Cruising Into the Golden Years

Ships offer alternative to assisted living, study says

FRIDAY, Oct. 29, 2004 (HealthDayNews) -- Sailing the seven seas might be more than just a vacation option for seniors.

New research finds that living on a cruise ship is a cost-effective, not to mention luxurious, alternative to assisted-living facilities for the elderly.

The authors of the study, appearing in the November issue of the Journal of the American Geriatric Society, did enough research to suggest they were serious about the idea. But even if they weren't, the idea may float with those trying to solve an increasingly problematic dilemma.

"I don't think it's really to push people to living on the Queen Elizabeth or Queen Mary. It's basically saying that we can devise something better," said Dr. Michael Freedman, a professor of geriatric medicine at New York University School of Medicine. "Families aren't willing to take care of older people, and nobody has been quite happy with institutions. It's a question of what are the alternatives."

"Using cruise ships as assisted-living alternatives is certainly an 'out-of-the-box' idea," added Matt McCann, a long-term care insurance specialist in Darien, Ill. "The bottom line, why not? This idea gives people yet another option. As medical science continues to improve, we are all living longer and longer. The need for long-term care will continue to increase."

According to MetLife, assisted-living costs an average of $2,524 per month or $30,288 per year. The most expensive location in their 2004 survey was Stamford, Conn., at $4,327 a month and the cheapest was Miami, at just $1,340. According to the study authors, some high-end centers charge as much as $48,000 or more per year.

By contrast, one month sailing on the Royal Caribbean Majesty of the Seas costs $2,651, the researchers reported.

They figured out that, over a 20-year life expectancy, the net costs of a cruise ship were only about $2,000 higher than an assisted-living facility, or $230,497 vs. $228,075.

Not to mention that these "floating assisted-living facilities" have many of the amenities of a landlubber's center, minus the linoleum floors and institutional paint: three nutritious (and probably delicious) meals a day; escorts to meals; housekeeping and laundry services; and plenty of opportunity to socialize. And cruises may have some features assisted living facilities don't have, such as 24-hour doctors.

"Most people whose ADL [activities of daily living] needs can be handled by an assisted-living facility can have the same benefits on the cruise ship," McCann said.

Ships have smaller rooms, the authors pointed out, but this is more than made up for with common-area dens, libraries, dance halls, and atria. The larger cruise ship lines also have a ratio of two to three passengers for each employee, far more than in an average assisted-living facility. Presumably, these individuals could be available to those guests needed extra assistance and might even be able to dispense medications at meals.

The solution isn't perfect, of course. While the authors stressed that "more visitors would be inclined to go see Grandma if she was living on a cruise ship," others might be disinclined.

"For some people, this would not be appropriate due to seasickness issues or family concerns," McCann said. "Family members may not like the idea due to lack of access to parents while the ship is at sea."

"I can see this as an alternative for a specific portion of the aging population -- those who don't want/need to be near family or friends, those who function well and don't suffer from dementia, and those who are isolated but otherwise doing all right," said Donna Schempp, program director of the Family Caregiver Alliance in San Francisco.

There would have to be certain support services, including a means to get off the ship for medical emergencies, a way to evaluate if someone's care needs are greater than the ship can provide and an idea of what the backup plan might be. "The biggest problem might be the fall danger -- it takes a fair amount of coordination to step over the sills at the tops of stairs, or to manage during unstable seas; there would have to be help available," Schempp added.

The authors also noted that cruise ships, like assisted living facilities and nursing homes, are closed populations and can be ripe environments for epidemics such as the flu. They recommend that passengers get all the recommended vaccinations before boarding. If they fall ill while on board, they can be stabilized by resident medical staff. The passengers can also disembark at the next port or, if necessary, be airlifted via helicopter.

Would it be feasible? "Licensing would be a concern," McCann conceded. "What state would license the facility, or would they need a license at all? Since more and more people are obtaining long-term care insurance, this could be a concern, since many policies require that caregivers or facilities be licensed and/or operate legally in the location they are located."

Certainly the market seems to be there. Just to see if anyone actually wanted to spend their final years living on the high seas, the authors interviewed a group of seniors aged 65 to 85 who gave the idea a thumbs up.

More information

For more on caregiving, visit the Family Caregiver Alliance.

SOURCES: Matt McCann, long-term care insurance specialist, Darien, Ill.; Michael Freedman, M.D., Diane and Arthur Belfer professor of geriatric medicine, New York University School of Medicine, New York City; Donna Schempp, Program Director, Family Caregiver Alliance; November 2004 Journal of the American Geriatric Society
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