Research and trials focus on three main treatments: checkpoint blockade drugs, adoptive cell transfer therapies and immunotherapeutic vaccines.

Checkpoint Blockade Drugs

The most widely used form of immunotherapy for cancer takes the so-called “brakes” off the immune system, telling it to start attacking cancer again. The body uses a mechanism, a “brake,” to keep the immune system from going overboard and attacking normal cells. In many instances, cancerous tumors tell the immune system not to destroy cancer cells. Blockade drugs, also called inhibitor drugs, block that mechanism, which frees killer T-cells to attack the tumor. The Food and Drug Administration (FDA) has approved four checkpoint blockade drugs to treat advanced melanoma, Hodgkin’s lymphoma and cancers of the lung, kidney and bladder.

“Generally, 20 percent to 40 percent of patients are helped by checkpoint inhibitors—although the rate can be higher among those with melanoma,” according to the New York Times. Some patients with advanced cancer have had remissions that lasted for years, but for others, the drugs don’t work at all or provide only temporarily benefits.

However, checkpoint blockades have side effects, as do other immunotherapy treatments. Removing the brakes can cause the immune system to attack healthy tissue as well as cancer, causing inflammation. Common issues include breathing trouble, diarrhea, joint and muscle pain, and rheumatoid arthritis. While such reactions can be serious, steroid medicines, such as prednisone, can often control them.

Examining the Alcohol-Cancer Link

A new review of scientific research concludes that alcohol causes seven cancers and “probably” others. The seven cancers are oropharynx, larynx, esophagus, liver, colon, rectum and female breast. While alcohol consumption has been causally associated with these seven cancers before, the new review from the Department of Preventive and Social Medicine, University of Otago, in Dunegin, New Zealand, strengthens and clarifies previous findings.

So should you stop drinking all together? Writing in the Harvard Health Newsletter, Dr. Steven J. Atlas takes a more balanced approach. First, alcohol may decrease risk of heart disease. Also, because alcohol isn’t a known carcinogen (unlike cigarettes), scientists aren’t sure how alcohol causes cancer.

“Instead, I will continue to categorize my patients based upon their pattern of alcohol use,” he writes. “Even if moderate alcohol use has some finite risk, there is also the question of how much of a risk it is—and how does that risk compare to other things they do or don’t do in their lives. I see this as a key role for primary care physicians. We want to frame personal choices—not enough activity, safe driving habits, unhealthy eating, and yes, alcohol use—in a way that provides perspective and hopefully motivation. My role is to advise about the things each of us can do to improve the quality and quantity of our lives. We all can do better, but I don’t think that scaring patients with the C word is the way to do it.”

Sources:

“Perspective on alcohol use and cancer risk,” Aug. 12, 2016, Harvard Health Newsletter.

“No Confusion: Alcohol Causes Seven Cancers,” July 27, 2016, Medscape Medical News.

Adoptive Cell Transfer Therapies

In this therapy, immune cells are removed from a patient’s body, reengineered to attack the cancer and then re-infused into the patient’s body. Because these treatments are personalized for each patient, they are more difficult and expensive than checkpoint inhibitors. Although results have been highly promising in early clinical trials, adoptive cellular immunotherapy is not yet widely available. This therapy has been used mostly for blood cancers like leukemia and lymphoma.

Cell therapy can produce complete remissions in 25 percent to 90 percent of patients with lymphoma or leukemia, depending on the type of cancer, according to the New York Times. In some cases, the remissions can last for years, but in others, relapses occur within a year.

Side effects include severe and potentially fatal reactions, because the immune system is overstimulated to fight the cancer. Although these reactions can usually be controlled, patients may need treatment in an intensive care unit.

Immunotherapeutic Vaccines

Unlike vaccines that prevent diseases such as measles, these vaccines trigger the body’s immune system to beef up its response to cancer cells. Currently, the FDA has approved only one cancer treatment vaccine, for advanced prostate cancer patients who no longer benefit from hormone therapy. Other vaccines for various types of cancer—from bladder to breast to lung—are in trials.

Long-term View

Pharmaceutical companies have stepped up the pace of clinical trials for immunotherapy. However, few treatments are available to the general public, and insurers will pay only if the drug is approved for the patient’s type of cancer. Currently, checkpoint inhibitors are available publicly, but cell therapy is available only through clinical trials. To find out if you’re eligible for a clinical trial, go to the Cancer Research Institute websiteor ClinicalTrials.gov.

Deadline approaching. – Alzheimer’s research

Our Matching Gift Challenge deadline is almost here. Can we count on you today to bring us one step closer to our $100,000 goal? When you give today, you can choose to make your contribution in honor of someone who has faced Alzheimers’s — it’s a great way to double your support in their name.
A family foundation that wishes to remain anonymous is beginning its support for the Alzheimer’s Association by offering to match every gift we receive by October 31 — up to $100,000. That means that for a very limited time, your tax-deductible donation of $35 can become $70 — or your especially generous gift of $60 can become $120.
Any amount you give can make twice the impact to advance Alzheimer’s research, care and support, but you must hurry. This special Matching Gift Challenge ends soon, so please don’t wait to double your support for the people who need it most.

Team Up Against Alzheimer’s

The Alzheimer’s Association invites you to Team Up Against Alzheimer’s! This is a student-focused fundraiser designed to promote brain health, spread awareness and raise funds through student-coordinated events or activities. It is flexible enough to be an on-going effort or a one-time occurrence and aims to motivate young people to get involved in the fight against Alzheimer’s disease.

The Alzheimer’s Association®, Greater Illinois Chapter invites you to Team Up Against Alzheimer’s. This is a student-focused fundraiser designed to promote brain health, spread awareness and raise funds through student-coordinated events or activities. It is flexible enough to be an on-going effort or a one-time occurrence and aims to motivate young people to get involved in the fight against Alzheimer’s disease.
Who can participate?

Anyone can form a team. Whether it’s a sports team, a club, a class or a group of friends–everyone can help in the fight against Alzheimer’s disease.
When does this event take place?

“Team Up” fundraisers can occur anytime during the school year. Depending on the group hosting, the fundraisers can coincide with athletic events, school functions, holidays, etc.
What is the level of involvement?

The type and number of activities your team hosts, are completely up to you! You can even create your own!
Click here for a list of activities to help you get started.

Why it’s important for younger generations to act now

The earlier we educate people about this disease, the better chance we have at preventing it, fighting it, and even curing it. Teaching students to recognize symptoms helps increase the number of early diagnoses and become better prepared for the emotional and financial burdens as the disease progresses. As this issue becomes more prominent throughout people’s lives, it may encourage them to donate or participate in studies to help advance research. It can inspire young people to take a vested interest in a global issue, partake in community service or pursue careers in science, medicine, healthcare, or public policy to help the cause. The cure for this disease may even lie in one of the minds of today’s youth!
Questions? Please contact Sari Eilon at seilon@alz.org or 847.779.6952.
Whether you’re an athlete or a fan, you are the MVP in the fight against Alzheimer’s!

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