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06/12/2001
AGENDA MAPLEWOOD HOUSING AND REDEVELOPMENT AUTHORITY TUESDAY, JUNE 12, 2001 7:00 P.M. CITY HALL MAPLEWOOD ROOM 1. Call to Order 2. Roll Call 3. Approval of Minutes November 14, 2000 4. Approval of Agenda o Communications a. Annual City Tour (1) July30, 2001 (2) HRA's Involvement 6. Unfinished Business a. Home Replacement Program - Property Purchases 7. New Business 8. Date of Next Meeting 9. Adjournment c:memo~HRAAGEND.MEM 'T .... T ' T T T T T .... T ..... MINUTES OF THE MAPLEWOOD HOUSING AND REDEVELOPMENT AUTHORITY NOVEMBER 14, 2000 II. III. IV. VI. CALL TO ORDER Chairperson Fischer called the meeting to order at 7:05 p.m. ROLL CALL HRA Commissioners: Lorraine Fischer, Tom Connelly, Joe O'Brien, Gary Pearson (arrived at 7:08), Beth Ulrich. APPROVAL OF MINUTES May 9, 2000. Commissioner Connelly moved approval of the minutes of May 9, 2000, as submitted. Commissioner O'Brien seconded. Ayes-4 (Fischer, Connelly, O'Brien, Pearson) Abstain-1 (Ulrich) APPROVAL OF AGENDA Commissioner O'Brien moved approval of the agenda as submitted. Commissioner Connelly seconded. Ayes-all COMMUNICATIONS Ken Roberts, associate planner, introduced Beth Ulrich and welcomed her aboard as the new HRA commissioner. Ms. Melinda Coleman distributed an article from the Star Tribune about a study that was done by the Maxfield Research Group that talked about the relationship between affordable family rental housing and home values in the Twin Cities. UNFINISHED BUSINESS None T~T T T" I HRA MINUTES 11 - 14-2000 -2- VII. NEW BUSINESS Home Replacement Program--Operations and Procedures Plan. Mr. Roberts presented the staff report for the city. On May 9, 2000, the Housing and Redevelopment Authority (HRA) met and reviewed a proposed operations and procedures plan for the Housing Replacement Program. Since then, Mr. Roberts and Bob Wenger, the Maplewood Environmental Health Inspector, revisited some of the sites. One site they did not feel should be included on the list and a couple other sites were removed due to the homeowner improving the site. Ms. Fischer questioned why the particular sites were on the list. Was it due to structural issues or housekeeping problems? The difference being if it was just housekeeping and a new owner moves in, that issue could be eliminated within a couple months. If it was a structural issue, the problem would still be there with the new owner, and possibly continue to deteriorate. Dilapidated and Substandard Houses - Maplewood (October 2000) 1. 1819 Birmingham Street (PIN 15-29-22-32-0023) Structure 2. 1890 Adele Street (PIN 16-29-22-42-0018) Both 3. 1779 Frank Street (PIN 16-2922-43-0004) Structure 4. 1742 ¼ English Street (PIN 15-29-22-33-0094) Structure 5. 549 Farrell Street (PIN 36-29-22-14-0022) ?-Size 6. 1694 Sylvan Street (PIN 18-29-22-34-0035) Size 7. 1724 Sylvan Street (PIN 18-29-22-34-0039) Size 8. 1287 Lark Avenue (PIN 09-29-22-44-0002) Housekeeping 9. 1800 Bradley Street (PIN 17-29-22-34-0020) Housekeeping Chairperson Fischer noted the home on 1819 Birmingham Street (#1 in priority) has a for sale sign on the property. The property on Adele Street has five new homes built around it and staff feels a lot could be done for the neighborhood if that home was removed. Maps and information were collected for each of the properties listed which includes ownership, lot size and current market value. Ms. Fischer would prefer item C to be switched with item A under #8 in the Practices and Methods of Property Purchase and Resale, in a priority listing. The reasoning for item 8 was to improve the overall visual effect and improvement of the city and also to increase the city tax base, but Ms. Fischer stated "it appears that we seem to be going away from that. We are eliminating an unsightly house and building a new home to increase the tax base. The goal is to create additional tax base and not to create side yards." Staff reminded the board members the goal was to visually improve the neighborhood. If an old ratty home is gone and now there is open space and a new home gets built to replace it, the city has accomplished its goal. Staff does not feel the city wants anyone building on a 40-foot lot. It is just not good public policy. Ms. Fischer felt if the word got out that the city would allow a variance to build on a 40- foot lot, people would start paying their variances for the additional lot in fear of losing the lot. Ms. Coleman suggests getting feedback from the council to inquire if the Maplewood City Council would support building on a 40-foot lot (vs. 60 feet). She also felt if a variance is approved, the city should be able to stipulate what style of home is being built. HRA MINUTES 11 - 14-2000 Under the Practices and Methods of Property Purchase and Resale, #6 will read: "The community design review board will review and approve all new house design and site plans. Also, the developer or builder may appeal the staff decision about design issues to the city council. When considering house plans, staff will consider the color and materials of the architectural elements of the proposed buildings". Ms. Coleman also thought it would be a good idea to run the plans through the design review board especially due to the fact there are not all that many per year. It was suggested that a committee could be created that combines HRA members and community design review board members. The developer or builder will have the right to appeal the staff decisions about design issues to the city council. Under the practices and methods, item 8, C will be listed first. B will state: "Divide the property and sell the pieces to the adjacent property owners". Item 8 will now state: If the property the city has bought does not meet the city's zoning standards for lot size or lot width, or street frontage, the city may choose to: a. Grant variances to allow the construction of a new house. b. Keep the property for open space rather than transfer the property to another owner. c. Divide the property and sell the pieces to the adjacent property owners. Mr. Roberts noted the home on English Street appears to be a chicken coop or a garage that at some point was turned into a home. It is currently landlocked with the two homes sharing a driveway. The property in this case could be sold between the two property owners. Commissioner Fischer noted that some of the lot values did not seem comparable to neighborhood values. Why more of the "clone" homes in the area were not included in the list was a concern to Ms. Fischer. Was it because staff had been inside the homes on the list and found them to be structurally unsound? Staff responded in saying the decision was probably based upon complaints from neighbors and after being inspected by Bob Wenger. If a home is taken down and replaced, what about the clones on the same street? Could we include other similar homes on the list and actually create a larger base? About six weeks ago staff made contact with the Realtor who had listed the Birmingham residence for sale. The real-estate agent stated the home was listed for $59,900. He did have a couple of people at that time that had made offers, but did not qualify. Commissioner Pearson shared several photos he had taken of the properties on the list. One of the commissioners noted the property on 1779 Frank has more board than paint showing on the exterior. Why hasn't the city ordinance for maintenance been applied as of yet? As far as staff knows from the Environmental Health Inspector, he has not received any complaints on this property as of yet. Ms. Fischer did not understand why the owner has not been tagged as of yet and told to get a paint job. Staff explained there are other problems with the property also. There is a city employee familiar with the home and has heard there are structural issues with the roof also. When this program gets underway, and the owner is approached by the city, staff is hopeful they will be interested in selling and moving on. HRA MINUTES 11-14-2000 -4- Mr. Roberts stated that he felt Dennis Campbell, a local home builder who builds three or four homes a year, would love the opportunity to build on some of these properties. Some cities are paying for contractors to be trained to become updated with the rehabilitation projects. If they are applying for renovation loans, they would need to select a contractor off the list that has been trained for that type of project. The contractors are required to carry the liability insurance, therefore, so many contractors are hesitant to do it. Also, there is so much work out there, why take the rehab jobs that cost so much for hazardous waste removal? Ms. Fischer noticed the irony of the home owner who has too much money to receive federal funds will not be required to follow federal regulation, and therefore will probably leave the lead paint. One of the commissioners noted that Minnesota was not one of the states that were having issues with containing the lead paint. Other states were not complying with the way the regulation said it needed to be handled. They made the regulations nearly suffocating, so in order to follow them to the letter, people end up relocating out of the house. All of the homes listed are on city sewer except possibly the property on Bradley Street which may have a well. The city property off of Frost and English has a little well that goes down 600 feet. It had been covered up by the railroad and they are working on getting it capped. There are about 140-150 homes in the city that are not yet connected to city sewer with the majority of them in the south end of Maplewood. Ms. Coleman questioned how often Ramsey County actually goes out and appraises homes. Mr. Roberts responded in saying he thought it was once every four years. Ms. Coleman suggested a caveat be added stating the list is not in any way, shape or form exclusive (it is subject to change). Ms. Fischer was concerned that the practices and methods did not define dilapidated. She felt possibly using the term "substandard" may be more appropriate. Ms. Coleman suggested using both in the definition. Mr. Roberts informed the housing and redevelopment authority that the Harvester area just had their streets redone in the last couple years. He will be interested to see if that now creates more interest in that area for people to spruce up their property. Staff wanted to discuss item 10 which is the home that burned on Prosperity. Much of the inside of the home was destroyed and has been sitting boarded up for 12-15 years. Staff has it listed as a possible rehab project. If the owner is not willing to sell, it does not matter, but Ms. Fischer thought he may change his mind if the county looks at it, valuate the worth and makes an offer. The city gets one or two calls a month on the property. A good approach may be to watch for a for sale sign and approach the owner at that point. Ms. Coleman discussed the issue of how the city wants to disburse the funds. If funds are used for Iow to intermediate housing, the funds will not go as far. She would like to see the city jump in and start doing something, stop talking and start moving. The main question was" how quickly do we want to start"? The HRA commissioners felt a workshop at the city council may be the best place to start and the most informative for everyone. HRA MINUTES .$. 11 -14-2000 Commissioner Pearson was willing to offer the services of his company to build Manufactured homes on the lots for cost only. He felt the sites were large enough for attached or detached garages and would sell for $45,000 to $55,000. All the homes would be 28-feet wide and 40 to 70 feet long. The home installed on Century Avenue, just north of the Dairy Queen, is this type of modular home and looks just like a little rambler. Mr. Pearson's product is a little more finished than the Wausau modular homes. Mr. Pearson's homes come with a little less woodwork, and can be ordered with a Lindsey Floor Truss which is made to go on a foundation. If they want to have a finished basement it runs about $10,00-12,000 more. That product typically comes without appliances and does not have the furnace and water heater, which could be installed after the unit is sited. It would appear to be beneficial for the city to install these homes on the sites, sell them and make a profit on them. Staff felt this proposal should be brought up to the council. One of the board members stated an empty lot does not have any adverse effects on the tax base for the surrounding properties, but when you place a new home on the lot it does increase the value of the surrounding properties. The HRA board members viewed the picture of the property on 1724 Sylvan Street and tried to figure out why that property was on the list. Staff felt that property did not look that bad esthetically and it was possible it was placed on the list by mistake. There may be another address on the block that should be listed instead. Staff clarified that with the majority of the properties listed, they are owner occupied. A commissioner questioned, "If some of the properties are dilapidated looking, can the city ticket the owner to fix it?" Staff responded in saying the maintenance ordinance could be applied. The commission would appreciate it if staff would include the maintenance ordinance in the next meeting packet so they know what they have to work with. Ms Fisher felt the ordinance has not been looked at since it has been adopted, and felt it would be beneficial to view the ordinance and maybe improve upon it. Staff feels when health and safety issues are involved, the Health Inspector becomes actively involved and includes the police when needed. His frustrations are when the courts get involved and the tickets are not followed up on. It may be beneficial to have Bob Wenger attend some meetings since Bob has been working in his field for over 20 years. When a complaint is received, Bob's first attempt is to gain rapport with the owner and get the problem fixed. If not, it usually ends up in the Ramsey County court system. VIII. DATE OF NEXT MEETING The next HRA meeting will be in January or February after the workshop with the city council. IX. ADJOURNMENT The meeting was adjourned at 9:03 p.m. 'T I i '1 i MEMORANDUM TO: FROM: SUBJECT: DATE: City Manager Ken Roberts, Associate Planner HOUSING REPLACEMENT PROGRAM - PROPERTY PURCHASES June 4, 2001 INTRODUCTION City staff is asking for city council approval to buy four houses under the Housing Replacement Program. BACKGROUND On January 22, 2001, the city council approved the Housing Replacement Program Operations and Procedures Plan. This plan, starting on page nine, has the goals, history and practices the city will follow when buying property and the options the city has once we have purchased a property. This plan also is the city's policy guide for the Housing Replacement Program DISCUSSION Larpenteur Avenue Properties The first three properties under consideration for purchase are at 209, 211 and 215 Larpenteur Avenue. (See the maps on pages 3-5.) These homes are just west of Adolphus Street on the north side of Larpenteur Avenue. Unfortunately, these homes were flooded during the rainstorm on April 23, 2001 and received a large amount of damage. Since then, the city has been trying to work with the property owners to help them in any way possible. After reviewing this matter with the city attorney and with the League of Minnesota Cities, staff has determined that the best available remedy the city could provide to the property owners would be to buy the properties. On May 29, 2001, the city council authorized city staff to begin negotiations with these property owners to buy the properties under the city's Housing Replacement Program. If successful, the city would buy the properties, demolish the homes, regrade the properties to help ensure that flooding would not occur in the future and then resell the lots as building sites for houses. The city is now having appraisals done for each of these properties. The following is the information about these properties: Property_ Address 209 Larpenteur Avenue 2000 Tax Market Value* $102,800 211 Larpenteur Avenue $110,000 215 Larpenteur Avenue $102,100 *Note: The tax-market value can be 20-25 percent below market value. Property values have increased about 10-15 percent for 2001. The city's net cost for the purchase of each lot will range from $80,000 to $100,000 for a total city cost of about $250,000 to $300,000. McMenemy Street Property The other property under consideration now for purchase now is at 2080 McMenemy Street. (See the maps on pages 6-8.) This property is an older home (about 100 years) and has several items of deferred exterior maintenance, including the siding and windows. The city, after discussions with the property owner about possibly buying the property, had an appraisal done in April 2001. The appraiser noted that the house if functionally obsolete in that it is located about four feet from the north lot line and faces McMenemy Street, while having access from Belmont Avenue (See the map on page 8). This orientation limits the privacy and does not utilize the entire site. As such, the appraiser states that "functional obsolescence is present." The appraiser set the value of this property at $100,000. If the negotiations with the owner are successful, the city would buy the property, demolish the house and garage, regrade the property and then resell the lot as a building site for a house. The Housing Replacement Program now has a balance of $547,000. RECOMMENDATION Authorize city staff, including the city manager and city attorney, to negotiate with the property owners of 209, 211 and 215 Larpenteur Avenue and 2080 McMenemy Street to purchase their properties for the appraised value. Staff will: 1. Conduct these negotiations and purchases under the Maplewood Housing Replacement Program. 2. Have the city council approve any proposed purchase agreements. kdp:miscell\hsgpro7.mem 1. Location Map - Larpenteur Avenue Properties 2. Property Line Map - Larpenteur Avenue Properties 3. IRIS Area Map - Larpenteur Avenue Properties 4. Location Map - 2080 McMenerny Street 5. Property Line/Zoning Map - 2080 McMenemy Street 6. IRIS Area Map- 2080 McMenerny Street 7. Housing Replacement Program Operations and Procedures Plan Attachment 1 / PLAZA a, LVARADO DR BE1/~'CR£~'T DR DEA~'VIL~J~ DR MERIDla~ DR ,< Z ST. PAUL OOD LOCAT,ON MAP~ 1~ Attachm_~ent 2 I0 10 26 ,AC. FLOWA4~ ESMT. PONDING AREA 17'01 LARPENTUER AVENUE ~' I"'"1 '""1. '"'l~"'~"'T'"'T~;-'"';~?;,-'''~ ~-~'~ ~-~<~ ........................ ~ .................. , ~ SAINT PAUL PROPERTY LINE MAP 4 Attachment 3 Address: IRIS Map Printout ©PropertyKey. com, 2000 Printed on 05/29/01 at 11:45 AM Scale: 0.07 miles PONDING AREA ?~lt. ?4ft. 145 lt. 15~ ft. · 13= FI 80~, ?~' ~t, ¶SOft, LARPENTUER AVENUE Information deemed reliable but not guaranteed. Attachment 4 C 2640N 2400N co. PLAZA C~ ALVARADO DR BFJJ. ECRE:ST DR DE. AUV/L/.E DR MERIDIAN DR c~ Z 0 I,I RD. B2 COUNTY LI'FI'LE CANADA RD. B KINGSTON o SKILLMAN AVE. MT. VERNON DOWNS AVE. ~IMER AVE. ROSELAWN LWOOD RIPLEY ST. PAUL LOCATION MAP BELMONT BELLWOOD Attachment 5 4. ,m o., BE )NT BELMONT AVENUET Address: 2080 MCMENEMY ST N MAPLEWOOD Scale: 0.09 miles Attachment 6 IRIS Map Printout ©PropertyKey. com, 2000 Printed on 06/01/01 at 09:39 AM 101ft. 1 Sl~ ft. ~Oft. ?Irt. 2090 · 3;s 362 -- 1 351 ~ ~o~ ~ 367 ~ [ 3~s ~,~ BELMONT AVENUE AREA MAP 8 Information deemed reliable but not guaranteed. Attachment 7 MAPLEWOOD HOUSING REPLACEMENT PROGRAM OPERATIONS AND PROCEDURES PLAN January 22,2001 Introduction The Maplewood City Council has been discussing the condition of older housing in Maplewood for several years. ^ concern of the council has been that if a single dwelling deteriorates to the point of becoming a detriment or an eyesore it will have a negative affect on the surrounding area. As such, the city council has made a commitment to improve the condition of the single family residential housing stock in scattered sites with the Maplewood Housing Replacement Program. Goals The following are the goals of the Maplewood Housing Replacement Program: 1. To keep the Maplewood housing market viable and values increasing by constantly improving and upgrading housing. 2. To eliminate problem housing by removing housing that can only deteriorate because its basic quality is inherently Iow. 3. To have a program and plan that will benefit the whole city and each of its residents. History The Maplewood City Council and the Housing and Redevelopment Authority (HRA) have been discussing and reviewing the condition of housing in Maplewood for several years. In 1992, the comprehensive plan identified two related issues about housing and neighborhood quality. The first issue is naming the steps the city can take to prevent the deterioration or abandonment of its older housing stock. A second issue is to identify the steps the city can take to prevent neighborhoods from deteriorating. Specifically, if a single dwelling deteriorates to the point of becoming a detriment or an eyesore, it will have a negative affect on the surrounding area. That is, other property owners may not be motivated to care for or to improve their properties if they live next to or near a rundown house. Because of the above concerns, the city council hired Quam and Associates in 1996 to do a housing program concepts evaluation. This evaluation was to provide the city with a summary of the following program issues: The type of programs (home replacement, existing home transformation, area redevelopment) that would be most effective in updating neighborhoods and conserving existing open lands. 2. The possible funding sources for such a program. 3. The cost effectiveness of any housing initiatives and the positive impact they might have on the taxes and revenues of the city and the school district. The housing program evaluation completed by Quam and Associates determined that a home replacement program would be the best program for Maplewood. This is because there are properties that have deteriorated and are inconsistent with the character of the rest of the neighborhood. It is important to remember that much of the housing in older Maplewood neighborhoods was built before zoning and building restrictions were in place. These are often the houses that are now deteriorated and an eyesore. Removing an existing eyesore property and replacing the worst home with a new home that sets a new quality standard is an effective action for change. In a meeting on August 2, 1999 with the HRA, the city council again discussed possible future housing programs. At this meeting, the council directed staff to prepare a housing plan that would replace dilapidated houses with new, higher-value replacement homes. On August 23, 1999, the city council approved developing a Housing Replacement Program that would: Use the surplus tax increment proceeds (up to about $687,000) from Districts 1-4, 1-5 and 1-6 to fund the housing program. The city must reasonably expect to spend this money within 3 years. 2. Buy vacant or dilapidated properties from willing sellers at fair market value. 3. Demolish any dilapidated houses and other structures and rough grade the lots. Deed the vacant properties at no cost to an agency or group that will use the lots to provide new housing for Iow-to-moderate income persons. Such a transaction would be subject to all Maplewood zoning and building requirements. Note: Because the city was going to be using tax-exempt bonds to fund this program, the city may only do no-cost grants of property. The city cannot sell the property or provide Iow interest loans with the tax-exempt money. The council also adopted resolutions at this meeting that provided preliminary approval for the sale of $719,094 1999 General Obligation Tax Increment Bonds and authorized the use of excess tax increment revenues from the Carefree Cottages to finance debt service on the bonds. On September 27, 1999, the city council approved a resolution approving changes for the Development District No. 1 and changes to Housing Districts Numbers 1-4, 1-5 and 1-6. These changes designated that the city will spend the excess funds from the three TIF Districts on a housing replacement program. The total funds available to the city to spend from this program should be about $687,000. On December 13, 1999, the city council approved several city staff requests for the Housing Replacement Program. These included amending the resolution for the 1999 Tax Increment Bonds. The council made the amendments so that the proceeds can be used to reimburse the Sanitary Sewer Fund for the cost of sanitary sewer improvements directly related to the Carefree Cottages Phase I, II and III. The improvements involved slip lining a sanitary sewer main to decrease leakage into it and to increase its capacity. Decreasing the leakage has caused a decrease in the flow through the sanitary sewer main and a corresponding decrease in sewage treatment costs. This will result in about a ten-year payback of the improvement costs by l0 decreased treatment costs. There was no need, therefore, for the Sanitary Sewer Fund to keep the $646,929.86 reimbursement for sanitary sewer improvement costs. At this meeting the council also established a Housing Replacement Fund and transferred $646,929.86 from the Sewer Fund to the Housing Replacement Fund. These actions created the Housing Replacement Fund, set a budget for the fund, and most important, gave the city more flexibility in how the city may spend the money in the fund. General Policy Guidelines The city shall follow the standards and guidelines in the Maplewood City Code of Ordinances and in the Maplewood Comprehensive Plan when administering and operating the Maplewood Housing Replacement Program. The Director of Community Development shall make the final decisions in cases or issues of uncertainty in the program. Anyone may appeal the Director's decision to the Maplewood City Council for review and possible change. Practices and Methods of Property Purchase and Resale 1. Maplewood will only buy vacant, substandard or dilapidated properties from willing sellers. 2. The city will have an appraisal done and will only pay fair market value for a property. 3. The seller of the property is responsible for properly sealing or capping any wells on the property. 4. After the city closes on the purchase, the city will hire a contractor to remove the structures on the property and rough grade the site. The city also may have a survey of the property done. For a buildable site, the city may do one of two things with the property. First, the city may choose to deed the property at no cost to an agency or group that will use the lot to provide new housing for Iow-to-moderate income persons after the contractor has graded the site. The other option the city has would be to put the property up for sale by sealed bid. In either case, the new construction would be subject to city staff review and approval as outlined below and all Maplewood zoning and building requirements. The city council shall approve any property ownership transfer. The Community Design Review Board (CDRB) will review and approve all new house design and site plans. The construction shall include a garage at least big enough to hold two motor vehicles. The design of the new construction shall be compatible with adjacent and nearby houses. Staff shall consider the following when reviewing these house plans: a. The height, bulk and area of the existing and proposed buildings. b. The color and materials of the proposed buildings. c. The physical and architectural relationship of the proposed structure with the existing buildings (including the architectural elements). d. The site, layout, orientation and location of the proposed and existing buildings and their relationship with existing topography, landscaping and vegetation. City staff or the CDRB may require changes to the plans or may add conditions they deem necessary to ensure that the proposed design is compatible with the existing neighborhood. The city must make the following findings to approve the proposed plans: The design and location of the proposed construction and its relationship to neighboring, existing or proposed developments are such that it will not impair the desirability of the existing neighborhood. b. The proposed design and location of the construction are in keeping with the character of the existing neighborhood. c. The proposed design would be aesthetically pleasing in composition, materials, textures and colors. The developer or builder may appeal the staff decisions about design issues to the city council. If the property the city has bought is substandard in width or area for the neighborhood or area and it is next to publicly-owned property, the city may choose to keep the property for open space rather than transfer the property to another owner. The city council shall approve any property transfer or decision to keep a property. If the property the city has bought does not meet the city's zoning standards for lot size or lot width, the city may choose to: a. Grant variances to allow the construction of a new house. b. Keep the property for open space rather than transfer the property to another owner. c. Divide the property and sell the pieces to the adjacent property owners. The city council shall approve any property transfer, variance or decision to keep a property. This plan was approved by the Maplewood City Council on January 22, 2001. 12 Is as.sisted liv. ing the r, ght cho,ce? The promise and the pitfalls of a residential option designed to fill the gap between independent living and nursing-home care. perhaps you've been worrying about Mom lately. Her arthritis keeps her from taking care of the house, and she has so much trouble reading fine print that you wonder how she can keep track of her medications. Some days she doesn't feel like eating, and even a daily phone call leaves you more concerned than reassured. Mom says she'll never set foot in a nursing home, but every day you drive past an assisted-living facility, and its tidy buildings and manicured grounds look like an appealing alternative. Assisted-living facilities offer a relatively new way to care for seniors who can't man- age on their own. A cross between an apart- ment building with services and a nursing home, these facilities offer residential units, which sometimes include a kitchen, house- keeping services, meals, transportation to doctors and activities, and various levels of personal assistance---all for a monthly rental fee. The brochures for assisted-living facilities highlight independence, support, and communal activities for the frail and disabled elderly. With the number of peo- ple who will need help with activities of daily living pro- jected to increase by 51 per- cent in the next 20 years, assisted living is in a growth mode. The number of licensed facilities built by indepen- dent chains like Sunrise, hotel chains like Marriott and Hyatt, and individual entre- Complete Guide to Health Services FOR SENIORS preneurs--has increased 30 percent since 1998. Some communities now have many facilities to choose from, although rural areas may have few or none. Today more than 500,000 people live in places loosely called assisted-living facilities, where the average age is 84. Most residents require help with at least three activities of daily living, such as eating, bathing, toileting, dressing, and walking. One industry survey found that nearly half of residents suffered from mild dementia or early to midstage Alzhehner's disease. Nearly one-quarter of facilities have special Alz- heimer's units. Assisted-living facilities are not substitutes for a nursing home. Many do not admit or keep residents who need ventilators or catheters, or help with con- tinence problems. About 36 percent of all residents eventually go to a nursing home because the assisted- living facility cannot accommodate their increasing needs, and 2 percent go to nurs- ing homes because they have exhausted the means to pay for care. The price of care at an assisted- living facility can exceed $4,000 a month, depending on the size of the unit and amount of personal care needed. The finan- cial arrangements are usually different from those of continuing-care retirement com- munities (CCRCs), which may require an entrance fee ranging in the hundreds of thousands of dollars. CCRCs offer a contin- CONSUMER REPORTS O JANUARY 2001 I I I I 1 uum of residential arrangements bom inde- pendent living units to assisted-living and nursing facilities (see "Spectrum of Avail- able Care, "page 28). PROMISE VS. REALITY Assisted-living entrepreneurs emphasize that their facilities don't look, feel, or smell like nursing homes. Yet some practically offer nursing-home care, with little government oversight, while others provide so little care that families must hire home attendants to meet their relative's needs. '~Dpearance is 75 percent of the battle to get families to sign up,~ explained Patti-Ann Hopkins, a manager at a Marriott facility in Boynton Beach, Fla."What sells the family are safety and security, value for price, the food, and a homelike environment." And so facilities appeal to the aesthetics of residents and their adult children. Some facilities sport features like old-fashioned ice-cream parlors and 1940s-style jukeboxes. At one Sunrise facility the dining room is called the "servery' and the Alzheimer's wing % reminiscence neighborhood? Virginia Fraser, a long-term-care ombudsman in Colorado, warns that "the critical consideration is the philosophy of the place and how the staff carries it out? A fancy front room with Georgian-style furniture does not guarantee that a resident needing hdp with a bath every day will get it, or that the facility will accommodate a resident's declining eyesight with appropri- ate help and activities. "Marketing assisted living is less about need than where adult children want their friends to know Mom is living," says Dr. Donna Yee, executive director of the Asian Community Center of Sacramento Valley, Calif., and a former associate research pro- fessor at Brandeis University. While Yee was at Brandeis, she and her colleagues conducted the first national study of 396 residents in assisted-lMng facilities in the mid-1990s and found that although many experienced fairly independent and autonomous lives, they also had unmet health and long-term-care needs. Some- times they were socially isolated, experienc- ing limited participation in activities or community life. Yee and her colleagues also discovered that those facilities that offered residents more autonomy had more avoid- able negative health outcomes than facilities that offered less choice. Therein lies the crux of assisted living: autonomy vs. supervision. Long before they sign on the dotted lines, adult chil- dren and their parents must understand those trade-offs and what they mean for quality of life. Assisted living offered by many entre- preneurs embraces the concept of the"dig- nity of risk." This means that residents can make their own decisions about their care and safety, and even choose certain courses of action that others consider risky. For example, ifa diabetic wants to eat cake and. ice cream once a month, should that be his or her choice, or should the facility step in and say no? Should the facility allow a resi- dent to use a walker even if she falls and hurts herself, or should the facility insist the woman stay in a wheelchair? Some facilities require prospective residents to sign con- tracts that include provisions for negotiated risk--that is, how much risk the resident is willing to assume and how much risk the facility will take. Balancing a resident's desire for auton- omy with his or her need for assistance and protective care is no easy task. "The reality is no one knows how to have people 'age in place' in assisted living with a good balance of choice and safety issues," says Dr. Joanne Lynn, director of the Center to Improve Care of the Dying at Rand Health, Trudy Lieberman, d/rector of the Center for Consumer Health Choices at Consumers Union, describes what she learned on her visits to 50 assisted-l/yin9 facilities in 12 states, while writin9 Consumer Reports Complete Guide to Health Services for Seniors (Three Rivers Press, When I set out to investigate assisted-living facilities, I was blaz- ing a trail; riffle information to guide consumers existed. Glossy brochures featuring smiling people socializing with one another seemed to promise the ideal place to spend one's last years. But did the facilities actually live up to that ideal? It was hard to say. There is no federal database that tells about the quality of care delivered in them as there is for nursing homes, and states offer little con- crete guidance. And, as I soon learned, assisted-living contracts present multiple traps for unwary families. In the absence of good information, I set out to see firsthand what life is like inside these facilities. My overall conclusion: While people move to assisted-living facilities to obtain help with daily adiv- ities in a safe environment, too many facilities are more interested in selling real estate than in selling quality care. You will have to make many visits to facilities in order to find one that seems right. And while people go to assisted-living facilities for social stimulation as well aS for care, I seldom saw residents walking about and interacting with one another or the staff. At a Denver facility, the activity room looked unused. T-shirts and paint trays were neatly arrayed as if they were props for a play. At a Georgia facility, the activity room was empty of people but well stocked with perfectly filled'in coloring books. This is not what you want to see. Nor do you want to find unhappy people simply resigned to living in a facility because their children selected it for them. Some residents I met conveyed a sense of unhappiness about their lot. "This is not what I intended, but I do the best I can," said Emily, whom I met in Virginia. Like other long-term-care facilities, the quality of care depends on the commitment of the management, and you want to see positive, warm, friendly interactions that signal the managers and the staff care that your relative will be treated well. What I observed at some facilities told me I could not go wrong placing a loved one there. At a Section ZOZ facility in Colorado where residents contributed a dollar or two to maintain an indoor garden, a resident named Jean came up to me. "The thing I like best here is the management," she said. "After I was here two months, I asked for a 50-year lease." In turn, the facility director said: "My philosophy is, this is their home. We do all we can to make it work." At a cozy, warm facility in an old Philadelphia mansion run by an order of nuns, residents were encouraged to read and sew and engage in all the activities that they once enjoyed. But it was the care that went into meal preparation that caught my eye and said that this was a good option for Mom or Dad. Each place at the table was set with a dish of lemon Jell-O and a small green salad with dark green lettuce and cherry tomatoes. On the stove a big pot of spagheffi sauce bubbled away, and bread was warming in the oven. The sights and smells of that lunch are still with me. At some assisted-[iving facilities, cabinets and furnishings are not adapted to the needs of elderly residents. JANUARY 2001 · CONSUMER REPORTS 27 f~ To find eldercare services, call the Eldercare Locator at 800 677-1116, which will put you in touch with the Area Agency on Aging in your community. The Triple As, as they are known, were established under the federal Older Amer- icans Act to help people connect with services. Home care You can arrange to have your relative cared for at home by a home attendant, who can be hired from a Medicare-certified agency, a licensed home health agency, or a registry. Expect to pay around $20 an hour for a worker from a Medicare-certified agency and less from others. Home care keeps people at home, so there may be little social stimulation. And if your relative needs close to 24-hour super- vision, this option can become as costly as nursing-home care. Adult day care This is a good option to consider in conjunction with home care. If your relative has a care~iv- er for the evening, adult day care may be the ideal solution. Clients attend a program for several hours during the day and participate in activities, including music and exercise, that are appropriate for their condition. Most people pay for adult day care out of their own pocket; there is little public funding available. Find out if your community has a Program for All Inclusive Care for the Elderly (PACE), which provides an integrated approach to long-term care for those eligible f~gr Medicaid, and others who buy into the program. PACE is basically a day-care arrangement, where participants receive personal-care services, social interaction, and medical care. The coordination of services through PACE saves you a lot of the hassle of seeking them on your own. To find out if there is a PACE program in your area, call the Nation- al PACE Association at 703 535-1565. Continuing-care communities For those with significant capital, continuinq- care retirement communities (ceRes) offer a continuum of care on the premises. Residents may buy or rent a living unit while they can still live independently, ceRes often have assisted-living wings and nursing facilities available for residents who temporarily or permanently need help with activities of daily living. Some ceres require a large initial fee in addition to monthly fees. Section 202 housing If your relative's income is Iow, consider putting him or her on the waiting list for government- subsidized housing units found in some com- munities. Most units are available under what is called Section 202 housing (the name comes from the 1959 Housing Act). Facilities vary con- siderably in the amenities and the ambience of the buildings. Many have communal dining rooms that serve one or two meals a day. Some have limited or no medical personnel. You may have to stitch together your own package of services. Only about one-third of Section 202 projects have coordinators on the premises to help find services for their residents. Board-and-care homes These are found in every state, and most states require them to be licensed, regulated, or cer- tified in some way. Sometimes Medicaid pays for care in them. People who have space in their homes obtain a license and provide care and assistance with activities of daily living to four, five, and sometimes more residents. Your local Triple A can help you find one. These are much less expensive than some of the fancier assisted- living facilities. Nursing homes Useful information is available from the fed- eral and state governments to help you in your search for a nursing home. We have used this data to flag problematic nursing homes in each state, and we note them in the Consumer Reports Complete Guide to Health Services for Seniors. Many nursing-home residents pay for their care by spending down; that is, they use up virtually all of their income and all of their assets to pay for care before Medicaid steps in to pay the bills. Medicaid pays for about half of all nursing home stays. a research institute in Arlington, Va. Autonomy vs. risk is one issue you'll need to consider when helping an elderly relative get the care he or she needs. Con- sider, too, whether or not your relative can afford to stay in the facility for as long as it's appropriate. If assisted living seems a viable solution (see"Spectrum of Available Care;' above, for alternatives), some careful comparison shopping is in order. What follows is a guide to the questions to ask--and the things to observe---as you visit facilities in the area where your relative wants to live. SHOPPING FOR A FACILITY Be prepared to do some careful shopping to find a good facility. Start with initial visits to several in the area. Most residents we spoke with said that the quality of care and staff, and having someone to talk to, were more important than fancy sur- ;}8 CONSUMER REPORTS O JANUARY 2OO1 roundings. It may take several visits to evaluate those intangibles. FIRST VISIT: THE TOUR On the first visit, most likely the director of marketing (who may, in effect, be doubling as a real-estate agent) will show you around. You will see the common areas-the parlors, library, dining room, laundry facilities, and patio. Then she (many are women) will show the available apartments. Where the apartment is located is very important. In many assisted-living facilities, units closest to the dining room or elevator are more desirable and therefore may cost more. What your guide says or does not say offers clues to the quality of the facility. For example, if she doesn't ask any questions about your relative's needs, it may be a sign the facility is more interested in filling space than in the care your relative requires. Observe how staff members relate to the residents. Do they talk with them and know them by name, or do they ignore them? Do they seem genuinely interested in the residents and what they are doing, or do they seem phony, putting on a show for prospective families? After you visit three or four facilities, you'll be able to tell. Look for signs of life or energy. In most places we visited, residents seemed to prefer to stay behind closed doors, and there were few actMties going on despite the full activ- ities calendars posted on the walls. If you see few residents in the common areas or participating in activities, it may signal that the facility is not full. A half- empty facility could bode ill for the facility's long-term finances. If a facility needs resi- dents to fill up its units, you might en- counter the hard sell. High-pressure tactics are always a sign to continue shopping. When you do see an activity, note whether residents are really engaged and I I I I I T i enjoying what they are doing. At a facility in Boston's Back Bay, residents gathered in the parlor on a late winter afternoon to hear a travel program. They asked questions, talked, and appeared to be truly interested in the presentation. Observing activities is also important if you are placing a relative in the Alzheimer's unit. Margaret O'Kane, president of the National Committee for Quality Assurance, an organization that accredits HMOs, told how her mother gets no stimulation in an Alzheimer's wing at a Maryland facility. She s m bed most of the twne,~ O'Kane said. "The facility says it is going to change the situation, but nothing changes.~ Be specific about care needs. Find i out how the facility will accommo- date your relative's current needs and what it will do as those needs inten- sify and increase. Be forthright and explain exactly what your relative's functional, physical, and deficits are and how ~ change. For example, someone with glaucoma or macular degeneration may experience a progressive decline in sight. How will the facility accommodate the decline? When that question was posed to an admissions official at a government- subsidized housing unit in Boston, she referred us to the facility's Optelec system, a device that magnified print so residents with failing eyesight could continue to read their marl and other printed matter. When the admissions director at a competing and somewhat glitzier facility was asked the same question, she told about how wonder- ful one blind resident was, a patronizing remark that avoided the question. If the answers you get don't make sense, or appear to brush off the problem, look elsewhere. What's in the contract.* Ask for a copy of both the rules and the contract. This is a test of the facility's interest in full disclosure. If there's reluctance to part with such crucial information at this early stage, consider it a red flag. Level of care. Many assisted-living facilities have complex formulas for deter- mining how much care your relative requires. Brighton Gardens in Austin, Texas, figures out how much time it will take nursing assistants to help residents per- form various tasks, and then multiplies that by the number of times a resident needs ser- vices. The marketing official said that the facility places new residents in a higher level of care and then reassesses them after 30 days, possibly moving them to a lower level. "We decrease the level of care for 50 per- cent of my residents; says Hopkins, of the Marriott facility in Florida. It's important to know when periodic reassessments take place, since the level of care is linked to the amount you will pay. If you suspect the facility is trying to jack up its fees, you can secure an independent assessment from a geriatric-care manager. ADDITIONAL VISITS: FACT-FINDING It is very important for you or your relative to visit the facility two or three times. These visits should be regarded as serious fact- finding missions. Visit at different times of the day to observe the routines. If possible, join residents for a meal to get an idea of how tasty the food is. Chatting with residents in the lobby or outside is the best way to gather intelligence. The facility may tell you that there is suffi- cient stab residents may tell a different story--/ong waits for help, long waits for din- ing services, few people to talk to. The second visit is the time to inquire about a residents' council and find out how active it is. One resident noted that without the residents' council, the facility "would walk all over us." The second visit is also the time to take a harder look at the physical surroundings. How accessible is the dining room? Can someone with arthritic hands hold on to hand bars easily? One Savannah facility was equipped with handrails that were nothing more than grooves in the w'al/that would be hard for someone to grasp. A competing facility in the area had handrails that pro- truded from the wall and were much easier for residents to hold on to. Are there dizzying patterns on carpets or walls? These can make it hard for elders with poor eyesight to navigate. Observe the cupboard height in the kitchens. One resident our reporter visited had all her ldtchen paraphernalia stacked on counters because she couldn't reach the cupboards. Stafftraining, Ask about training in such areas as direct care to patients, safety and emergency care, first aid, CPR, sanitation, mental health and emotional needs, resi- dents' rights, and medication administra- tion. Get specifics: How many hours in what fields? Do they have continuing-education requirements? If Your relative will be in the Alzheimer's or dementia wing of the facili- ty, learn how the staff is trained to interact with difficult residents. Philosophy of negotiated risk. Does this facility want families and the resident to engage in a process of care planning around issues of risk and autonomy? Nego-. tiated agreements reflect a philosophy of consumer choice, autonomy, and indepen- dence, but they may also provide a way for the facility to escape liability ff the resident suffers harm as a result of certain actions. If you go down the path of negotiated risk, have a lawyer examine your agreement. The care plan. Ask who draws up the care plan, and how much input the resident and family will have. All should have a say. If your relative is able to make decisions, the facility should ask about his or her preferences. A care plan drawn up solely by the staffis likely to be a source of trouble hter when things go wrong. W~'IGHING THE PAP£RWORK As you're touring various facilities, begin to ask questions about admission procedures and contracts. The application. When you review the application form, don't be surprised if it asks for detailed financial information about your relative's savings and income. The facility wants to make sure you or your relative can pay the basic price for the unit, the monthly fees, plus the inevitable annual rate increases. But just as important, the application tries to find out whether your relative "qualifies" for care in the facility. At Hale House in Boston, residents must be able to get themselves up and dressed and down to the dining room without assistance. If they can't, the facility doesn't want them. Is there a waiting list? Facilities vary in how their waiting lists work. At some, any- one who does not accept an offer when an apartment becomes available moves to the bottom of the list. At others, the facility simply calls the next person on the list, leaving the others in the same position. To keep your relative on a waiting list, you will most likely have to leave a deposit, usually ranging from $300 to $500. Ask if the money is refundable if your relative eventually decides not to move in. And if he or she wants to go through the application JANUARY 2001 O CONSUMER REPORTS 29 '1 process, will the facility allow the deposit to be used as an application fee? Where will your relative live? Contracts should specify a unit and provide for flexi- bility when it comes to bringing personal furnishings, who can come to live or visit, and whether the same unit will be available after a temporary hospital stay. Many con- tracts are silent on those points. Be sure you are clear about what happens if a resident needs hospitalization. Will payment still be due? What will happen after discharge? Nursing homes are required to hold a room for Medicaid patients. But many assisted- living facilities are not. Be sure that yours will. Going to a new facility can be disori- enting to an elder who has just experienced an acute illness. Are meals included? Contracts usually specify which meals are provided. W',II the facility provide a special diet if needed? Does the facility give credits for meals not eaten or provide tray service if a resident is ill and confined to the apartment? Is there an extra charge for this? These extra charges can add up. How do residents get about? Contracts should specify who will provide transpor- tation and to where. Some contracts don't say, or they specify that residents must arrange their own transportation. When they do mention the subject, contracts may impose restrictions and conditions. Can residents see their own doctor? Most residents prefer to see their own doc- tor, but in some facilities, they may have to use the doctor the facility provides. Ifa facil- ity requires all residents to use the same doctor, and if that resident also belongs to an HMO that requires the use of its own physicians and other providers, he or she could be caught in the middle, unable to obtain medical care without incurring unnecessary out-of-pocket expenses. Who is in charge of medications? Con- tracts should specify who is responsible for administering, coordinating, and schedul- ing medications. What if a resident's health fails? Few contracts specify what-happens when a res- ident's physical or mental status declines. Ideally, contracts should specify that the facility will devise an individual program to accommodate those needs. But instead the contract might say residents can hire their own aides and assistants to help. Many facil- ities are neither licensed nor equipped to deal with the increasing medical needs of their residents. Who decides about transfers? It's not uncommon for residents to live in several units during their stay in assisted living-- first in a private unit and then, as money runs low, in a shared room, perhaps in an unde- sirable wing or floor. Nor is it uncommon for residents to be sent to a nursing home or placed in a higher level'of~care~as their phys- ical or mental capacity declines. Knowing who makes the decisions about transfers, the factors they're based on, and whether a resident has any say in the matter is crucial. Beware of contracts that say decisions are "determined" by the facility. What if it doesn't work out.* See whether the contract provides for a probationary period during which the resident decides if he or she is suited for assisted living. If no probationary period is allowed, will the facility offer a prorated refund of fees already paid if your relative decides to move out after a few weeks? Even though the marketers promise that your relative can "age in place;' state law or the facility's own policy may undermine that promise by limiting the services that can be provided. Contracts should allow for a minimum 30-day notice if the facility wants to end the agreement. Who pays the costs? Almost 95 percent of assisted-living residents pay for care out of their own funds. The rest get help from family and friends and occasionally from state agencies. Monthly fees for assisted living can easily exceed $3,000 or $4,000 a month for rent and care, and there is little public funding available to help. Generally, Medicare does not pay unless skilled-nursing care is needed and given in certified facili- ties. But Medicare does pay for some skilled care if your relative meets the requirements for the Medicare home health benefit. In these cases it may also pay for some personal-care services. Thirty-seven states pay for care in assisted- living facilities through Medicaid. To be eli- gible for Medicaid, your relative must be poor or become poor by spending down assets in order to qualify. Because states limit the number of people served through waiver arrangements, you may encounter long waiting lists even if your relative qualifies financially. Your state department of social services or the Assisted Living Fed- eration of America (703 691-8100) can tell you whether or not your state pays. COMPARING COSTS Be forewarned that residents of assisted- living facilities face a web of charges-- everything from the monthly fee to specific charges for various services the staff gives to help them through the day, even walk- ing them to the dining room. It's difficult to disentangle different fee arrangements. Although pricing can be complicated, assisted-living facilities generally use one of these ways to charge for their services: · Flat or bundled rate. With this arrangement the facility estimates the aver- age amount of care residents will need. Everyone pays the same for personal-care services that are folded into the basic rent for the living unit. · Tiered rate. A facility may include four or five tiers, or rate levels, in its pricing structure. Each tier represents a different level of care needed by a resident. · Flat rate plus an hourly charge for assistance. Hourly charges add up. At one Boston facility, residents could be charged an extra $6 for every 15 minutes of personal care they needed beyond what was specified in the base rate. Fees can be as out- rageous as charging for tying shoes or opening draperies. · Onetime entrance or commtmity fees. These can equal a month's rent, though they rarely exceed $5,000. One facility that was charging $2,000 called it a membership fee. Rate increases. Caring for physically and mentally impaired elders is labor-intensive and very cosily, and most facilities raise their rates 3 to 5 percent each year. Some resi- dents run out of money while still in an assisted-living facility, especially if they stay a long time. Eighty-eight-year-old Helen Roberts, who lives in a Sunrise facility in northern Virginia, moved into the facility in 1990 and paid a monthly fee of $2,432. One year, Sunrise announced an increase of 5 percent, but Roberts's cost-of-living raise from Social Security that year was only 2.4 percent. Residents, working through their active residents' council, prevailed on Sun- rise to limit the increase to 4 percent."None of this was written in the entrance papers," Roberts said. By 2000, she was paying $3,525 a month just for the unit and meals, but no additional care. Additional costs. Sometimes residents require visits from home health aides in addition to the assistance the facility staff 30 CONSUMER REPORTS O JANUARY ;'001 I [ I '1 I ~ i provides. Some 40 percent of assisted-living facilities charge extra for administering medications. Ask if the facility requires res- idents to use certain home health agencies or pharmacies. One facility switched to a new pharmacy. The old pharmacy charged one family $4.44 for 27 Brethine tablets; the new one charged $102.93 for 30. Using the new pharmacy was the only option if the family wanted the facility to administer their mother's medications. RECOMMENDATIONS · Decide if your relative really is a good candidate for assisted living. For people who dislike the idea of communal living, home care, sometimes in combination with adult day-care programs, might work better. But for gregarious people who are begin- ning to experience a decline in function, assisted living might be a good option, at least for a while. · Take a realistic look at your relative's financial picture. Do some hypothetical financial projections; look ahead at least four years or maybe more to see if he or she can continue in an assisted-living facility. Consider the likely possibility of increasing frailty, needs, and expenses, as well as increases in monthly charges. Will future income and assets cover those contingencies? · Carefully consider the philosophy of care given by the facility. Does the facility seem caring and concerned about your rel- ative or are personnel more interested in keeping units filled? · Be sure you understand what the facility can and cannot do to accommo- date your relative's increasing frailty. Will personnel help you make arrangements for care that is needed but that the facility does not provide? Can you afford the additional cost? · Look beyond a facility's fancy interi- or. Is the space functional for residents who may have different kinds of canes, walkers, wheelchairs, and abilities to navigate dis- tances? Does the facility provide residents with camaraderie, activity, and support? ~ Adapted bom Constuner Reports Complete Guide to Health Services for Seniors by Trudy Lieberman and the editors of CONSUM£R RZPORTS. Copyright © 2000 by Consumers Union of U.S., Inc. Reprinted by permission of Three Rivers Press, a division of Random House, Inc. Available wherever books are sold. To order by phone call 800 500-9760. Or, order at vnvvv. ConsumerReports. org. ASSISTED-LIVING COST CALCULATOR Use this worksheet to get a rough idea of the services and what they will cost at the Step 1: Check the type of rate structure. Rat or bundled rate (includes sma services) Tiered rate (varies accordi~ to the amount of assistance needed) for Step 2: List the community or other onetime charcje. Step 3: List the monthly rate for the type of unit you selecL Studio Second-persou fee Step 4: Check which other services are included in the monthly fee, and add the cost of services that require an extra charoe. COST OF ADDITIONAL SERVICES $ Included in monthly rite Meals Breakfast Lunch Dinner Snacks Special diets Guest meals Room service Escorts to meals Housekeeping Dally Times per week Laundry services Personal (loads per week) Linens Apartment amenities Emergency response system Bathroom (sink, shower/ bathtub, toilet) Bathroom (toilet & sink only) Fully furnished unit Carpeting Cable-TV hookup $ Mini-refrkJerator Lockable door Gas/electric/water Window treatments Basic cable-TV service Microwave oven Stovetop burners Local phone service Transportation Scheduled Unscheduled Car Van/mini bus with lift Other Social/recreational activities and services Awake staff on premises 24 hours per day On-site licensed nursincj staff (hours per day) Supervlslon of self* medication (I.e., reminders) Medication administration by licensed professional Activities of daily livincj assistance Unlimited Limited Beauty/barber shop "Wander manaqement" system (for dementia patients) Shopping assistance Incontinence supplies Toiletries Other personal-care services TOTAL ADDITIONAL CHARGES: Step 5: Add up your estimated total monthly expenses. Monthly rate S Second-person fee (if applicable) Source: Adapted from consumer Information statement created by the American Seniors Housinq Association and the Assisted Living Federation of America. JANUARY.2OO10 CONSUMER REPORTS 31