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Continuing Care Retirement Communities

• Benefits of a CCRC
• Community Characteristics
• Payment Plans
• Important Considerations
• Communities Under Construction
• Seek Professional Advice
• Tips to Remember

Continuing care retirement communities (CCRCs) give active older Americans the option of moving to a place where they can live in a supportive environment with their peers, and be provided with current and future needs -- including nursing home care.

In most cases, signing a contract to enter a CCRC is a lifetime commitment. Thus, it is important to choose wisely, and select a facility after considering health, mobility, physical and psychological needs, as well as financial situations.

It is particularly important to start early and plan ahead as much as possible, so that all the options may be weighed carefully. In addition, many CCRCs have long waiting lists, and some health conditions may prevent an individual from being accepted into the CCRC of choice.

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Benefits of a CCRC

Generally, older Americans enter a CCRC when they are in relatively good health and capable of living independently, or living with limited assistance.

CCRCs offer residents a complete range of housing and care for the rest of their lives, as long as they remain in the CCRC. As a CCRC resident, an older American can make a gradual transition from living independently to having medical and/or personal care, and continuous skilled nursing care, while staying at the same location.

A major benefit is that nursing home care is available when needed, and it is not necessary to search for a new facility. CCRCs are not nursing homes as such. Instead, they are, as the name indicates, continuing care communities, which provide for the everyday needs of the residents.

For CCRC residents, the transition to a nursing home setting is much easier because they are still in relatively familiar surroundings, and in the company of friends who can still visit conveniently. For couples, it is convenient and comforting to be able to stay in the same community and see each other, even though one of them may require nursing home care.

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Community Characteristics

There is a wide variety of CCRCs, each with its own characteristics. CCRCs can be located in the city or out in the suburban countryside where the emphasis is on nature and a peaceful, quiet setting. Even in suburban communities, transportation is usually provided to many urban places.

While some CCRCs may offer apartments, others offer townhouses or detached dwellings. Some communities have several hundred residents; others are much smaller.

The amenities in CCRCs vary greatly, from luxurious settings with tennis courts, swimming pools and hotel style dining rooms, to more modest facilities with similar, but less plush accommodations. Most CCRCs have public reception and meeting areas, dining rooms, recreational areas, and various health care facilities.

The services available to residents at CCRCs also vary. Regardless of the type of facility, there generally is a choice of daily recreational, cultural, and social activities. Other amenities such as libraries, beauty parlors, barbershops, dry cleaners, banks and convenience stores vary from facility to facility. Nursing home accommodations are usually on the premises of CCRCs; but a few make arrangements for nursing care at nearby facilities.

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Payment Plans

Since CCRCs are essentially agreeing to take care of residents for the remainder of their lives -- in health and in sickness -- the fees they charge are not low. Payment plans vary from one CCRC to another and, in many cases, each CCRC will offer several types of contracts and payment plans.

Most CCRCs require initial upfront fees that are used to help defray a portion of future costs, which may include nursing care. Others may not require a substantial entry fee, but will charge residents for additional health care services as they are needed.

Generally, higher entrance fees may be found at more luxurious living facilities or when contracts contain more extensive long-care nursing guarantees. The lower fees are usually for more modest accommodations. Contracts providing health care on a fee-for-service basis are usually less costly.

In general, there are four different types of plans at a CCRC:

• Extensive Plan

  This is the most expensive plan which offers the largest amount of services. Fees cover housing, certain services and amenities, and unlimited nursing home care. Monthly fee increases usually occur only as the facility's costs rise with inflation.

• Modified Plan

  In addition to housing and certain amenities, this plan offers only a specified amount of long-term nursing care for the initial fee. If residents need more than what they contracted for, they will be charged for those services.

• Fee for Service Plan

  This option lowers the entrance fee and monthly fee, and allows residents to avoid paying for services they may not need. Under this type of arrangement, residents do not pay for nursing home care in advance, but are charged a daily fee for these services on an as-needed basis.

• Pay-as-you-go Plan

  While this type of plan requires that a contract be signed, there is no entrance fee; only monthly fees are required.

All of these plans are usually lifelong commitments, although the majority of CCRCs make their entry fees refundable to varying degrees for residents who leave after a specified time. Fees can be fully or partially refundable to a resident or to his/her estate, or they may be non refundable.

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Important Considerations

Following are some important considerations to weigh when selecting a continuing care retirement facility. Some of these factors will be more important than others, depending on individual circumstances.

Visit a number of facilities and compare one with another. Before you sign any contract, make sure that the facility is the right one for you. Moving out could mean losing thousands of dollars.

Administration:

• Is the facility accredited by the Continuing Care Accreditation Commission? Remember, accreditation is voluntary. All homes have not been evaluated.
• Is the nursing center certified for federal Medicare and Medicaid programs?
• What type of reputation does the facility have in the community?
• How long has it been in business? Is it in good financial health? Does the facility follow generally accepted accounting procedures? What are the qualifications of the chief executive and business manager?
• If the facility is sponsored by a nonprofit organization and managed under contract with a commercial firm, what are the conditions of that contract? How could that affect residents?
• Is there a resident council or organization through which residents have a means of voicing their views on the management of the community? Is it effective?
• How are complaints about the facility or services handled?
• Is there a waiting list? If so, how long do they estimate it will take to be admitted?
• What type of rules and regulations exist?

Care:

• What type of health care and social services are available? Does the facility have both short and long-term services, such as routine physical and dental examinations and pharmacy services, as well as skilled nursing?
• Who provides the services? What are their qualifications?
• Will the staff dispense medication to ambulatory residents? If so, what are the dispenser's qualifications? Will they monitor residents taking medications?
• What type of services are there to help residents stay healthy and, if ill, receive therapy to recover?
• What type of insurance is required? Medicare? Medigap?

Charges:

• What is the basic entrance charge, and what is included for that fee? What charges are extra?
• How much is the monthly fee? How often can it be increased and for what reasons? Is there a limit on the amount of increase per year? Has the monthly fee been raised in the past? How often, and for how much?
• Are refunds or rate reductions ever granted? Under what conditions?
• Are any portions of the charges covered under long-term care insurance that the resident may already have or be eligible for? Are there charges that are duplicated?
• What happens if a couple moves into an apartment and then one of them must go to the nursing home and/or dies? Will the other one be allowed to stay in the same apartment, or will it be necessary to move to smaller accommodations? If so, what happens if the spouse in the nursing home gets well after they have moved? Will they pay a reduced fee or the same price?

Contracts:

• What happens if someone wants to leave after just a few weeks or months, or if they die? Is any portion of the entrance fee refunded to their estate?
• What type of health and medical coverage is included in the entrance and monthly fees? Are dental work and routine wellness checkups included?
• What will determine when a resident may be moved to the nursing care facilities, and who makes that decision?
• Will the facility guarantee that nursing home care will be available on the premises, or nearby, when needed? What rates will residents be charged for such care?

Facilities:

• Are the living quarters secure, comfortable and well-maintained? Are they easily accessible and safe for residents?
• Does the facility meet federal and state fire codes? Do the living facilities have emergency buttons that residents can activate, if immediate care is necessary?
• Is there enough privacy?
• Are residents allowed to keep pets?
• Are there spacious and pleasant public areas for visiting and socializing?

Location:

• Is the facility located in a safe area near family, friends, churches, stores, and hospitals?
• Is public transportation available/accessible?

Residents:

• Who lives at the facility? Do the residents seem compatible with each other? Do they appear happy?
• Why did they select this facility? Do they like it? Why or why not?

Staff:

• Do the staff members have professional backgrounds in the continuing care and geriatrics field?
• Are they sincerely concerned with the safety, security and well being of the residents? Are they pleasant and caring?

Services:

• What services are available? If there are different fee structures, which services are included in the fees?
• Are housekeeping, linen service and personal laundry included in the fees, or are they available at an additional charge?
• What types of meals are available? Are they healthful and appealing? How many meals are included in the fee? If a resident becomes ill, is tray service available?
• Will staff prepare meals that satisfy medical, or religious, dietary restrictions? Can residents have guests dine with them for an additional fee?
• Are the kitchen facilities clean and sanitary? Does the staff follow safe food-handling procedures?
• Are there fitness facilities, as well as regularly scheduled exercise classes?
• What types of recreational and social activities are offered? How often do they take place and who schedules them? Do the residents like them? Does the facility schedule trips or other events away from the premises?
• What personal services are available to help residents bathe, shampoo and take care of other necessary grooming?
• Are there active volunteer programs that encourage individuals in the surrounding community to spend time at the facility, or encourage residents to offer their services within the facility or in the community?

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Communities Under Construction

As the number of active older Americans increases, so do the waiting lists at CCRCs. In some cases, in order to plan ahead and find the right facility, it may be necessary to consider a CCRC that is under construction or being developed. In order to have funds for construction the CCRC might require a number of signed contracts with residents before proceeding.

Since it is not possible to make physical inspections of these proposed facilities, it is even more important to be diligent in asking searching questions -- especially about the financial soundness of the company, its prior experience in senior services, end how your funds will be handled.

Remember, assumptions and promises by salespeople may sound very sincere, but nothing is likely to be binding if it is not in the written contract.

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Seek Professional Advice

As with any major life commitment, it is important to make certain a CCRC is a good investment before you sign a contract. Before signing any contract and paying any fees, take the time to investigate and make sure that the CCRC is financially sound. Make certain that it will be able to maintain high quality services and will be in business long enough to deliver on its long-term health care promises. Do not be pressured into making a hasty decision.

If you are seriously considering a particular CCRC, ask to review copies of past financial statements. Have a certified public accountant, preferably one who does financial counseling as well, or another financial professional look over these statements to advise you about the facility's financial health.

It is also important to have a trusted financial adviser examine your personal finances to make certain you can afford the facility.

Additionally, it is a good idea to have an attorney who is familiar with your needs and financial situation review the terms, conditions, and requirements of the contract. As with any legal document, the contract may be complicated, and it is important that it clearly spells out the rights and responsibilities of both resident and facility.

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Tips to Remember

Before signing any CCRC contract:

• Read the documents very carefully and make sure you understand all the provisions.
• Make certain that your assets will allow you to fulfill financial or contractual obligations you agree to.
• Make sure you thoroughly understand what services will be provided and how much they will cost.
• Ask as many questions as possible to learn all you can about the facility. Do not assume anything.
• Check with local consumer organizations, the Better Business Bureau and state regulatory agencies, to see if any complaints have been filed against the facility.
• Ask if the facility has been accredited by the Continuing Care Accreditation Commission (CCAC).

  Accreditation by the Commission means that a team of experts has scrutinized the community and found that it meets national standards for quality care. The accreditation process involves extensive self-study by the community's staff, board of directors and residents, and includes an on site evaluation by trained professionals, culminating in a comprehensive review by the commission.

  For additional information, contact:

  The American Association of Homes for the Aging
  901 E St., N.W., Suite 500
  Washington, D.C. 20004, or

  The American Association for Retired Persons
  601 E Street, N.W.
  Washington, D.C. 20049.

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