A continuing care retirement community (CCRC) involves three distinct phases. The first is independent living, when a resident enters into the community with few if any, disabilities requiring limited assistance. In this phase, community residents typically take advantage of the broad range of social, physical, and intellectual offerings.

The second phase is assisted living, which includes long-term personal senior care support services that include help with activities of daily living like medication management, bathing, meals, dressing, and transportation.

The third phase is nursing home care, also known as a skilled nursing facility. This third phase addresses a resident’s requirement for 24-hour monitoring and medical assistance in the case of serious injury or severe illness. Nursing home care locations within the CCRC are usually located near an associated hospital if the need arises for acute care or hospitalization. The linked three phases of a CCRC provide a continuum of care so that a resident can spend the rest of their days moving between the levels of care as needed.

Experiences with CCRCs Vary By Facility and State

These residencies are also referred to as life plan communities, active adult community homes, and lifetime communities. CCRCs vary from state to state and aren’t licensed or governed by a single oversight entity. There is no reliable data as to how many seniors are living in CCRCs, but it’s evident that continuing care within one inclusive community is gaining popularity. One way to distinguish a well-maintained and safe CCRC is through the Commission on Accreditation of Rehabilitation Facilities (CARF). This organization is America’s only accrediting body for these types of communities. It is an independent, non-profit organization focused on advancing the quality of services to meet the residents’ needs and provide the best possible outcome. The Continuing Care Accreditation Commission, a CARF International listing of accredited providers, is a valuable reference when researching a move into a CCRC.

Deciding if a CCRC is Right for Your or Your Loved One

Opting to live in a CCRC is a costly senior housing option and requires due diligence and careful financial planning to optimize the experience. Payment plan specifics are different at each CCRC. However, an entrance fee is required that can be as little as $10,000 and as much as $500,000. Most CCRCs don’t allow ownership of the residence. Instead, a monthly maintenance fee requires additional monies ranging between $200 and $2,000.

The residence is just one part of the contract negotiation. Healthcare coverage and costs are typically broken down into three fee schedule options:

1. An extensive contract is the most expensive. It provides the resident with unlimited access to healthcare with little or no monthly maintenance fee increases.
2. A modified contract offers a resident unlimited access to healthcare, but healthcare is paid for as needed, and monthly maintenance fee increases offset the pay-as-you-go approach.
3. A fee-for-service contract. It may seem like a conservative spending approach, but if the aging resident eventually requires extensive healthcare, it’s costly. This fee schedule option allows residents to pay for all health care costs separately.

Websites that offer advice on senior living options, like aPlaceforMom, suggest that the admission agreement for a CCRC should cover:

• The three residence phases
• Fee schedule options
• Health care coverage
• Cancellations and refunds
• Services
• Insurance requirements
• Conditions for transfer within the community to other levels of care
• What the CCRC’s responsibility is if a resident becomes unable to pay fees

Reviewing the Contract with an Estate Planning or Elder Law Attorney

Contract review by a trusted elder law lawyer or financial advisor is paramount. Contracts should include a clause that addresses refunds in the event a resident leaves the CCRC, and, like the fee-for-service health care options, most CCRCs have multiple agreement choices that offer varying degrees of refundability. In the past, most continuing care retirement communities were non-profit organizations, but today, many CCRCs are for-profit businesses. Check into the possibility that the business entity of your retirement living arrangement may one day be sold and understand how that would affect a residential contract.

Questions to Ask When Researching Continuing Care Retirement Communities

• What if assisted living and nursing home facilities that are part of the CCRC are full when I need them?
• Is there a reciprocal agreement between the CCRC and nearby communities?
• What type of background checks are done for staff members?
• What is the staff-to-patient ratio in each phase of living?
• How can a resident participate in the organization’s decision-making?
• What type of memory impairment (or dementia) services are available?

The above questions are good starting points for learning everything possible about a particular CCRC. Some items will be specific to your health, financial situation, and family relationships. We often help families determine the right type of living situation for senior family members and review their contracts.

If we can assist you or a loved one, please contact our law firm to speak with a qualified elder law and estate planning attorney to tailor a long-term care protection plan. We look forward to the opportunity to work with you.