Carmen Saleta, 90, has felt rejuvenated since she moved to an assisted living facility in 2011. Her goal is to reach 100 as cheerful and active as she is today. "I’m independent, I can bathe alone and take my medicines without help. I love to eat, dance and sing," said this Dominican grandmother, who is also a cancer survivor. She lives at Residential Plaza at Blue Lagoon, a non-profit assisted living facility for low and moderate-income seniors in Miami, Florida.
"I came to visit my friend Maruja and since that day I wanted to live here," she said. She previously lived with her son in Boca Raton, where she mentioned she had everything but "felt a little lonely." Saleta has four children, 12 grandchildren and 10 great-grandchildren who visit her often.
On the day she arrived at Residential Plaza, seniors were celebrating a birthday party with music and food. "My daughter-in-law always tells me 'you are in a luxury hotel' and the truth is that since I moved here I’m very happy and comfortable," she said.
About 85% of the 350 residents at Residential Plaza are Hispanic like Saleta, according to administrator Barbara Galindo. The facility also has a memory care unit and respite care services.
Malena Muñoz, Director of Health Services, is one of the facility's 130 employees. Muñoz began as a registered nurse when she was 21 years old; now she's 35. "I always had good relationships with my grandparents and took care of my grandmother until her last days," she said, explaining what motivated her to become a caregiver.
Thirteen years later, Muñoz is the head of a team of 40 caregivers.
"We all love what we do," she said, adding that being a Latina has been a plus in her career. "If I didn’t speak Spanish, I would not be able to communicate with them or have such an empathy for them, which builds trust."
For Saleta, a normal day includes daily sessions of exercise and physical therapy. On Tuesdays, she goes to mass. Every week, she gets regular check-ups from a visiting doctor. Staff also helps her to coordinate appointments with other specialists.
Afternoons are busy at the facility. "From 2 to 3, a pianist comes to play music, at 3 we have bingo until 4, and after that we play canasta and domino," she said.
Saleta pays her housing costs through a combined plan: "I have Medicaid and my son pays the difference," she said.
For residents, rent varies from $1,100 to $3,000, depending on the type of room and services. The majority of the rooms are single occupancy. Eighty-five percent of residents receive financial aid from the government to pay for their rent.
Something in common
There are more than 30,200 assisted living communities for the elderly, with a million certified beds, according to the 2013-2014 National Study of Long-Term Care Providers by the National Center for Health Statistics.
Business is booming. Most facilities are private, but there is a significant group of non-profit organizations and many providers that are faith-based. Of the 150 leading senior living providers in the U.S., more than 75% are faith-based, according to the LeadingAge Ziegler list.
ArchCare, the continuing care community of the Archdiocese of New York, operates an assisted living facility in The Bronx, New York. The residence is part of a service network that offers rehabilitation programs, specialized care, home care and short or long-term housing for those in need, as well as five nursing homes.
Julia Cruz, Administrator for ArchCare's assisted living program, explains that the facility opened in 2012 to serve seniors who had lost their homes after Hurricane Sandy. Now it serves people from all five boroughs. Many of them are Latinos in their 70s.
"Residents may have physical needs but we provide limited assistance," Cruz said. "We can help them bathe and they may use a wheelchair but they must be able to move by themselves, as well as to move from the chair to the bed without assistance. Their memory should be pretty good so they can leave their room and know where to go."
ArchCare has 59 beds in double bedrooms that each contain one bathroom. "We always look for what residents have in common [such as religion, origin, profession, etc.] so they can share a room," Cruz said. Each person pays $1,235 a month.
Who pays for long-term care?
According to Robert Burke, professor of Health Management at The George Washington University, most Americans think Medicare will pay for long-term care, but that's "wrong."
Medicare’s website states that it only pays for hospital expenses, medical care and supplies while the beneficiary is in a nursing home. In the short term, these facilities can provide care for up to 100 days. From day one to day 20 Medicare pays 100% of the expenses; from day 21 to 100 there is a co-payment from the user and after the 100th day the coverage is the responsibility of the patient and his/her family.
Medicaid pays for the expenses of six out of every 10 nursing home residents. In each state, the eligibility requirements are different and people must have limited income and assets to qualify. Other payment sources are life insurances and long-term care policies.
Rent in assisted living facilities is paid out-of-pocket at the beginning.
When Irene Sosa's mother-in-law got sick, the family first used savings to pay for the residence, but then that money ran out. Over the next nine years, CMS (Centers for Medicare and Medicaid services) paid.
"All her assets and income were absorbed by Medicaid to pay for her care," Sosa said. "People believe that they will inherit their parents’ assets but that never happens because the money is used to pay for their long-term care."
Barbara Galindo, Administrator of Residential Plaza, explains that some people receive a pension from Social Security and a supplementary social security check to pay for rent and food. Medicaid covers medical and assistance services, Galindo says. They also accept Section 8 vouchers (a program for low-income people) to pay for rent. PACE, Medicaid/Medicare's all-inclusive care program for the elderly, is another option to cover expenses.
"We study each case well to determine what benefits our residents can obtain and our social workers help them," she said. "Many believe they do not have enough funds to pay for an assisted living facility, but there is always an intermediate solution to be found."
At ArchCare in New York, regular Medicaid coverage is required. That's available to those who cannot cover their medical expenses, according to Peggy Reyes, ArchCare's facility coordinator. Each person must have a source of income (social security pension, disability benefits or SSI). "With this income, they pay the rent and they also receive a monthly payment for their expenses but the most they can have in savings is $2,000."
In general, assisted living costs per month can range from $2,500 to $4,000, according to Ben Opps, Vice President of Marketing for SeniorAdvisor.com, the largest online review site of assisted living options in the U.S. and Canada.
"Many states offer alternative programs and there are federal, non-profit and private assistance options available," he added. Texas' Star Plus Program and New Jersey's Managed Long Term Services and Support Program are two examples. "California only offers a cost share type program that has a waitlist for their assisted living waiver through Medi-Cal."
Traditionally, Hispanics take care of their elderly at home. But, this situation could be changing, according to SeniorAdvisor.com. Opps said Spanish language searches are one of our fastest growing segments in the U.S., surging 109% from 2016 to 2017.
To narrow a search, he said people should consider aspects like needs and wants, quality of care, location and costs.
He also recommended people read the fine print of the resident contract at the assisted living facility. Some centers provide a package of services for one price; others may offer a base amount with a 'menu' of additional services you can buy separately.
Galindo said the most important thing is not to wait too long to find an assisted living facility and to visit four or five residences to find a place that best suits your needs. She also suggested checking CMS and licensing records for elder care homes.
Start saving early
Mischelle Rios Copeland, First Vice President of Wells Fargo Investment Advisors, learned about the financial challenges of a family caregiver when she needed a long-term care solution for her mom.
"My mother had no money and it cost me about $3,000 a month to have her living in an assisted living facility and for her to get the care she needed," Copeland explained. "I’m the youngest of five children and I always saw my mom making sacrifices for us, but in the end she had nothing to take care for herself."
In a 2017 Wells Fargo/Gallup Investor and Retirement Optimism Index survey about personal finances, investments and retirement plans of the "sandwich generation" (middle-age adults who take care of their relatives), 32% of respondents said they provide financial support to their adult children, their parents or both; 61% of those who provide help said it hinders their own retirement savings. The results are based on interviews with a random sample of 1,007 individuals.
"Many people retire at age 65 and live to be over 80. That's a long time to live without an income and on a social security pension which means they will live in poverty," said Copeland. "When you're 40 you should start thinking about you and your parents." This is something "very difficult, especially for Hispanics who do not trust investment funds and do not like to take risks."
"It’s important to understand that we should not be a burden to our children," Copeland added.
National associations: The American Health Care Association and National Center for Assisted Living represent more than 13,000 non-profit and proprietary skilled nursing centers, assisted living facilities and homes for individuals with disabilities. Another umbrella organization that represents assisted living providers nationwide is Argentum.
Resources for preparedness: This guide from The Scan Foundation's guide has basic information to help you prepare for aging with dignity.