Continuing Care Retirement Communities (CCRC's)

Overview

A Continuing Care Retirement Community (CCRC) is a type of housing community for older retired adults. A CCRC offers its residents a contract that provides residential living and health care services for the rest of their lives. Residents (usually 65 and older but might be a younger adult with a disability) receive board and nursing services. If a person decides to live in a CCRC, they usually agree to stay for the duration of their life. They usually sign a contract stating this agreement. They also may pay an entrance fee and monthly fees. Part of the entrance fee covers future health care needs similar to an insurance policy.

CCRCs are unlike other types of senior housing. They offer at least three levels of housing, and special resident and health care services. CCRCs allow older adults to age in place. 'Age in place' is a phrase that is used when someone lives in the same home or community, as they grow older. CCRCs have the resources to change your living arrangement when your health care needs change.

Activities & Services

CCRCs have various type of living arrangements and levels of care. Each level of care and residence meets the changing needs of people as they age.

Independent Living Units: These include condominiums, apartments, studios, cottages and houses. Residents live independently in their home but have the assurance that nursing care is close by in the event they should ever require it.

Assisted Living Units: These include studios and one or two bedroom units with a full bath and sometimes a small kitchenette. Residents are given help with chronic health problems. Residents in assisted living may not be able to care for themselves alone. They may need help with daily living skills such as bathing, dressing or taking medicine and they are given additional help.

Intermediate and Skilled Nursing Care: Rooms for one or two persons (private and/or semiprivate). Both short-term (respite) and long-term nursing care is provided as needed. A Medical Director oversees the care of each resident (in conjunction with their Primary Care Physician if they have one).

Some CCRCs are very basic. Some are very luxurious. Most CCRCs have apartments, cottages, an assisted living and a health care unit. They are usually all on one campus. Staff is on-call and available 24-hours a day. Common services found in a CCRC include:

• Meals in a dining room
• Grounds maintenance
• Scheduled, local transportation
• Security
• On-site physician services
• Rehabilitation centers
• Emergency call system
• Fitness/ wellness/ activities programs
• Libraries

Other services that may also be offered include:

• Housekeeping
• Laundry and linen
• Hair and beauty salons
• Utilities
• Banking on the premises
• Financial assistance such as the filing of insurance claims

Cost & Coverage

There are many different types of contracts offered by CCRCs. You should read each contract carefully. It is important that you know exactly what your plan includes. You should expect a CCRC to offer a contract stating that the community will offer a home, social activities, a list of services and amenities and access to other on-site levels of care.

Extensive(Most expensive contract)
An entry fee and monthly fee is required. Fees usually include housing, residential services, amenities and unlimited long-term care.

Modified Entry
An entry fee and monthly fee is required. The fees usually include housing, amenities and residential services. This plan limits the number of days per year when nursing care is covered. If the resident is unable to pay for the needed care, the CCRC is not required to provide the care.

Rental of Fee for Service Type(Least expensive)
With this plan the resident pays only a monthly fee. The fee covers housing and residential services. The resident has secured access to nursing care. The resident must pay the daily rate when he/she uses skilled services at the home.

In Virginia, the entrance fees range from approximately $15,000-$400,000. The rental fees typically range between $63,000 and $143,000 annually depending on level of care. The average monthly rental fee can range from $2,000 - $4,000 for an individual in Independent Living depending on the facility and services.   Assisted Living and Health Care monthly rental fees are more expensive.

All CCRCs have rules for entry. Most of the rules have to do with financial and health status of the future resident(s). Some CCRCs have a fellowship policy or benevolent fund. This policy or fund helps residents who no longer have the funds to pay for their stay at the home.

Medicare does not pay for independent or assisted living at a CCRC. If nursing care at the CCRC is accredited by Medicare, then part of the skilled nursing care is covered. CCRCs may also accept long-term care insurance.

Entry fees may be refundable on a sliding scale within a short time after move-in if you decide to withdraw.

Licensure & Accreditation

Assisted living and skilled nursing care at a CCRC must be licensed by the state of Virginia. The Virginia Department of Social Services licenses assisted living facilities. The Virginia Department of Health licenses nursing home care. A licensed nursing home administrator must oversee the nursing home.

A CCRC has a choice to certify their assisted living services and nursing homes. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) offers voluntary certification for assisted living and long-term care services. The Commission on Accreditation of Rehabilitation Facilities (CARF) also offers a voluntary certification program for assisted living facilities. The Continuing Care Accreditation Commission (CCAC), a private non-profit organization, is the only organization that certifies CCRCs as a whole, rather than assisted living and nursing home separately. The CCAC process is voluntary and takes about twelve months to complete.

Be informed when choosing a community. You may think a community is a CCRC, when it is not. In Virginia, you may want to check if a community is registered with the State Corporation Commission (SCC). CCRCs that are registered with the SCC must file a financial disclosure statement every year. They are also regulated under the Continuing Care Provider Registration and Disclosure Act, (38.2-4900). This act watches over the financial strength of the CCRC.

Consumer Tips

Before signing a contract with a CCRC, read the Continuing Care Accreditation Commission's checklist for CCRCs.

Have all contracts reviewed by your lawyer or financial consultant if possible before signing.

You may want to compare fees for services and health care at a CCRC to fees at stand alone assisted living facilities and nursing homes to see how the costs match up on fee services. Keep in mind the guarantee of a life-long place to live provided by a CCRC whereby assisted living and nursing home do not make this guarantee and may ask you to leave if they are unable to provide appropriate care for your medical condition.