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K4-9 - Why are we getting K-4? And why will we need it? - Part 2 - backstory

Wm Magill - October 2017

I received an email in September. . .

On Sep 29, 2017, at 10:46 AM, Lee Heile wrote:

Could you send me anything for this question: " Why are we getting K-4? And why will we need it"?. All I can say is they are nice people and it is free. Lee

At the time, I responded:

This is a difficult pair of questions to answer briefly.
There is a lot of “back-story” involved relating to many different fields — from technological innovation to Federal and State Regulations.

A quick and dirty answer is:

You may not need K4 today, but you will need it soon! …. and it’s not free.

Continuing on with the backstory. . . I’ll start with the Why part of the story. Note that I’m really skimming over much of this. . .

The Masonic Handshake

Most people do not realize what the Masonic Village itself IS and what that means — a Continuing Care Retirement Community (CCRC).

At best, their understanding is that of the origins as the Masonic Home of the Grand Lodge of Pennsylvania and the Masonic Home of Pennsylvania in 1910 and 1871 respectively or maybe the Grand Chapter’s Masonic Home of Warminster in 1929 — if you were a Mason or member of the Eastern Star, the Fraternity operated a “Home” where INDIGENT Freemasons (and their wives, children and unmarried daughters) were taken care of in their advancing years — a roof over their heads and three meals a day. This is often known as the "Masonic Handshake" - a commitment by the Fraternity to take care of its own. (https://masonicvillages.org/history/)

It is hard to understand the importance of the concept of “Continuing Care” without the knowledge of and understanding this history of the Fraternity and of the evolution of the concepts surrounding what today are called “homeless” members of society.

Freemasons have always “taken care of their own” - uniquely at the time, they operated what were called in the 1700s, poorhouses or almshouses or “an old-people’s home” - but with a care and compassion which did not exist outside of the Fraternity.

Over the years, the general public’s perception of these entities changed and various terms and concepts were used to describe them - convalescent homes began to be established in the general time period of World War II. These board-and-care homes would provide basic levels of care and meals in a private setting for a specific fee. As time moved on, Federal and State regulation began to address the abuses of the poorhouse, and the “Nursing Home” began evolving.

Medicare became the law of the land in 1956 to provide medical care for families of individuals serving in the military. Medicare as we know it today came into being in 1965 as a change to Social Security.

Evolution of the Continuing Care Retirement Community (CCRC)

As society in the United States changed - multi-generational families living together ceased to be the norm. The elderly’s dependence upon their younger generations for their care has become less and less a viable option.

"It almost goes without saying that most of us would prefer, in our later years, to settle into comfortable, friendly, home-like surroundings where our changing needs would be met as our care requirements increase—without making us dependent on family members for our care. Living in the same place as we age, one in which we can receive the various types of health and homemaking services we may need in a familiar setting, is called aging in place."

"Among the wide range of housing and care options available to financially secure seniors is an option called the continuing care retirement community, or CCRC. Based on the premise of aging in place, this unique residential arrangement is gaining in popularity across the nation." - Dr. John Connolly.

There are two important phrases in that paragraph: "aging in place,” and "financially secure seniors” terms you hear used frequently in discussions of retirement. Which brings us to the Masonic Villages of today.

Again quoting from Dr. Connolly: "CCRCs aren't independent living communities, assisted living facilities, or nursing homes. They are combinations of all of these residential and care options, owned and operated by private companies and staffed to provide a ''continuum of care'' for residents. The assisted living and nursing home components of CCRCs usually are intended for use only by residents from the independent living units that are part of the CCRC and not by seniors from outside it."

These all represent trends which continue to shape culture and attitudes in the United States today. Many of these cultural changes are now codified into law; and as the demographics of society change others will continue become new laws.

CCRC Regulation

One last point I would make about a CCRC — it is largely unregulated.

Everyone in management and the media likes to extol the virtues inherent in getting a multi-star rating. However, what they do NOT emphasize or normally even talk about, is the fact that those stars only apply to two portions of the Masonic Village at Elizabethtown — the Health Care Center and Personal Care. Those are the only two areas inspected regularly by State and Federal agencies (regulators). Physically, those two units represent a small potion of our 1400 acre campus here at Elizabethtown.

According to the December 2016 Consilidated Financial Statement, the Masonic Village at Elizabethtown contains:

"In Pennsylvania, CCRCs are reviewed by the Pennsylvania Insurance Department (PID) and the Departments of Public Welfare (DPW) and Health (DOH). The PID examines the financial records of each CCRC to ensure the CCRC is operating on a solid financial basis and in a financially responsible manner. DPW licenses both personal care and assisted living residences – while DOH licenses skilled nursing, and if the CCRC provides any kind of home care in the independent living section, DOH also licenses home care agencies."

Also, by and large, there are many Federal and State laws which apply to those two facilities, which do not apply to the independent living portion of the community. The Americans with Disabilities Act of 1990, a civil rights law that prohibits discrimination based on disability, is one in particular which causes great confusion for Masonic Village Residents.

All of Independent living is completely unregulated, and un-inspected. In Pennsylvania the only requirement for a CCRC, is to obtain an initial license, pay an annual fee ($750 in 2016)and file an annual fiscal report. To get that license does impose a number of one-time requirements, most having to do with financial stability. And the License comes from the Insurance Department, not the Department of Health and Human Services! The Pennsylvania Insurance Department does not inspect a CCRC.

The IRS form 990 (Return of Organization Exempt From Income Tax), which the Masonic Villages, Inc is required to file annually can be found on the main website:

All of which is to say, Management is basically free to do whatever they please, making whatever requirements they choose at whatever the cost — the only stipulation being that the tenants of the Fair Housing Act are adhered to - which are basically all anti-discrimination items.

The Resident’s Agreement is the contract between you and the facility. It contains information such as: