Chapel Hill News

Housing for the rest of your life

In the third conversation about Aging in Place held at the Friday Center this spring, Paul Klever, executive director of Charles House Association, began the dialogue by asking the audience, “What happens when you need care or help to manage your daily routines?”

The answer he gave included more than the traditional, institutional answers of finding an assisted living center or nursing home. Klever walked the audience through the process of intentional aging, which is defined as planned, deliberate and intended; and considers the type of housing available as our bodies and minds become “frail,” a term Klever used to describe the stage of life requiring fully-supported living, at home or in another facility where a cohort of friends, family, neighbors and/or trained caregivers will be needed.

The numbers that Klever says count are: 70 percent of people age 65-plus will need long-term care support services; 45 percent of people age 85-plus will have some form of dementia. Women will need long-term care support services for 3.7 years; men for 2.2 years.

How much this will cost, he said, can be found in annual surveys by long-term-care insurance companies, such as Genworth, whose 2014 Cost of Care survey was conducted during January and February 2014 and is now online with figures by state and by major metropolitan areas within each state. In Durham-Chapel, annual median costs for long-term care vary from $15,860 for Adult Day Health Care to $48,000 in an Assisted Living Center and $94,944 for private room Nursing Home Care.

And you still have to pay your supplemental healthcare and deductibles on top of those costs, Klever said as he reminded the audience to consider the type of care they will desire as they age. Klever asked the audience to think about the difference between “normalization” and “institutionalization” when looking into long-term care options.

“For a lot of us, institutionalization is where one becomes subservient to an institution,” Klever said. “Person-centered care options are movements away from institutionalization. As individuals, we should look at services and places where ‘I” continue to be a ‘normal’ person first.

“During our ‘Phase of Frailty,’ we are considered abnormal or in the margins,” Klever said. “At Charles House (Adult Daycare), our seniors come here and are totally normal to our staff and volunteers. Our motto of ‘helping people age the way they have lived,’ is the basis for how we interact. The same is true for the Eldercare home we built in Heritage Hills; although there, the daily activities are structured as they would be around family life as it is lived in a neighborhood.”

The annual cost of living in a Charles House Eldercare Home is $69,000; and the staff to resident ratio is 1:3 during the day and 1:6 at night, Klever said. Whereas the staff to resident ratio at Assisted Living Centers and Nursing homes is closer to 1:15 during the day; and 1:30 at night, Klever said.

Fully 78 percent of adults in need of long-term care depend on family and friends as their only source of help; only four percent live in nursing homes and assisted living, Klever said quoting information from the Family Caregiver Alliance of the National Center on Caregiving. The Alliance figures show 51 percent of care recipients live in their own home and 29 percent live with their family caregiver, which means that the foundation of long-term care is the family and “informal caregivers,” Klever said.

Klever said that before the Phase of Frailty, there are two phases of later life: active years and supported life. He told the audience that while they are in their active years, they need to consider how they want to live when they age into the other two stages.

Klever said that when considering healthy aging, low-interaction is equivalent to smoking 15 cigarettes a day or being alcoholic, according to PLOS Medicine, an open-access, peer-reviewed medical journal (; July 2010). Low interaction is a greater risk factor than not exercising and is two times as deleterious as being obese, he said.If active seniors decide their goal is an age-integrated neighborhood of caring, connected families helping those who need some support and providing places to live when full-support is required, then seniors need to build that neighborhood during their active years, Klever said.

Independent seniors working together as neighborhood elders can be seen as the Outer Ring of an age-integrated neighborhood, Klever said. There is an Inner Ring of Elders needing/wanting support; and a Center Core of eldercare home(s) for fully-supported living and to provide some support for Inner Ring Elders.

The Outer Ring must be created by each neighborhood’s elders, Klever said.

“Identify yourselves and become a “group of elders” who agree to a “Concierge of Care” you can provide,” Klever said. “Read David Wann’s ‘Superbia!’ and follow the 21 steps that can help any neighborhood be more connected.”

Klever said those steps include: canvassing neighbors, creating and maintaining an email listserve and directory; initiating and coordinating activities that bring neighbors of all ages together; creating a community center.

The Supported Life Stage he described as an “inner ring of elders needing or wanting support. They could receive that support through in-home services coordinated by active senior neighbors; shared housing with services (think the old “Golden Girls” television show); or a cottage cluster of senior homes in an age-integrated neighborhood.

He encouraged the audience to meet with family, friends and neighbors to start the process of intentional aging with its focus on finding a vision and then envisioning how a future can be created that includes a connected neighborhood with a caring cohort of active adults who can provide support when it is needed and even come together to build an eldercare house in the neighborhood when full support is needed.

Klever said that both Charles House Eldercare Homes are close to 2,400 square feet and are similar in costs to build. Charles House purchased both the lot at 112 Della Street in Winmore and the original house/lot at 303 Yorktown Drive in Heritage Hills, he said. The costs for the renovation/retro-fit and the new neighborhood construction (including land or the original house) total around $500-550,000, Klever said.

He elaborated, saying that the higher construction cost for new construction was off-set by a lower cost for the land without a house on it. The retrofit construction cost was lower, but the cost of the land with the house on it was substantially higher, he said. The “debt service” for both homes is comparable, he said.

To create engaged neighborhoods and a culture change that accepts a household model of eldercare, active seniors have to start asking questions of themselves and each other, Klever said.Do you see yourself as a caregiver to your neighbors? What kind of caregiver am I? What kind of recipient of care-giving will I be: grateful, cooperative, demanding? Who is in my Caring Circle: family, friends, neighbors?

Klever encouraged the audience to think about the “activities of daily living” (ADLs) which are as diverse as personal hygiene and grooming to financial management and home maintenance (see Senior Homes “Activities of Daily Living” or the U.S. Department of Health and Human Services “Measuring the Activities of Daily Living: Comparisons Across National Surveys”). Klever asked to keep those ADLs in mind as they asked themselves and others: Would you want me to participate in your care? Would you participate in my care?

In wrapping up his Aging in Community conversation at the Friday Center, Klever asked the audience to consider going “off-warranty” during the frail part of life. It is an idea that Dr. Norton Hadler coined in his book “Rethinking Aging: Growing Old and Living Well in an Overtreated Society.” Dr. Hadler asks people to think of aging and even frailty as a part of life to be embraced instead of fought off with medications, surgeries and treatments that may reduce the quality of life and not prolong it by much, if at all. Klever said, ask yourself, at what point will I be less fearful about preventing or stopping the end of my life from coming? When do I focus on the humanity in the days I have left, rather than the science of staying alive?

Paul Klever’s reading recommendations include: “Aging in Community” by Janice M. Blanchard; “Pocket Neighborhoods: Creating Small-Scale Community in a Large-Scale World” by Ross Chapin; “A Pattern Language: Towns, Buildings, Construction ” by Christopher Alexander and his colleagues at the Center for Environmental Structure; “Superbia!” by David Wann; and “Rethinking Aging: Growing Old and Living Well in an Overtreated Society” by Dr. Norton M. Hadler.