For those that can afford it and make the decision to move before major health concerns catch up with them, a Continuing Care Retirement Community (CCRC) is pretty much the gold standard when it comes to retirement living. However, that isn’t to say that they are all the same.
“They are not licensed or certified by one entity. They are defined differently in every state; some are called CCRCs, others are called Active Adult Community Homes or Lifetime Communities,” says Sue Matthiesen, the managing director of Aging Services at the Commission on Accreditation of Rehabilitation Facilities (CARF).
To be defined as a CCRC, however, a community must offer Independent Living, Assisted Living and Skilled Nursing all on one campus. They may sometimes offer Memory Care, as well, either on an assisted living, skilled nursing basis or both.
As a result, a CCRC allows seniors to “age in place” as they seamlessly transition from one level of care to the next—lessening the stress and worry for both the resident and their loved ones. So much so, in fact, that many have described moving into a CCRC as a gift to their children as much as themselves.
Services and Amenities
Often undistinguishable from an upscale suburb, you might find landscaped grounds, cottage homes, townhomes, apartments, swimming pools, fitness center, fine dining and a wealth of social outings and activities at a CCRC. Other services and amenities may include:
- Emergency call monitoring
- Garbage removal
- Health monitoring services
- Lawn care
- Snow removal
- Social activities
While healthcare is conveniently available, you should also be aware that it may also be too convenient. As opposed to a stand-alone independent living community (which will do everything it can to hold onto a resident), residents at a CCRC may feel pressured to move from one level of care to another—whether that is by management or even other residents.
Before signing a contract, you’ll want to ask about rules for hiring your own caregiver and the process for transferring to the next level of care, keeping in mind your rights under the Americans with Disabilities Act.
To determine the quality of the care you may eventually receive, there are a couple of online options. Even though there is no national comparative website for assisted living facilities as they are all individually regulated by each state, A Place for Mom maintains a website to determine the state-by-state overall quality of a community. (Please keep in mind, should you use their locator services, they may ignore a wonderful CCRC near you or your loved one if they don’t have a contract with them.)
You should also be able to look up the rating of the community’s skilled nursing component at Medicare.gov. Though not a perfect assessment, a five-star rating is certainly the best possible score. You can also ask your state long-term-care ombudsman if there are any complaints on file. ConsumerVoice maintains their contact information on its website.
Types of Contracts and Costs
All of the amenities and services of a CCRC, can give great peace-of-mind to seniors and their families. However, these types of communities are not without their costs.
Generally financially unavailable to lower or even middle-income seniors, those with serious prevailing medical conditions or already at an advanced age, most of these communities require an entrance fee ranging from $10,000 to $1,000,000 (which may or may not be refundable upon death). Residents must then also pay a Monthly Maintenance Fee that can vary from $3000 to more than $5000 a month.
Although it sounds expensive (and certainly is) most people cover the entry fee with the proceeds of a home sale. Although it generally won’t be a wash, you’ll then want to compare the monthly charges with what you are paying now for housing, food and activities.
Depending upon the time of contract you sign, this Monthly Maintenance Fee may be guaranteed to remain constant throughout a stay, possibly saving tens or hundreds of thousands of dollars should a long-term stay in memory care or skilled nursing be required.
In 2010, the US. Government Accountability Office studied the CCRC industry in their report, “Continuing Care Retirement Communities Can Provide Benefits, but Not Without Some Risk.” Although a bit dated, it does give a good overview of the basic types of contracts and a comparative analysis of the rates at the different types of CCRCs. It found that:
Life Care of Extended or Extensive Contract (Type A): The most expensive option, this plan offers unlimited assisted living and skilled nursing care without additional charges.
Entry Fee: $160,000 to $600,000
Monthly Fee: $2,500 to $5,400
Modified Contract (Type B): This contract offers a selected set of services for a set length of time. After this occurs, additional services can be obtained for a higher monthly fee.
Entry Fee: $80,000 to $750,000
Monthly Fee: $1,500 to $2,500
Fee-For-Service Contract (Type C): With this contract, the initial entrance deposit may be lower, but Assisted Living and Skilled Nursing will be paid for at current market rates.
Entry Fee: $100,000 to $500,000
Monthly Fee: $1,300 to $4,300
Rental Agreements (Type D): Usually requires no entrance fee but guarantees access to CCRC services on an “as needed” basis.
Entry Fee: $1,800 to $30,000
Monthly Fee: $900 to $10,700 depending on level (assisted, nursing, etc.) of initial care
All of these fees will depend on a number of factors such as the type of housing (single family home, condo, apartment); whether they rent or buy; size of the facility; kinds of services; type of contract, etc.
Jack Cumming, the director of research for the National Continuing Care Residents’ Association, noted in an article in Time by Carla Fried, “The CCRC concept is the most dependable way for people to provide for their own old age.” But, he warned, “there are few standards or regulatory safeguards that a prospective resident can look to as assurance that a particular CCRC is all that the marketing staff presents it to be.”
As contracts vary widely from community to community and it would be well-advised to have family members, an attorney and/or financial advisor to review any contracts, make sense of the community’s audited financial statements and understand all potential costs thoroughly before signing. According to the AARP, any contract with a CCRC should cover:
- Fee schedules
- Health care coverage
- Cancellations and refunds
- Insurance requirements
- Conditions for transfer within the community to other levels of care, and a description of the CCRC’s responsibility should a resident become unable to pay fees.
- Conditions under which all or part of the entrance fee is refundable
At MyLifeSite.net you can download a sample report that includes recommended levels of profitability, debt, and liquidity measures that may be helpful to your financial advisor. CARF International, which runs an accreditation program for CCRCs, also has free guides for consumers.
You can locate CCRCs at LeadingAge.org, the website of an advocacy group that represents more than 6,000 senior-care nonprofits, and MyLifeSite.net. Developed by financial planner Brad Breeding, MyLifeSite allows seniors and other financial planners to input their own specific finances to navigate the pluses and minuses of a CCRC.
When you visit, go out of your way to talk with the residents—and be wary of any community that won’t welcome your efforts. As Eleanor Laise of Kiplinger recommends, “To get a sense of what life is really like at a CCRC, make several unannounced visits and have a few random meals there. You may find a lively, collegial community—or something that more resembles your worst memories of grade-school bullying.”
There are a number of different options for care as your loved one. A Continuing Care Retirement Community offers the most options in one place. However, it does come at a cost—which may or may not be affordable. The best way to find out to visit one near you, talk welcome your loved one’s greatest companion along the gray mile.