Limited continuing-care options in rural Virginia create challenges for an aging population

Linda Weir, 84, sits at the round kitchen table of her Main Street home in Danville, which is covered with booklets, catalogs and notes from tours at various retirement communities. Her husband, Bob Weir, 82, sits across from her as they discuss their options — most of which are in other localities.

The Weirs started looking at retirement communities about 10 years ago. Though they weren’t ready to leave their home yet, they wanted to be proactive and have a plan for when the time came, they said.

But a lack of options has them considering a move, even though they love living in Danville.

Many of their friends and neighbors have already left the area, they said.

“Our friends are leaving town and we suddenly realized we were kind of socially isolated,” Linda Weir said.

Between the expense and waitlists — not to mention personal preferences — there are limited options in Southwest and Southside for the type of care that the Weirs are looking for, they said.

The couple would like to move into a continuing care retirement community, sometimes called a life-plan community.

These communities offer independent living in homes or apartments to older adults. If, or when, they need more aid, they can move to a different part of the campus to receive assisted living or memory care.

Only about 2,000 such facilities exist across the country, said Karen Roberto, a senior fellow at the Virginia Tech Center for Gerontology.

They are often attractive because they provide a sort of “one-stop shop” for older adults, Roberto said. But because of the robust services they provide, they require a large upfront investment, meaning they often cater to a more affluent demographic.

The Weirs fear they will either need to move out of Danville or consider a different type of living arrangement, like a more traditional nursing home. Many older adults, especially in rural areas, opt to age in place or live with other family members — two things that the Weirs don’t want to do.

About 27% of Danville’s population is aged 65 or older, meaning that thousands of residents are either already facing this problem, or will soon.

The local Health Collaborative is aware of gaps in these types of resources for older adults, but there aren’t any ongoing programs to address them, said executive director Maggie Richardson.

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Adequate care for older adults — especially continuing care — is a common challenge in rural areas, said Teresa Fontaine, executive director of the Southern Area Agency on Aging.

“It’s a wider issue,” she said. “I don’t think this is something that specifically Danville is lacking.”

Much of this is because of supply and demand in the market, Roberto said.

“It’s about having a big enough market of individuals who can pay the upfront fees and the upfront monthly maintenance fees and so on,” she said.

There is one continuing care provider in Danville: Commonwealth Senior Living, which currently has just over 80 residents, filling almost every unit.

There are no such facilities in Pittsylvania County. The next closest options are in Martinsville, Lynchburg and Roanoke, and across the state line in Burlington and Greensboro, North Carolina.

Because of the limited options, these communities often have waitlists, which are usually both lengthy and expensive.

The Weirs are paying to be on waitlists for retirement communities in Roanoke and Burlington, both of which are several years long.

This brings up another factor: cost, which can be a challenge for older adults when it comes to regular housing, Fontaine said, not to mention pricey retirement communities.

The Weirs have toured continuing-care facilities that cost as much as $9,000 a month, Linda Weir said. Additional fees, even for lower-cost options, can add up very quickly, she said.

For example, one of their options runs $4,100 per month for a two-bedroom suite but charges an additional $900 per month for a second person and a community fee of $3,000 upon arrival. Costs can increase as residents need different levels of care.

Most continuing care facilities charge a large entry fee on top of monthly residential fees, Roberto said.

“The rationale of that thinking is that people would sell their homes and be able to use those funds to pay for the upfront fee, but the costs don’t stop there,” she said. “It’s not a cheap option for people.”

The average entry fee is about $402,000, though they range widely, from as low as $40,000 to as high as $2 million, according to the National Investment Center for Seniors Housing and Care, which tracks prices at continuing care facilities across the country.

And average monthly fees were around $3,555 in 2021, with rents rising about 2% per year, according to NIC.

“If one of us dies, we could maybe afford it,” Linda Weir joked.

Bob Weir spent most of his career with Southern Bell Telephone, working in positions including engineer and safety manager. Linda Weir also worked at Southern Bell, which is where the two met, and then she went on to run her own home furnishing business.

The couple has put some money away for retirement, but they still have to budget carefully.

“I understand there are people who don’t have our income,” Linda Weir said, acknowledging that this must be an even more difficult process for them.

In larger metro areas, the cost for this type of care generally increases, which is one reason the Weirs would like to stay put.

The Weirs are also weighing the amenities of retirement communities. Adequate space, the quality of the food and the available programming are important to them, they said.

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Lots of smaller cities and rural localities prioritize attracting younger residents, Linda Weir said. But older adults also provide considerable contributions to a community, and often want to be able to stay in their town as they age.

“Older folks pay their taxes, they go to different clubs, they do community service, and they don’t really call the police that often,” she said. “I have an older friend that teaches literacy. I have another one that works at the welcome center. They may not be full-time jobs, but they make a contribution.”

Plus, the older population holds knowledge and wisdom, especially in a place like Danville, with its rich history. Stories about Dan River Mills and other historical moments in the city’s lifespan live on through older folks, Weir said.

The Weirs moved to Danville from Atlanta in 2008 to be closer to family in North Carolina, and have learned a lot about the city from talking to their older neighbors, they said.

The community is one of the things that the Weirs love so much about living in Danville, they said. They enjoy walks through their neighborhood and events like Halloween, when everyone is out and about.

“You go places and you see people that you know,” Linda Weir said. “It’s just genuinely nice.”

If they moved to another locality, it would likely be bigger than Danville, they said, and might not offer the tight-knit community they’re looking for.

The Weirs have looked at care options in both Virginia and North Carolina, in places like Roanoke, Lynchburg, Greensboro, Burlington and Winston-Salem.

“If you moved to a bigger city where they have more [options], it would cost a whole lot more money, and you get lost in the traffic,” Linda Weir said. “So ideally, Danville is a lovely place for us.”

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An alternative to moving to a retirement community is aging in place, or staying in one’s home.

A 2021 report by AARP showed that 77% of adults aged 50 and over want to remain in their homes and communities as they age. This is especially true in rural areas, because people often want to stay where they have roots, relationships with friends and neighbors, and a sense of safety and comfort.

Another alternative is living with family members.

But neither of these options appeals to the Weirs, who expect to downsize and don’t want to be a burden to their children.

Fontaine said that local Area Agencies on Aging can be resources for folks like the Weirs, who are grappling with this problem. The national network includes 650 agencies, with 25 in Virginia alone.

“Area Agencies on Aging should be a household name when it comes to families and older individuals and their caregivers,” she said.

AAAs can help people get an understanding of what resources are available in their area, Fontaine said.

The agencies also work directly with localities, both to provide information about the needs of the older population and to create solutions, with the goal to create livable communities for residents as they age.

“We advise and educate local government officials about the growth of the [older] population and the appropriate services and resources that are going to be necessary to aid that population,” Fontaine said.

Older adults looking for resources should also turn to local organizations, she said. In Danville, many local groups work closely with the Southern Area Agency on Aging to address needs like transportation and provide programming for the older population.

But addressing these needs doesn’t happen overnight. And the Weirs are not optimistic that there will be an option that they like in Danville in time for them to take advantage of it.

“It’s just going to be sad to leave,” Bob Weir said. “And unfortunately, unless something changes, we’ll have to sooner or later.”

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