Senior-living communities are taking on an impressive new look. The senior living market is growing, and senior communities are catching on to increasing consumer demands. The Dallas Morning News reported last month on the new trends of retirement communities, and recent changes are striking.

Developers and architects are teaming up in preparation for the generation of baby boomers who have always shopped with a discerning eye  "Developers of senior communities have begun to pay more attention to design as consumers have become more demanding and discriminating," said David Schless, president of the American Seniors Housing Association.

Once hospital-like retirement communities are now taking on the look and feel of fine resorts, boutique hotels, and spas.Architects nation wide are moving away from the conventional retirement-home design, and towards that of an elegant resort. "You may have to look twice at some before you realize they aren't upscale hotels or resorts," said Bob Lagoyda, an executive with the International Association of Homes and Services for the Aging. The Edgemere retirement community in Dallas, for example, is a beautiful re-creation of a Tuscan village.  Stucco walls, earthy tones, and tile roofs contribute to the sleek look and feel of the community. Residence improvements will feature larger kitchens, baths and dens, and more natural light.

The senior population and families can look forward to tomorrow's senior communities following these upscale trends across the nation.

Admitting a loved one to a nursing home can be very stressful. In addition to dealing with a sick family member and managing all the details involved with the move, you must decide whether to sign all the papers the nursing home is giving you. Nursing home admission agreements can be complicated and confusing, so what do you do?

It is important not to rush, but rather to read. Read the agreement carefully because it could contain illegal or misleading provisions. If possible, try not to sign the agreement until after the resident has moved into the facility. Once a resident has moved in, you will have much more leverage. But even if you have to sign the agreement before the resident moves in, you should still request that the nursing home delete any illegal or unfair terms.

Two items commonly found in these agreements that you need to pay close attention to are a requirement that you be liable for the resident's expenses and a binding arbitration agreement.

Responsible party

A nursing home may try to get you to sign the agreement as the "responsible party." It is very important that you do not agree to this. Nursing homes are prohibited from requiring third parties to guarantee payment of nursing home bills, but many try to get family members to voluntarily agree to pay the bills.

If possible, the resident should sign the agreement him- or herself. If the resident is incapacitated, you may sign the agreement, but be clear you are signing as the resident's agent. Signing the agreement as a responsible party may obligate you to pay the nursing home if the nursing resident is unable to. Look over the agreement for the term "responsible party," "guarantor," "financial agent," or anything similar. Before signing, cross out any terms that indicate you will be responsible for payment and clearly indicate that you are only agreeing to use the resident's income and resources to pay.

Arbitration provision

Many nursing home admission agreements contain a provision stating that all disputes regarding the resident's care will be decided through arbitration. An arbitration provision is not illegal, but by signing it, you are giving up your right to go to court to resolve a dispute with the facility. The nursing home cannot require you to sign an arbitration provision, and you should cross out the arbitration language before signing.

Other provisions

The following are some other provisions to look out for in a nursing home admission agreement.

• Private pay requirement. It is illegal for the nursing home to require a Medicare or Medicaid/Medi-Cal recipient to pay the private rate for a period of time, though they may decline to admit someone already qualified for Medi-Cal. The nursing home also cannot require a resident to affirm that he or she is not eligible for Medicare or Medicaid/Medi-Cal

• Eviction procedures. It is illegal for the nursing home to authorize eviction for any reason other than the following: the nursing home cannot meet the resident's needs, the resident's heath has improved, the resident's presence is endangering other residents, the resident has not paid, or the nursing home is ceasing operations.

• Waiver of rights. Any provision that waives the nursing home's liability for lost or stolen personal items is illegal. It is also illegal for the nursing home to waive liability for the resident's health.

As continuing care retirement communities (CCRCs) gain in popularity, the payment options are growing as well. CCRCs offer a spectrum of care, from independent housing to assisted living to round-the-clock nursing services, all on one campus. According to an article in the New York Times, the new payment options mean selecting a CCRC has become more complicated.

CCRC residents must pay a large entrance fee plus a monthly fee, but the amount of each fee and what it covers can vary, depending on the contract. There are three basic CCRC contracts: life contracts, which cover unlimited long-term nursing care at little or no increase in the monthly fee; modified contracts, which include a specified duration of long-term nursing care, beyond which fees rise as care increases; and fee-for-service contracts, in which residents pay a reduced monthly fee but pay full daily rates for long-term nursing care.

Communities typically offer several variations on each contract. Some CCRCs give residents the option of paying a higher entry fee, which remains refundable. Part of the entry fee will be refunded either to the resident when the resident moves or to the resident's estate once the resident dies. At some other CCRCs, entrance fees are refundable for a period of time, and then become nonrefundable. Still other communities may require residents to purchase their residences. What the monthly fee covers can also vary. Some places include housekeeping and meals, and others don't.

All these choices mean that CCRC contracts have become much more confusing. There is help available. At www.ccrcdata.orgyou can find a directory of CCRCs and sort them by location, price, long-term health coverage, and refund plans. In addition, once you have selected a CCRC, you should have a lawyer review the contract before signing it. Deciding on a CCRC is a once-in-a-lifetime choice, and it is a decision that should be made carefully.

SOURCES: News release, Novartis. FDA: Information Sheet: "Rivastigmine Tartrate (marketed as Exelon)." Guardian Unlimited: “Alzheimer’s Patch Approved.” ABC News: “FDA Approves Patch to Treat Dementia.”

The U.S. Food and Drug Administration approved the first transdermal, or skin patch, treatment for patients diagnosed with Alzheimer’s or Parkinson’s disease dementia. This innovative new therapy treats mild to moderate patients through a skin patch that maintains steady drug levels in the bloodstream.

The drug, called Exelon or Rivastigmine Tartrate, which is currently available in capsule form, will soon be offered as a patch dispensed by U.S. pharmacies. It has offered significant benefits to memory and overall functioning in patients with dementia due to Alzheimer’s and Parkinson’s disease dementia. In addition to providing improved drug-therapy management, the patch eliminates gastrointestinal side effects that are commonly associated with this class of cholinesterase inhibitor drugs.

The patch is made by Germany's LTS Lohmann Therapie-Systeme AG and will be distributed by Novartis Pharmaceuticals. The company expects to be distributing the patch by the end of this year.