REITS: The Truth about Your Elderly Parent's Montlhy Service Fees

Creative Commons License; Brett VA

You know that monthly service fee for the grandiose residents where your senior mom is living? Or how the monthly fee doubles when you or your elderly parent moves from independent living into assisted living - even though his or her bedroom/living room space is half the size? You may think that increase is going to increase services, which your elderly parents increasingly need. Then how come it doesn't? And how come you're so frustrated?

Where do you think the funds that your parents - or you, if you're supporting them - are paying are going to?

My mom lives in senior housing that began as senior housing run by Quakers and that is now one site owned by a national corporation. I used to think her service fee is split between her specific location, and the national corporation, each getting a piece. I thought I was so brilliant for figuring out that not all the money goes to getting her good care, but rather also to "the corporation."

Now even that turns out to be naive.

Have you ever heard of a REIT? You may not have but plenty of investors in it for the long haul have.  It stands for Real Estate Investment Trusts and this category of investment fund was created in 1960 by Congress. One type of REIT is Healthcare. We start with the fact that the land and physical facility on which you or your elderly parent live, or will live, is owned not by the senior services company but by the Real Estate Investment Trust.

Almost immediately after this type of stock portfolio was created, investors loved REITS. 

Read this from Forbes: 3 Recession-Proof REITs With Yields Up To 7.6%

or this from RealMoney:Top Healthcare REITs to Play an Aging Population

One reason why healthcare REITS are in demand is that they are required to distribute at least 90% of their income as shareholder dividends. In a normal company, profits would go back into the company in the form of better services, improved facilities, land maintenance and land improvement. Not so with REITS. 

AT LEAST 90% of their income is going to shareholder dividends!!!

Where my mom lives, the company advertises 74 acres that include 6-hole executive golf course,community garden plots, a greenhouse and hiking trails. But when you go there, the land is decrepit, the golf course overrun and uncared for. Bittersweet has overtaken acres and acres, shrouding out the tall trees that are probably hundreds of years old, squeezing the life out of them, now bare except for a few branches at the tippy top, and the REITS company does not cut the bittersweet down. Their way of dealing with it is to clear cut the trees and where they haven't clear cutted, the bittersweet just continues to overtake.

Once, I brought my golf clubs down. The land was soggy and pockmarked. The boundaries were overrun by bushes and invasive species that narrowed the fairways. To get from one green to the next hole, I had to wind my way through overgrown bamboo and bushes, often unsable to see to the next hole.  


This is not land stewardship. This is doing the least amount possible, to increase profits the most. There is no incentive to steward the land.

Every now and then an infrastructure improvement is made. But think about it: To get a physical structure improvement, the request has to go all the way from this individual facility to the REIT. 

I'll stop here for now, because I have a laundry list of improvements that could be made to the land and to the physical structure where my mom lives, and I have a laundry list of how services could be improved. But just start where it counts: 90% of the income of the assisted living facilities goes straight out to shareholder dividends.

the part of you that wants to sleep

When I called Mom's room at noon, I wasn't surprised that she was still in bed but I was surprised that none of the care aids had been in to get her up for lunch (or, in her case, the first meal of the day). Or at least that's what she said. If that's to be believed, given her current memory. But I said I'd call her back in 15 minutes, thinking that a care person would come in by then.

I was wrong.

I told her, "Mom, press the button on the thing around your neck." Sometimes I don't recall the name "pendant." It's no piece of jewelry, that I can tell you for sure.

Well, today she was able to press it and while it was blinking we had at least lots of time to talk. You know that having conversations with somebody with dementia can be challenging. 

"I'm tired," said she.

"I know," said I. 

"I just want to go back to sleep," said she.  

"Well, you can go back to sleep after lunch. It's not a very busy day. I don't have anything scheduled for you," said I. I know to say this, to promise her she can go back to sleep, which she can. I'd rather she do an activity, or sit outside in the sun, but I know to promise her the thing that will give her comfort. The thing she wants to hear. Then something surprising happened.

"I'm afraid," said she.  Now I start to think maybe I should have the facility psychiatrist come in and talk with her because she's talking about emotions! And she's in touch with them. This can be a good beginning.

"Afraid of what, Mom?"

"I just want to sleep." This is not such a stupid statement. This is a moment of self-awareness. For a person with dementia to be so self aware and to be able to share that, to bring me in to this thinking, is a moment I'm cherishing.  "I'm afraid that I"m going to be like this."

"Like what, Mom?"

"To be like this, and I'm not going to be more active." Suddenly we are in another zone of consciousness.  This word "active" is not a word I've heard her say in a long very long time.

"You me to be more active, and do things? Like what, Mom?" Am I pushing too much? Too fast? How far can I take this? Will I get another chance to have this conversation again?

She doesn't answer. The pendant is still blinking and the care person has not come in. I know that lunch will be over soon but I want this conversation to continue.

"So part of you wants to sleep and part of you wants to be active. Which one would you like to have right now?"

"I want to be active but the one that wants to sleep is stronger."

It is strong. And it's her biology at this moment. And while this moment is intimate, I think that after lunch the part of her that wants to sleep will win.

She may not remember this conversation but it made my day.

 

Today Is Not That Day

If you don't know what a rollator is, you are either not old enough yet or you're probably not a caretaker. I fit into the latter group. Those who are also caretakers understand just what a challenge it is.  In my case, we do it by phone. We live 300 miles apart.

 

I think I've got it down to a science now, even though all science pays big respect to the notion of randomness. And there are lots of things that even science cannot predict.

At least I know to phone my mom between noon and 12:30 every day- sometimes even in the middle of a doctor's appointment - because that's when she's waking up. Not from her nap but from her night's sleep. Getting her up and to eat is a delicate maneuver.

"Why is she sleeping so much?" people ask. The easy answer is "That's her disease." But I"m not sure really what disease she has, other than one symptom is she sleeps an awful lot. Whatever disease she has, this is what it does.

I'm not sure what disease she has because the doctors say it's one thing but none of us believe, even 4 years later, that that's what she really has.  Like Alzheimer's.  They don't really know if you have it until you die and they look at your brain and even the they don't really know because many people with a so-called "Alzheimer's Brain" are perfectly fine. But she does have a disease.

The other phone call is, on most days, between 3:30 and 4pm and that call also is a wake-up call, after she has gone back to sleep after lunch. This call is to get her to get up, stand up, walk down the hall.

"I'm comfortable here in bed," she says. "Why can't I just stay here under the covers?"

Then I have some sort of answer. I've been practicing this answer for a long time. "Well, you need to stand up straight, it's better for your back"

"I'm tired." I've practiced this too. "Then you need to walk some and get your blood circulating and get some oxygen to your brain." 

"But you told me I could sleep until dinner."

"No, Mom, I didn't. Somebody else might have said that but I didn't.  I said, "I'll phone you between three thirty and four and you'll take a walk and you said "okay."" They tell us to go along with people who don't remember things like that. I've found that telling her somebody else may have promised her that she could stay in bed until dinner works.

And back and forth we go.  Doing this for close to a year now, I know to say "Take the walk and then you can go back to sleep until dinner."  The promise of being able to go back to sleep is often enough to get her willing to walk down the hall and back.

Today we had version B of this. As she was getting up and out of bed and reaching for her rollator, she said, "I'd rather be dead than get up and walk down the hall." She wasn't kidding, either. We don't take this lightly. I know life is difficult for her.Wanting to live is difficult for her. But this is no time to focus on this truth.

"Well, Mom, I don't think today's going to be that day." She doesn't bite back.

 "Are you ready? Okay, let's go!" 
 
I've gotten out of that one, for now.

A Place for Mom? What the Pictures (and the Administration) Don't Tell You

The photos of the stately homes-turned-senior living look so nice you want to live there yourself. The lawn is green and plush. The dining room is so plush it looks like it could be in the Waldorf. Or Trump Tower. Or the Titanic.

Your grey-haired mother, or grandmother, is surrounded by and being hugged by care staff, and all are smiling profusely.

Don't fall to the advertising gimmick. Just think how great these photographers make your greasy Chinese food take-out orders look  But this is your mom, or your grandmom, or your dad, or your granddad. This is her life, and in many ways yours too. Or it will become yours.

They may show photos of the Independent Care on the Assisted Living page. 

You look at what's nearby, look at the websites, maybe A Place for Mom, but this is not like Amazon, where the information is readily available. You cannot see the reviews until you register. Worse, you cannot write a review until you register. 

You take a trip there, for the day. Looks nice enough. You may see a golf course. You may see tennis courts. They show you all the beautiful stuff.

Then the application. There's usually a lot of questions about finances, your elderly parent's, and maybe even yours. There's a nonrefundable deposit for the application. There's a Plan A and a Plan B and a Plan C, each one requiring a different amount up front and a different monthly fee. How do you choose? This is new stuff.

Because of the up front deposit, you really cannot be doing too many applications and you don't have time to really go and talk to residents. 

And when you or they have to make that decision, it may need to be rather quick.

I'm going to write a series about what to beware of. Believe me, you won't read this on the senior living websites, and you won't be told this stuff when you go check the places out.

But it's all very deliberate, and once your parents has made the decision, or you for your parent, you're pretty stuck, with the upfront money usually required. This is the rest of their lives.

Never forget that this place is in it for the money. They are in the business of helping senior, but they are in it for a profit and that profit motive will affect every aspect of your or your parents' lives. Smaller corporations become bigger, and pay dividends to shareholders. It's much more complicated than you realize, before you begin this journey to help yourself or your loved one.

Let's visit this. I'm happy to share what I've learned the hard way.