No longer home alone

For more than five years Donald Kruse, a retired bank officer in Whittier, Calif., considered the pros and cons of moving into a retirement center. But his wife, Anna, opposed

the move, preferring to stay in their home of 45 years.

"We talked about it a lot, and we investigated a lot of different places," says Mr. Kruse. "But to give up your house, that's something else."

Finally their daughter and son-in-law, Lynda and Richard Patton, aware that the couple needed assistance, stepped in. "I was pretty much the prime mover," Mr. Patton says. They found a large, efficiency apartment in Stanton, Calif. - a nonprofit facility where options range from independent living to assisted living and nursing care. Last June the Kruses moved in.

"Actually we waited too long," Kruse says, explaining that his wife died a month later. "We didn't realize my wife was as ill as she was." Now in particular he relies on services the center provides, such as meals.

Where to live in retirement is a question that looms large as the ranks of the elderly increase. Those 85 and older, like Kruse, make up the fastest-growing group in the US. For people hoping to "age in place" and avoid a succession of moves as their needs change, choosing the right facility becomes increasingly important.

The decision centers around three "W's" - whether to move, and if so, where and when. It can also involve adult children. Patton, of Pasadena, Calif., calls the role he and his wife played in arranging the Kruses' move "not untypical," adding, "Some of our friends have just gone through the same thing."

A roof and support

For many people like Kruse, assisted living ranks as an appealing option. Residents live in their own apartments and maintain as much independence as they want. But they also have access to support services such as meals, transportation, and personal care - bathing, dressing, grooming. Many facilities offer a range of activities - lectures, discussions of current events, music, local outings.

Not surprisingly, such amenities come with widely varying price tags. In the middle range, Kruse bought his apartment for about $100,000 and pays $1,800 a month for food, assisted care, and medication. At Edina Park Plaza in Edina, Minn., a typical one-bedroom rental apartment averages $1,900 a month. That includes 45 meals, housekeeping, and transportation. Home-care services cost an additional $6.30 for each 15-minute increment.

Typically, says Toby Mullenger, marketing director at Edina Park Plaza, women make up 70 percent of residents in these facilities and men, 30 percent.

Housing is, in fact, a central issue for older women. Ruth Harriet Jacobs, a gerontologist at the Wellesley College Center for Research on Women in Wellesley, Mass., notes that 46 percent of women over age 65 are widows, 70 percent of whom live alone. "Surveys show the last option most women want is to move in with adult children," she says.

Irene Wechsler, president of Elderlink Referral Service in Santa Monica, Calif., a free service that matches older people with appropriate facilities, receives 20 percent of her calls from retirees themselves. "They don't want to live in their big old house, and they want someone to cook and do the driving," Ms. Wechsler says. "Widows decide they don't want to be home alone, they want good meals, and they want people around."

How to help mom or dad?

The remaining 80 percent of calls come from adult children. "Usually they're at a loss to know what to do," she explains. "They suddenly realize their folks aren't safe with the stove or are malnourished or need help. For kids it's really hard, because they look at their parents with respect and don't want to go against their wishes. But keeping parents at home may be putting them in danger." In such cases, she says, "you have to look at this as a gift to your parent."

Yet Wechsler cautions, "Any time kids intervene and try to make decisions for a parent who is clear-minded and healthy, that parent will not move."

When clients call, Wechsler assesses their need, then gives referrals based on the family's preferred location and ability to pay.

Whatever the circumstances surrounding a move, Dr. Jacobs urges prospective residents to "ask a lot of questions and do a lot of visiting. You have to be very careful what you're getting."

Some places, she says, assign residents a time to eat and a table. "You must eat with the same three people every meal." One resident she knows finds that "very hard." At another facility, the pool is small and open only two hours a week. Another requires residents to park in the garage for $90 a month.

She has coined a phrase, "chandelier places," to describe facilities that "sink a lot of money into the front, but you can't get a maintenance man to come."

For continuing-care facilities, Jacobs says, "The question you always have to ask is, How good will that care be?" Ratings are available for nursing homes in some states, such as Massachusetts, through the state Department of Public Health.

Wechsler suggests taking "baby steps" before making a commitment. Stop by a prospective place once a week and sit in on an activity. Eat a meal in the dining room.

For men and women alike, Mullenger says, the biggest adjustment is the loss of perceived independence.

Eleanor Bixby, a resident of the independent-living unit at North Hill retirement community in Needham, Mass., moved in as a new widow in 1992. Sometimes, she says, people wonder, "Am I in a sheltered place and can't get out?" Although Mrs. Bixby no longer drives and must plan around bus schedules, she emphasizes that those who move locally can still keep their contacts. "You don't give up your church, your activities, your friends," she says.

Still, not all families are satisfied. Tamara Bliss of Newton, Mass., whose mother spent several years in an assisted-living facility before moving in with Dr. Bliss and her husband, says her "biggest disillusionment" involved turnover. "At the end of 2-1/2 years, we were on the fifth executive director. Within two years, there was not a single professional staff member left from the original group, and only a few aides." Some elder-care specialists call that atypical.

Bliss says she has also known people who have put parents in adult day care because they did not think they were getting enough activity at their facility.

Mullenger calls assisted living "definitely the wave of the future," noting that the industry "is growing by leaps and bounds."

Jacobs expresses particular concern about overbuilding in the luxury category, noting a shortage of affordable units for middle-income people. "My fear as a gerontologist is that if the industry overbuilds and they can't sell your unit if you decide to move, you will not get money back." One woman in a continuing-care community waited three years for her apartment to sell because developers still had empty units.

Kay Smith, an Elderhostel director in Milwaukee who previously worked as a program coordinator for a retirement community in Santa Rosa, Calif., offers other considerations. Calling size "quite important," she says, "A larger facility allows for different interest groups, so you can find your own group. A community that's just opening is ideal. You're in on the ground floor. No groups have formed yet."

Moving by age 75, Mrs. Smith found, was often the "optimum time" to adjust. But, she adds, "we're sliding that age upward because people are living longer."

Wechsler adds that people wait too long "all the time. Moving is such an emotional experience. It's not just about moving. It's about packing up your memories. We get very set on materialism, when in fact the emotional issues are what's most important. The materialism - the furniture, how many rooms they have - seems to bog them down. Once they get moved, they find that the trade-off is terrific - meals, transportation, companionship."

Still, Kruse sums up the mixed emotions many people feel. "I'd rather be at home," he says. "But I thank the Lord for places like this. We get good care here. They're always looking after us. It relieves us of a lot of responsibility."

And with 400 residents in the center, he says, "I make friends every day. That's part of the fun."