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About Continuing Care Retirement Communities

Learn what they are and how they work

Senior African American Man Robe, Nurse Listens to Heart, About Continuing Care Retirement Communities

Fuse/Corbis/Getty Images

En español | When your parent or loved one decides they’re ready to move from the family home, Continuing Care Retirement Communities (CCRCs) may be worth considering. Offering a variety of services within one community, CCRCs guarantee lifetime housing, social activities and increased levels of care as needs change. These features, however, do come with a price. Learn more about CCRCs to decide whether they’re right for your loved one.

What CCRCs Are

Part independent living, part assisted living and part skilled nursing home, CCRCs offer a tiered approach to the aging process, accommodating residents’ changing needs. Upon entering, healthy adults can reside independently in single-family homes, apartments or condominiums. When assistance with everyday activities becomes necessary, they can move into assisted living or nursing care facilities. These communities give older adults the option to live in one location for the duration of their life, with much of their future care already figured out. This can provide a great level of comfort to both your parents and you and take much of the stress out of the caregiving relationship.

What CCRCs Cost

The most expensive of all long-term-care options, CCRCs require a hefty entrance fee as well as monthly charges. Entrance fees can range from $100,000 to $1 million — an upfront sum to prepay for care as well as to provide the facility money to operate. Monthly charges can range from $3,000 to $5,000, but may increase as needs change. These fees are dependent on a variety of factors including the health of your loved one(s), the type of housing they choose, whether they rent or buy, the number of residents living in the facility and the type of service contract. Additional fees may be incurred for other options including housekeeping, meal service, transportation and social activities.

Types of Contracts

There are three basic types of contracts for CCRCs:

  • Life Care or Extended Contract: This is the most expensive option, but offers unlimited assisted living, medical treatment and skilled nursing care without additional charges.
  • Modified Contract: This contract offers a set of services provided for a set length of time. When that time is expired, other services can be obtained, but for higher monthly fees.
  • Fee-for-Service Contract: The initial enrollment fee may be lower, but assisted living and skilled nursing will be paid for at their market rates.

It is very important to review with your loved one each option as well as the long-term financial plan to support them. Often, charges above and beyond the entrance cost and monthly fees arise. Ensure that everyone understands just how much money will be needed to support this housing option.

Also, make sure the facility they are considering will be financially viable over the long term. Get assurance that 10 to 15 years down the road your loved one’s CCRC will still be operating and able to provide them with the care they’ve already paid for.

Where to Begin

Help your loved ones research CCRCs in their area and offer to accompany them on visits. While there, investigate thoroughly and meet with a representative who can walk them through the different housing options, cost structures and contract choices. Here is a checklist of things to look out for and ask while you’re visiting.

If your loved one decides on a CCRC, suggest that they request a weekend or week-long stay at the facility to ensure it’s the right choice for them. Once they are ready to commit, run the contract by an attorney to be sure everything is spelled out as it was agreed upon with the facility.

What to Observe and Ask During Your Visit

  • How many homes/units are there?
  • How many homes/units are available at this time and can you see specific spaces?
  • Are there general visiting hours, or are they broken down by type of residence? What are they?
  • Is there a waiting list? If so, how long may it take to be accepted and admitted?

  • Are the facility’s grounds well maintained, manicured and easy to navigate?
  • Is the facility located in a desirable area?
  • Are there ample conveniences in and around the community (i.e. grocery stores, cleaners, a shopping mall)?
  • Are your loved one’s doctors within close proximity?
  • Is there a hospital nearby?
  • Is there bus or mass transit available nearby?
  • Is this a smoke-free facility? Are there designated spots for smokers?

  • Are you greeted upon entering?
  • Is the main office easy to find?
  • Is the staff professional and happy to help?
  • Do residents seem happy and well cared for?
  • Are residents social and interacting with one another?

  • What credentials do staff members hold?
  • What is the hiring procedure for staff, doctors and nurses?
  • Are staff, doctors and nurses required to take continuing education classes?
  • What hours do facility administrators work and are they usually available for questions throughout the day?

  • If possible, arrange to talk to current residents. Consider asking:
  • How long have you lived here?
  • How do you like living here?
  • How are the services?
  • How is the care?
  • Is the staff attentive without being intrusive?
  • Are the doctors and nurses helpful and accommodating?
  • Is there anything missing?
  • Is it worth the cost?

  • Do the housing options meet your loved one’s needs?
  • Are there different floor plans available and options to choose from?
  • Are both single- and double-occupancy homes available?
  • Are residences equipped with modern conveniences (laundry, dishwasher, etc.), full kitchens and individual thermostats?
  • Are common areas properly cooled/warmed, furnished and clean?
  • Do homes/units have outdoor living space for residents to enjoy?
  • Is there ample light and are rooms/homes equipped with sprinkler systems and emergency exits?
  • Are the assisted living and nursing facilities clean and modern?
  • Are layouts in all types of housing wheelchair and walker friendly?
  • Are floor plans efficient and pleasing to your loved one?
  • Is each residence equipped with handicap bars, non-slip floors and other safety features?
  • Do multi-level residences have elevators?
  • Are furnished residences available?
  • Can rooms/homes be painted? Are there decorating rules?
  • How is security addressed in each type of facility?
  • Are rooms in the assisted and nursing facilities private? Does each room have an en suite bath?
  • Are units/houses set up for cable and telephone service? Are these utilities included in monthly fees or paid separately per unit/house?
  • Is parking available to residents? And is additional parking easy to find for visitors?
  • Are pets allowed?

  • Do the assisted living facilities offer group meals or in-room meal programs?
  • What meal programs are offered?
  • Are special diets catered to?
  • Can residents make special requests?
  • How many entrée choices are offered daily?
  • What is the meal schedule and is there any flexibility with it?
  • Are snacks included in any of the meal plans?
  • Can guests dine in with their loved ones? If so, is there a fee?
  • Ask to see a sample of a month’s worth of menus to see how meals are changed up.
  • Ask to sit in on a meal to see if the choices are to your and your loved one’s liking.

  • What healthcare services are available for each level of care?
  • What healthcare services are built into the entrance and monthly fees?
  • Do residents have to stay within the facility network for healthcare? Or can they continue seeing their own doctors and care providers outside of the community?
  • Can residents receive assistance with activities of daily living, regardless of housing type? Or are those services available only to assisted living and nursing home residents?
  • Is there specialized care for those with dementia, Alzheimer’s and other health conditions?
  • How are emergencies handled?
  • Are there emergency alert systems in each unit/home?
  • Is there a pharmacy on site?
  • Is medication monitoring available? If so, is medication dispensed by a qualified staff member?

  • What transportation services are offered? 
  • Are there on-site hair salons, cleaners, physical therapy offices and other conveniences?
  • Are any types of housekeeping, laundry or linen service offered? Are these services included in the entrance or monthly fees or at an additional cost?
  • What other personal services are available?
  • Is there a gym on campus? How about organized exercise classes?
  • Are there houses of worship on campus or is transportation provided to weekly services?

  • What kinds of social events are planned? Is there a monthly schedule of activities? 
  • Who organizes social and recreational activities?
  • What is attendance like at social events?
  • Are these events and activities included in the entrance or monthly fees or are they charged separately?
  • Are off-site day trips planned? If so, to where?
  • Is there ample notice for upcoming events and can all residents participate?
  • Are these event and activities capped at a certain number of residents?
  • How do residents sign up?
  • Is there a common social area that is open at all times for residents? If so, are games, cards, TVs, movies and other supplies available?
  • Are there any classes offered on site?
  • Is there a forum in which residents can suggest activities and events?
  • Is there a planning committee that residents can become a part of?

  • What’s involved in the application process?
  • What is the assessment process and what does it involve?
  • What are the contract options?
  • Are residences owned or rented?
  • What is the breakdown of fees? Entrance fee? Monthly fees? Can we expect the monthly fees to be raised on a yearly basis? If so, by how much?
  • What is the payment schedule?
  • What services are included fully in the entrance and monthly fees? Ask for a breakdown of additional services and their fees.
  • Does Medicaid, Medicare or other long-term care insurance cover anything?
  • What happens when one member of a couple needs the next level of care?
  • What happens if a resident decides this community is not for them? Will they be refunded?
  • What happens when a resident dies? Is their estate refunded any of the fees they’ve paid?
  • Who makes the decision to move a resident into the next level of care? The resident? The resident’s family? Or the doctors and care providers?
  • Do the entrance and/or monthly fee cover any medical or health coverage? If so, what?
  • Do residents retain control over their finances in regard to the community services? Is assistance available for those residents who request it?
  • What happens when a resident requires assisted living or nursing care, but there are no rooms available within the community?
  • Does the Continuing Care Accreditation Commission provide accreditation to this facility?
  • Do Medicaid and/or Medicare certify the nursing facilities?
  • Is there an ombudsman or an organization of residents who can help raise issues with the staff and management?
  • Are there any issues on record about the facility that you can review?

Other Tips

  • If your parents are considering a CCRC as a couple, be sure they understand what will happen if one of them needs a higher level of care or dies, or if their circumstances dramatically change. Investigate whether there are circumstances where they can get a refund or leave any of their entrance fee to their estate should a change be necessary.
  • When visiting, spend ample time visiting each part of the facility, regardless of whether your parent or loved one is in perfect health. Chances are they will need assisted living or nursing care at some point.
  • Make sure they see all financial reports, licensing and inspection reports and any complaint investigations.

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