It goes without saying that most of us would prefer, in our later years, to settle into comfortable, friendly, home-like surroundings. Ideally, we would find a place where our changing needs would be met as our care requirements increase, without making us dependent on family members for our care. This concept of living in one place over many years and receiving elder care services in this setting is called “aging in place.”
Among the wide range of housing and care options available to financially secure seniors is an option called a continuing care retirement community (CCRC). Based on the premise of aging in place, this unique residential arrangement is gaining popularity across the nation.
What is a Continuing Care Retirement Community?
CCRCs aren’t independent living communities, assisted living facilities, or nursing homes. Rather, they are a single campus that features all these residential care types in a central location. The goal of CCRCs is to provide a full “continuum of care” for residents so that they do not have to make disruptive moves from facility to facility as their needs change. The continuum of care begins with an independent living area that may consist of rental units, condominiums or cooperative housing units. Seniors usually have the luxury of living in the same apartment or house while living independently or in assisted living. However, once an elder requires skilled nursing care or memory care, they usually make a short move to a different part of the building or campus.
As with other types of senior living, CCRCs and their residents establish a business arrangement through a legal contract specifying exactly what kinds of supportive services, skilled nursing care, amenities, and housing will be provided initially and over the long term. In addition to providing a complete continuum of care, CCRCs are unique in that they offer contracts guaranteeing care and housing for a senior for the remainder of their life.
What Services do CCRCs Provide?
One of the key attractions of CCRCs is the wide range of healthcare and supportive services that these establishments can provide. These may include skilled nursing care, social work, nutrition counseling, assistance with activities of daily living (ADLs), physician care, an onsite pharmacy, and rehabilitative services like physical and occupational therapy for residents who experience either a temporary health setback or an ongoing medical condition. Contract fees may cover housekeeping, laundry services and a certain number of meals served in onsite dining facilities. Some transportation services may be included in basic fees also.
While the guarantee of basic healthcare and the amenities of senior living are certainly important, most CCRCs aim to go beyond the basics to offer a higher degree of comfort and a wider selection of daily activities. They are intended to be upscale communities set apart in choice locations that afford a great deal of privacy and convenience. Within these communities, residents are likely to find a full range of social and physical activities and amenities, including dining, dancing, lifelong learning opportunities, swimming pools, exercise classes, art studios and golf. For an additional fee, members may have access to more specialized healthcare services, nonscheduled transportation and increased meal service.
Requirements for Moving into a Continuing Care Retirement Community
If your loved one should decide to move to a CCRC, they will be asked to fill out an application with information regarding their health and financial status. Potential residents must undergo a comprehensive needs assessment to determine the level of care they require and the types of services that are best for them upon move in. This will, of course, also impact the expenses they incur.
Financial arrangements must be in place before a senior’s application can be approved as well. A very significant down payment is often required from a potential resident or their family members upon moving in. There are several different types of contracts that CCRCs offer and therefore various types of financial agreements available to fund one’s care. The one common factor is that a senior must have significant assets and/or income to afford living in a CCRC. It’s wise to have an attorney and/or an accountant review any CCRC contract before signing, even if you’re fairly confident that you understand its terms.
CCRC Ownership and Business Models
Typically, CCRCs are privately owned and operated by a business organization or corporation. The actual business structure may be very complex, but the contractual arrangement between a CCRC and its residents is always based on the types of care, services and housing that each resident requires. Government regulation of CCRCs is largely based on state finance laws, which can vary considerably. Of course, the CCRC must meet all appropriate state licensing requirements and regulations in order to provide health care services. Your state’s elder affairs department, office for the aging or housing authority can be a valuable source of information about CCRCs.
Since residents pay for CCRCs privately, there are no federal requirements for Medicare or Medicaid certification. However, in an effort to prove the excellence of their care and service, many CCRCs independently seek accreditation. The Commission on Accreditation of Rehabilitation Facilities (CARF) is one such independent accrediting body that promotes a set of standards concerning the corporate and financial stability of a CCRC’s parent company—an extremely important consideration given the long-term nature of CCRC residential living—and the quality of life of CCRC residents.
When Should a Senior Consider Moving to a CCRC?
A major selling point of CCRC living is that prospective residents can settle into an accommodating environment and maintain their normal independent routines for as long as they are able to do so. Unlike in other senior living options, if a senior becomes more dependent as time passes, they won’t have to leave familiar surroundings to obtain the kind of care they require. If you’re doing long-range planning for yourself or a loved one, you may greatly appreciate the unique advantages a CCRC has to offer. Residents are able to enjoy many of the amenities and freedoms of living in a private home (with some limitations due to shared facilities and common areas) with none of the concerns of property maintenance, personal safety, loneliness and isolation that may occur when an elder lives in a typical neighborhood setting.
Of course, moving into a CCRC is a major life change that should always be discussed thoroughly among a senior, their family members, their healthcare professionals, and their legal and financial advisors. This is a personal decision and a highly individual choice that should be based on anticipated or potential future care needs as well as on current needs. Because a CCRC contract involves a long-term commitment and significant financial resources, the decision should be carefully researched and planned. Prospective residents should never make a change until they are absolutely convinced that this is what they want, not only for the short term, but also for years to come. Ideally, CCRC residency should begin while a senior is still fully capable of making decisions and is physically and mentally able to manage their own daily routine.
Choosing the Right Continuing Care Retirement Community
While CCRCs are becoming increasingly common across America, they are more numerous and best established in the Southeast, where the CCRC “movement” originated. Geographic location may be one of the most important factors for a senior, especially if maintaining close family contact is a priority. There may be a lengthy waiting list at some CCRCs, which also may be a deciding factor in choosing one over another.
In addition to location, you should be assured that your loved one will receive a full complement of amenities. Make sure that if a CCRC is what a senior wants—an establishment that provides a full range of care options in one location—that is what they’re actually getting. Some senior residential arrangements may not include nursing home facilities, so if a resident becomes unable to remain in their current housing, they will be forced to leave the community for a nursing home in an unfamiliar place. This is particularly important because significant financial obligations on the part of the resident are involved and they may not be getting what they think they’ve paid to receive.
It’s crucial to visit CCRCs as well to see the location and layout in person, meet with staff members and talk to current residents. In addition to traditional guided tours, many CCRCs maintain guest housing so that prospective residents can spend a weekend to see firsthand what the experience is like. This is an ideal way to judge the dining facilities, facility management, amenities, social opportunities and general atmosphere of the CCRC. Be sure to talk with the residents to see what their opinions are of the facilities and care provided. You can learn a lot about the overall quality of life in a CCRC by the positive or negative comments you hear from the people who already live there.
After spending time at a CCRC and learning about the activities and the staff, the main question to ask is, could you/your loved one be comfortable living there? Of course, a resident should be physically comfortable, but they should also feel socially and culturally at ease. CCRCs promote a distinct senior lifestyle based on being discreetly set apart, monitored and protected. This appeals to many seniors, but it may not be to everyone’s taste, especially if a person enjoys being around younger people and children.
Beyond being pleased by the surroundings and feeling at home with the staff and residents, there are some harder questions to ask. Do residents have a say in determining what services are provided by the CCRC? Does the CCRC staff help its residents arrange for services that they may not be able to provide? How are resident complaints handled?
There should be little or no restriction on personal property that a resident may bring to the CCRC. Living spaces are roughly equivalent to one’s own home and generally may be furnished as such. Based on location, availability, services and amenities, plus your own observations about the quality of life in a CCRC, you should be able to make a satisfying choice.
Paying for Continuing Care Retirement Living
Of the many senior housing options, CCRCs are among the most expensive and least subsidized. Medicare and long-term care insurance do not pay for the independent residential living costs of a CCRC that include housing, meals or non-skilled care. In some cases, limited amounts of skilled nursing care or other types of health care may be covered under Medicare or by private insurance. However, given the high cost of CCRC living, it’s highly unlikely that anyone living in a CCRC would meet the income guidelines required to qualify for Medicaid. Therefore, residence in CCRCs is paid for out-of-pocket.
Most CCRCs ask for an entry fee (also known as a “buy-in” fee) plus a monthly fee based on the type of care for which the resident contracts. Entry fees in most parts of the country range from $40,000 to $90,000 or more for a single occupancy studio apartment. The buy-in fee is often in the $200,000 to $300,000 range for a two-bedroom cottage, but this initial payment can approach $1 million in some communities. This entrance fee covers some of the additional costs associated with higher care levels.
In addition to the entrance fee, a monthly fee is required, which is sometimes referred to as “rent.” Monthly fees range from $1,500 to $5,000 (or higher in the most expensive parts of the country). When care levels increase, the monthly fee increases. These fees can also increase annually because of inflation, but most communities limit annual increases to no more than 10 percent. Again, given the huge financial outlay, it would be wise to involve an attorney and a financial advisor to represent a resident’s interests before signing any type of legal agreement with a CCRC.
The CCRC model, as it is today, is clearly a long-term care option only for wealthy seniors and should be considered only if the prospective resident is absolutely certain that this is an affordable expense. Seniors can be evicted for nonpayment of rent or cooperative maintenance fees. Still, many experts in senior housing and healthcare feel that the exclusivity of the CCRC will diminish over the coming decades as senior consumers with more moderate incomes begin to demand similar options. Meanwhile, for many seniors who have saved well for their retirements, CCRCs offer an appealing solution to concerns about aging in place, preserving independence and living life to its fullest.
