Continuing Care Retirement Communities (CCRC Definition)
Paul Williamson – October 14th, 2020
Paul Williamson – October 14th, 2020
Continuing care retirement communities (or CCRCs) offer several senior living options in one location. Typically, these long-term care options include independent living, assisted living, and nursing home facilities. CCRCs allow for seniors to age in one place, providing them with varying levels of care as their needs change. As the United States population continues to age, these life care communities are expected to assume an increasingly prominent role in the senior living landscape. Are you considering a continuing care retirement community for yourself or a loved one? If so, keep reading. We discuss the typical CCRC structure, admission requirements, and types of contracts. We also cover the costs and provide some ideas on where to get the funds. Finally, we discuss how to find the perfect CCRC for you or your loved one.
A continuing care retirement community is a facility focused on senior living. It accommodates seniors based on their various care needs. Also called a “life care community,” each CCRC enables seniors to structure their retirement by planning for the levels of care they’ll need for the rest of their lives. CCRCs allow seniors to age in place, providing them with a continuum of care as they age. As residents’ needs change, so do the services they receive. Because CCRCs allow seniors to plan for the rest of their lives, some facilities have renamed themselves as “life plan communities.” This revised name reflects a focus on each resident’s ability to live a rich, vibrant life while having senior care services available. Continuing care retirement communities offer several onsite housing options, each with different levels of care. Facility staff continually reevaluate each resident’s needs to determine if a higher level of care is necessary. As a resident’s needs change, they move to a different facility within their familiar community. Upon CCRC admission, most residents qualify for independent living. As they move through the continuum of care, they transition to different onsite care facilities. Regardless of which care option they receive, all residents have access to emergency medical care.
A new resident’s CCRC experience typically begins in the independent living complex. Typically, these complexes feature spacious common areas and outdoor facilities. Some of the CCRC’s features may include swimming pools, restaurant-style dining rooms, exercise classes, and numerous onsite and offsite social activities. With regular social activities and outings, independent CCRC residents enjoy quality retirement living. Residents in independent living facilities enjoy a lifestyle often found in upscale senior living communities. Accommodations include houses, duplexes, cottages, or apartments. The CCRC independent living complex is often nicely landscaped with outdoor courtyards, walking paths, and gardens. In addition, the CCRC complex handles all home maintenance issues, leaving residents free to enjoy their vibrant, independent lifestyles.
As a resident’s needs change over time, it’s likely they’ll move from an independent living unit to the CCRC’s assisted living facility. In the assisted living section, older adults receive home care services along with activities of daily living (ADLs) assistance. Assisted living residents enjoy private rooms or apartments. They benefit from transportation to and from medical care appointments. Plus, immediate assistance is available 24/7 via an emergency call button. Even though assisted living residents need varying levels of healthcare, they continue to maintain a rich quality of life. Residents enjoy trips and outings to shopping venues and social activities, often accompanied by family members. Additionally, community college classes, community group performances, and special events take place on the assisted living facility’s premises.
As a loved one’s medical care needs increase, they may transition into the CCRC’s skilled nursing facility. This higher level of care typically includes round-the-clock help with ADLs and medication management. Skilled nursing services are always available for residents’ healthcare needs, and licensed physicians are onsite. Residents in this long-term care facility live in private or shared rooms, and a resident’s emergency call button will quickly summon help. Nursing homes also function as short-term rehabilitation facilities for recently discharged hospital patients. Skilled professionals deliver speech, physical, and occupational therapies under a physician’s supervision.
Many nursing homes include a designated wing for dementia and Alzheimer’s patients. These skilled nursing care facilities provide Alzheimer’s and memory care residents with the healthcare services that meet their specific needs. Each self-contained unit offers staff trained to provide various levels of memory care to residents. Memory care sections also include more staff supervision, and stricter security protocols help to ensure residents’ safety. Family members of residents receive increased peace of mind knowing their loved one is safe, and their home care and healthcare needs are being met.
Continuing care retirement communities have very rigorous admission requirements compared to other types of long-term care facilities. The first criterion is that applicants must currently be in good health and be able to live independently.
To apply to be a CCRC resident, applicants must be within a certain age range. In most cases, continuing care retirement communities require residents to be at least 55 years old. However, many CCRCs limit applications to those between the ages of 55 and 65. And, depending on the facility, some CCRCs are even more restrictive, only permitting applications from seniors 62+ years old.
Each CCRC applicant must provide their complete medical history along with relevant family medical history details. During their application, they receive a comprehensive physical examination and may undergo a mental health exam.
Each applicant must show proof of financial assets sufficient to cover their current care needs. They must also demonstrate that they can pay for a higher level of care in the future.
Certain religious, ethnic, or cultural organizations may operate their own retirement care communities. A group’s admission criteria may require that applicants are members of that organization. However, it’s best to check with the specific organization for its requirements.
Senior care facilities tend to require that applicants provide specific legal documents. These documents are called “advanced directives.” They provide legal instructions for your medical care preferences, should you be unable to make those decisions yourself. Doctors and caregivers will rely on advanced directives for legal guidance in making healthcare decisions. Each CCRC’s advanced directive requirements may differ; however, it’s likely that they’ll ask for a “power of attorney” and a “living will.”
This widely used legal document permits you to name a person or organization to manage your affairs in the event that you’re not able to perform those functions. There are several different power of attorney types. Each one endows your attorney-in-fact (the person who will make decisions for you) with varying levels of control.
A living will specifies the medical treatments you would like to be used to keep you alive. It also spells out the treatments you don’t want to be used. A living will can also include your preferences regarding other medical decisions.
A well-run continuing care retirement community provides its residents with several distinct benefits. Collectively, CCRCs enable residents to enjoy the best possible quality of life as their needs evolve.
When a resident first enters a CCRC, they are typically in good health and have a high degree of mobility and independence. As the years pass, the resident’s health may decline and necessitate their move into the CCRC’s assisted living community. Eventually, they may transition into the complex’s onsite nursing home.
As a resident moves through the CCRC’s continuum of care, remaining in their familiar community can provide a sense of comfort and security. In addition, staff who get to know a resident’s personality and living habits can easily detect changes that could indicate an emerging physical or mental issue. The resident’s family can have peace of mind knowing that their loved one’s needs will continue to be met.
Many CCRCs are designed to accommodate couples with different care needs. For example, a spouse who meets the facility’s independent living criteria can share a living space with their partner who needs some assisted living services. Or, if one spouse moves into the facility’s onsite nursing home, their partner can easily visit them.
Sharing the CCRC complex with other residents helps to build relationships based on shared values and interests. Lasting friendships may begin in classes, outings, worship services, or other venues. Even if one party’s care needs change, the friendship can continue as long as both people remain on the CCRC premises.
In evaluating continuing care retirement communities’ costs, understand that a CCRC costs more than other long-term care options. This higher cost results from the CCRC’s all-inclusive monthly fee structure.
All incoming CCRC residents pay an entrance fee in addition to their customary monthly fee. This entry fee is directly related to the community size, along with the resident’s living arrangement and their use of services and amenities. Note that an increased need for services raises the resident’s monthly fee accordingly. Ask if any fees are refundable if the resident doesn’t use those services.
Continuing care retirement communities utilize three types of care contracts that determine residents’ monthly fees. These types of contracts include an all-inclusive option along with two modified contracts.
This all-inclusive contract carries the highest price tag and entrance fee. A Type A contract includes all amenities along with housing and residence-related services. The resident has unlimited access to assisted living and healthcare services without any additional costs.
In comparison to a Type A contract, a Type B modified contract contains a reduced entrance fee and initial monthly fee. The resident enjoys many of the same services as a Type A resident. Under a Type B contract, however, the resident can only access limited healthcare services. Additional healthcare services require an additional cost. If the resident needs services outside the scope of the contract, their monthly fee will rise.
With a Type C contract, residents enjoy low entry fees and reduced initial monthly costs. However, this type of contract is a fee-for-service contract. This means the resident must pay market price for all accessed healthcare services.
Because CCRCs are more expensive than other long-term care options, funding can be an issue. Potential residents and their families often search for ways to meet CCRC funding requirements. The following are some potential funding sources.
CCRC residents frequently tap retirement savings to fund their senior living. If the resident owns stocks and/or bonds, liquidating those investments will provide additional capital. Family members may be able to help as well, depending on their financial situations. Additionally, house sale proceeds are a popular way to raise funds for CCRC entry fees. Before the house sale can proceed, though, the home’s contents must be liquidated and removed from the premises. This is usually done through an estate sale. Here’s where a professional estate sale company can help, as they’ll handle the entire estate sale process from start to finish.
Long-term care insurance policies frequently cover assisted living costs. If the resident has existing long-term care insurance, check their policy for details. Also, note that the policy may place restrictions on funds used for activities of daily living (ADLs). If that’s the case, and depending on the type of contract desired, the resident may have to find funds for the rest of the CCRC elsewhere.
Medicare does not provide coverage for long-term care community expenses. However, some health-related services may be covered under the resident’s Medicare Beneficiary Agreement. The care must be deemed medically necessary, and a participating Medicare provider must perform the service(s).
If you or your loved one meets low-income criteria and have very limited financial resources, the Medicaid program may provide some assisted living funds. In most cases, the recipient must have less than $2,000 in assets, not including their home or vehicle. The recipient must also meet functional eligibility requirements. Most CCRC residents don’t qualify for Medicaid assistance. Therefore, they must use their own financial resources to pay the facility’s fees.
If a CCRC resident served in the armed forces, they may be eligible for United States Department of Veterans Affairs (VA) benefits that cover some long-term care expenses. The resident must go through the VA to access these benefits. Because this is a complex process, the resident may wish to obtain help from a geriatric planner.
Locating the best CCRC for your situation is key to a satisfying long-term care experience. Three online resources provide updated information for facilities within your geographical region.
The federal government’s Eldercare Locator provides a list of local continuing care retirement communities. They also have information on elder rights, housing options, and insurance benefits. We suggest you bookmark this website for verified help with all of your eldercare questions.
LeadingAge, a non-profit eldercare providers’ member association, offers an Aging Services Directory. You can search for CCRCs in your area based on your state, city, or zipcode. Additionally, you have the option to search for a specific community.
Before signing on the dotted line, delve into the CCRC’s offerings as they pertain to your or your loved one’s needs. Develop a list of “must-have” services and amenities, and decide if you’re willing to compromise on other offerings. Remember that this is where you or your loved one will be spending the rest of their lives, so take your time and carefully evaluate each CCRC.
Determine the CCRC’s proximity to doctors, specialists, and hospitals. Note the facility’s distance to grocery stores, pharmacies, and other frequently accessed businesses. Also, consider if the resident should be close to family members and loved ones.
Review different facility floor plans and note whether residences have safety enhancements, such as grab bars and non-slip floors. Determine whether assisted living and nursing home facilities offer private rooms with baths. See if common areas are clean and well-maintained, and note whether outdoor spaces are easily accessible. Finally, ask about sprinklers, emergency exits, and other safety measures.
Ask about different types of meal programs, and learn if residents with special diets can have their nutritional needs met. Request to see recent menus, as that will help to determine the variety of entrée choices and meal combinations.
Determine if independent living residents can also get occasional assistance with ADLs. Ask about onsite services such as hair salons and worship facilities. Find out if transportation services are available to meet residents’ appointment needs.
Confirm which healthcare services residents can access with each level of care. Verify that the facility has secure lodgings for residents with dementia and Alzheimer’s. Ask if there’s an onsite pharmacy staffed by qualified pharmacists and pharmacy technicians.
Learn about social and recreational activities for different care levels, and ask to see weekly and monthly activities schedules. Observe common areas, and learn whether residents can access television, movies, and games. Find out if the facility offers activities such as onsite exercise classes and off-site trips.
Learn about the staff’s credentials, and observe their demeanor as they interact with residents. Ask if administrators are generally available during daytime working hours.
As you objectively evaluate CCRCs for yourself or your loved one, the following tools can help you during each facility tour. Be sure you jot down any relevant information, record your questions, and note any observations.
CARF International is a well-known accrediting organization for nationwide health and human services providers. CARF provides a free downloadable consumer guide to all things CCRC. Get details on fee structures, CCRC contracts, and companies’ financial performance.
If you’re considering a non-profit CCRC, review its tax filings to help you determine the company’s financial health. ProPublica, an investigative news organization, operates the informative Nonprofit Explorer research site.
The American Association of Retired Persons (or AARP) provides a printer-friendly Long-Term Care Worksheet that you can take along on your facility tour. Review it regularly, and make changes as you navigate the CCRC selection process.
The Legg Mason Financial Services Firm created a CCRC facility guide for your facility tour. Topics include location, environment, and services provided.
Finding the right continuing care retirement community isn’t a spur-of-the-moment decision. Take time to research area facilities online, and speak with each complex’s admissions coordinator. Next, schedule a leisurely campus tour. While you meander through the grounds, chat with several residents, and ask them how they enjoy their living space and quality of care. Afterward, record your impressions of the facility, and compare it to other area continuing care retirement communities. Then, choose the CCRC that offers you or your loved one the most enriching environment for the future.