Kendal at Hanover resident Sam Franz inspects a handcrafted wooden toy in the community Woodshop (Courtesy of Kendal at Hanover)
With NH’s aging population projected to get even older, one sector of the state’s economy is booming: retirement communities.
“It’s math. There’s an absolute need,” says Justine Vogel, president and CEO of RiverWoods Retirement Communities, noting the state’s population of those over 75 is expected to grow 119% between 2020 and 2034 to 230,000. “That’s more than double. It’s crazy.”
Communities that cater to elders, as well as the amenities they offer, vary by type, but most provide housekeeping and landscaping services, dining, fitness centers, and opportunities for social interaction. Many also provide some level of health care.
One of the most popular types is the continuing care retirement community, or CCRC, which provides higher levels of care as a resident’s needs change, with a continuum that can include independent living, assisted living, memory care and nursing home care.
New Hampshire has 14 licensed CCRCs across 11 organizations, most of them nonprofit, and demand is growing. Among them is NH’s largest CCRC, RiverWoods, which has three campuses serving almost 1,200 residents, with a waiting list of over 500 in Exeter, 150 in Durham and 30 in Manchester, according to Vogel. And the facilities are expanding, with 18 additional cottages recently constructed at the Manchester site and 55 additional independent living units planned for Durham.
“If everything else was simple, we would build another community tomorrow,” says Vogel. “The need is there.”
Other CCRCs report similar demand, as well as lengthy waiting lists. “New Hampshire is well positioned because of its tax environment,” says Lisa Henderson, executive director of LeadingAge Maine & NH, an association representing more than 50 senior living and long-term care providers in the two states. “A lot of the people who move into these communities are not necessarily moving from New Hampshire.”
Community Centered
What does a CCRC offer? Community, for one thing. “People think about independence in terms of ‘I own my own home,’ but your home can become a ball and chain,” says Vogel. “You have all these things taking up your time. Is your roof going to leak? Can I get up the stairs? Is the lawn mowed? This neighborhood, these are my people but then your neighbors move away, maybe a spouse passes away and your world gets smaller. You move into one of our communities and your world gets bigger.”
Other attractions vary by community. Kendal at Hanover, a CCRC with about 350 total residents, partners with the Dartmouth Health system and offers a Dartmouth clinic on site staffed by a physician and support staff, according to CEO Beth M. Vettori. It also has an Early Learning Center for children through preschool age on campus. “To have every generation under one roof is fantastic,” Vettori says.
Kendal at Hanover has about 70 interest groups, from art to woodworking, all led by residents. One group interested in the environment created its own 501(c)(3) called SSAFE (Senior Stewards Acting for the Environment), which now has chapters at other Kendal facilities across the country.
Silverstone Living in Nashua, like RiverWoods and Kendal at Hanover, has a continuing care model, allowing people to receive care in their home on the campus before transitioning to a higher level of care and different housing if needed.
Hard Math
Such extensive offerings come with a robust price tag. Residents pay an up-front “entrance fee” ranging from the $200,000s to $700,000 or more, in addition to monthly fees that run in the thousands.
“Longevity carries with it a terrible price,” says Brendan Williams, president and CEO of the NH Health Care Association. “People are living longer and longer … A lot of people simply haven’t saved for the cost of longevity.”
But Henderson cautions that the expense may pay off in the long run for those who can afford it because someone in independent living who later needs assisted living could experience “a big jump” in costs and an even bigger jump going into a nursing home. “With many CCRC [contract types], your monthly fee stays the same regardless of whether you move into assisted living or nursing care,” she says.
The cost-benefit analysis may work out, but not all Americans have the bank account for it. According to the Federal Reserve, the average retirement savings of 55- to 74- year-olds is $537,000, but the median is only $185,000, suggesting there are many people with little savings and a much smaller number with significant savings.
Henderson disagrees with some estate planning attorneys who advise transferring or shielding one’s assets to qualify for Medicaid because approximately “70% of people will need long-term care sometime in their lifetime. Do you want to be limited to only providers that accept Medicaid when that time comes? Medicaid-paid assisted living, in particular, is virtually non-existent in New Hampshire.”
CCRCs typically work with prospective residents beforehand to determine whether they can afford to live there, and some offer calculators on their websites.
Unlike traditional real estate, CCRC residents do not own their units. Rather they are purchasing a “life share contract,” an insurance product regulated by the NH Department of Insurance. Depending on the contract, the entrance fees can be non-refundable or up to 90% refundable.
A new law goes into effect in January, expanding CCRC requirements for annual reporting and offering additional financial protections for residents.
Other Options
Other types of communities, like assisted living facilities, are regulated by the NH Department of Health and Human Services, as are nursing homes.
The DHHS website lists 39 licensed assisted living facilities in the state meant for those who need help with daily activities but still want to maintain some independence and social interaction. They are less expensive than CCRCs, and typically operate on a rent basis, with a full array of services.
Wheelock Terrace in Hanover is an example. Rents range from about $9,000 for a one-bedroom to $12,000 for a larger two-bedroom unit, according to Kristie Daigneault, the facility’s executive director and a board member of the NH Association of Residential Care Homes (NHARCH). People buy in with a $3,000 deposit and the first month’s rent, and 30 days are required to terminate the lease. “We are not interested in the profit margin, more so serving human beings,” she says.
The facility, which has a waiting list, offers “an all-inclusive, packaged lifestyle” including activities, chef-prepared meals, a social calendar, routine medical care, medications management, 24/7 nursing care, laundry, housekeeping and transportation, Daigneault says. Wheelock Terrace, now with about 70 residents, also has a memory care program.
Not all residents need assisted care. Daigneault says people are turning to Wheelock Terrace because they are living in a large home requiring a lot of maintenance. “A single [elderly] woman widowed with a five-bedroom home on six across of land can no longer jump up to do the lawn and plowing,” she says. “Rather than go into a condominium, they are looking for an all-inclusive place with the amenities we offer.”
Because demand for retirement communities is so high, competition among them is low, according to Vogel. “We spend more time trying to help one another than compete against one another,” she says. “It doesn’t hurt that there are plenty of older adults to go around. We’re not scraping for customers.”
Retirement community administrators often share ideas and information at education sessions sponsored by groups like LeadingAge.
As for those who can’t afford either a CCRC or an assisted living community, many facilities offer programs to help people living at home. RiverWoods recently started NaviGuide, which connects callers to benefits and services that can help them with issues like transportation, shopping, food delivery and household tasks.
Industry Challenges
Despite their popularity, retirement communities in NH do face challenges, among them the workforce shortage. Retirement communities compete for medical and administrative staff with places like nursing homes and hospitals. Staffing costs have also gone up dramatically since the pandemic, Vogel says.
Vettori looks forward to finding ways retirement communities can collaborate using smart technology to help address staffing shortages “while maintaining that human compassion and touch.”
The rising costs associated with construction can also stand in the way of expansion plans, Vettori notes, as can limited or aging town infrastructure like water and sewer availability.
Growth Potential
“The state is really ripe for the picking in terms of opening new [retirement community] businesses and developing new properties,” Daigneault says. “God knows it’s needed.”
That, administrators agree, would be good for more than just the industry. “Not only do people want and need this, it’s great for the communities we operate in because if 150 older adults sell their single-family homes and move into a community like ours, that’s 150 homes that come into the market to help families,” says Vogel. “You build back up the flow of housing.”
Having a retirement community in a town can only be a boon, she adds, because “we pay property taxes, generally discounted, we provide the town with wonderful people … The more we can think about how we work together, it helps the town, it helps the region … We don’t want to be a best-kept secret. This is a great way to live.”
Kendal at Hanover CEO Beth M. Vettori (Photo by Matthew J. Mowry)
How to Pick a Retirement Community
Parents do extensive research and take their kids on college tours to find the right fit. If you’re thinking of joining a retirement community, experts recommend a similar research effort. Here are some things they recommend:
- Make inquiries about the place’s reputation, advises Brendan Williams, president and CEO of the NH Health Care Association. Perform a “scratch and sniff” test, visiting the facility, asking questions and investigating.
- Look for fit. Know yourself and whether congregate living is for you. “In the end, it’s ‘do I want to be part of a community?’ It’s not for everyone,” says Justine Vogel, president and CEO of RiverWoods Retirement Communities. Visit the facility as you would a college campus, she adds. Look beyond your apartment and ask yourself “Are the people invigorating to you intellectually? Are they aligned with the way you see life?”
- Investigate the finances. Take a hard look at your finances because, especially with continuing care retirement communities, you’re making a lifetime commitment. Most communities have actuarial programs to help you determine what you can afford.
Also take a hard look at the community’s finances. “Do the research,” recommends Beth M. Vettori, CEO of Kendal at Hanover. “Look up the 990s [informational returns that tax-exempt organizations file with the IRS], public documents, to make sure it’s a financially viable, strong organization and make sure they’re transparent with that, so you know your funds are going to a safe place where you’ll be able to get all the care and services you’ll be paying for.” - Make a checklist of needs. Know what your needs are and examine whether the facility and its community partners can meet them. “Coming from a home setting to a congregate setting is total culture shock,” says Kristie Daigneault, administrator of Wheelock Terrace in Hanover and a board member of the NH Association of Residential Care Homes. “When I interview families, I ensure that they’re well acquainted with the resources in our organization and our community partners, the ombudsman office, outside agencies, so they have an idea what resources are available to them and how to properly utilize them.”
- Think twice: Take a good look at the community’s dynamics, including how residents, staff, management and board members interact, and how advice is given and decisions are made, advises Vettori.
And be selective. “Do your due diligence in terms of making inquiries and shop around,” says Williams. “Like any place you might rent or buy, don’t fall in love with the first thing you see.”
