1. November 2014
Between 2010 and 2015, the number of seniors living in New Hampshire is on
track to double, increasing the demand for assisted living facilities and
continuing care retirement communities, says Bill Ray, managing director of
policy planning and communications of the NH Housing Finance Authority
(NHHFA).
In NH, 154 assisted living facilities and eleven continuing care retirement
communities currently offer housing for seniors, usually those over the age of
65. These facilities range in size from small mom-and-pop homes with only a
few beds, to national companies like Genesis HealthCare that also specialize in
the nursing home industry.
Residents in assisted living facilities pay monthly fees to receive help with daily
living activities, such as bathing, grooming or simply getting around. They also
receive medical attention without the 24-hour skilled nursing found in nursing
homes.
In continuing care retirement communities (CCRC), residents join when they
can live independently and, in addition to a monthly cost, pay an entrance fee
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by
SHERYL RICH-KERN
Between Home and the Nursing Home
Between 2010 and 2015, the number of seniors living in New Hampshire is on
track to double. Where will they want to live?

2. November 2014
that guarantees a spectrum of care, from assisted living through skilled nursing
care. This guarantee acts as an insurance contract, and as such, the state’s
department of insurance licenses it.
Aging Economics
Nationally, 1,926 CCRCs dot the country with 676,000 residents. The majority
—80 percent—are nonprofits. And 75 percent of these nonprofits are faith-
based organizations. In NH, all of the CCRCs are nonprofits and three of the
11 have religious affiliations.
During the 2008 recession, CCRCs and other retirement developments
struggled with vacancies, says Lisa McKracken, a senior living research analyst
at Ziegler, a Chicago-based investment bank. But the industry is coming out of
its slump, she says, especially with more CCRCs offering more flexible
contracts and a wider variety of living arrangements.
RiverWoods at Exeter is a prime example. With 620 residents, the three-
campus community on 200 acres is 98.5 percent occupied, its highest rate in a
decade, says Cathleen Toomey, vice president of marketing.
RiverWoods has doubled in size since opening in 1994. The spike in residents
doesn’t surprise McKracken. “We’re right in the middle of the age wave,” she
says, with 19 percent of the population expected to be over the age of 65 by
2030.
That’s also good news for communities with CCRCs.
RiverWoods generates $1.45 million in taxes for the town or Exeter and
employs 493 full- and part-time workers. RiverWoods pays out $14.53 million in
wages, half of its operating budget. Plus, it stimulates commerce for companies
that service the property, from construction workers to food suppliers.
According to the NH Department of Health and Human Services, the number
of assisted living facilities has risen by only 10 percent in the last nine years,
from 139 in 2005 to 154 today. The bigger push is in the recruitment of direct
care workers, says John Poirier, president of the NH Health Care Association
(NHHCA). Employers, which include short-term nursing homes as well as
long-term assisted living residences, are hiring nurses’ aides, LPNs and RPNs,
managers, housekeepers and grounds maintenance keepers. Statewide, the
industry employs 7,500, paying out more than $120 million in wages each year.
Benchmark Assisted Living, which operates four assisted living facilities in NH,
employs more than 400 in the Granite State, a number that’s increased as
much as 50 percent in the last five years. “We’re caring for more residents with
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In NH, all of the
CCRCs are
nonprofits.

3. November 2014
more needs than perhaps we were 10 years ago,” as people arrive older and
frailer, says Christen Bergeron, Benchmark’s regional director of operations.
The company spends close to $8 million on salaries.
Resident care associates are the biggest share of its employee roster, but
Bergeron says the company relies heavily on other positions and encourages
promotions from within. For example, Heidi Cole joined Benchmark in 2000
as a part-time receptionist at the Birches in Concord. By leveraging the
leadership training, tuition reimbursement and in-house courses, she stepped
up the management ladder several times and now serves as traditional care
director at Nashua Crossings.
Arthur O’Leary, vice president of operations for Genesis Health Care in NH,
says the Pennsylvania-based organization runs more than 400 skilled nursing
centers and senior living communities nationwide and provides jobs to more
than 4,000 in the Granite State.
Genesis is one of the state’s largest employers with 30 facilities, of which 22 are
nursing homes. The other eight are assisted living homes Genesis Health Care
acquired. And its employment needs outstrip supply. The challenge, O’Leary
explains, stems mostly from a lack of masters-level nursing instructors in the
schools. He also says eldercare environments compete for staff with fast-paced
emergency room or ICU departments. “I could hire 20 nurses today if they
walked through the door,” says O’Leary.
Older nurses are retiring and younger nurses are not replacing them. Nursing
aides, who do the bulk of personal care—such has bathing and dressing—are
often older women. “We’re a training site for a lot of nursing programs,” says
O’Leary. And once in a while when young students do rotation shifts with
elders, they realize the emotional rewards, he says.
To service the 360 residents at the Hunt Community and the Huntington, both
CCRCs in Nashua, parent organization Hunt Senior Living (HSL) requires a
cadre of 300 full and part-time employees. And since both campuses are a
stone’s throw from large retail centers, local merchants draw from a network of
consumers from these organizations. Teachers and civic leaders also benefit
from the resources that seniors with time on their hands provide. For example,
HSL residents read to elementary school children and retired engineers
participate in science fairs.
For the most part, CCRCs benefit seniors with deep pockets. A national survey
in 2009 by the American Seniors Housing Association identified typical
entrance-fee CCRC residents as earning more than $50,000 a year, with an
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4. November 2014
average age of 81, likely to be widowed and significantly more likely than the
average population to have a college degree. Almost all received at least
$100,000 from the sale of their home.
It’s not a stretch for some NH seniors to qualify for these CCRCs. In NH, 30
percent of homeowners don’t have a mortgage, and the majority of these are
older adults, says Bill Ray of the NHHFA.
Where for Art Though, Romeo?
Among those opting for a CCRC are Dick and Barbara Tompkins, formerly of
Rye. Dick Tompkins jokes that he’s one of the “Romeos”—or Retired Old Men
Eating Out—who dines with friends every Thursday. A retired military officer,
he keeps a steady pace other days of the week by volunteering at a nursing
home, collecting medical equipment for developing countries and greeting
troops as they pass through the Pease International Airport.
When his wife gave him marching orders to get off the roof of his 1960s Cape,
the time seemed right for these feisty octogenarians to halve the size of their
living space. The Tompkins sold their three-bedroom home for $399,000,
giving them more than enough cash for the $341,000 entrance fee, which is 50
percent refundable to their estate.
The Tompkins pay $4,900 a month for a one-bedroom at The Woods (the
original campus of RiverWoods at Exeter), a price that eclipses most apartment
rentals. However, the fee also gives them access to the fitness center, spa,
library, music room, at least one meal a day, all utilities, campus shuttles, arts
and education programs, as well as assisted living and skilled nursing when and
if they need it.
Competing for Seniors
Bill Ray of the NHHFA says people in their 60s may grow weary of mowing
lawns and clearing icy driveways, but with the large properties they currently
own, along with “the kayak, the motorcycle, the two cars,” most aren’t ready to
surrender a lifetime of possessions.
In fact, in a recent AARP survey, 95 percent of NH residents say they want to
remain in their homes as they age. But at the same time, disabilities associated
with growing older may require them to seek health-related services.
To prepare for the boomers who will reach their mid-70s in the next 10 years
and want to age in place, RiverWoods and other CCRCs are designing spacious
cottages on bucolic grounds, creating a landscape that’s anything but
institutional looking. The construction of 2,000-square-foot cottages with
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5. November 2014
hardwood floors and a walkout basement was the lure that convinced Janet
Brown, a relatively young senior at age 75, to move with her husband from their
cavernous home in Rye to the Huntington CCRC in south Nashua. “It was an
easier downsizing,” says Brown. “We had always had property and privacy.”
The Browns paid a 90-percent refundable $620,000 entrance fee and pay
$6,500 monthly. Deborah Riddell, CEO at Hunt Senior Living, which
oversees the Huntington and the Hunt Community, says these fees are at the
high end of the spectrum for this CCRC. Yet, at the Huntington, the larger
accommodations are the more popular.
That demand signals that the economy is improving, says Riddell. “Yet people
are still cautious.”
While the Huntington guarantees a plan for life, the Hunt Community offers a
fee-for-service version of assisted living or nursing care that is 30 or 40 percent
less than current market rates. And its entrance fees are less expensive, with
fees starting at $109,000.
Continuing Care at Home
To differentiate itself in the marketplace, Hunt Senior Living is offering a third
option that is the first of its kind in New England. Called “Hunt at Home,” it is
a plan for older adults that guarantees the health services seniors would receive
in a continuing care retirement community without having to move there.
Riddell explains those most interested are headstrong about receiving care at
home, and not at an assisted living or a nursing home. And most likely, she
laughs, “they have a social network as it is — or they don’t want a social
network. They’re true loners.”
But should Hunt at Home members want it, the outlet of a CCRC is nearby.
They can exercise in the gym, participate in some of the trips, or attend Osher
Lifelong Learning Institute classes around the state.
While only 30 people have signed up so far, Riddell hopes to grow the
membership to 80 or 120.
“It’s a tough sell,” says Riddell, “because you’re not selling bricks and mortar.”
The continuing care at-home (CCaH) model is an insurance product like the
other continuing care plans. Fees vary widely, with the actuarial rates
dependent on the applicants’ age and health.
Around 17 continuing care at-home (CCaH) models exist in the country, and
many more are in development. According to Leading Age, an industry
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6. November 2014
association, they present a growing opportunity for CCRCs to spread out
administrative costs for shared services.
Assisted Living Facilities
Perhaps the largest generation on the cusp of retiring is also one of the most
selective in wanting surroundings that blend with nature, provide light-filled
spaces and feature energy-conserving elements.
That proclivity propels architects of these senior living homes to create
sustainable designs like the LEED-certified building at Bedford Falls, which
opened in 2012 and coincidentally bears the same name as the fictional utopia
from the 1940s classic film, “It’s a Wonderful Life.”
It is part of the 50 communities in six New England states operated by
Benchmark Assisted Living, headquartered in Wellesley, Massachusetts. The
$390 million company entered the NH market in 2000 with Greystone Farm at
Salem and the Birches at Concord, with the latter designed exclusively for
residents with dementia, Alzheimer’s disease and other forms of memory
impairment. The for-profit Benchmark also has a location in Nashua and, in
total, serves 325 residents, contributing more than $650,000 in property taxes.
The demand for assisted living in NH is on an upswing, Bergeron says,
particularly as the concept gains acceptance and more facilities manage care for
family members who are gradually losing some of their intellectual functions.
While the majority of seniors say they want to stay in their homes as long as
possible, a new survey by the National Council on Aging revealed that 48
percent say they would consider moving to an assisted living facility if they
could no longer live independently.
Bergeron says she is also seeing a rise in the number of couples entering homes
where only one spouse is presenting signs of dementia, but want a facility that
oversees the social and personal needs of both.
Those who do make the transition to assisted living will do so without
government aid, shelling out an average monthly starting fee of $4,000.
Bergeron says most of the funds come from the seniors’ estates, and in the last
decade, she says more people are leveraging their long-term care insurance to
foot at least half the bill.
BNH
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