Continuing Care Retirement Communities

Continuing Care Retirement Communities:Lifelong Security and Care

Created with active, independent seniors in mind, continuing care retirement communities are a fast-growing option. CCRCs offer the entire “continuum of care,” from independent living to assisted living to nursing care–all in one campus setting. Residents can move among the three levels of care as they need to. Retired couples can move into a CCRC and know that as their health and medical needs change over the years, they’ll both be cared for in the same facility. Also called “life care” communities, CCRCs are committed to providing lifelong housing and medical care to older adults.

Part retirement community, part health care facility, and part insurance company, a CCRC, for some people, can offer the best of all possible options. Although they’re increasing at a rate of20% a year, CCRCs require some advance planning, since many have waiting lists of several years.

The Resident Community

Many CCRC residents are affluent, well-educated retirees who no longer want the work of keeping up a home. Some choose a CCRC for its sense of security: a major decision–where to live–is decided just once, and they won’t have to move several times in later years as medical needs change. CCRCs can also ease financial worries since the large entrance fee to join is like medical insurance: the CCRC contract with residents for their anticipated, lifelong housing and health care costs, except hospitalization.

Each CCRC is truly a community, since its residents may live together for several years. Each has its own style and atmosphere, ranging from rural to urban, condos to cottages, high-rises to resorts. Most residents share the desire to blend independence with companionable recreation,from art classes to woodworking and golf. A lot of retirees move into a CCRC when they are still relatively young and healthy, and plan to live there the rest of their lives. Some residents move indirectly to assisted living or nursing care units.

Philosophy

Each CCRC reflects its own philosophy and style in the services it offers. Some emphasize golf and leisure; others have a religious or cultural orientation. Most offer all three levels of care–independent living, assisted living, and nursing care. Some of the common services below are included in fees; others carry an extra charge.

What Does a CCRC Offer?

Independent living units are typically apartments, houses, or cottages, designed as studios, one-bedrooms, or two-bedroom units. Many include kitchens. Most CCRCs provide housekeeping, a meal service for one, two, or three meals daily, maintenance, and a variety of social programs and amenities. Health care, including the services of primary care and specialty physicians, dental care,and pharmacy services, is provided by the CCRC’s plan, much like a health-insurance plan.

Assisted living is provided by a staff available to help residents with personal care, such as bathing, dressing, and eating. Assisted living services may be housed in its own wing or area of the CCRC, or may be available in the standard independent units.

Nursing care is provided for short-term illness, rehabilitation, and longterm care. Most CCRCs provide the specific, skilled nursing care covered by Medicare. Because nursing care is provided within the “community,” residents can receive their treatment in a familiar setting. You pay a entry fee to cover these extensive medical costs, so be sure to evaluate medical staff and policies before moving in.

Residential Services

• a well-maintained apartment, house, cottage, or townhome
• housekeeping and linen service
• one, two, or three meals a day in common dining areas, including medically advised diets
• maintenance on living space and grounds
• security and an emergency response system
• wellness, cultural, social, and recreational programs

Health Care Services

• health care coverage for contract-specified services, such as health clinic visits and care by a primary care physician and specialists
• pharmacy and dental services
• personal care services, to help with bathing, dressing, and other daily activities, for assisted living units
• nursing care with 24-hour staffing in a wing of the CCRC or a nearby facility physical therapy and other rehabilitative care
• respite and hospice care
• Alzheimer’s or other special-patient care

Amenities vary wildly and may include a few of the following: shops, postal services, a bank,cafe, salon, spa, pool, gym, library, transportation, religious services, auditorium, meeting rooms,tennis courts, golf courses, a game room, crafts rooms, movies, gardening plots, walking paths, guest apartments, travel services, or special events at nearby universities.

CCRCs Have Complex Contracts

All CCRC contracts are legally binding and complex, and each will outline its own policies on fees, medical services covered, refunds if residents move out, and policy if residents run out of personal assets. Be sure to review contracts with a financial or business advisor, since the management and financial strength of the CCRC will greatly affect its ability to deliver on its promises.

Health Care Plans

An extensive, or life care, contract covers housing, residential services, and unlimited use of its specified health care services. (It may cover days in the nursing facility, for instance, but not all medical supplies.) You pay a known monthly fee regardless of the amount of medical care you use. A modified contract covers housing and residential services but limits the number of days you’re covered for nursing care; you pay extra ($50 to $200) for each extra day you use. A fee-for-service contract covers housing and residential services only; you “pay as you go” only for each specific medical service you use.

Payment Plans

Some CCRCs use a monthly fee arrangement, where you pay a set amount that covers housing and health care, in some cases with a small initial deposit. Read all contracts carefully to know exactly what’s included and what services incur an extra charge. Most CCRCs charge a monthly fee with an entry fee. Know that entry fees don’t actually “buy” anything, except the right to occupy one of the CCRC’s units. Entry fees may be non-refundable to residents (or their families)who move out or die; partially refundable; or refundable only under certain circumstances after a penalty is paid. Others have an equity option, where you buy your housing in the CCRC outright,as a condominium, co-op, or membership-style CCRC, and then pay extra for residential service sand health care.

The Cost of a CCRC

CCRC price ranges are perhaps the most variable of all housing options because of the vast difference in residential and health care services. Monthly fees range from $750 to $1,500, with a one-time entry fee of $40,000 to $100,000, depending on the size of the unit, services, and location. A few are available for less. Resort-style and more luxurious facilities charge from$1,500 to $3,500 monthly, with entry fees of $100,000 to $500,000.

Residents may be asked to disclose their financial resources before being accepted into someCCRCs, to assess whether their assets will cover projected fees. Because so much money is at stake, it makes sense to review all contracts, agreements, and policies carefully with an attorney and financial planner (entry fees may have tax implications).

Licensing

Those CCRCs that are Medicare certified to accept federal benefits for the skilled nursing care they provide may require residents to be covered by Medicare; others also require you to have Medigap coverage. A few CCRCs are certified for Medicaid, as well, and care for some residents whose personal assets are minimal.

CCRCs are regulated by each state’s department of insurance, health, aging, or consumer affairs.In addition, about one-fifth of CCRCs have chosen to be examined and accredited by theContinuing Care Accreditation Commission, to prove they meet stringent standards for quality of care, resident policies, management, and financial strength.