Aging Gracefully in Oconee County

BOGART, Ga. – Lil Berry is a petite, white-haired lady of 87 whose mint-green dress matches her living room  chairs.     “I’m fortunate in my life,” says this retired Air Force nurse and survivor of both breast and liver cancer.  “I’ve seen a lot of things and I’ve been well taken care of.”  Newspaper articles and photos detailing Berry’s time as an army wife and nurse are scattered on the living room table and the rich smell of brewing coffee fills her apartment at Highland Hills.

Berry’s daughter, Sandy Berry, emerges from the kitchen with a cup of coffee in each hand.  “Mom is a true optimist,” she says, “and that seems to have carried her through quite a bit.”  Sandy lives only a mile away from Highland Hills and visits often.  She sometimes stays overnight in her mom’s apartment, and the two go out to dinner or on a family outing at least once a month. “That has been good for all of us,” Sandy says.

Georgia has the largest population of older adults in the South, according a  report  compiled by the University of Georgia’s Institute of Gerontology.  As in other parts of the country, the growth of this population outstrips the growth of healthcare services they’ll need during the coming decades. Georgia ranks 45th in terms of the physical and mental wellbeing of it’s elderly residents, and Georgia’s annual Medicaid allocations, per person, are $100 below the national average,

Although those numbers sound bleak, some Georgia residents are aging gracefully in clean, well-lighted places like Highland Hills, an assisted living complex in Oconee County, just outside Athens. The catch is that living in a place like this can cost more than $2,000 a month.

Berry and her late husband, Army Colonel James Berry, were not rich. But they were thrifty and they planned ahead. . The couple retired to Black Mountain, N.C. in the early 1980’s after being stationed in such far-flung places as New Guinea, Germany, and Japan.    After James passed away, Lil kept living on her own and made smart financial decisions that allowed her to remain independent.

Then seven years ago, when Berry was eighty, she was diagnosed with an autoimmune disease and decided it was time to move closer to her children in Georgia.  She sold her home in Black Mountain and moved to Iris Place, an independent living complex on the edge of Athens, GA. Amenities for apartment dwellers include a gym, attractive  communal dining room  and housecleaning service for apartment dwellers.

Berry loved the community at Iris Place, but didn’t always want what the chef prepared. Two years ago she relocated to Highland Hills, an independent living facility that also offers cleaning and communal meals, but where Berry also  has a kitchen of her own.  Highland Hills also has a personal care wing that she could easily move to if  her mobility and health  decline.

Living in Black Mountain, a mecca for retirees, it was obvious to Berry that many of her friends were finding it harder to get around on their own, and harder to keep up with home maintenance. People canceled bible study meetings and sometimes refused to even walk to the mailbox when it snowed. Berry did not want to live like this, so she and  Sandy began researching independent living complexes near Athens.

“I would recommend to anyone in their eighties that they move into a retirement home,” said Berry.  “A house comes with so many responsibilities, and when things break, it becomes a stress just to keep up with it all.”

At Highland Hills, the minimum monthly charge for a one-person  apartment is $1,774; for a couple  the cost is $2,119.  These prices include transportation to the grocery store and doctors’ appointments, maintenance and gardening, dinner in a communal dining room, optional laundry and housekeeping services, regular social activities, 24-hour emergency care staff and an emergency call system in bedrooms and bathrooms.

For the Berry’s, on-site emergency care and call systems provide a sense of security.  Highland Hills is part of the St. Mary’s Health System, and emergency medical transport to the hospital is there when needed.  Lil called the ambulance once, when she was struck by a serious case of flu.  “Most people hate the hospital, but it is a good place to be when you need to be there,” Lil said.  After a serious bout, she was back in her apartment within a week.  Lil and Sandy don’t like to talk about what an abrupt downturn in Lil’s health would mean,  especially if she needed to move to a nursing home.

Nursing homes routinely get a bad rap from marketers and managers for independent living centers, who praise their facilities’ superior sense of community and quality of life.  “I’ve managed independent living centers, I’ve managed assisted living centers and I’ve managed nursing homes,” said Ron Cox, an administrator at Iris Place.  “Let me tell you this: there’s something about a nursing home that just makes people give up.”

Nursing home residents experience more depression, pain, incontinence and mobility impairment than adults living at home or in assisted care, according to a team of Chinese and American researchers led by public health Professor Jye Wang at Chang Jung Christian University in Taiwan. These factors impair daily activity levels, which worsens mental health the researchers report in the February 2009 issue of the Journal of Gerontology, a quarterly journal published by the Gerontological Society of America.  Although the researchers speculate that people who move into the nursing home from some other type of group facility  may experience less depression, they haven’t established this.  It makes sense to Ron  Cox, however, whose experience is that an abrupt transition from  complete independence to a skilled nursing facility  can be traumatic. He believes that independent living facilities offer a more gradual transition.

Individual and family attitudes largely determine how well people do in assisted living, said Beth Guthrie-Johnson, the sales coordinator for Highland Hills.  “If the people who live here see it as a way to maintain their independence, then they tend to live longer and be a bit happier.”  Families who see nursing homes as cold and impersonal, a setting to be avoided as long as possible, often perceive the progression from independent living to assisted living as a highly desirable alternative.  If people move in before they experience too many problems, like Berry, they have more tools help them stay independent.

Berry navigates her apartment with ease and cook what she wants without worrying about home maintenance.  Several of her less-mobile neighbors get around thanks to  walkers, respirators, wheelchairs, automatic scooters or human help..  They view caregivers and devices not as burdens, but as  ways of staying in command of their own lives.   “Even when people pay someone to take care of them,” said Cox, “they still exert a bit of their own independence.”

When staying in their own apartment no longer makes sense, Highland Hills residents can move into a personal care unit that provides  daily assistance with bathing, dressing and medication, as well as three prepared meals each day.  “We offer built-in levels of different care,” said Guthrie-Johnson.  Though Lil and Sandy Berry don’t talk about this very often, one reason Lil moved to Highland Hills was the assurance that should the need arise, she could move easily from independent living into personal care without leaving the building, let alone the county.

Even in Oconee County, whose citizens have the highest per capita income in the state, not everyone will be able to afford Iris Place or Highland Hills. Only people who can write a monthly check for $2,000 or more live at Iris Place, although military veterans  get a discount and  VA benefits sometimes help with costs.

Most Highland Hills residents also pay their own way, although certain long-term care insurance policies cover assisted living facilities like this one.  “The type of people who want to come here know whether or not they can afford it,” said Cox. “We’ve never had to turn anyone away based on lack of funds.”
It is often said that money can’t buy happiness, but maybe that is not universally true.   Money, at least, buys more options.

Family members, elderly adults, caregivers and medical professionals share the belief that older people are healthier if they have autonomy and self-determination, according to a survey conducted by University of Texas medical ethicist Dr. Eugene V. Boisaubin, Writing in the Summer 2007 issue of the Journal of Medicine and Philosophy, the authors emphasize  that people who depend on Medicare and Medicaid can’t afford upscale retirement homes, and typically rely on their families for care.

“I work, and I know that I could not give my mom the type of care and independence she has now if she lived with me,” Sandy said. Lil, like many of the other residents at Highland Hills, has a private caregiver who helps clean her apartment, prepare meals and take Lil on errands. “She pampers mom,” said Sandy, “but I think a fair bit of pampering can be healthy.”