Photo: Igor Grochev/Shutterstock

To Board a Cruise Ship -- and Never Get Off

by Leigh Alexander Mar 2, 2017

Aboard a cruise ship called the Crystal Serenity, 88-year-old “Mama Lee” lives a life of leisure. On the day before her husband, Mason — with whom she’d taken over 100 cruises — died in 1997, he pleaded with her, “Don’t you quit cruisin’,” and by all accounts, she never has. She now lives year-round at sea, and says she’s come to feel more comfortable than she ever did ashore.

“I talk to [my family] every day,” Mama Lee told CBS News last summer. “I’ll talk to them twice a day if it means I don’t have to be there!”

Mama Lee, whose real name is Lee Wachstetter, has earned a degree of fame for her unconventional retirement. She’s written of her years of cruise ship life in The Washington Post, and her life at sea has been profiled by nearly every news outlet you can name in recent years. She makes an exciting character — a shipboard diva making the most of an unconventional choice.

While Lee might be one of the best-known cruise ship retirees, she’s certainly not alone. In a news report from last summer, multiple older couples describe a luxurious lifestyle at sea, where they’re warmly “adopted” by an attentive crew who embraces their needs. I’m especially fond of this charming gallery of unclaimed photos, circa 1990s, of seniors bewildered by scheduled activities, or photo ops, or both. It’s not too hard to see why these stories of late-life adventures continue to capture the imagination. The idea that cruise ships might make ideal, if offbeat, retirement facilities has never really gone away.

Dr. Lee Lindquist is chief of geriatric medicine at Northwestern University, and a fan of cruise vacations. She says that the happy, energetic seniors she has met on cruises remind her of some of her patients, inspiring her to explore whether they might be able to live on ships year-round. The result was an oft-cited 2004 study, comparing the costs of retiring on a ship to assisted living facilities. That study, she says, led to a surprising wave of international calls from both the ship biz and the senior living industry alike. It seemed she was on to something.

Cruise ship living is an option only for the relatively wealthy. Costs start at about $229 per day, while some year-round cruises cost up to $40,000 annually, or more. Mama Lee herself claimed to spend $164,000 every year in 2015, and by 2016’s reports, that number had climbed to $175,000.

Lindquist found, however, that the cost of living onboard a ship was generally comparable to that of a high-end senior living facility (at least as of 2004), yet it came with a higher standard of care and attention. In fact, she found the ratio of capable medical staff to passengers was often much more favorable on cruise ships than in senior facilities, where a few nurses often find themselves responsible for all residents during their given shift.

“It may even be better than retirement living as far as physician presence, and people are actually excited to go on a cruise ship in a way they aren’t for retirement living.”

Lindquist also felt that onboard amenities, quality activities, and the opportunity to meet new passengers regularly would keep seniors busy and happy in a way that long hours alone in a home couldn’t. “It may even be better than retirement living as far as physician presence, and people are actually excited to go on a cruise ship in a way they aren’t for retirement living,” Lindquist tells me. “We see a lot of depression in people that enter retirement communities.”

The response to Lindquist’s study was immediate and fervent, she says, especially in places like Denmark and the Netherlands that were struggling at the time with a “gray wave” — more longer-lived and healthier seniors, but with such limited space and such high-priced options that people were sending their older relatives to Spain for retirement because it was cheaper.

“With Spain there was a language barrier, so nobody wanted to go,” Lindquist says. “They saw a ship as its own water-bound country, and so they they were thinking about buying ships.”

Those ships never came, and today the possibilities Lindquist raised clearly remain under-explored. Self-sustaining floating facilities where silver foxes shuffleboard and swing dance away all night and day, subject only to maritime law and the whims of the islands, stubbornly refuse to materialize in the mainstream. I decided to set sail for answers, sending missives to multiple cruise lines that advertised residential facilities, especially those cited in these articles about senior living.

The replies I received — if and when I received them — were emphatic. None of these cruise lines, even those I’d only heard of from articles about their own senior residents, wanted to step confidently forward as a destination for the elderly. Residences aboard The World, which bills itself as an aboard-ship vacation home, start at upwards of half a million — but while the average resident is 62 years of age, The World’s spokesperson emphasized to me that it “is not a ‘retirement’ option.”

Carnival Cruise Lines, which permanently installed Kathie Lee Gifford singing “If They Could See Me Now!” into the American national consciousness, insisted it serves only a “younger demographic,” (the average cruise ship fan is 54 years of age, earns about $75,000, and takes a cruise per year). In an email statement Carnival told me it was “not a fit” for stories about senior living.

“They’re worried about being known as ‘death ships,’” Lindquist ruefully reflects. Despite the initial surge of interest generated by her 2004 study, the leisure ship industry has thus far been unwilling to take it further: “Their money ultimately comes from big spenders on short-stay visits, and they are afraid to lose that to seniors just sitting on the boat.”

Most cruise lines’ websites highlight onboard medical facilities as a selling point.

The senior living industry has also diversified in a relatively short space of time. When Lindquist was doing her study, multiple options competed for the attention of a demographic that was enjoying longer lives and more active, healthy years than ever before. Simply skipping the fusty old nursing home still felt radical and fresh. Since then, the concept of a “retirement home” — a lifestyle community aimed at older folks whether by land or by sea — has crystallized as an entirely distinct concept from assisted living, which is geared for older patients who may need more medical facilities and supervision than the cruising life can provide.

Oswego, Oregon-headquartered Holiday Retirement has been in the senior living industry since 1971. “We call them cruise ships on land,” says senior communications vice president Jamison Gosselin of the company’s all-inclusive facilities, which include round-the-clock staff, activities, amenities, and transportation. While he sees cruise ships as yet another option for well-off older folks who maintain an appetite for adventure, he is skeptical that today’s vessels can meet the medical needs of assisted living patients, which range from sophisticated equipment to skilled nursing (usually a Medicaid service) and access to a battalion of pharmaceuticals that need regular replenishment.

Most cruise lines’ websites highlight onboard medical facilities as a selling point. Royal Caribbean has gone a step further with an in-depth video showcasing its treatment technology. But serious emergencies would probably require a helicopter airlift, not exactly ideal for an ailing elderly patient. Most of all, Gosselin says, the senior passengers risk being cut off from a crucial source of emotional healthcare support — the presence of their children and grandchildren.

Setting sail for your retirement is also a risky idea when it comes to legal protection. For the most part, the laws governing a vessel would be the same as for on-land facilities in the country in which the ship is registered, though “flags of convenience” make it trivial to pick and choose from whichever laws you want to follow. For example, one doctor announced in 2001 that he planned to take advantage of differing international euthanasia laws to create a “death ship” where assisted suicide would be legal, though no such boat has yet materialized.

Interestingly, courts have repeatedly found, most recently in 2007 (Carlisle v. Carnival Corp.), that ship owners or cruise lines are not liable for any negligence on the part of their staff — even on the part of shipboard doctors. That principle was challenged in 2014, after an elderly cruise ship passenger hit his head and later died at sea. A judge in that case found that as cruises have medical facilities competitive to those on land, they may now be held to the same standards. But history shows a strong precedent otherwise, and significant legal recourse or financial compensation for medical malpractice doesn’t seem guaranteed. That’s a massive factor to consider before setting your health afloat.

The 2006 Maritime Labour Convention, sometimes known as the “seafarers’ bill of rights,” contains a clause that makes seafarers’ entitlement to medical care comparable to that on land. But maritime law itself is mostly devoted to the care of sailors or military personnel. A ship that planned to act as a medical facility would probably have to designate itself a hospital ship officially, where it would be subject to some universal legal guidelines under the Hague Convention X of 1906 — it would need to be clearly marked as a hospital ship, and attacking it would be a war crime. The U.K.-headquartered Mercy Ships claim the world’s largest floating medical facilities, but in their case the main advantage of a boat is the ability to travel with lots of equipment to areas of need, rather than any inherent virtue in keeping treatment options afloat on the waves.

Perhaps for these reasons, relatively few seniors currently seem interested in shipping off as a permanent lifestyle, and fortunately none are being dumped over the sides of boats. Though according to this creepy report, close to 200 people per year die aboard cruise ships, mostly older folks of natural causes. Cruise ships are required to carry body bags, and have morgues that fit six to 10 bodies. Getting a death certificate at sea, though, is apparently a more complicated and paperwork-intensive process than it would be on land and requires the cooperation of an issuing port.

For now, then, the dream of sophisticated retirement or medical residencies at sea remains only that. From the cost per passenger to the unique limitations, most seniors probably have less eccentric, more affordable options on land and close to their families. It seems the liability for private vacation liners is too great, while the market for a designated retirement and care facility may not be vociferous enough.

But every generation is looking for post-retirement options distinct from those of their previous cohort. Holiday Retirement’s Gosselin says that as today’s Baby Boomers enter the twilight of their lives, they’re clearly eschewing anything that might recall the ornate silk flowers and homey wallpaper of their parents’ nursing home facilities.

“Their sense of interior design is very different,” Gosselin tells me of Boomers. “They don’t want all the flowers and stuff — they want a more modern look, with stone and brick or light wood. Their parents wanted a cozy and intimate environment, but they like it to be airy, something like a ski lodge.”

While being at sea is probably as airy as one can get, the cruise industry’s self-described bid for that younger demographic might mean that forthcoming generations of retirees won’t see ships as their sort of thing. For the time being, the future of retirement seems firmly grounded on dry land.

This piece was originally published at How We Get To Next and is reposted here with permission.

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