Cruising Through the Sunset Years

For seniors who need help with day-to-day activities, living on a cruise ship would cost little more than moving to a typical assisted-living facility. But experts warn that many retirees can't afford either--and suggest that society come up with more economical options.

Ballroom dancing, a midnight buffet, and lounging on deck while sailing from one tropical isle to the next: This pampered lifestyle awaits people vacationing aboard luxury liners. Now researchers at Northwestern University suggest that seniors who are contemplating a move into an assisted-living facility (ALF) might instead consider boarding a cruise ship--for good. The cost, it turns out, would be about the same, yet the lifestyle on the ship far outshines that offered by most landlocked facilities.

Approximately 800,000 seniors now live in ALFs, where they receive assistance with a few activities of daily living such as dressing, bathing, or taking medicines on schedule. The facilities typically provide residents with a room or small apartment, three meals a day, weekly housecleaning, and limited nursing services.

But a cruise ship can do all that--and more, say gerontologists Lee Lindquist and Robert Golub. In a paper in the October 2004 Journal of the American Geriatrics Society, Lindquist and Golub compared the health care, staffing, dining, and other amenities aboard a Royal Caribbean cruise liner to those offered by an average, mid-western ALF. The ship wins.

Using a well-established computer model, Lindquist and Golub analyzed the costs, risks, and benefits of assisted living on land and at sea. They assumed that the cruise passengers would experience comparable numbers of medical emergencies and visits to the hospital as their landlubber counterparts. Seafaring seniors have to be evacuated by helicopter for emergency trips, but the authors factored those costs into the analysis.

The results showed that 20 years of cruising would cost a mere $2000 more than a typical midwestern ALF--a total of $230,497 compared with $228,975. That's the base price: Both options can get more expensive. Many ALFs charge additional fees for meals and services, and ALFs in other areas of the country can cost more. On shipboard, optional excursions can also run up the bill, although some seniors seem content to socialize on deck instead of sightseeing. But, Lindquist explains, the ships already provide several activities of daily living--meals, daily housekeeping, laundry, and even attractive escorts--all-inclusive.

Lindquist, a practicing geriatrician, decided to do the study after taking a cruise and noticing elderly passengers using wheelchairs, walkers, and oxygen tanks. "They looked just like my patients," she remarks, and they seemed happier. Lindquist considers an extended voyage a serious option for many seniors. She says her patients often resist admitting they need help. They balk at moving into ALFs, arguing that they aren’t ready to be cooped up. Meanwhile, many patients who are in ALFs complain about the quality of meals and care and question whether they're getting the best service for their money.

But seniors shouldn't rush to book passage. Although it might be possible in the future, no cruise line currently caters to people with assisted living needs such as help with medications, says J. Michael Crye, president of the International Council of Cruise Lines. He notes that onboard physicians have no training in geriatrics, and seniors who need to see their specialists would have to figure out how to make land for their doctor visits. The cruise ships' staffs would also need training in the same 4 to 6 week course that ALF caregivers receive for helping seniors with medications, dressing, and other daily activities.

Even so, cruise ship life "might be an interesting option for a small number of people," says Janet Belsky, a psychology professor at Middle Tennessee State University in Murfreesboro, who specializes in aging. "Rich people are doing it already on an ad hoc basis," but they still enjoy relatively good health. However, most people want to be "anchored" near their families as they become more frail, she says.

Some experts guardedly praise the study for its fresh approach to a looming problem. The U.S. Census Bureau projects that the 65+ population will more than double from 35 million in 2000 to 77 million in 2040. "If you look 20 years out, we'll have a huge crisis on our hands," warns David Kyllo, executive director of the National Center for Assisted Living. "We'll have so many seniors, but we don't have a health policy in place to care for them."

Only 10% of Americans 65 and over have insurance that covers long-term care--and not all of those policies cover ALFs, says Susan Coronel, director of long-term care for America's Health Insurance Plans, a trade association representing health insurance companies. Government programs don't offer much help. Medicare does not reimburse seniors for assisted living at all, except during recuperation from a Medicare-covered hospitalization. In some states, waivers allow Medicaid to cover daily assistance, but the waivers affect only 10% of Medicaid recipients nationwide and do not include room and board. Medicaid will cover nursing home costs for seniors who have largely exhausted their life savings. But the vast majority of people over 65 must tap into their reserves to pay for assisted living.

The American public is naïve about aging in general and the financing of long-term health care in particular, Kyllo says: "We've done a poor job educating people about what life is like at 92. We certainly have not done a good job preparing them financially." Too many people find out too late that most ALFs require dipping deep into savings. And cruising won't resolve that problem.

Society needs to come up with less costly alternatives, says Belsky: "We need models that are not just for rich people." For example, she suggests, a group of elderly residents could share a house, Golden Girl style, with a communal health aide. Communities could establish intergenerational homes in which younger residents help with shopping, cooking, and looking after their older housemates. Or families could adopt a senior as live-in grandparent, reversing the foster-care relationship. These arrangements would lessen the financial burden on seniors, and because they would ease the strain on ALFs and nursing homes, says Belsky, government and private insurance plans should help foot the bill.

Graying baby boomers will likely devise diverse and funky situations for their sunset years, some traditional and some still unimagined. If they can afford to, they'll cruise or live in fancy hotels in their favorite vacation spots or near their children. Or maybe they'll come up with cheaper alternatives--perhaps senior dorms with loud music, jam sessions, and a kegger every Friday night after bingo.

Cathryn M. Delude is a freelance writer in Andover, Massachusetts. She hopes to explore the cruise ship alternative firsthand and welcomes funding for her research.