Between 2010 and 2015, the number of seniors living in NH is on track to double. This is likely to increase the demand for assisted living facilities and continuing care retirement communities, says Bill Ray, managing director of policy planning and communications of the NH Housing Finance Authority (NHHFA).
While the resale market may improve in the coming years, allowing aging boomers to sell their multi-level homes, they may not find the smaller homes they need due to the lack of construction of homes that size.
That will mean some seniors will instead try to retrofit their homes for greater accessibility and take advantage of visiting nurse and homecare services, while others will seek out age-restricted communities.
In NH, 154 assisted living facilities and 11 continuing care retirement communities offer housing for seniors (usually those over the age of 65). These facilities range in size from small mom-and-pop homes, with only a few beds, to national companies like Genesis HealthCare that also specialize in the nursing home industry.
Residents in assisted living facilities pay a monthly fee to receive help with daily living activities, such as bathing, grooming or simply getting around. They also receive medical attention, but not the 24-hour skilled nursing found in nursing homes.
In continuing care retirement communities (CCRC), residents join when they can live independently and, in addition to a monthly cost, pay an entrance fee that guarantees a spectrum of care, from assisted living through skilled nursing care. This guarantee acts as an insurance contract, and as such, the state’s department of insurance licenses it.
Aging Economics
Nationally, 1,926 CCRCs dot the country with 676,000 residents. The majority—80 percent—are nonprofits. And 75 percent of these nonprofits are faith-based organizations. In NH, all of the CCRCs are nonprofits and three of the 11 have religious affiliations.
During the 2008 recession, CCRCs and other retirement developments struggled with vacancies, says Lisa McKracken, a senior living research analyst at Ziegler, a Chicago-based investment bank. But the industry is coming out of its slump, she says, especially with more CCRCs offering more flexible contracts and a wider variety of living arrangements.
RiverWoods at Exeter is a prime example. With 620 residents, the three-campus community on 200 acres is 98.5 percent occupied, its highest rate in a decade, says Justine Vogel, president and CEO. RiverWoods has doubled in size since opening in 1994. The spike in residents doesn’t surprise McKracken. “We’re right in the middle of the age wave,” she says, with 19 percent of the population expected to be over the age of 65 by 2030.
That’s also good news for communities with CCRCs. RiverWoods generates $1.45 million in taxes for the town or Exeter and employs 493 full- and part-time workers. It also pays out $14.3 million in wages, half of its operating budget, and stimulates commerce for companies that service the property, from construction workers to food suppliers.
According to the NH Department of Health and Human Services, the number of assisted living facilities has risen by only 10 percent in the last nine years, from 139 in 2005 to 154 today. The bigger push is in the recruitment of direct care workers, says John Poirier, president of the NH Health Care Association (NHHCA). Employers, which include short-term nursing homes as well as long-term assisted living residences, are hiring nurses’ aides, LPNs and RPNs, managers, housekeepers and grounds maintenance keepers. Statewide, the industry employs 7,500, paying out more than $120 million in wages each year.
Benchmark Assisted Living, which operates four assisted living facilities in NH, employs more than 400 in the Granite State, a number that’s increased as much as 50 percent in the last five years. “We’re caring for more residents with more needs than perhaps we were 10 years ago,” as people arrive older and frailer, says Christen Bergeron, Benchmark’s regional director of operations. The company spends close to $8 million on salaries.
Resident care associates are the biggest share of its employee roster, but Bergeron says the company relies heavily on other positions and encourages promotions from within. For example, Heidi Cole joined Benchmark in 2000 as a part-time receptionist at the Birches in Concord. By leveraging the leadership training, tuition reimbursement and in-house courses, she stepped up the management ladder several times and now serves as traditional care director at Nashua Crossings.
Arthur O’Leary, vice president of operations for Genesis HealthCare in NH, says the Pennsylvania-based organization runs more than 400 skilled nursing centers and senior living communities nationwide and provides jobs to more than 4,000 in the Granite State.
Genesis is one of the state’s largest employers with 30 facilities, of which 22 are nursing homes. The other eight are assisted living homes Genesis HealthCare acquired. And its employment needs outstrip supply. The challenge, O’Leary explains, stems mostly from a lack of masters-level nursing instructors in the schools. He also says eldercare environments compete for staff with fast-paced emergency room or ICU departments. “I could hire 20 nurses today if they walked through the door,” says O’Leary.
That is because older nurses are retiring and younger nurses are not replacing them. Nursing aides, who do the bulk of personal care, such has bathing and dressing, are often older women. “We’re a training site for a lot of nursing programs,” says O’Leary. And once in a while when young students do rotation shifts with elders, they realize the emotional rewards, he says.
To service the 360 residents at the Hunt Community and the Huntington, both CCRCs in Nashua, parent organization Hunt Senior Living (HSL) requires a cadre of 300 full- and part-time employees. And since both campuses are a stone’s throw from large retail centers, local merchants draw from a network of consumers from these organizations. Teachers and civic leaders also benefit from the resources that seniors with time on their hands provide. For example, HSL residents read to elementary school children and retired engineers participate in science fairs.
For the most part, CCRCs benefit seniors with deep pockets. A national survey in 2009 by the American Seniors Housing Association identified typical entrance-fee CCRC residents as earning more than $50,000 a year, with an average age of 81, likely to be widowed and significantly more likely than the average population to have a college degree. Almost all received at least $100,000 from the sale of their home.
It’s not a stretch for some NH seniors to qualify for these CCRCs. In NH, 30 percent of homeowners don’t have a mortgage, and the majority of these are older adults, says Bill Ray of the NHHFA.
Where for Art Though, Romeo?
Among those opting for a CCRC are Dick and Barbara Tompkins, formerly of Rye. Dick Tompkins jokes that he’s one of the “Romeos”—or Retired Old Men Eating Out—who dine with friends every Thursday. A retired military officer, he keeps a steady pace other days of the week by volunteering at a nursing home, collecting medical equipment for developing countries and greeting troops as they pass through the Pease International Airport.
When his wife gave him marching orders to get off the roof of his 1960s Cape, the time seemed right for this feisty octogenarian to halve the size of their living space. The Tompkins sold their three-bedroom home for $399,000, giving them more than enough cash for the $341,000 entrance fee, which is 50 percent refundable to their estate.
The Tompkins pay $4,900 a month for a one-bedroom at The Woods (the original campus of RiverWoods at Exeter), a price that eclipses most apartment rentals. However, the fee also gives them access to the fitness center, spa, library, music room, at least one meal a day, all utilities, campus shuttles, arts and education programs. And it may pay off down the road as it includes assisted living and skilled nursing when and if they need it.