New `barons' emerge in the House

Kendal at Longwood is a splendid site for a retirement community. The hills around it have inspired three generations of painting Wyeths and a whole school of American landscapists. History flows through the area. A stone's throw away is the Revolutionary War battlefield of Brandywine, where Washington vainly sought to block the British advance on Philadelphia, now less than an hour's drive away.

Kendal is home to about 360 retirement-age Americans. Called a continuing-care retirement community, it is gaining favor across the United States.

Typical residents are vigorous and healthy, and they are past retirement age. As in other retirement facilities they eat most meals together, and take part in activities, retiring to the privacy of their rooms when they choose.

Entrance and monthly fees entitle the few requiring long-term care to receive it in the medical wing, at no added cost. It's a classic example of insurance: All residents pay for care that only a few will use.

A facility ``is definitely in the long-term care insurance business,'' says Lloyd Lewis, Kendal's executive director. He says the medical wing of facilities that are similar to Kendal provide ``one of the most viable, cost-effective'' kinds of long-term care available.

Residents have ``a lifetime contractual guarantee'' of accommodations, meals, and medical aid, says Anne Somers, a geriatrician and professor at the Robert Wood Johnson Medical School in Princeton, N.J.

A decade ago there were few such facilities across America. But the number is ``growing by leaps and bounds,'' says Alice Biache, vice-president of Goodwin House, a continuing-care retirement facility in Alexandria, Va. ``Everyone is jumping on the bandwagon,'' she says. Yet fewer than 5 percent of America's elderly live in retirement homes, and only a modest percentage of them are in continuing-care facilities.

Professor Somers says there is vast potential for growth. ``My own guess is that at least 25 percent of the elderly'' are willing and able to pay the money required to live in such facilities. ``Provided,'' she adds, ``they have confidence in the [financial] integrity of the institution.''

It's not cheap. Somers says an applicant must pay a $35,000-to-$90,000 entrance fee. Additional monthly payments run from about $1,000 to $1,600.

Skeptics say high fees automatically limit growth. They note that 1 of every 8 older Americans lives in poverty, despite improvements in care for the elderly made in the past two decades. At least an equal number live just above poverty's edge.

Advocates note that most Americans over 65 own homes. Thus, Somers says, by selling their houses most could come up with the entrance fees. But, she concedes, it is ``more speculative'' as to how many could afford the monthly fee.

Some of these facilities, like Kendal, are spread out like campuses. Others, in urban settings like Goodwin House, are high-rises that look like apartment buildings.

Many residents find a sense of home and extended family in their continuing-care communities. Says Marjorie Trent, a former teacher and school administrator who has lived for 14 years at Kendal: ``I think it's the ability to be independent and yet to have backing, as if you had a family. To have somebody to fall back on, that makes this place so attractive. You feel secure.''

Yet Ms. Biache warns such a facility ``isn't for everyone. Not everyone could adjust to congregate living.'' Then there's the matter of location - ``a big factor,'' she says. It's something anyone planning retirement ought to consider. ``Nearness to family,'' for one thing. And does a person prefer the city or the country?

The vast majority of continuing-care retirement communities are nonprofit. But profitmaking corporations, eyeing the prospects for a greatly expanded market, are beginning to enter the field.

Experts warn that the elderly check: (1)the commitment of the sponsoring organization to the needs of the elderly and not merely to the financial bottom line; (2)the financial stability of the sponsoring organization.

And when these facilities are built for those will no expertise, Alan Hunt warns, ``in most cases, those have been just trouble.'' The costs have been too high; some have gone bankrupt. Mr. Hunt chairs the legal committee of the American Association of Homes for the Aging.

But well-run facilities can provide residents with protection from a deep concern of many elderly: how to pay for long-term care, should they need it.

The very affluent have sufficient financial resources; the very poor have medicaid. But the majority of middle-class Americans are still looking for a way to protect the bulk of their estate, however modest, so they can give it to family or friends.

Fortunately the stirrings of progress are now present. Organizations that speak for the elderly are insisting on progress, as are the elderly and their children.

The insurance industry is offering a host of new programs. Government is moving toward decisions on care.

How the situation will be resolved is not yet clear. What is apparent is that the old answer - that nothing can be done - no longer suffices.

Last of five articles. Other stories ran Monday through Thursday.

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