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The concept of these is great. Execution or more specifically the financial & management goals of the people running them can be another matter.

We have not been in one and based on our direct knowledge of one bad operation I do not foresee us every going there.

Both facilities I have knowledge of are located in Nashville TN. They are considered successful and have been in business for more than 20 years.

Facility #1 is setup where you can buy a condo unit on the property or rent an apartment. At a point in time you can move into Assisted Living. That transition, unless you are renting in the Retirement community may take a bit of time. At this point is where issues developed. My wife and I handled affairs for a person who had a stroke at age 70. About age 74 she entered the Assisted Living section. That transition went well. After about 18 months the management basically said she had to leave Assisted Living and offered a bed in the Skilled Nursing section. It was the view of the patient, the patient's physician and ourselves the transition to Skilled Nursing was not needed. At that point we made application for another Assisted Living facility and our friend moved there where she lived for over 10 years.

Facility #2 - is one my mother in-law has signed up to enter. In this facility one purchases an "ownership" of a unit. There are different floor plans and hence costs. These are all independent living apartments. Upon moving in, the resident become eligible to transfer into an Assisted Living or Skilled Nursing section as needed. These transfers are not one way events, although a significant number of people moving from independent living never return. When a resident leave the independent living section they can give up their right to return. With that they get back 80% of the original buy-in or ownership cost plus a portion of any increase in the ownership cost of their specific floor plan.

In summary, there is no substitute for candid comments from both pleased is displease residents. Keep in mind a stand alone Assisted Living unit, has some motivation to adjust to changing patient needs. If a patient cannot be taken care of, that facility gets no more money. Correspondingly a combination unit has a built in source of Skilled Nursing clients in its Assisted Living section and it certainly can encourage transfers.
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