Continuing Care Retirement Communities (CCRC’s) are often seen as a smart investment and insurance policy for changing care needs throughout a person’s life. These communities offer a continuum of of living options. They typically include independent living, assisted living, post-acute rehabilitation, memory care and skilled nursing care. In many cases individuals decide that investing in these communities provides them with the “peace of mind” in knowing that when they need care due to illness, chronic disease, injuries or surgeries the “care will be there”.
However, there are considerations that should be carefully weighed when determining if it is the right fit for you. There are nuances in CCRC contracts in terms of financial investment, availability and type of care at the time that you need it, the quality of the care, and the ability for you to choose your healthcare providers.
Financial Investment
CCRC’s have move in requirements that require an assessment of your finances and your overall level of health. Some may require that you move in while you and your spouse are still independent. That is why it is important to understand the details of the contract and the various options available. Below is a high level breakdown of what you may see;
CONTRACT TYPE RISK / COST CONSIDERATIONS
Full Life Care Type A
Low Risk / High Cost • Pre-pay for unlimited care
• No increase in monthly fee for cost of care
• Predictable expenses
• CCRC absorbs the “risk” of the cost of care
• In-home care not typically covered
Modified Care Type B
Moderate Risk / Moderate Cost • Pre-pay for “some” care
• Pre-determined number of days of care at a discount rate
• You and the CCRC share the “risk” of the cost of care
Fee for Service
High Risk / Lower Cost • No pre-pay for care
• Monthly increases to reflect market rate for care
• You take all of the “risk” for the cost of care
• Monthly expenses unpredictable
Availability, Type of Care and the Right to Choose Your Provider
The CCRC model generally is designed to meet higher level of care needs in specific environments like assisted living, memory care or skilled care. Consequently, contracts typically stipulate that the facility will determine when a different level of care is needed. This can often be a point of disagreement between the facility and an individual wanting to age in place in an independent living apartment with in home assistance.
Additionally CCRC’s typically have their own requirements for certain levels of care and may differ from those at other communities. For instance, they may require that you or a loved one have the ability to walk to be in their Memory Care Unit and if you cannot you must reside in the Skilled Care Unit.
Just because you’ve invested in a CCRC does not mean that you will get care at that community. Many contracts are written to reflect that if the community does not have capacity to accommodate you they will find another facility to do so.
If you need home or hospice care many CCRC’s have their own employed team to provide that service and you may not be permitted a choice.
Quality of Care
All CCRC’s are regulated by the state. However, states do not require the same quality outcome requirements as federally regulated care facilities. The state survey process focuses more on adherence to regulations around facility safety, food handling and some medication administration.
Communities and healthcare facilities that accept Medicare are required to publicly report Health, Staffing, Quality of Care, Outcomes and any Penalties that have been cited during routinely required surveys and inspections. Since many CCRC’s do not accept Medicare they may not release that information to you if requested. Additionally, if you are in a facility that does not accept Medicare, you may be foregoing your Medicare benefits for rehabilitation services.
Keep in Mind
As is true for all major life changes, it is crucial to carefully review your options and consequences of your decisions. CCRC’s can be a good choice for some, but keep in mind that a deep review, discussion and understanding of the contract is necessary in order to ensure that you understand exactly what you’re buying.