As NH's population gets more gray hairs, the retirement industry is seeing more greenbacks flowing into its coffers. Baby boomers are turning 65 and transforming the state's retirement industry. The industry's customers are now living longer, driving up the demand for services. Scientific breakthroughs have extended the expected lifespan for those over age 65 by, on average, an additional 19 years, according to the Administration on Aging. All that means a broader and more robust spectrum of services are needed to serve NH's aging population.
Housing Developments for Retirees
Master-planned, active adult resort communities flourish in large states like Florida and Arizona. But in NH, known for its brutal winters and smaller population, options are more limited. There are almost 100 senior housing developments in NH, according to retirementhomes.com. By 2020, the state is expected to have more than 100,000 households occupied by residents 65 to 74, according to the New England Economic Partnership. But both an AARP survey and Peter Francese, director of demographic forecasts for the New England Economic Partnership, predict the majority will choose to stay at home.
Only a small percentage of people over 65 change their residences, Francese says, citing U.S. Census mobility statistics. As such, he considers the market for age-restricted communities limited and says resale values of those homes are falling faster than that of other types of homes. Most [seniors] want to live in a mixed neighborhood, he adds.
If graying boomers do relocate, they're more likely to do so before their 65th birthday, which may explain why many age-restricted communities are 55+. And many of those move to minimize their maintenance, move closer to their children, or simply to downsize.
Samir Khanna is vice president of CPM Inc., a property management company in NH with two of 15 rental developments targeting the 55-plus market. One of CPM's properties, Briston Manor West in Bedford, offers one-bedroom apartments that start at $1,300 per month. The 70-unit development provides van transportation for shopping and doctor's appointments, gourmet meals, 24-hour emergency maintenance, and an array of events, managed by a full-time activity coordinator. CPM's other senior-focused property, the 90-unit Merrimack Commons, is less expensive with fewer amenities, and monthly rents start at $1,000. CPM's vacancy rates in both properties are low, with apartments turning over every six to 10 years.
Real estate entrepreneur Mario Plante of MDP Development enjoys similar success with Palm Square, a downtown Nashua apartment complex. In 2009, Plante transformed an old mill that once produced shoes and later manufactured caskets into an affordable haven for residents over 55. Tenants in the 140 units don't have to walk far for a meal or a haircut: its atrium houses a restaurant, hair salon, game room and fitness club. With rents starting at $650 per month, Plante sold out within two years despite the recession.
Home Health Care
Most people-nearly 95 percent-would rather remain at home when they get older, according to a recent AARP-NH survey. The preference for home health care explains why Inc. magazine ranked home health among the top 20 industries for starting a business. The Home Care Association of NH estimates that about 200 agencies here provide homemaker services, personal care and nursing to NH's elderly.
Home health care requires the support of family and friends-usually women-though the pool of women between 25 and 44 who are most likely to become unpaid caregivers is dwindling. Other services, from housekeepers and health aides to nurses, are filling the void.
Susan Ashworth, director of community relations at Home Healthcare, Hospice and Community Services (HCS) in Keene, says the agency has nearly doubled its size in the past decade. In addition to the Concord VNA and Home Health & Hospice in Nashua, HCS is currently one of the largest home health agencies in the state, with a staff of 225 full-time and 236 part-time employees.
While HCS provides in-home nursing and therapy services to a range of patients, from infants to the terminally ill, the elderly comprise more than 90 percent of its patients. Advances in technology, such as intravenous therapy, says Ashworth, are among the reasons seniors can receive care at home. Some things that were only done at a hospital setting are now being done at home, she says.
Among the issues stay-at-home seniors face is family members with conflicting opinions about the type of care needed. To break through family tensions and streamline the process, HCS launched a geriatric case management program in 2009. A team of professionals works closely with patients to assess their abilities to remain home. They look at what volunteer supports the patient can rely on, such as Meals on Wheels, and whether the home needs accommodations like ramps or chair lifts. A business manager coordinates with attorneys, social workers and financial planners to determine resources family members may not even know they have.
In most cases, geriatric case managers can demonstrate that home health is the least expensive option, especially when the average annual cost for one nursing home resident is $69,715, compared to 20 hours of weekly at-home companionship for one year at about $18,000. As the HCS geriatric management program has grown, so has the need for home health aides, LNAs, and physical and occupational therapists. We're hiring LNAs fairly steadily, adds Ashworth. In 2008, there were close to 3,000 home health aides working in NH. That's expected to hit 4,500 by 2018, according to the Economic and Labor Market Information Bureau.
People are more aware these services are out there, says Jason Harvey, who owns Live Free Home Health Care in Bristol with his wife Jennifer, a former nurse. His agency provides more than 1,200 hours of service a week to about 100 clients. Live Free Home Health Care, founded in 2006, has a staff of 64, with a full-time equivalency of 28. While Harvey agrees with the state's projections of need for home health workers, he worries filling positions may be difficult. Non-licensed caregivers, who are essentially housekeepers, earn low wages, between $9.50 and $11 per hour. They may find the work rewarding, but they're not in it for the paycheck, says Harvey. And, he says, those type of workers are not easy to find.
Private pay clients comprise at least 70 percent of Harvey's business. Typically, says Harvey, they purchase more hours than the Medi-caid patients who may only receive five hours a week. There's more opportunity for revenue growth, he adds, particularly if clients want round-the-clock care. The average client is 72 years old, and the majority are women. Without having to rely on Medicaid, we've averaged a 40 percent growth over the last three years, says Harvey. This year, it's over 50 percent. Franchises are also entering the state to serve state residents. Home Instead Senior Care out of Nebraska has a number of franchises in NH.
Continuing Care Communities
More than 2,000 continuing care retirement communities dot the American landscape, but only a handful are in NH. They include RiverWoods in Exeter, Havenwood-Heritage Heights in Concord, Kendal in Hanover, RiverMead in Peterborough, the Huntington in Nashua, and the newly-expanded Birch Hill Terrace in Manchester.
RiverWoods is the largest of the continuing care retirement communities with 625 residents. Its three campuses sit on 200 acres. Justine Vogel, CEO and president, says people who enter into an agreement with the nonprofit do so through an insurance, rather than real estate, contract. It's a policy that guarantees lifetime care, and is licensed by the state's department of insurance. Entrance fees, which are 90 percent refundable to individuals or their estates if they move or pass away, start at $162,000 for a studio apartment and climb to $739,000 for a 2,000-square-foot cottage. Residents also pay an average monthly fee of $4,000, which covers an array of amenities like housekeeping, at least one meal a day, utilities, campus shuttles, and arts and education programs.
That monthly fee also brings a sense of security to elders and their families. Residents can move fluidly from independent to assisted living or a nursing facility and then return to their own apartments-all within one community and at the same monthly rate.
In general, skilled nursing can cost as much as $10,000 a month, Vogel says. At RiverWoods, residents may pay as low as $2,000 per month for the same level of care. To be eligible for RiverWoods, seniors need financial strength and good health. Usually they have a home they can sell and investments in the bank, says Vogel. It's an expensive endeavor, admits Vogel. In return, you do get a lot of insurance, she says. Not only do you know where you're going if you need assisted living, you know who's providing it and you know what the pricing is. RiverWoods, which is the Exeter area's third-largest employer and largest taxpayer ($1.4 million), also serves as an economic engine for the region. It employs 450, who are paid more than $13 million in wages, for jobs from dishwashers, cooks and servers, to accountants, social workers and medical professionals.
Medical Device Vendors
Another sector of the economy benefiting from a graying population are companies selling portable medical equipment for the home. According to Karyn Estrella, executive director for New England Medical Equipment Dealers, 85 percent of the association's members are businesses with sales under $6 million.
Estrella says federal and state agencies want to increase the level of home-based care to avoid costly hospital stays. For example, oxygen equipment and services for the home cost about $7 a day, compared to about $8,000 charged by hospitals, she says.
Bernie Herron of Herron & Smith, a provider of medical equipment in Hooksett, says in addition to being more portable, today's equipment is more sophisticated, requiring qualified critical care staff to maintain it. His firm runs a 24/7 service that hires medical professionals, delivery drivers, equipment assemblers, and therapists. The company receives referrals from rehabilitation facilities, visiting nursing agencies, doctors, clinics and hospitals.
To preserve its national accreditation for Medicare, the company must document equipment safety checks and provide training. That, in addition to the certification fees, surety bonds, and layers of paperwork for claims submission, contributes as much as $25,000 to its annual $1 million operating budget. Operating costs have increased for me and everyone else, Herron says. Still, he sees the industry expanding about 8 to 9 percent a year.
Steve DeYoung, program manager for the Home Medical Equipment and Infusion Services of Manchester and Southern NH, a department of the Elliot Hospital, agrees with Herron's projections for growth. However, he sees margins shrinking. One increase in cost, he says, is because pharmacies have consolidated, and fewer mom-and-pop shops can enlist the manpower needed to customize medical supplies for customers. For example, patients with edema used to get fitted for compression stockings at their local pharmacies. Now they must visit a specialty shop like Home Medical Equipment and Infusion Services. DeYoung manages a staff of eight, including a nurse, five service technicians and three respiratory therapists. The latter, he says, are in short supply and command salaries from $40,000 to $73,000. Recent forecasts expect respiratory positions to grow more than 20 percent in the next seven years.
Nursing Homes
Landmark legislation in the late 1980s elevated standards of care for nursing facilities that rely on Medicare and Medicaid funding. On the heels of those tighter regulations has come fewer federal dollars, and many independently owned nursing homes have gone out of business. Between 1999 and 2000 alone, 35 percent of nursing homes in NH filed for bankruptcy.
In NH, Kindred Healthcare, a post-acute, private health care provider out of Louisville, Kentucky, runs three properties in Dover, Nashua and Hanover, all offering a combination of short-term rehabilitative and long-term care. Kindred employs 670 at its three NH facilities. John Getts, executive director at Greenbriar, Kindred's Nashua facility, says, We are hiring more registered nurses than we have in the past. At the same time, state Medicaid dollars have plunged by $300,000, provoking the company to squeeze employee benefits rather than initiate layoffs.
Kindred acquired Greenbriar in 2000. Getts says a large corporation provides expertise to develop specialized programming, such as a cardiac or stroke rehab program, and enjoys better buying power. Getts sees demand increasing. However, he's less certain how the health care industry will finance it.
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