The idea of the “Continuing Care Retirement Community” (CCRC) is to enable seniors to “age in place” by providing independent living, assisted living and skilled nursing care in close proximity on the same “campus.” The idea is to enable seniors to remain in a familiar setting as their care needs change.
Seniors who are independent may live in a single-family home, cottage, townhouse, duplex or apartment within the CCRC complex. In general, these living spaces will have been designed with seniors in mind and include such adaptations as step-free entries, grab bars, a monitored emergency call system, etc. When seniors need help with activities of daily living such as bathing, dressing and eating, assistance may be provided in their existing accommodations or they may be transferred to an “assisted living unit,” a small studio or 1-bedroom apartment with a scaled down kitchen or no kitchen at all. When further care is needed, seniors may be moved to the nursing home wing.
Most CCRCs offer group dining areas and common areas for social and recreational activities. Since it’s in the community’s interest to keep residents healthy for as long as possible, many also offer regular immunizations and examinations, proper nutrition, physical therapy, and exercise equipment or classes. At the high end, there are places with beautiful grounds and common spaces, fine dining, and an array of in-house musical and cultural entertainment.
Contracts and Costs
Seniors living in a CCRC typically sign a contract to be cared for by the CCRC until the end of their lives, no matter what their needs are in the future.
Most CCRCs offer three types of contracts:
- A life care/extensive contract that provides unlimited long-term nursing care at little or no additional cost for as long as the nursing services are necessary (most expensive)
- A modified/continuing care contract that provides long-term health care or nursing services for a specified period of time, after which the resident is responsible for any additional cost
- A fee-for-service contract in which the resident pays additional fees for all long-term health care or nursing services provided (least expensive)
CCRCs are generally the most expensive communities available to seniors. In 2009, entrance fees ranged from $200,000 to over $400,000. Monthly fees ranged from $400 to over $2,500. Costs depend on many things, including whether the senior owns or rents the living space, the size and location of the living space, the amenities and services provided, and the probable need for intensive, long-term care when the contract was signed.
Weighing the benefits
The selling point for CCRCs is that they enable residents to remain in familiar settings as their care needs grow. However, it’s not clear whether a move to the assisted living or nursing home wing constitutes “staying in a familiar setting” even if it’s on the same campus. Some studies show that within CCRCs there’s a stigma associated with moving to an assisted living or nursing home unit and that visits from acquaintances quickly taper off, even though distance isn’t an issue. In other words, when you move to an assisted living facility, it hardly matters whether you move from a building away or half a city away. Even a few floors of a building may mark a distance that is hard for acquaintances to bridge.
Moreover, you may have limited say in when the moves are made. When the CCRC administration decides that it’s time for you to move to assisted living, that’s what will happen. Without family or friends to advocate for you, you’re vulnerable to abuse and arbitrary treatment.
Evaluating a CCRC
CCRCs are accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF). The first thing is to find out if a CCRC you’re considering is accredited by this organization. If not, be especially thorough in reviewing services, operations and finances.
Another national organization that evaluates facilities is the Continuing Care Accreditation Commission. You can also see if your state has inspection data for the skilled care portion of the CCRC.
Many CCRCs allow potential residents to visit for short periods. Try to spend at least one night at the CCRC and participate in all the activities for two or three days before you make a decision. Since this will be your permanent home, observe the living accommodations and the social, recreational and educational activities that are offered. Eat all the meals, and observe the staff to see if they are friendly and responsive to the residents. Find out what types of healthcare and personal care services are available and how they handle medical emergencies. Inquire about the short-term and long-term services they offer such as routine physical and dental examinations, pharmacy services, skilled nursing services and physical therapy services. If you have a pet, inquire if can keep your pet.
Be especially sure to check out the assisted living and nursing home facilities. Find out what would cause you to be moved to an assisted living wing. Will you still be able to have a private room? Find out what you can do to challenge a decision on the part of the facility.
Examine the contract carefully. It’s a good idea to have the contract looked at by an eldercare attorney. This is a binding, lifelong contract, so you don’t want to make a mistake.