Posts Tagged ‘Aging’

Nightmare in Nanaimo?

Wednesday, December 7th, 2011

A recent article in the Nanaimo Daily News about seniors housing suggests that the average Nanaimo senior can afford 37.5 months of assisted living. And after that? The article leaves it to your imagination. Ice floes maybe?

But perhaps the situation is not as dire as the article suggests. For example, the average cost of assisted living per month is indicated to be $6,000. The average sale price of a condo in Nanaimo is indicated to be $225,000 resulting in the aforementioned 37.5 months.

Where exactly the reporter found that $6,000 unit is a good question. I have never heard of a $6,000 assisted living unit in Nanaimo. And most people who move to a retirement community don’t need assisted living anyway—they need housing that provides meals, housekeeping, laundry etc but they don’t need the level of care provided in assisted living.

According to CMHC, the average cost of an independent living unit in Nanaimo (one that provides meals, housekeeping, laundry etc) is $2,553—a long way from $6,000. And many people don’t move from a condo to seniors housing—they move from detached houses, the average value of which in Nanaimo is currently $356,000. And people use their income to finance their monthly housing costs, not just the proceeds of house sales. The article says the average after-tax income for 65+ people is $25,996. In fact, the average income of all 65+ households in Nanaimo is $46,471; of owners is $50,334 (80% of 65+ households in Nanaimo are homeowners).

All this is not to say that low income seniors, especially renters, don’t face serious housing challenges. They do. But to scare people by saying that the average senior in Nanaimo will only be able to afford to stay in a seniors’ community for 37.5 months is highly misleading. What is needed is a mix of options, ones that take into consideration peoples means before lumping them all together into one big pot of seniors.

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90 is the new 80

Tuesday, November 29th, 2011

In case you haven’t been keeping up, 90 is the new 80 or more precisely, 90 is the new 85. A recent report from the US Census Bureau (I know what you are thinking—why doesn’t she ever reference Canadian data in her posts? Because there isn’t any is the short answer to that question.) points out that among the seniors population as a whole, the 90+ group has been growing the most rapidly. When all of the baby boomers reach the age of 85 (in 2050), 2% of the US population will be 90+ which is pretty amazing if you stop to think about it. That is a lot of 90 year olds.

What are today’s 90 year olds like?

• Women outnumber men 3 to 1

• 6% of the women are married; 43% of the men (which is one of the big reasons that the vast majority of the residents of seniors housing communities are women—not only do they live longer, they are much more likely to be alone.)

• The likelihood of living in a nursing home rises from 20% between 90 and 94 to 31% between 95 and 99 to 38% for those over 100. These ratios are probably lower than what many people would expect. I usually quote a ratio of 35% of the population over the age of 85 living in nursing homes in Canada but either my estimate is wrong or there is a much higher incidence of institutionalization in Canada. We will try and check this out.

• Not surprisingly, people living in nursing homes have more disabilities than people living in the community although overall, the differences aren’t huge—98% of nursing home residents have disabilities (I don’t know why it isn’t 100%) compared to 81% of people living in the community. But there are major differences in a couple of categories—trouble remembering (73% versus 30%) and needing help with activities of daily living such as bathing and dressing (85% versus 35%).

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US Market Improving (slowly)

Friday, November 18th, 2011

I know I do go on about the US market, but I find it endlessly fascinating. Of course that’s partly because there is so much data on the US market. We have so little data in Canada that it is usually quite difficult to figure out what’s going on.

The chart below, courtesy of NIC, shows a steady improvement in occupancy levels in independent living (IL) and assisted living (AL) communities in the US since the seniors markets bottomed out in the first quarter of 2010. It’s interesting though, or maybe depressing is the better word, to think about how long and how deep the slide has been, really since the latter part of 2006. Not only that, over the same period of time the 75+ population in the US increased by over 800,000 people. To put that number in perspective, in Canada there are a total of just over two million people over the age of 75.

US Occupancy Rates

So while things are getting better, they are still a long way from good, thanks largely to the still extremely sluggish US housing market.

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Transforming Institutional Long Term Care

Tuesday, November 8th, 2011

To most people in the field “institutional long term care” is a redundancy. If it’s long term care, it’s institutional.

But a movement in the US, called the Green House Project, is aiming to change all that. And it’s not green as in sustainability, it’s green as in grass, plants, gardens, the outdoors.

Here is a brief description from the web site:

‘The Green House residence is designed to be a home for six to ten elders. It blends architecturally with neighboring homes, includes vibrant outdoor space, and utilizes aesthetically appealing interior features. Each elder has a private room or unit with a private bathroom. Elders’ rooms receive high levels of sunlight and are situated around the hearth, an open kitchen and dining area. While adhering to all codes required by regulations, Green House homes look and feel like a home, and contain few medical signposts.’

To anyone familiar with modern care facilities in Canada and their associated regulatory frameworks, such a model seems impossible. But lots of research shows that not only is the Green House Project possible, it delivers better outcomes than traditional skilled nursing facilities and it doesn’t require any more staff resources. Many green home communities are now operating throughout the US although I have never heard of one in Canada, not surprisingly. It took us 10 years to catch up to the US in the assisted living sector.

We have lots of questions about this model as you probably do too. My first question is: how frail is too frail, physically and mentally, for a Green House client? We’ll find out and let you know in future posts.

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Numbers: Canada vs. US Nursing Homes

Tuesday, August 16th, 2011

A recent study published by Brown University (July 2011 edition of Health Affairs) shows that between 1999 and 2008 the nursing home population in the US shrank by just over 6% while at the same time the population over the age of 70 increased by just over 8%. The shift is attributed largely to the growth of alternatives such as assisted living.

Here’s another interesting thing to note—in Canada, there were 250,000 nursing home residents in 2008/2009. In the US in the same year there were 1.2 million. Using the standard 10 to 1 ratio suggests that there are twice as many people in Canada in nursing homes as there are in the US on a per capita basis. That is undoubtedly due in large part to the lack of Canadian alternatives, assisted living in particular. Assisted living in the US is almost entirely a private pay phenomenon and when it comes to care, no matter how light, Canadians do not like to pay for it. As a result, the private pay assisted living market in Canada is a very thin one.

On the surface, the impact of twice as many nursing home residents and very few assisted living residents would seem to result in much higher public expenditures in Canada for the elderly compared to the US, particularly in light of recent dramatic cuts to US Medicare and Medicaid budgets (11% reductions). And maybe that is as it should be, although it seems inevitable that Canadian public expenditures on the elderly are going to be spread much more thinly in the future than they are now.

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Primary Market Areas

Tuesday, July 26th, 2011

Historically, market areas in the seniors’ housing industry in Canada have been defined for the service enriched segment of the market. Primary market areas (PMAs) are considered to be those areas from which 75-80% of the residents of a project will come. Sometimes radiuses are used, 10 miles being a popular one as in “This is a 10 mile business”. Occasionally the 10 mile rule even works but it is a risky thing to hang your financing on. Bridges, municipal boundaries, socio-economic neighborhood characteristics, competing projects—any of these, plus dozens of other factors, can and do affect the determination of primary and secondary market areas.

And of course there is the big one, the location of children. From the perspective of market analysis it would be comforting to think that the location of children is a neutral factor when it comes to estimating demand from primary and secondary market areas because it is a difficult factor to estimate. But it is far from neutral. It may even be as important as the presence of seniors themselves in a market area. Job-generating market areas will attract more seniors than they lose, which is why Alberta attracts and retains more people over the age of 65 than BC (strange but true).

As is almost always the case in Canada, there is very little hard data indicating whether the definition of primary market areas has any basis in fact at all, beyond the research Lumina has done with the BC Senior Living Association. Operators know where their residents come from of course but there has been no systematic collection and analysis of data that shows how reliable the 75-80% estimate really is.

But things are different in the US, where the industry sees the value of research and actually spends money on it! Wow – what a concept. The most recent NIC Insider Newsletter references a 2003 study that found that 22.5% of a large sample of new residents moving to CCRCs (Continuing Care Retirement Communities) had moved from farther than 15 miles away. Results of this study have been supported, in a way, by a just-published Reuters/University of Michigan survey. Of respondents to that survey aged 70+, 20.4% said that where they live was not convenient from the perspective of where their children live. NIC sees this as supporting the results of the 2003 survey and I suppose in a very indirect way it does.

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Interprovincial Migration to BC (no no it’s not boring!)

Tuesday, July 12th, 2011

Readers of my book and this blog will know that I have what is probably an unhealthy, or at least an unnatural, interest in migration patterns. But anyone who is interested in seniors housing markets, or indeed any other kind of housing market, should pay close attention to who is moving where and for what reason. We just finished a market analysis in Saskatoon. Interprovincial and international migration to Saskatoon has been positive (ie in-migration has exceeded out-migration) for about 4 years now, after at least 40 years of more people leaving than moving in. The impact of that on almost every aspect of life in Saskatoon has been, if not quite profound, certainly noticeable.

Which, then brings me to BC. Immigration from other countries to BC is fairly constant from one year to the next. And almost all immigrants settle in the Lower Mainland, so it is a factor of less interest to other communities. Interprovincial migration on the other hand is hugely variable and affects communities throughout the province. Contrary to the urban myth that BC is a giant magnet for retirees, almost all interprovincial migration depends on economic conditions in BC compared to our eastern neighbours, particularly Alberta.

It sounds simplistic but it really isn’t—when interprovincial migration to BC is positive, things are good. When it’s negative, things are bad.

That’s why it was alarming to see in BC Stat’s First Quarter 2011report on interprovincial migration that for the first time in 9 years, quarterly migration has been negative. The report cautions that numbers are preliminary but states: “we can be reasonably assured that interprovincial migration to BC appears to be trending down”.

That is a sobering thought. In future posts we will talk about the sub-provincial impacts of these changes. As readers of my book know, great information on inter-, intra- and international migration trends is available from your friends at the Canada Revenue Agency. Your friends at Lumina Services pay close attention to this information in our unceasing search for the truth.

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CKNW Interview

Monday, June 27th, 2011

For all you non-Vancouverites following our blog, CKNW is the # 1 rated talk radio show in the region. I just did an interview with Jill Bennett, one of the hosts on the station. Before the interview started I was thinking about interesting ways to talk about the numbers—how our population is aging and what that really means. For example, the Vancouver metropolitan area is expected to grow by 1 million people between now and 2035. That’s a pretty interesting number in itself (where are they all going to live you might reasonably ask) but what is more interesting is that fully 40% of those 1 million people will be over the age of 65.

What does that really mean though? The fact is that there are lots of communities that already have much higher proportions of their population over the age of 65 than Vancouver will have in 2035 (22%). For example, Parksville-Qualicum at 33%, or Penticton at 24%. If you visit Penticton you do not get the sense that it is overrun with seniors. Parksville-Qualicum is a little different, partly because it is quite a lot smaller than Penticton. I know people who decided to retire in Nanaimo rather than Parksville-Qualicum because they got frustrated in grocery stores by slower-moving shoppers. Just imagine though what life would be like in Sun City Arizona, where 80% of the population is over the age of 65.

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Aging in Britain

Monday, June 6th, 2011

A recent article in the Economist (An age-old problem, May 28th, 2011) discusses the findings of a report from the Law Commission, an agency in Britain that helps Parliament “tidy up legislation”, in the inimitable words of the Economist. The report is focused on long term care and how to pay for it. At present, poor people have their care paid for by the state; wealthier people have to pay for it themselves, either by running down their savings or selling their home or both. This is a much different situation from Canada, where almost all long term care is paid for by the state. (Rich people pay a little more than poor people for subsidized care, but not much more. How long this can last is another question entirely.)

The Law Commission considered the fairness of the situation in Britain—should people who have worked hard all their lives, saved their money and bought property be faced with financial ruin if they require long term care? The Economist expects that further work by the Commission will recommend an insurance scheme of some sort, probably underwritten by the state, to help deal with these problems. Almost no one in Britain buys long term care insurance but as loyal readers of this blog will know, almost no one in any other country does either.

Another solution for aging Britons, suggested by the Joseph Rowntree Foundation, involves a home equity scheme. People would sell a stake in their houses, which would be reclaimed after death. The money so raised would be used to pay for home modifications designed to facilitate aging in place—showers instead of bathtubs and so on. A pilot project in North London has experienced only modest take-up so far but that is partly because a similar scheme in the 1980s did not work well and people remember.

Something is going to have to work, in Canada as well as in Britain. State-funded long term care is most definitely a time-limited solution to emerging needs.

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Baby Boomers (one more time)

Thursday, April 28th, 2011

Emmylou Harris has just released a new record which, by all accounts, is excellent. Reading the reviews I learned that Emmylou, who is 64, lives with her mother, who is 89, just outside Nashville. That got me thinking, yet again, about the future housing behaviour of the boomers. Coincidentally we have been cleaning out files and found a 2005 article from Australia written by Val O’Toole called Baby Boomers Housing Demands. The article references psychologist Erik Erikson, who theorized that when people are enmeshed in one stage of life it is very hard to foresee the next. That is certainly true of the boomers—it is probably true of everyone. When you are, say, 60 and fit, how can you possibly foresee what you might want when you are 85 and frail? People are always saying the boomers will be different when they are 85 but I am not so sure. It’s one reason I am looking forward to actually being 85—finding out how the story ends.

The Australian article speculates about all the possibilities and concludes that typical older boomers, like Emmylou Harris and her mum will choose to remain in the family home no matter how inappropriate it may be. That certainly mirrors the situation in North America as well.

But that is partly a matter of options, or lack of options. Today there isn’t much choice for mobile seniors beyond active adult type housing and service-enriched type housing. There are a few cohousing communities around, but very few other examples of more communal type living arrangements. That is one area I think is going to be a much more prominent part of the landscape in future years.

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