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Plan Ahead for Continuing Care

Don't wait to have the talk about living arrangements in your later years

JBQ: Plan for Continued Care

Yau Hoong Tang

Budget future living arrangements and home health costs into retirement plans to "age in place" successfully.

En español | Where will I live when I start to need help with the daily business of living? I don't want to wait for my children to open "the conversation," in carefully casual tones. ("Ahem, Mom, we were wondering …") I want to start that conversation myself. Their input will influence me, but I want the decision to be mine.

As do we all. But we can blunder into decisions simply by doing nothing. Most of us want to "age in place" with occasional side trips to other nice places. That works fine as long as we can take care of ourselves. When we can't, however, we'll start depending on someone else. That's the decision I'm thinking about. Who will be there to help, and what can I do, in advance, to ease the transition? I don't want to be stubborn about aging in place if it's going to create caregiving problems for my children (not to mention medical risks for me).

If you don't have children, or have children you can't depend on, the question becomes even more important. Kindly neighbors running errands isn't a permanent solution.

People hoping to stay in their homes should look at the floor plan as if they were already using a walker. You might have to add a bedroom downstairs with a bathroom whose door can accommodate a wheelchair. A pretty front porch will become a trap if there's nowhere to build a ramp to the sidewalk. If you don't want to renovate, perhaps you should simplify — sell the house now and buy a condominium in the same community, to stay close to your friends and social activities.

Whether in a house or a condo, you might eventually need caregiving services, if a spouse or child isn't constantly available. You'll also need someone you trust to supervise home-care aides — to be sure they're always doing right by you. Who is that likely to be? This shouldn't be a snap decision made under duress. The whole family should plan.

See also: 5 bad money moves

Some older people expect to move in with an adult child. If you have a house to sell, consider using the proceeds to put an addition on the child's home, to provide each of you with some privacy.

Setting an example

My own parents set an example for me. In their 70s and in reasonably good health, they decided to sell their house and move to a lovely apartment in a continuing care retirementcommunity (CCRC). These communities may provide housekeeping, laundry, meals in a common dining room, fitness centers, new friendships, entertainment and activities. They're also safe places to live. If you start to fail physically, there's help with bathing, dressing, medications and so on. A skilled-nursing unit cares for the bedridden or those who develop dementia.

CCRCs relieve adult children of the minutiae of parent care, which is a special gift to kids who live far away. They're also a serious financial commitment. You usually pay an entry fee — the median currently stands at $211,625, according to the National Investment Center for the Seniors Housing & Care Industry in Annapolis, Md. (Half the CCRCs charge more and half charge less.) Median monthly charges run $2,825.

Costs vary

The cost depends on the particular property and type of contract you choose. Some contracts cover all your health and living expenses. Others provide residential services but charge extra for health care. For checklists on how to evaluate CCRCs, go to the AARP Caregiving Resource Center and, the website of CARF International, which accredits these communities. On the CARF site, type "financial performance" into the search box to read the organization's "Consumer Guide to Understanding Financial Performance & Reporting in CCRCs." There have been some bankruptcies among CCRCs, so get audited reports for your lawyer or accountant to read.

Community: How do you make the most of your money? Join the discussion

For people who stay in their homes until the last possible minute, the best option might become a residence for assisted living. There, you live as independently as possible but can get help with basic physical needs such as dressing and bathing. Like CCRCs, they usually provide activities and a social life. There might be a nursing-home wing attached. You can find a directory of local facilities at Assisted Living Federation of America.

The key is to plan ahead. What can you afford? What's a reasonable way to live? Today I'm OK, but tomorrow? I want to be prepared.

Jane Bryant Quinn is a personal finance expert and author of  Making the Most of Your Money NOW.