During the past several years, directors at Royal Plaza Retirement Center, on Spokane's North Side, say they have seen a noticeable shift in the characteristics of residents who live in its assisted- and independent-living units.

Because of those changes, they say that many services offered to the facility's residents also have been altered somewhat to meet those seniors' needs.

Mia Walden, admissions and marketing director at Royal Plaza, says, "When assisted living was new, it was just that—people were tired of living alone and wanted help with food and yard work. Now, it's expanding, and people are staying home longer and now require a higher level of care—sometimes the same type of care they would get from a skilled facility."

Located at 302 E. Wedgewood and just a few blocks off North Division Street, Royal Plaza has 34 independent-living units and 86 assisted-living units.

Walden and Leann Springer, administrator for Royal Plaza, say they have seen a shift occur during the last several years to the retirement center's assisted-living units being completely full with a waiting list to move in, when that formerly had been the case with its independent-living units.

"I think with the economy, it's reversed, and people that could stay at home longer are doing that," Springer says.

Seniors living in the facility's assisted-living wing have access to on-site physical therapy, occupational therapy, speech therapy, blood draws, mobile X-rays, and other health care services, Springer says. The center also employs several nurses, and a nurse practitioner to monitor residents' health, she adds. In all, Royal Plaza has about 45 employees, she says.

She says another noticeable change in the acuity levels of Royal Plaza's residents can be seen during meal times in the assisted-living side's dining room.

"In the dining room, you would see a cane or walker every once and a while, but now you see them everywhere," Springer says.

Incoming assisted-living residents range in age from their 80s to early 90s, Springer and Walden say, adding that they feel the trend of people waiting until they are older to leave their homes will be a permanent change in the retirement care industry.

"We think they are staying home too long past the time they need help," Springer says. "Once they get here and get three meals and get their medicine given correctly, some are like a completely different person. They really bounce back."

Seniors who live in Royal Plaza's independent-living center can choose between a number of room configurations, with one- and two-bedroom units, some with balconies and fireplaces. Those units range in price between $2,215 and $2,780 per month, depending on size. Couples who live at Royal Plaza are charged an additional $260 per month for a second person to live there.

Rent contracts are on a month-to-month schedule, and monthly fees include one hot meal per day, washers and dryers in the units, cable TV, and weekly housekeeping assistance, among other amenities. Residents living in one of the center's independent units also can opt in to receive extra assistance services for added fees, Springer says.

Should an independent-living resident decline in health or in their ability to complete tasks of daily living, those changes would qualify them to become an assisted-living resident, Walden and Springer say.

Walden adds that residents on the independent-living side of the facility are monitored by Royal Plaza's staff for any changes in behavior, or if they seem to be struggling in certain areas. Residents also have the option to wear pendants that have a button they can press to call for help should they fall or become immobile, she says.

Residents in the facility's assisted-living units can expect to pay between $2,095 and $5,680 month, depending on the size of their unit and the care services they receive.

Assisted-living units are smaller in size than the independent units, but Walden says that size difference can be helpful for a resident who has dementia, and also cuts down on overhead living costs since those residents or their families pay additional fees for support services. Rent for an assisted-living unit costs between $1,725 and $2,730 a month, depending on the size, she says.

Assisted-living services are provided on an individual basis, and the costs for that support are determined on a point-based scale, Springer and Walden say. Various tasks that a resident could need help with, such as bathing, dressing, or medication and dietary management are assigned a point value depending on the activity and frequency the resident needs assistance, they say.

A resident who doesn't need a high level of extra help could pay a minimum of $370 a month additionally to their unit rent fee, while a high-need resident who needs continual monitoring and assistance could pay up to $2,950 a month on top of rent.

Another trend the administrators at Royal Plaza say they've noticed since the economic slump set in is the failed attempts of adult children who have tried to care for their aging parent at their home or the parent's home in lieu of having the parent go to an independent- or assisted-living facility.

"It really takes a toll on a spouse, or a sibling or child," Walden says. "This is something we're seeing more ... but the (senior) doesn't get the adequate care there, and the (caregiver) doesn't have the experience to give them the correct assistance they need."

Also, she says that because many residents at Royal Plaza are in a state where they need to receive regular medical check-ups or treatments outside of the facility, she sees a lot of adult children of those residents coming in to take their parent to appointments on an ongoing basis.

Says Springer, "If the resident needs outside care, the children still take a lot of time to care for them even though the parent is here."

"Some of them come daily," she adds.

Similarly, Walden says there are a few residents living at Royal Plaza who are receiving some financial support for their care from family members.

"It's not often, though, because there aren't many children in a financial position to help," she says.

Springer says most residents are footing their own bills, and adds that Royal Plaza allows its residents who are eligible to use Medicaid to pay for their living and care expenses after they've lived there for two years.

Should a resident at Royal Plaza experience a serious medical event that would require them to be hospitalized for more than three days and also need around-the-clock, skilled-nursing care, the retirement center's sister facility, Royal Park Care Center, is located nearby.

Springer and Walden say they try to place Royal Plaza residents needing such services there, and when the resident recovers to a level that the assisted-living services are adequate they can return to their apartment.

Royal Park has 164 skilled nursing beds and is located at 7411 N. Nevada.