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.

Is Your Parent Ready for CCRC Living?

A major selling point of CCRC living is that prospective residents can settle into a ''user-friendly'' environment and maintain their normal independent routines for as long as they are able to do so. However, they are assured that if they become more dependent as time passes, they won't have to leave familiar surroundings to obtain the kind of care they require. So if you're doing long-range planning for yourself or a loved one, you may well appreciate the advantages of a CCRC's independent living setting should declining health or maintaining independence becomes a problem. CCRCs offer many of the amenities and freedom of a private home (with some limitations due to shared common facilities and areas) with none of the concerns of property maintenance, personal safety, loneliness and isolation that may accompany the life of an elderly person in a typical neighborhood setting.

Perhaps your loved one is showing some early signs of mild physical decline—difficulty with driving or meal preparation, for example—or simply isn't up to caring for a large home anymore. Or perhaps there just isn't a reliable support system of friends, neighbors and family nearby to help out with daily chores or to be available in emergencies. These common concerns can seriously interfere with your loved one's desire to live as independently as possible. But CCRC living will do away with these problems and provide your loved one with the opportunity to continue living on his/her own indefinitely in a sheltered, carefully monitored environment.

Of course, moving into a CCRC is a major life change that should always be thoroughly discussed among the individual, family members, healthcare professionals and legal and financial advisors. Since it is such a significant change and will involve legal contracts and a long-term commitment of time and financial resources, the decision to take up residence in a CCRC should be carefully researched and planned. Prospective residents should never make a change until they are absolutely convinced that this is what they want, not only for the near term, but also for years to come. CCRC residency should begin while your loved one is still fully capable of making decisions and is generally able to manage for him/herself both physically and mentally.

Would Your Parents Benefit from Living in A CCRC?

Moving to a CCRC is a personal decision and a highly individual choice that should be based on anticipated or potential future care needs as well as on current needs. Due to the indefinite nature of future needs, there may not be as much guidance available from local agencies or professionals as there might be for someone who must go into a nursing home immediately. But you still may wish to seek assistance and advice from professionals in your local Area Agency on Aging to be sure you're not overlooking other options.

Many CCRCs have their own internet sites with general information on their services and numbers to call for brochures or to speak with a representative. A CCRC also may have public relations staff members who work with prospective residents and their families to familiarize them with the establishment, its services and costs. You should request an information packet that will include descriptions of the physical setting, professional staff and governing organization. The packet also may include a financial worksheet that will help you compare the costs of living in a CCRC with the cost of maintaining a home with additional home health or personal care services in the community. But keep the source of information in mind since brochures are sales tools that may exaggerate the attractiveness and availability of residential and care services.

If your loved one should decide to move to the CCRC, he/she will be asked to fill out an application with information regarding health history and finances. It's important to make sure the healthcare staff at the CCRC has accurate and complete information, since they will be taking an active part in providing all of your loved one's basic healthcare needs. Financial arrangements will have to be in place before your application can be approved.

The business structure of CCRCs is complex. There can be a very significant financial commitment from the resident or family. It's wise to have an attorney review any contract before you sign it even if you're fairly confident that you understand its terms. You also may wish to have an accountant review the contract to explain its financial aspects. The contract may either be for the rental or purchase of living space and money invested in the CCRC may or may not be refundable if the resident dies or moves to a different facility. Be sure you know in advance what will happen to the residential space once it is no longer needed by your loved one.

Choosing the Right Continuing Care Retirement Community

While CCRCs are becoming increasingly common across America, they are more numerous and best established in the Southeast, where the CCRC ''movement'' originated. Complete national guides to the geographic locations of American and Canadian CCRCs are available from an organization called Senior Selections, which can be found on the internet. Geographic location may be one of the most important factors for you or your loved one, especially if maintaining close family contact is a priority. There may be a lengthy waiting list at some CCRCs, which also may be a deciding factor in choosing one CCRC over another.

In addition to location, you should be assured that your loved one will receive a full complement of amenities. Make sure that if a CCRC is what you want—an establishment that provides a full range of care options in one location—that it is what you're actually getting. Some senior residential arrangements may not include nursing home facilities so if a resident becomes unable to remain in the current housing, he/she will be forced to leave the senior community for a nursing home in an unfamiliar place. This is particularly important because significant financial obligations on the part of the resident are involved and you may not be getting what you think you've paid to receive.

Of course you wouldn't consider making such an important decision without actually visiting the CCRC, meeting some of the staff and seeing the physical location and layout for yourself. The public relations staff will set up a guided tour for you. Many, if not all CCRCs, maintain guest housing so that you and your loved one can spend a weekend at the CCRC to see firsthand what the experience is like. This is an ideal way to judge the dining facilities, physical plant maintenance, socialization and general atmosphere of the CCRC. It is also a wonderful chance to meet some prospective neighbors. Be sure to talk with the residents to see what their opinions are of the facilities and care provided. You may be able to tell a lot about the overall quality of life in a CCRC by the positive or negative comments you hear from the residents themselves.

To date, consumer advocacy groups haven't researched customer satisfaction among CCRC residents, so you'll have to do your own market research and make your own assessments. Begin with a little self-assessment after spending time at the CCRC and learning something about the activities and the staff. Could you/your loved one be comfortable there? Of course, a resident should be physically comfortable, but also socially and culturally at ease. CCRCs promote a distinct lifestyle based on being discreetly set apart, monitored and protected. This appeals to many seniors, but it may not be to everyone's taste especially if a person enjoys being around younger people and children.

Beyond being pleased by the surroundings and feeling at home with the staff and residents, there are some harder questions to ask. Do residents have a say in determining what services are provided by the CCRC? Does the CCRC help its residents arrange for services that it may not be able to provide? Is the organization licensed, certified according to state regulations and/or accredited? Will facilities and staffing be adequate when all residential units are filled? How are resident complaints handled? Take note of parking and storage availability, if these are important to you.

There should be little or no restriction on personal property that a resident may bring to the CCRC. Living spaces are roughly equivalent to one's own home and generally may be furnished as such. Based on location, availability, services and amenities plus your own observations about the quality of life in a CCRC, you should be able to make a satisfying choice.

Paying for Continuing Care Retirement Living

Of the many senior-housing options, CCRCs are among the most expensive and least subsidized. Medicare and long-term health insurance do not pay for the independent residential living costs of a CCRC that include housing, meals or non-skilled nursing care. Limited amounts of skilled nursing care or other types of healthcare may be covered under Medicare or by private insurance. However, given the high cost of CCRC living, it's highly unlikely that anyone living in a CCRC would meet the income guidelines required to qualify for Medicaid.

Residence in CCRCs is paid for out-of-pocket. Most CCRCs ask for an entry fee plus a monthly fee based on the type of care for which the resident contracts. Entry fees in most parts of the country range from $40,000 to $90,000 or more for a single occupancy studio apartment and in the $200,000 to $300,000 range for a two bedroom cottage. Monthly fees range from $1,500 to $5,000 (or higher in the most expensive parts of the country). Again, given the huge financial outlay, it would be wise to involve an attorney and an accountant to represent your loved one's interests before signing any type of legal agreement with a CCRC.

The CCRC model, as it is today, is clearly a living option only for affluent seniors and should be considered only if the prospective resident is absolutely certain that this is an affordable expense. Even elderly persons can be evicted for non-payment of rent or cooperative maintenance fees! Still, many experts in senior housing and healthcare feel that the exclusivity of the CCRC will disappear within the foreseeable future when senior consumers with more moderate incomes begin to demand similar options. Meanwhile, for many seniors who have saved well for their retirements, CCRCs offer an appealing solution to concerns about aging in place, preserving independence and living life to its fullest.


Developed by, and made available with the permission of John J. Connolly, Ed.D., President and CEO of Castle Connolly Medical Ltd. "America's trusted source for information on top doctors and quality healthcare."

 
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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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