Don't make assumptions about the level of care you can expect a retirement village to provide. Even if a frail-care facility is available, this may not mean you can be treated for all medical conditions. And, as always, good-quality care comes at a price.
One of the drawcards of retirement villages is that many of them offer on-site care if you become incapable of looking after yourself.
Many people therefore want to move into a retirement village that offers care services, which could range from preventative care to home-based care, assisted living and frail care. Entities that provide these services will, when regulations under the Older Persons Act of 2006 come into effect this year, need to register with the Department of Social Development.
It is also a good idea to check whether a retirement village has a 24-hour emergency service that could assist you if you have a fall, suffer a stroke or have any other kind of medical emergency in your unit.
What you can get
Not all retirement villages provide a full range of care services - some offer none at all. With those that do, the range of services includes community care, which is made up of two components: preventative care and home-based care; and frail care.
- Preventative care.
A retirement village may provide only preventative care, which includes basic health monitoring, such as checking your blood pressure and cholesterol levels, and advice. The cost of this care is usually included in your levy.
- Home-based care
is offered when you need assistance with activities of daily living, such as bathing and dressing.
A nurse-supervised caregiver will assist you in your home with these activities. This caregiver will probably not be a qualified nurse and will therefore be unable to assist you with the administration of medicine, but may, for example, be trained to monitor blood pressure.
These caregivers will in future need to be registered and trained in terms of regulations under the Older Persons Act, Syd Eckley, a director of the board of the Older Persons Forum, says. Eckley says research has shown that older people prefer to stay in their homes and to be cared for there rather than to move into a home or frail-care centre, and in line with this the Department of Social Development is encouraging the growth of home-based care services.
In some cases, home-based care can extend to frail care, but would stop short of terminal frail care.
Some retirement villages offer residents who need permanent assistance with daily living the opportunity to buy a smaller unit in an assisted-living facility. These units are usually sold on a life rights basis.
Assisted-living facilities usually provide a nurse on 24-hour call, cleaning services and at least one meal a day. Some establishments offer more comprehensive services at a higher price.
Some retirement villages offer another level of inter-dependent living in the form of a room in a residential home catering for you when you are regarded as "semi-frail".
Moving into either an assisted-living or a semi-frail facility could, however, entail selling your existing unit and buying another one within the village.
- Frail care.
The Older Persons Act defines frail care as 24-hour care in a residential setting. If a retirement village provides a frail-care facility, it needs to be registered with the Department of Social Development, Thuli Mahlangu, the department's director for older persons, says.
Mahlangu says her department and the Department of Health usually inspect a frail-care facility as a team. The health authorities will consider the health issues, while the Department of Social Development will consider the welfare of the individuals being accommodated there.
Eckley says under the previous legislation, the Aged Persons Act of 1967, those who ran facilities for debilitated people had to register with the Department of Social Development. But this Act had many loopholes that were exploited to avoid registration. This will not be possible under the Older Persons Act.
A number of retirement villages operate step-down or sub-acute facilities that offer both short- and long-term convalescent care following a serious illness or an operation, as well as permanent frail care. These facilities are often also referred to as frail-care centres.
However, step-down or sub-acute facilities more closely resemble hospitals, although the level of care is of a lower level than that of hospitals.
These facilities have in the past often registered only with provincial health authorities, but the Department of Social Development is of the view that any facility offering frail care should now register with it.
Eckley says many retirement villages that could not make their frail-care centres work have sub-contracted them to outside service providers to operate as step-down facilities. He says these facilities are usually more expensive than frail-care centres, and your medical scheme may bear the cost of your stay in such a centre.
Heidi Kruger, the head of communications for the Board of Healthcare Funders, which represents medical schemes, says usually schemes will pay for three weeks of rehabilitation or recuperation - after surgery, for example - in a step-down or sub-acute facility.
But long-term care in a facility offering frail care is not something schemes usually cover.
Right of admission reserved
While step-down facilities will often have a wide range of services, the services offered by frail-care facilities may be limited.
Geoff Stead, the chief executive officer of Kloof Rest Homes, says Kloof Rest Homes operates a frail- care centre on the same site as Chartwell Estate retirement village in Winston Park in KwaZulu-Natal. This frail-care centre cannot accommodate villagers with Alzheimer's disease or dementia. It can also not take you if you are a cancer patient in need of morphine management.
Some frail-care centres will apparently also not take residents who have illnesses such as schizophrenia or manic depression, Eckley says.
Mahlangu says facilities have the right to refuse to treat you if they are unable to offer you the service you need.
You should also check whether the body corporate or managing association has the right to decide that you must move into a frail-care facility because, for example, you have Alzheimer's disease and are regarded as a "nuisance" to other residents.
Frail-care costs can range from R4 000 to R12 000 a month, depending on the level of the care you need and the facility at which you are accommodated.
The cost of frail care is determined by the financial model adopted by the developer of the retirement village and depends on whether the cost of the service is subsidised by levies or profits from the resale of units in the village.
The cost of frail care is unlikely to cover the cost of consultations with your doctor and any medication prescribed. In addition, you may also be charged for any materials, such as dressings or incontinence pads.
If your move into a frail-care centre is not permanent and/or your spouse remains in your unit while you are in frail care, you could face paying the monthly charge to be accommodated in frail care in addition to the monthly levy for your unit.
Long-term viability
Frail-care centres at retirement villages are difficult and expensive for bodies corporate or management committees to run. It costs more to buy a unit in a village with frail care than in a village without such facilities, and the levies may also be higher to subsidise the cost of the service.
Eckley says a frail-care centre can add about 8.5 percent to the cost of a unit in a village.
Over the years, a number of retirement villages have been forced to close down their frail-care facilities or to bring in external contractors to manage them. If your village closes its frail-care centre, not only will you have lost the potential use of the facility but you would have paid a premium for your property that will now be worth less.
Frail-care beds are very scarce and it is difficult to get into a frail-care centre on short notice unless you are guaranteed a bed by virtue of being a resident of a particular village.
There may be a lot to be said for having a frail-care facility on-site if you are part of a couple. If one spouse needs to go into the facility, the other can remain in the village and visit. But it may be more cost-effective to live in a village that is close to a frail-care or step-down facility but which is not on-site.
Stead says it is well known that only six percent of residents in retirement villages need to use the frail-care facilities, and the average stay in such facilities is only about 18 months.
Eckley says only five percent of retirement village residents die in a frail-care centre that provides terminal care. He says if you have access to good home-based care, you need these centres only when a caregiver is unable to cope with caring for you, and this is likely to be for only two to three months.
Carl Scheppening, a director of Cape Retirement Consultants, has a different view and says in his experience most people in frail-care facilities are long-term patients who suffer from some form of dementia.
Eckley says there have been cases of villages in which the levy has been R2 500 a month, of which R600 was used to subsidise the frail-care facility despite the fact that residents might have needed it for only a few months at the end of their lives.
Eckley says he favours retirement villages that do not have their own frail-care facility but are situated close to one.
Carenet, a Pretoria-based company, is also of the view that villages should not have their own terminal frail-care facilities and that such facilities should rather be built close to a number of villages.
Carenet has built one such 60-bed frail-care facility at De Groen Kloof in the Pretoria area, and is building more such facilities in Gauteng, KwaZulu-Natal, North West and the Western Cape.
Lodie van Staden, the operating manager of Carenet, says residents of retirement villages that use Carenet's services do not indirectly subsidise the cost of building a Carenet facility or of running one through the cost of their properties or levies. Instead a village and its residents pay a "service activation fee" to be affiliated to Carenet's facilities and services.
Currently, residents of villages affiliated to Carenet pay a one-off fee of R25 000, or R40 000 for a couple, when they purchase a unit. They are guaranteed a bed in the Carenet facility and the accompanying services at what Carenet says are prescribed tariffs. This fee, which is currently R270 a day, includes meals, laundry and 24-hour care, but excludes materials, medication, doctors' fees and consultations.
If the facility is unable to admit you or if your village is affiliated to a Carenet centre that is still under construction, you could be accommodated in the nearest available Netcare hospital.
Van Staden says you should check not only whether the retirement village in which you plan to live will provide you with care services now, but also whether there are any guarantees on the continuation of those services at a reasonable (market-related) tariff. Also ensure that there are quality controls on the services offered, he says.
If you decide to go it alone
When making a decision about buying into a retirement village and the medical services it offers, it is useful to know what you would pay for frail care if you stayed in your own home.
A lot depends on the level of care and the nursing agency you choose, but you can expect to pay between R18.95 and R112.42 an hour to have a private nurse visit you in your home.
Cape Town-based Nursing Atlantic Homecare charges R90 for a nursing sister to visit you at home and assess your needs. There is no charge for the nursing sister's subsequent visits to assess the care you are being given.
You will pay R18.95 an hour for a caregiver to work a minimum of eight hours a day - R151.60 a day. If you need a caregiver to attend to you around the clock, you will pay R454.80 a day, or about R14 770 a month. The exact amounts will vary depending on the number of weekends and public holidays in a month.
The fees for nursing exclude the cost of medication and medical equipment.
Nursing Atlantic Homecare has registered nurses who can provide services, such as wound treatment, enemas and catherisation, at a rate of R160 per procedure, excluding materials.
Another nursing agency, Ambition24, the South African division of a British personnel agency, charges different rates depending on your needs.
If you do not need medication to be administered and want a caregiver who is not a qualified nurse, you can expect to pay R30.17 an hour. If you need a low level of medication, you will be provided with an auxiliary nurse (one with basic training) at a cost of R58.59 an hour.
The rates for a more highly qualified nurse, such as one who is capable of administering medication to a person with a terminal illness, range from R98.29 to R112.42 an hour, which works out to between R2 358.96 and R2 698.08 a day.
- The prices quoted are approximate, and will vary depending on your circumstances and requirements.
This article was first published in Personal Finance magazine, 1st Quarter 2008. See what's in our latest issue