What You Learn When You Move Your Parents Into Assisted Living - Quartz

1/12/2020 What you learn when you move your parents into assisted living — Quartz
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Just people.
LETTER FROM A HOME
Senior living is starting to look like millennial

living
✦ Member exclusive by Lila MacLellan for The birth of geriatric cool
On the day we moved my mother into an assisted-living facility, the only reason I was
able to tell her that she would see her home again was because I honestly believed it.
Over breakfast that morning, as she made her ritual tea in her own kitchen, she looked
at the boxes and suitcases my sister and I had packed and repeatedly sought
reassurance about our plans. “But I’ll be coming back eventually, right?” she asked.
“I hope so,” I told her, careful not to overpromise. “That’s the plan,” I said the next time
she asked.
When we nally locked the door behind us, the house still looked like it was waiting for
its occupants to return, with all the furniture and family photos in place, the beds made,
https://qz.com/1779316/what-you-learn-when-you-move-your-parents-into-assisted-living/ 1/11
the closets jammed as usual with coats and snow boots.
I still had so much to learn.
In the rst story we published for this series, I explained that my father’s dementia had
landed him in the hospital nearly two years ago, sending me and my sister on a grand
tour of assisted-living homes in suburban Toronto, where my sister lives, and—because
we weren’t sure what we were doing—near our parents’ rural village more than two
hours away. (I live in New York, so that locale was automatically ruled out for them by
virtue of citizenship.) What I didn’t mention was that my mother could not be my
father’s caregiver because she has dementia too.
Whenever this comes up in conversation, I try to make the news less burdensome to the
listener by adding that, compared to my father’s disease, my mother’s af iction has
moved at a snail’s pace, and has been essentially limited to her short-term memory.
With him, it was like a bomb went off in his brain. In the space of a year or so, he
became increasingly emotional and paranoid. He saw people who weren’t there, and
called the police on them in the middle of the night. He bought a $4,000 vacuum before
realizing he’d been conned by a traveling salesman.
Then one day, after a night of agitation and hallucinations, he had a small seizure
during an X-ray at a local hospital. Because I had accompanied him for the
appointment, I was on hand to help a nurse rush him to the ER. And that was it. He
didn’t die, but he never went home again. It took the coordinated efforts of a team of
people—one particularly generous neighbor, extended family, and various community
health nurses and social workers—but my sister and I moved both of our parents into an
assisted-living facility after our father’s month-long, delirium-inducing hospital stay.
Even as it was nally happening, I resisted considering their relocation permanent. I

worked the phones searching for a private caregiver who might move into my parents’
house if my dad’s behavior could be stabilized with medication, but the rock-bottom
rate I sourced from a local agency was a minimum of $250 per day, assuming only one
person in the home needed care. A freelance care worker quoted me $17,000 monthly.
If we’d had that kind of money, I would have spent it. Every night, my parents were
packing up their belongings at their assisted-living center and calling us and other
relatives to ask for a ride home.
But the option we had chosen for them had one saving grace: My mother, who had
joined our inspections of different retirement homes, thought the properties were
beautiful. She marveled at the grand pianos and found the idea of sitting down to be
served three meals per day preposterously luxurious. “No more laundry?” she said,
clasping her hands with glee. “Oooh,” she said, when we stepped into one residence’s
small library and took note of the wingback club chairs and shelves lined with the latest
bestsellers. “I’d love to live in a place like this,” she said.
Now, with the bene t of time, I can say that assisted living was the right call for our
circumstances, which isn’t to say that the industry is perfect. Here’s what I’ve come to
learn, as an indirect customer, about the fast-changing world of senior housing.
It’s unavoidably expensive, but so is staying home

The high cost of decent senior-living residences is the primary reason everyone should
be preparing for their own future, as well as that of their aging parents.
In North American cities, the cost of rent in a modern assisted-living residence is

typically around $4,000 to $5,000 per person, per month, which includes meals and
light housekeeping. Rents are lower in second-tier cities and rural areas. Memory care
packages can be an extra $1,000 or more, per month. Some upscale urban
developments, featuring the modern aesthetics that the moneyed often prefer—think
Room & Board instead of Raymour & Flanigan—will feature kitchens equipped with
herb gardens, access to lap pools, and physiotherapy, along with exclusive outings to
the theater or opera, though monthly per-person prices can reach $20,000 or more.
You wouldn’t know any of this by cruising the websites of all the businesses that will
come out of the woodwork when you rst google “seniors’ home near me.”
Frustratingly, most senior housing websites do not include price sheets—your rst sign
that this industry has not yet been forced to take transparency as seriously as others
selling big-ticket items, like colleges or regular real estate. To get your hands on some
price tags in this market, you’re obliged to hand over your contact information at least;
you’ll then likely receive a follow-up phone call, which might broach the topic of
nances, and you will be invited on a tour.
Senior housing companies claim that the pricing is too complex and customer-speci c
to make sense for them to share it openly. That reticence may only be natural in a
business that so many people purposefully ignore and thus don’t understand.
When you nally do learn the cost of care, without context, it seems scandalous. Then
you add up the costs of in-home care, plus groceries, home insurance, electric and water
bills, and the hassle of nding and paying someone to x a leaky roof, shovel snow, and
mow the lawn. You think about the pathetic “meals” your parents have been eating—
plenty of seniors who age at home start eating things like Cheerios or oatmeal cookies,
and little else all day—and the promise of a selection of warm, chef-prepared meals is a
particularly meaningful bene t.
But then, just when you’re starting to wrap your head around the rent, you’re bound to
discover that it doesn’t include add-ons and extra costs, including a one-time move-in
fee, or tiered pricing for medication distribution. At one property, we found that if Dad
takes ve pills, med management would cost $22 per day, but six would bump him into
the next price range, at $28 per day, or more than $800 per month. Extra housekeeping
may cost $25 per 15-minute interval. An extra shower? At one spot, that was $14.
Whether or not medication is brought to your room can also impact fees:
With time and its ravages on the body also comes costs for more intense care, too,
meaning your invoices can jump up a few thousand dollars per month. Most seniors
who move into senior housing have some limiting condition, like heart disease, chronic
pain, or memory loss, that makes complete independence impossible or hazardous. A

fall can lead to a broken hip, a fainting spell can cause a head injury. Loneliness is itself
a powerful risk factor for cognitive, emotional, and physical decline. What is an
appropriate price for any extra care required? Meanwhile, it’s not entirely clear that
higher prices mean better care, or more staff, as a Florida lawsuit alleged in 2017.
The most ethical salespeople will make the potential for higher monthly bills clear at
the outset. They might claim the home, like an airline or hotel, keeps costs down for
those consumers who need less. But there are signs that unbundled pricing has been
played out: At the showroom for the still-under-construction Sunrise at East 56th
Street, a luxury Manhattan assisted-living facility, a sales manager told me that the
property has done away with piecemeal add-ons—customers nd them grating.
Similarly, Elroy Jespersen, founder of The Village Langley, a dementia village in British
Columbia (the rst of its kind in Canada), may be onto something with his simple
arrangement: Assisted living is $7,300 per month and complex care (equivalent to
nursing home care) is $1,000 per month more.
Senior living and millennial living are starting to look alike

My parents are now settled in an assisted-living home run by a large Canadian chain. It
suited our budget and gave my mother access to an upright piano on the memory care
oor and a commercial grade Nespresso machine that dispenses sugary mochas and
foamless cappuccinos, for free, in the basement bistro. On the same level, just across
the hall, the billiards room is inviting enough—with its dark taupe walls, gold accented
furniture, and old photos of local skating clubs— that my father will stop pacing long
enough to play a rules-agnostic game of pool.
As I’ve spent time visiting them there, I’ve come to see how much these places have in
common with other co-living spaces that don’t have such a bad rap. As you would in a
college dorm situation, in a senior living home, you furnish your own room and sign up
for a meal plan—or not, if you’re in independent living (see our glossary for more on
these distinctions). The bulletin boards feature invitations to expert talks on wellness
or history, along with iers promoting luncheons, and announcements about special
vendors with crafts for sale who will be visiting the building, as they might in a
WeWork.
Senior communities have been known to make eld trips to marijuana dispensaries and
invite food trucks onto the property, according to Senior Housing News, and one in
Atlantic Beach, Florida built its own.
Assisted living also, rather famously, has its own version of hookup culture, only here
it’s enabled by the dark cover of movie night and a tendency to live with less inhibition
in old age. More than one salesperson I met made a winking reference to this
phenomenon, even though they knew my parents were arriving as a couple. The subtext
of every hosted tour is “life goes on.”
The more upmarket you go, the more the aesthetics of millennial and senior living blur.
At the Sunrise at East 56th Street showroom in New York, the look is contemporary and
urban. (Increasingly, retirees want to live in walkable areas, rather than an old-age
island on the edges of town.) I spied Kind bars stacked by an espresso machine in a
model of a kiosk that will be found on every level of the 17- oor residence when it
opens next year (the entry cost is $13,000 per month for a studio). I immediately
thought about millennials casting about for precisely the same snacks and caffeine in
startup spaces all over New York City.
COURTESY SUNRISE
An architectural rendering of what shared space will look like inside
Sunrise at East 56th, in Manha tan.
Let’s not forget that millennials have become homebodies, making them not very
different from 70- and 80-somethings who stay in most evenings, many connecting to
loved ones through screens, whether via FaceTime or an Alexa-enabled device—which,
by the way, are arriving pre-loaded in some new seniors’ units and are getting installed
in others.
DKLEVY
The glam look at Knoxville High Apartment Living, for adults aged 55+,
in Tennessee.
Millennials call Ubers and Lyfts to take them out when they do leave their homes; a
small but growing number of seniors do, too, because paratransit, which needs to be
booked 24 hours ahead of time, is far less convenient and still carries a stigma, says
Stephen Golant, a gerontologist and geographer, and professor emeritus at the
University of Florida.
Millennials also would feel at home in the Sunday brunches at my parents’ retirement
home, where only the occasional phlegm-y hacking of old men and the clutter of
walkers betray your venue. There are cliques of friends getting together, gossiping and
trading opinions about politics or the quality of the french toast versus the omelettes.
Yet there’s one big, unavoidable difference between millennial co-living or co-working
communities and senior housing: in the latter, when your friends stop renewing their
memberships, it’s never to take a new job in Atlanta or to spend a few months touring
Southeast Asia while working remotely.
The constant losses can take a toll. I know of a widower in Toronto, a friend’s father,
who moved into an upmarket assisted-living place when he lost his wife. The new
environment eased his loneliness at rst, until he noticed a pattern: He’d make a new
acquaintance and the next week discover that the friend had been taken to the hospital,
and wouldn’t return.
That’s what assisted-living boosters rarely emphasize: These are the places you go to at
the end, or the beginning of the end, of your life. Your spiritual or creative life may
deepen if that’s your bent—plenty of the facilities offer yoga and craft rooms, and some
niche senior co-living spaces target artists speci cally—but physically, the most you
can usually hope for is a long plateau.
Insiders say this is one of the problems that next-generation senior housing is likely to
x: it will stop creating elder ghettos in favor of multi-generational projects, and
encourage relationships across generations through shared spaces and experiences, like
college classes, gyms, or mentoring programs.
There are, however, issues with assisted living that are far harder to solve and that do
not mix well with the social-justice agenda that has become a millennial hallmark.
The social injustices outside assisted living persist on the inside

In the US, there is currently a labor shortage for every category of employee in assisted
living—from facility directors down to the care assistants. It exists partly because of low
unemployment in the labor market generally, but also thanks to fears about current and
future immigration policies (estimates say nearly a quarter of direct care workers across
various settings are not born in the US), and increased competition as more developers
break ground on new senior-housing projects.
Industry and academic sources project a need for 1 million to 2.5 million additional
long-term care workers over the next decade, according to the nonpro t National
Investment Center for Seniors Housing & Care. (The home-healthcare business is
confronting the same labor crunch, only on an even more massive scale.)
But the laws of supply and demand don’t seem to be working properly when it comes to
salaries for the industry’s lowest-ranking workers. The people who help your mother
shower, or who are present when a dementia patient throws a violent tantrum, or who
laugh it off when your cranky father compares the texture of his steak to the backside of
a hound, are, in many cases, struggling to get by and often relying on public assistance
for their own housing and groceries, according to data from PHI, a Bronx, New York-
based research and advocacy group for direct care workers.
PHI’s most recent data, from 2018, shows that the average hourly wage for this class of
caregivers (including those in residential facilities for adults with intellectual and
developmental disabilities, as well as senior-living centers) is $12.07 an hour, landing
between the median wage for home care, which is $11.52, and the $13.38 median wage
for nursing assistants and nursing homes. That puts their median annual earnings at
$20,200. “For a lot of workers, this is a poverty-level job,” says Kezia Scales, director of
policy research at PHI.
That problem is only compounded by all the consolidation in the industry, with fewer
pro t takers controlling the fortunes of a greater number of caregivers.
One reason the work pays so little is because, in the US, the single largest payer of
caregiver salaries is Medicaid, and the wages set by nursing homes anchor the salary
levels for caregivers in the private-pay setting. But another in uential factor is the
historical legacy of this type of work, says Scales, “which is being seen as low-skilled
work, sort of naturalized feminized labor.” The industry and our culture are only now
“catching up with recognizing how important this work is, what skills it really does take
to do it well, and how important it is to our long-term care system, our communities as
a whole, and our economy,” she adds.
Josh Crisp, a senior living developer and marketer in Tennessee and co-host of Bridge
the Gap, a podcast about the industry, tells Quartz that a reckoning is most likely
coming, as senior housing companies look for ways to pay people more, without
necessarily passing the cost onto residents.
“I do think if we are going to become an industry with more-affordable options—I’m

conscious to not say [just] affordable, because affordable is a very relative term—
everyone’s margins are going to suffer. You know, my margins as a manager/operator
are going to suffer—the capital markets, investors, their margins are going to have to
suffer.”
Let’s not forget that who gets to be a resident at these facilities also is symptomatic of
larger inequalities in our culture and economy. Because the assets you acquire in life,
including the house you might sell to pay for assisted living, are often dictated by race
and class, the option to choose this style of living belongs to the privileged, while not
enough people are working on solutions for low-income seniors. To make senior
housing more palpable to the next generation of customers, something will have to
give.
Happiness is never a given
You won’t nd a lot of reviews of senior living properties on sites like Yelp or Facebook,
though Tim Mullaney, editor in chief of Senior Housing News, says smart providers are
starting to pay attention to what’s happening on social media. That part of millennial
culture is coming to disrupt the broker-driven referral system that has dominated so
far.
For now, the best barometer of how happy you or your parents might be with a
particular assisted-living home is your knowledge of who they are already.
I can’t say my parents have found bliss in their new living conditions. Rather, they have
had many moments of contentment and joy that punctuate days of boredom. But it also
turns out that you can’t always go by what you see. One manager at a home my parents
tried out observed that I was pleasantly surprised to see my father waltzing merrily
with a caregiver one day. “Family members don’t see the full picture,” I remember the
manager saying. “They get a tearful call and they feel terrible, but they don’t know that
half an hour later, their parents are all smiles in Zumba class.”
I’ve come to the conclusion that there’s only so much control you can have over the
happiness metric. As a family member, you do your homework, choose wisely, and
advocate as needed, but ultimately, people are who they are. Their life experiences,
genetic make-up, and cultural expectations may all combine to make them a curious
soul who makes friends easily—or they might struggle to adapt.
This was never clearer to me than the day I watched the seniors at a mid-summer dance
party at my parents’ residence. My mom and dad were still the new kids, hanging back
nervously, and most of the other seniors clapped along politely. But one woman barely
sat down. With every danceable tune, she took to the oor, waving her scarf as she
danced, almost Bollywood-style, to Elvis and The Beach Boys, without a partner. The
man I recognized as her 40something-looking son came rushing in, perhaps as soon as
he could make it there from work, but he didn’t try to get her attention. I saw him smile
at his mother admiringly as he watched her for a few minutes, until he could slip away
unnoticed, and return, I presume, to his own life. For the children of assisted-living
residents, in families that can afford it, this is peace of mind worth paying for.

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1/12/2020 What you learn when you move your parents into assisted living — Quartz

LETTER FROM A HOME

Senior living is starting to look like millennial

the closets jammed as usual with coats and snow boots.

I still had so much to learn.

Even as it was nally happening, I resisted considering their relocation permanent. I

It’s unavoidably expensive, but so is staying home

In North American cities, the cost of rent in a modern assisted-living residence is

pain, or memory loss, that makes complete independence impossible or hazardous. A

Senior living and millennial living are starting to look alike

The social injustices outside assisted living persist on the inside

“I do think if we are going to become an industry with more-affordable options—I’m

Happiness is never a given

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