Instead of moving his mother into an assisted-living apartment three years ago, Eli Portnoy rented condos for both of them, two floors apart, at Canyon Ranch Hotel & Spa in Miami Beach, Fla.
His mother received many of the same services and amenities that would have come with an assisted-living facility -- on-site doctors, healthy meals, a gym and a variety of wellness classes -- but in a far more appealing setting.
The kicker? Portnoy, a 57-year-old branding consultant, estimates that he saved $50,000 to $75,000 a year -- even including round-the-clock private nursing aides -- over what he would have paid for an assisted-living apartment luxurious enough for his mother, a retired New York art dealer who died in December at age 90.
A growing number of intrepid retirees, wary of spending years in an assisted-living facility or staying at home, are opting for arrangements that provide them with a full range of services and a greater sense of adventure -- fully staffed homes in Costa Rica, backyard bungalows on their children's property, so-called cohousing arrangements, full-time spa living and even serial cruises.
Assisted living emerged in the 1990s as a popular alternative model to nursing homes for older people who no longer felt comfortable on their own but were too independent for a nursing home. An estimated 733,200 people in the United States lived in an assisted-living facility as of 2010, the latest data available, according to the American Health Care Association's National Center for Assisted Living.
Typically, assisted living consists of a small apartment with services that may or may not cost extra, such as medicine management, personal care, housekeeping and laundry, meals, activities and transportation to doctors' appointments.
Now, some pioneers are piecing together similar services on their own in a setting more to their liking -- often with help from their adult children -- and at a price comparable to or cheaper than an assisted-living apartment. A one-bedroom unit in an assisted-living facility cost as much as $9,500 a month in 2011 before any add-on services, according to long-term-care insurer Genworth.
Of course, coming up with your own plan for care requires a lot more work than simply writing a check to an institution. Finding paid help you can trust takes time, legwork and background checks -- and there are no guarantees. The total costs can be hard to pinpoint in advance. It is tough to pull it all off without the vigilance of a good advocate, typically an adult child.
On top of that, getting a long-term-care insurance policy to pay your care expenses could take some negotiating. Still, they should generally be covered, as long as you need help with at least two daily-living activities, such as dressing or bathing, or cognitive care. Additionally, many newer policies have language about covering "alternative plans of care" that are developed in the future, says Rona Loshak, a long-term-care insurance broker in Roslyn, N.Y.
There aren't data available on how many people are forgoing conventional living arrangements in retirement, but experts in the field confirm the trend is growing and is likely to expand as 77 million baby boomers -- more likely to identify assisted living as an option for their parents -- head into old age.
"People are getting more creative in how they're spending their senior years," says geriatrician Lee Lindquist of Northwestern University's Feinberg School of Medicine. Even as they start to develop medical problems, "they don't want to spend their time in one room every day."
For those who prefer to follow their own path, here are several alternatives:
Americans have been retiring abroad for years, but going abroad for long-term care is relatively new. One of the pioneers was Bob Preston, a retired CPA and actuary in Sarasota, Fla.
For $3,500 a month, Preston rented a home in Costa Rica for his ailing father a decade ago, shared with two other patients. The price included a supervising nurse, three aides, a care coordinator and a chauffeur.
"We had tried everything in this country," Preston says, such as an assisted-living facility that cost $8,000 a month, including private help. He was frustrated by the lack of attention being paid to his father, the retired chief financial officer of a large pharmaceutical company.
For less than half that amount, his father was able to live in relative luxury in Costa Rica. He attended church on Sundays, took a group to brunch afterward and went out to dinner several times a week.
The arrangement lasted for three years, until Preston's father died in 2001. Preston says that even including his monthly visits, the costs were much lower than long-term care would have cost in Florida. The flight from Connecticut, where he lived, took four hours and 20 minutes, just an hour and 20 minutes more than flying to Florida.
Preston concedes that he had qualms at first. For the first month, he hired a bilingual caregiver from the United States to be on the scene. He checked every reference he could. He contracted with a local secretary to pop in unannounced.
It worked so well that he was making plans for his mother, long divorced from his father, to go there after she suffered a broken hip last year. "We tried a nursing home for six weeks in a five-star place," he says. "But she disliked it." His mother died in February, at age 92, while he was planning the move.
One of Preston's friends followed his lead, moving her mother to Costa Rica, where she lived until she died.
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