Continuing Care Retirement Communities (CCRCs)

For seniors with the financial means, a Continuing Care Retirement Community (CCRC) may be the ideal senior living option to “age in place.” CCRCs are a combination independent living, assisted living, and nursing home.

What Is a Continuing Care Retirement Community (CCRC)?

Today’s seniors have access to more types of care than ever – and that's a good thing. CCRCs are one of the most ideal types for those who want as close to a home setting as they can get. This is a form of independent living, but it also incorporates part skilled nursing care and assisted living services. These locations vary to some degree, though. Some offer a tiered program where the amount and type of services desired are obtained. If an individual needs more services over the long term, they can obtain them. Perhaps the most desirable component of a CCRC is that healthy adults can live within these communities in a single-family home or apartment. Some are condo developments. They live independently as long as they want to or can. This creates a high level of independence and quality of life. Over time, when they begin to need help, it is there for them. They may move to an assisted living or skilled nursing area as their needs change. CCRCs give seniors the ability to live within the same community through their life. Adults remain comfortable and familiar with the people, surroundings, and the services. They maintain the same quality of life, activities, and interactions with their neighbors. Again, this improves quality of life and directly helps seniors to feel more comfortable and at ease. It also helps family members to know their loved one isn’t moving from one location to the next and is maintaining the same level of care. Services offered include health services, meals, personal care, housekeeping, transportation, and emergency help. In addition, the communities are chock full of social and educational activities. Because CCRCs are an “all-in-one”, there is a greater level of comfort for residents. And children of the parents enjoy a greater peace of mind knowing that all their parents' needs from housekeeping to medical care are taken care of.

How Are CCRCs Different Than Other Retirement Options?

The most important difference here is that CCRCs recognize that many seniors want to live as independently as they have the rest of their life. For example, a senior may find himself living alone after a spouse dies. He or she still can perform the necessary tasks of living on his own but is alone most of the time. To remedy this, the individual can move into the independent living component of a CCRC. There, he or she can maintain the same hobbies and interests enjoyed previously but nearby to those who can help when there is a need. They get to know the area, the people, and their neighbors. As that senior gets older, he or she may find that tasks like cutting the grass or mopping the floors are a bit too hard to do. This is when moving into or utilizing the assisted living components of the CCRC becomes necessary. Unlike in a traditional assisted living community, the senior already knows the community and the people. He or she is not moving away from the same community into a new one, just into a different area (in some cases) or getting a bit more help when they need it. And, when there is a need, seniors are then able to move into the onsite nursing facility component. Again, they maintain the same quality of life and stay in familiar areas. This improves the overall quality of life. Overall, this type of location offers customizable services to fit the needs of the individual at that point in their life. This ensures the very best level of care is always available when there is a need.

What Services Are Offered in CCRCs?

When living in a CCRC, individuals choose the amount and type of services they desire based on their needs. These communities can provide just about any of the care a senior needs over his or her lifetime. This includes health services including medical needs (in the skilled nursing component). It also includes all personal care such as toileting, bathing, and personal hygiene. Some individuals will obtain housekeeping services. Most often, CCRCs also ensure there is emergency medical help readily available to the individual who needs it. This can provide instant peace of mind for anyone living in the property. Residents also benefit from added services such as transportation to their appointments, to go shopping, or to other locations. They also can enjoy various programs such as social activities, educational activities, and outings. These differ from one location to the next. However, because these are full communities with numerous amenities to offer residents at all levels, they tend to offer more of the versatile needs that residents want. Residents benefit here because they choose what they need and want. They can count on having all of the care they need, though, if there is a time in their life where it becomes necessary.

Types of CCRC Contracts

In general, CCRCs have three main types of contracts with a fourth (rental) occasionally available.

• Extensive or Life Contracts (Type A) are the priciest because they generally include unlimited assisted living and health services with little or no extra fee.
• Modified Contracts (Type B) provide similar services to Type A except that only some health services are included in the initial monthly fee. If a resident's needs exceed those fees then they are charged market rates for services.
• Fee-for-Service Contracts (Type C) offers a lower initial enrollment fee, but residents pay market rates for health care services on an “as needed” basis.
• Rental Agreements (Type D) usually require no entrance fee but guarantee access to CCRC services on an “as needed” basis.

Cost of Continuing Care Retirement Communities

By far, a CCRC is the most expensive senior living option. There are a number of costs to consider when looking at CCRCs. According to an article in the Wall Street Journal, the “average entrance fee for each unit is $249,857.” The U.S. Government Accountability Office studied the CCRC industry and found these ranges of fees: Type A Entry Fee: $160,000 to $600,000 Monthly Fee: $2,500 to $5,400 Type B Entry Fee: $80,000 to $750,000 Monthly Fee: $1,500 to $2,500 Type C Entry Fee: $100,000 to $500,000 Monthly Fee: $1,300 to $4,300 Type D Entry Fee: $1,800 to $30,000 Monthly Fee: $900 to $10,700 depending on level (assisted, nursing, etc.) of initial care All of these fees will depend on a number of factors such as the type of housing (single family home, condo, apartment); whether they rent or buy; size of the facility; kinds of services; type of contract.

Evaluating CCRCs

Request a weekend or even weeklong stay at a CCRC. This will give you or your loved one a complete picture of the community. Consider the following whether you visit for the day or the week:

• Does the facility feel like home? Is there a community feel?
• Talk with the residents. How do they like living there? How are the services? How is the care? How attentive and professional is the staff? Is there anything missing? Is the community a good value? Do the residents seem like people you'd want to get to know better? Do the residents interact with one another?
• Talk to the staff. Do they seem to genuinely care? Do they seem concerned?
• Ask to see licensing, inspection reports, and any complaint investigations.

Other CCRC Considerations

Because it costs so much to run CCRCs and consequently, to live in one, it's important to know the financial health of the company. In order to survive, these communities must operate at or near full capacity. If they don't, then some resident services may be cut. Start by asking for the facility's audited financial statements. Here are some things to look for:

• Consider the facility's cash-to-debt ratio. This should be about 35%.
• What is the facility's cash on hand? CCRCs with “one campus average 306 days of cash on hand; those with multiple sites average 281,” according to an AARP article.
• “Watch out for facilities that rely heavily on investment income, donations or entry fees, which may signal an inability to run on income from operations,” says an article in the Wall Street Journal.

Where Can I Find a Continuing Care Retirement Community (CCRC) Near Me?

Often times, residents do not realize there are CCRCs close to them. That is a good thing because it means the location is doing a fantastic job of creating a modern, residential area that looks and feels just like a traditional home. However, most communities do offer CCRCs. Because they can cost a bit more than other types of senior living care, they are often found in communities with higher net worth or in areas where there is a higher density to older adults. From the outside, CCRCs look like larger developments. Many offer a one-stop-shop type of living setup, which means you may notice single-family homes or townhomes alongside nursing facilities or assisted living areas. Once you find available CCRCs in your area, take the time to really choose wisely. Learn about the services each one offers, the quality of care there, and the overall layout. You also will want to learn when more advanced care is recommended, what the process is for moving from one level of care to the next, and what your loved one can expect. Remember, each location is quite different. It is often a good idea to visit a location unannounced to get an idea of what life is like when someone is living there. CCRCs can range widely in services, and not always in relation to their cost. It is a good idea to learn what seniors do on a daily basis and what they can expect from choosing this location to call their long-term home.

Summary

CCRCs are the best of all senior living options because they allow residents to “age in place”. This gives both the resident and the resident's loved ones added peace of mind. However, CCRCs are the most expensive retirement option. There's a lot to consider before making the step to CCRC living. To compare CCRC living with other retirement options, read our Senior Retirement Lifestyles article.