Continuing Care Retirement Communities
A Continuing Care Retirement Community (CCRC), sometimes called a Life Plan Community, combines independent living with access to additional levels of care as residents grow older.
The basic idea is appealing: Move while you are still healthy and independent, enjoy an active retirement lifestyle, and have a plan in place if your health changes.
Many CCRCs offer apartments or cottages, dining facilities, fitness centers, lectures, concerts, and social activities. In that respect, they resemble other independent living communities.
The major difference is the availability of additional care.
What Levels of Care Are Available?
Most CCRCs provide some combination of:
Independent living. Residents live in their own apartments or cottages and manage their daily activities.
Assisted living. Help is available with activities such as bathing, dressing, medication management, and other personal needs.
Memory care. Some communities provide specialized services for residents with Alzheimer's disease or other forms of dementia.
Skilled nursing care. More extensive nursing and rehabilitation services may be available for residents with serious medical or functional limitations.
Not every CCRC offers all these services on the same campus. Some use affiliated facilities, and availability may depend on space and the resident's needs.
The Advantages of a CCRC
Planning for future healthcare needs. Residents may have access to additional care without searching for an entirely new community during a medical crisis.
Security for couples. If one spouse develops serious health problems, the other may be able to remain in independent living while visiting frequently.
Social connections. Organized activities, shared meals, and opportunities to develop friendships can help reduce isolation.
Freedom from home maintenance. Residents no longer have to manage many of the responsibilities associated with homeownership.
Opportunities for physical and intellectual activity. Fitness programs, lectures, concerts, discussion groups, and other activities can encourage continued engagement.
Peace of mind for families. Adult children may feel reassured knowing that their parents live in a community with access to additional support.
Understanding CCRC Contracts
Many CCRCs require a substantial entrance fee along with ongoing monthly payments.
However, the financial arrangements vary considerably.
Three common contract types are:
Type A — Life Care. Generally involves a larger entrance fee and provides access to higher levels of care with relatively predictable fees, although charges can still increase and additional services may cost extra.
Type B — Modified Contract. Includes a limited amount of assisted living or nursing care, after which additional charges may apply.
Type C — Fee-for-Service. Residents generally pay separately for assisted living and nursing care when needed, often at prevailing rates.
Some communities offer rental arrangements without large entrance fees.
Entrance fees may be partially refundable, but the amount, timing, and conditions of repayment vary. A refundable entrance fee is not necessarily immediately available when a resident leaves or dies.
Understanding the contract is just as important as evaluating the community itself.
The Potential Disadvantages
Substantial financial commitment. Entrance fees and monthly charges can be expensive, and annual increases may be significant.
Financial stability of the community. Residents depend on the organization's ability to maintain its facilities and fulfill its long-term obligations.
Loss of flexibility. A large entrance fee and the effort involved in moving may make it difficult to change communities later.
Availability of care. Having assisted living or nursing care on campus does not necessarily mean a bed will be available immediately when needed.
Differences in quality. Communities vary in staffing, healthcare services, food, management, facilities, and resident satisfaction.
An aging population. Residents may experience the illness or death of friends and neighbors. This can be emotionally difficult, even in a socially active community.
What About Alzheimer's Disease?
For individuals concerned about dementia, a CCRC may offer important advantages.
Some communities provide memory care programs, trained staff, and specialized residential facilities.
However, memory care is not always included in the basic contract, and some communities may require residents with advanced dementia to transfer elsewhere.
Families should ask specifically about memory care availability, costs, staffing, and policies for residents whose cognitive abilities decline.
Investigating the Community's Financial Health
Before making a substantial financial commitment, prospective residents should examine the community's financial condition.
Important considerations include its occupancy rate, debt obligations, financial reserves, history of fee increases, and whether it has experienced operating deficits.
It is also worth asking whether the community is nonprofit or for-profit, how major capital improvements are financed, and what protections residents have if the organization encounters financial difficulties.
An independent financial adviser or attorney familiar with CCRC contracts can help evaluate the financial risks and contractual obligations.
What If You Have No Family Nearby—or No Family at All?
For older adults without nearby family, the decision about where to live can be especially important.
Adult children and other relatives often provide assistance that may go unnoticed until it is needed: transportation after medical procedures, help with financial matters, arranging home care, dealing with emergencies, or advocating for someone during a hospitalization.
What happens when there is no one available to take on these responsibilities?
A CCRC may offer significant advantages. Staff members are nearby, emergency assistance may be available, and residents have opportunities to develop friendships and supportive relationships.
However, living in a CCRC does not eliminate the need for someone to act on your behalf if you become seriously ill or unable to make decisions.
Even in a well-managed community, staff generally do not take the place of a family member who can coordinate medical care, review financial matters, or advocate for your wishes.
Planning for Support
Whether you remain at home or move to a retirement community, several arrangements deserve consideration:
Healthcare proxy. Designate someone you trust to make medical decisions if you become unable to do so.
Durable power of attorney. Arrange for a trusted person to manage financial and legal matters if necessary.
Professional assistance. An aging life care professional (geriatric care manager), attorney, or professional fiduciary may be able to provide services that family members often handle.
Emergency contacts. Establish relationships with people who can be contacted quickly and are willing to help when needed.
Social connections. Friendships and community involvement become particularly valuable when family support is limited.
For someone without suitable relatives or friends, professional fiduciary or care-management arrangements may be especially important. The legal options and safeguards vary by state.
An Important Question for Retirement Communities
Ask management:
"How do you help residents who have no family nearby, particularly when they are hospitalized, develop dementia, or need someone to advocate for them?"
The answer may reveal a great deal about the community's approach to supporting residents.
For people without family support, a well-run CCRC may provide valuable security and companionship. But it is still important to establish independent arrangements for medical decisions, financial management, and personal advocacy.
Choosing the Right Community
Financial considerations are important, but everyday life matters just as much.
Visit several communities, preferably more than once. Attend a meal, participate in an activity, and speak privately with residents.
Ask whether residents are satisfied with the food, management, maintenance, activities, and healthcare services.
Also investigate the quality of the assisted living and nursing facilities. These may become more important than the amenities that initially attracted you.
A beautiful apartment and an attractive dining room are not substitutes for good management and reliable long-term care.
The Question Worth Asking
"Am I primarily purchasing a retirement lifestyle, or am I also purchasing financial and practical protection against future healthcare needs?"
For some people, a CCRC provides an attractive combination of independence, community, and long-term planning.
For others, the costs and contractual commitments may outweigh the advantages.
The answer depends on financial resources, health, family circumstances, and personal preferences.