Continuing Care Retirement Communities (CCRC)

These communities are popular with older adults and their families because it is assumed that a person will receive virtually all the care they need in one place for the remainder of their lifetime. CCRCs vary in the types of services they provide. Be prepared to pay for the quality and quantity of services.

Individuals have many kinds of needs. Some individuals are seeking different levels of care for a couple, while others are looking for a community that will allow a pet. Caregivers are often looking for respite care for a loved one. Take a look at the individual facility pages within this web site, along with their different levels of care to learn what they may be able to offer.

Many folks enter at the 'independent' living level. Here you choose from a number of different apartment options or small homes. Your individual contract will spell out the services included along with those that may be available 'a la carte'. Most include the apartment appliances and their maintenance, utilities except the phone and/or cable, a main meal, a sick day tray, a 24 hour emergency response system, some housekeeping, free laundry facilities, scheduled shuttled service to popular supermarkets and shopping centers, 24 hour security, access to a wellness nurse, chaplain and scheduled recreational and social activities. You would also have access to common areas such as lounge areas, library, chapel, recreation room, store, pharmacy, arts and crafts room, computers, fitness rooms, swimming pool, walking paths, beauty / barber shop, private dining room for company, on site bank and garden plots. Some programs also offer a designated number of free days (usually 30) in their skilled care facility if needed. This is a big help for those times Medicare will not cover some types of care.

The contract will usually be explicit as to when one should enter and/or move to another level of care. Until then you may bring in home health care services after a hospital stay or other personal supportive services to help you stay where you are. You may pay for more housekeeping, laundry services, assistance with a bath, meals or even pill boxes that have an alarm to remind you when to take medications.

If a person's health starts to decline and they begin to fall, need daily personal supportive attention, regular memory cueing, or other services, you may then move into the next appropriate level of care. The facility may be an 'assisted living' Residential Care Apartment Complex (RCAC) and sometimes the person does not need to leave their apartment. They would then have an assessment done and a service plan would be developed. (Please see this site's section on RCACs). If the facility is licensed as a Community Based Residential Facility the person may move into another part of the complex in order to receive more care. Often a spouse may move as well so a couple may stay together. (Please see this site's section on CBRFs.)

If a person needs skilled or rehabilitative care they would move to the health or skilled care facility. Some skilled care facilities are within the complex while others are just down the street or several miles away. Many people only need skilled care to recuperate from an injury or illness and then they return to their 'home'. Their skilled care could be covered by Medicare and supplemental insurance, long-term care health insurance, the special 30 day offer from the facility, private pay, or the facility's Life Care Contract. While recuperating in the health care facility the resident is still paying for their individual living unit, 'assisted living' apartment or room.

Continuing Care Retirement Communities are not licensed as a whole. Their individual special levels of care follow State regulations and licensing. Their financial agreements are regulated by the office of the Commissioner of Insurance. Residents have no ownership, interest or equity in their living unit.

The cost for services at Continuing Care Retirement Communities can be expensive and they vary, sometimes quite a bit. Most communities use an entrance fee to keep monthly fees lower. Therefore, those who choose a monthly rental option rather than paying an entrance or endowment fee will pay a higher rent. Some offer the ability to change options at a later date. These up front fees do help provide the funds for many of the amenities and the range of services a person will need as they age in place. Some entrance fees are refundable or amortize over a set number of months or years. The IRS allows a portion of the entrance fee and portions of the monthly fees to be taken as income tax deductions for medical expenses. The CCRCs must screen for financial stability and financial resources very carefully. The facility does not want to have to ask a person to leave because of a lack of funds or because some people could out live their financial resources.

Most skilled care levels of CCRCs do accept Medicare and supplemental insurance. Almost all accept Medicaid. Couples may then apply for the State Spousal Impoverishment program if necessary.

Most people are aware of what it costs them to live in the community and wonder if or how they could afford a retirement community. Many communities offer a financial comparison worksheet. You add up your current expenses along with the value of your home and translate it into alternative living costs. Many people are quite surprised as to what they could afford.

Not all CCRCs offer the same payment options described in the paragraphs above."Life Care" Communities are Continuing Care Retirement Communities that offer a different type of contract. Using the larger up front 'endowment' or 'entrance' fees, money is pooled and financial security is offered. Usually, based on the contract purchased which depends on the size of the living space chosen, there is one set of monthly fees that covers the continuum of care. If you enter into a life care contract you do not need long-term health care insurance. Life care also protects larger amount of financial resources. The IRS also allows a large portion of the entrance fee and portions of the monthly fees to be taken as income tax deductions for medical expenses.

The philosophy behind the "life care' contract says: If I or my spouse need assisted living or skilled care we will be taken care of at a rate that is not much more than what we are paying monthly for independent living arrangements. My family and I will have the peace of mind that I will be taken care of and that my the estate will not all be used up for our care.

Selecting a retirement community can take some time. There is a difference between communities, the services and contracts. You need to visit and compare them carefully. If there is a possibility that you might want or need to relocate, many of the contracts may not be for you.

Selecting the appropriate "home" however, does not need to be difficult if you are realistic about several things right from the start. Know and be honest about health conditions, finances and personality. A community cannot accept someone who cannot show adequate financial information and support nor can they accept or keep anyone whom they cannot realistically care for. The size of the facility can make a real difference to some people. Try to tour several facilities with the person who will be making the move. The 'personality' of a facility can often make a real difference and what one person may choose may not be to the liking of another. Look for:

• Accessibility and features such as ramps, steps, automatic or wide doors, elevators, wide hallways, railings, shelves, cupboards and electrical outlets.

• Enough lighting, natural and artificial.

• Am I comfortable in the atmosphere that has been created? Are there odor free halls and clean rooms throughout the complex

• Is the temperature comfortable and is there air conditioning?

• Does the building or complex meet local and or state licensing guidelines?

• Is the staff caring and yet professional. How do they interact with others as they tour with you.

• How do the residents appear and interact ? If you ask them about the community what is their response?

• What appliances are provided and what can you bring?

• What is the closet and storage space like?

• Are pets allowed and what kind? Can they help you with any assistance you may need with your pet?

• If needed, what is the 24 hour emergency response system?

• Information on shared features such as guest suites and dining rooms for larger parties and dinners.

• When is staff available?

• When is there help with dressing, medications, personal care, and toileting if necessary.

• Is there someone to help coordinate homecare, medical visits or therapy?

• How are medical emergencies handled?

• What services are right there and what may be in the neighborhood, i.e. pharmacy, bank, religious services, beauty or barber shop?

• How do you get there? Is there transportation?

• What are meals like? Special diets? Snacks? Are guests welcome?

• What type of activities and programs are there? What is available off site?

• Who does any initial assessment and who can or should be there?

• How do they meet changing needs?

• What is in the contract?

• What fees are included now or could there be later?

• What happens if the person goes on vacation or needs skilled care for a while?

• Is there an affiliated medical facility or skilled care facility to which the person would automatically be sent? What changes would you then have to make?

• Are there other affiliated services or are you free to choose your own?

Retirement Communities

Expense Sheet

After the Placement

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