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Continuing Care Retirement Communities Explained

It almost goes without saying that most of us would prefer, in our later years, to settle into comfortable, friendly, home-like surroundings where our changing needs would be met as our care requirements increase—without making us dependent on family members for our care. Living in the same place as we age, one in which we can receive the various types of health and homemaking services we may need in a familiar setting, is called "aging in place."

Among the wide range of housing and care options available to financially secure seniors is an option called the continuing care retirement community, or CCRC. Based on the premise of aging in place, this unique residential arrangement is gaining in popularity across the nation.

What is a Continuing Care Retirement Community?
CCRCs aren't independent living communities, assisted living facilities, or nursing homes. They are combinations of all of these residential and care options, owned and operated by private companies and staffed to provide a ''continuum of care'' for residents. The assisted living and nursing home components of CCRCs usually are intended for use only by residents from the independent living units that are part of the CCRC and not by seniors from outside it.

As with other types of residential environments that are specifically tailored to seniors' needs and tastes, CCRCs and their residents establish a business arrangement through a legal contract specifying exactly what supportive services, nursing care, other healthcare, and housing will be provided for residents. The continuum of care begins with independent living facilities that may be rental units, condominiums or cooperative housing units. If a resident's care needs increase over time, he/she will be able to move to the next level—assisted living or, if needed, the nursing home—without relocating geographically, since all levels of housing and supportive healthcare provided by the CCRC are usually (although not always) centrally located on one ''campus.''

One of the key attractions of CCRCs is the range of healthcare and supportive or assistive services that these establishments are able to provide within the limits of the basic contract. These may include nursing, social work, dietician services, physician care, pharmacy and various therapies for residents who may experience either a short bout of illness or an ongoing health problem. CCRC staff can provide emergency response systems, wellness programs, assistance with insurance claims and forms and routine health assessments. Contract fees may cover housekeeping and laundry services and a certain number of meals served in congregate dining facilities. Some transportation services also may be included in basic fees.

While the guarantee of basic healthcare and the amenities of senior living are certainly important, most CCRCs aim to go beyond the basics to offer a higher degree of comfort and a wider selection of daily activities. CCRC campuses are typically located in peaceful, picturesque and hospitable surroundings. They are intended to be upscale communities set apart in choice locations that afford a great deal of privacy and convenience. Within these communities, residents are likely to find a full range of social and physical activities from dining and dancing to swimming and golf. For an additional fee, members may have access to more specialized healthcare services, nonscheduled transportation and increased meal service.

As previously mentioned, CCRCs generally are privately owned and are operated by a business organization or corporation. The actual business structure may be very complex, but the contractual arrangement between a CCRC and its residents is always based on the types of care, services and housing that the resident desires and the CCRC provides. Government regulation of CCRCs is largely based on state law and may vary from state to state which is important to remember if you're considering taking up residence in a CCRC. The state's Office for Aging or State Housing Authority where you live or plan to relocate can be a valuable source of information.

Since most of the services provided by CCRCs are not reimbursed by Medicare or Medicaid, there are no federal requirements for accreditation. However, in an effort to prove the excellence of their care and service, many CCRCs independently seek accreditation. The accrediting organization for all CCRCs in the U.S. is the American Association of Homes and Services for the Aging, located in Washington, DC (AAHSA). The AAHSA promotes a set of standards concerning the corporate and financial stability of a CCRC's parent company—an extremely important consideration given the long-term nature of CCRC residential living—and the quality of life of CCRC residents. Information on accreditation of for-profit and not-for-profit CCRCs also is available from AASHA. AAHSA can also provide you with directories of CCRCs, including consumer checklists and financial worksheets. However, there may be a fee for these directories.

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Connolly is President and CEO of Castle Connolly Medical Ltd., America's trusted source for finding top doctors. He has an extensive background in management and healthcare. He was President of New York Medical College and a Fellow of the New York Academy of Medicine.

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