CCRC downpayments - how to handle?

[youbet]

Quote:

Originally Posted by nwsteve We are the process of making the move to a Life Care (Type A) CCRC. Our thinking for choosing the Type A model is based on our personal assessment of these factors: 1. Be able to choose where we spend our senior years as opposed to imposing on our only DD and being at risk having our choice of "what's available" vs what we chose. Early boomers should recognize that as our "bubble" hits later years the demand may well exclude supply of living arrangements when you may be in need. 2. Insurance to ensure we have protection should either of us suffer from a cognitive impairment that requires extensive supervision. No being victim of a court appointed nursing home. 3. Locking in our costs (yes monthly fees will raise but only by inflation) for future care and housing needs including any assisted living and skill nursing needs. 4. Ensure we have a framework that will encourage socialization, and healthful living. (one of the CCRCs we visited shared that their residents were outliving their actuarial tables--in part due to their living environment). 5. Gaining a medical advocate (on staff medical resources) to help sort out medical care and the complexity of finding appropriate medical resources. 6. And not the least, a great deal at a new property desiring to accelerate its occupancy ratios (It helped that the operator is an established non-profit management company of CCRCs). I am sure there are as many reasons as there are folks looking at the CCRC option, so YMMV.

DW and I have toured Type A, B and C facilities in this area. We like the concept of living in a CCRC sometime in the future but the differences between the pay-as-you-go Type B and C and the Life Care Type A contracts are making us dizzy. The more we tour and read, the more intertwined the pros and cons of the different contractual arrangements become.

Really enjoyed your list above, but isn't the only item particular to a Type A Life Care arrangement item #3? Wouldn't you get all the others in a Type B or C situation with the advantage being that you are less locked in should you want to move?

Also, in he facility you'll be moving to, is assisted living done by sending periodic help to your independent living apartment or would you actually move to an assisted living apartment? We've toured places here that do it both ways. We can see advantages to either way.

It seems important to really deep dive into CCRC's before making a final decision between Type A, B or C and then which particular CCRC. But, darn, we're starting to get overloaded with information about various nuances and the process is getting painful.

[nwsteve]

Youbet, you are correct that item 3 in my OP is probably the only one that is completely unique to a Life Care (Type A) property. In the facility we are moving to, full Asst Living is done in a dedicated wing. Most of the Type A properties seem to provide help in your unit if the aid is short term or doesn't require higher levels of skill from staff. If the assistance required is going be ongoing and especially if the assistance is for multiple needs, then you will be moved to Asst Living. What we like is that with the type As we seen, both spouses do not have to move if only one has the need. The only increase in cost is for the extra meals required in Asst Living. If you are in a Type B or C, you are faced with a big jump in costs and complexity when your cognitive horsepower may no longer be sufficiently robust to deal with the challenges esp if the spouse has serious medical complications.

Also agree +1000 times that the CCRC choice requires a fair amount of effort to unearth and understand the details before deciding. The book Holistic Living in Life Plan Communities I found very helpful in flushing out the multitude of issues you will want to vet. (got in paperback from Amz).
If you do decide a CCRC is part of your plans, I would recommend you make the refundable deposit to get on the waitlist (the ones we saw only required a $1000). The properties we saw would allow you to pass on open units until you are ready.

[harllee]

We are on the wait list for a Type A Life Care CCRC. One reason we are interested in the Type A is that with that kind we can have a handle on future costs if one or both of us need to move to skilled nursing or memory care. We do not have Long Term Insurance so it seems to us the a Type A facility sort of takes the place of LTCI. In fact, the one where we are on the waiting list tells you that you do not need LTCI if you move in there. They pretty much discourage LTCI.

[ChrisC]

Quote:

Originally Posted by nwsteve Youbet, you are correct that item 3 in my OP is probably the only one that is completely unique to a Life Care (Type A) property. In the facility we are moving to, full Asst Living is done in a dedicated wing. Most of the Type A properties seem to provide help in your unit if the aid is short term or doesn't require higher levels of skill from staff. If the assistance required is going be ongoing and especially if the assistance is for multiple needs, then you will be moved to Asst Living. What we like is that with the type As we seen, both spouses do not have to move if only one has the need. The only increase in cost is for the extra meals required in Asst Living. If you are in a Type B or C, you are faced with a big jump in costs and complexity when your cognitive horsepower may no longer be sufficiently robust to deal with the challenges esp if the spouse has serious medical complications. Also agree +1000 times that the CCRC choice requires a fair amount of effort to unearth and understand the details before deciding. The book Holistic Living in Life Plan Communities I found very helpful in flushing out the multitude of issues you will want to vet. (got in paperback from Amz). If you do decide a CCRC is part of your plans, I would recommend you make the refundable deposit to get on the waitlist (the ones we saw only required a $1000). The properties we saw would allow you to pass on open units until you are ready.

I think it is very difficult to generalize about the different types of CCRCs, even within the generic types of A, B or C. For instance, I'm seriously looking at what might be generally classified as a Type B community, with equity ownership in your unit, a membership fee equal to 10 percent of the purchase price of your residential unit, and a monthly maintenance fee, which covers almost every aspect of your campus living arrangements (e.g. breakfast is always served and free and then one gets a meal plan of 20 meals a month). It has highly active independent living features with resort-like amenities. But if one glides into needing more care, it offers home-care/ assisted living services in the unit you purchased (at no charge beyond the monthly maintenance fee); and if you later need skilled nursing care, it has an on-site skilled nursing health care center with XX number of beds available for residents in which the cost of care there is at a "discounted rate." Personally, I prefer the Type B or C arrangement especially if there's equity ownership of your unit -- this arrangement works well if you have LTCi to cover home care or skilled nursing care.

[nwsteve]

Quote:

Originally Posted by ChrisC I think it is very difficult to generalize about the different types of CCRCs, even within the generic types of A, B or C. For instance, I'm seriously looking at what might be generally classified as a Type B community, with equity ownership in your unit, a membership fee equal to 10 percent of the purchase price of your residential unit, and a monthly maintenance fee, which covers almost every aspect of your campus living arrangements (e.g. breakfast is always served and free and then one gets a meal plan of 20 meals a month). It has highly active independent living features with resort-like amenities. But if one glides into needing more care, it offers home-care/ assisted living services in the unit you purchased (at no charge beyond the monthly maintenance fee); and if you later need skilled nursing care, it has an on-site skilled nursing health care center with XX number of beds available for residents in which the cost of care there is at a "discounted rate." Personally, I prefer the Type B or C arrangement especially if there's equity ownership of your unit -- this arrangement works well if you have LTCi to cover home care or skilled nursing care.

Beyond the basic three contract types. I totally agree that generalizing about CCRCs can be misleading. Every property has its unique attributes. The property we are going to is managed by a company which runs another property about an hour away in a much larger community. The one we are going to is new so has a pretty young population (ave age 75) the other is a mature property with a long waitlist and ave age of 81. Similar contracts for entry and both Type A but looks and feel are night and day.

[youbet]

Quote:

Originally Posted by nwsteve Youbet, you are correct that item 3 in my OP is probably the only one that is completely unique to a Life Care (Type A) property. In the facility we are moving to, full Asst Living is done in a dedicated wing. Most of the Type A properties seem to provide help in your unit if the aid is short term or doesn't require higher levels of skill from staff. If the assistance required is going be ongoing and especially if the assistance is for multiple needs, then you will be moved to Asst Living. What we like is that with the type As we seen, both spouses do not have to move if only one has the need. The only increase in cost is for the extra meals required in Asst Living. If you are in a Type B or C, you are faced with a big jump in costs and complexity when your cognitive horsepower may no longer be sufficiently robust to deal with the challenges esp if the spouse has serious medical complications. Also agree +1000 times that the CCRC choice requires a fair amount of effort to unearth and understand the details before deciding. The book Holistic Living in Life Plan Communities I found very helpful in flushing out the multitude of issues you will want to vet. (got in paperback from Amz). If you do decide a CCRC is part of your plans, I would recommend you make the refundable deposit to get on the waitlist (the ones we saw only required a $1000). The properties we saw would allow you to pass on open units until you are ready.

Thanks. I'll be ordering the book and appreciate the tip on that.

We've toured one particular Life Care (Contract A community) several times and like it. But these questions keep popping into my head and I can't seem to get answers that put me at ease.......

1. The buy-in fee and monthly fee schedules seem to be structured so that higher tier clients are subsidizing lower tier clients. That is, the difference in fees seems excessive for the difference in accommodations. For example, they're asking about 60% more to live in an upper floor unit with a balcony, nice view and about 300 more square feet than a lower floor unit without balcony, limited view and 300 square feet smaller. Since all out-of-unit amenities are shared (dining rooms, indoor and outdoor common areas, etc.), this seems excessive and not a very good value for the higher tier client.

2. They don't have a separate section of assisted living units. Assistance is provided in your independent living unit if required (at some extra cost to you depending on what you want and need) until and if you need to move to the full nursing unit (which has an excellent rating). We're having difficulty determining exactly what assistance they'd provide gratis and which would result in an extra charge. I get it that that assistance levels might vary greatly from person to person with some folks perhaps wanting an unreasonable amount or frequently calling for frivolous reasons. And obviously someone requiring some assistance but with a healthy spouse living with them would require less outside help stopping by. Still, it seems a bit open ended to me.

3. There seems to be a sweet spot health and age-wise for applying and moving in. We feel too young for a CCRC today (on tours everyone seemed 5 - 10 years or more older). Yet we understand that once certain health or aging problems begin, you're not going to qualify for a Type A contract.

4. We're a bit concerned about location flexibility. If our son, DIL and the grandkids moved and we were still healthy, we'd want to follow them (which they would welcome). Not sure we can arrange a buy-in package where we could do that and receive enough of a refund that the financial beating wouldn't be too painful.

All in all, we like the CCRC concept. The cost predictability of a Type A contract is appealing. But we can self-insure for LTC, so it isn't a must.

It's really confusing. We found out that one place that we weren't too keen on wasn't even taking waiting list applicants (requiring the $1k deposit) because they already had more folks on the list than they'd be able to accommodate for years. So...... we're not too keen on the place yet it's wildly popular. Go figure!

Edit: Just back from Amazon. Ordered the book you suggested and also Find the Right CCRC for Yourself or a Loved One

OP - sorry for the hijack.......

[nwsteve]

Quote:

Originally Posted by youbet Thanks. I'll be ordering the book and appreciate the tip on that. We've toured one particular Life Care (Contract A community) several times and like it. But these questions keep popping into my head and I can't seem to get answers that put me at ease....... 1. The buy-in fee and monthly fee schedules seem to be structured so that higher tier clients are subsidizing lower tier clients. That is, the difference in fees seems excessive for the difference in accommodations. For example, they're asking about 60% more to live in an upper floor unit with a balcony, nice view and about 300 more square feet than a lower floor unit without balcony, limited view and 300 square feet smaller. Since all out-of-unit amenities are shared (dining rooms, indoor and outdoor common areas, etc.), this seems excessive and not a very good value for the higher tier client. 2. They don't have a separate section of assisted living units. Assistance is provided in your independent living unit if required (at some extra cost to you depending on what you want and need) until and if you need to move to the full nursing unit (which has an excellent rating). We're having difficulty determining exactly what assistance they'd provide gratis and which would result in an extra charge. I get it that that assistance levels might vary greatly from person to person with some folks perhaps wanting an unreasonable amount or frequently calling for frivolous reasons. And obviously someone requiring some assistance but with a healthy spouse living with them would require less outside help stopping by. Still, it seems a bit open ended to me. 3. There seems to be a sweet spot health and age-wise for applying and moving in. We feel too young for a CCRC today (on tours everyone seemed 5 - 10 years or more older). Yet we understand that once certain health or aging problems begin, you're not going to qualify for a Type A contract. 4. We're a bit concerned about location flexibility. If our son, DIL and the grandkids moved and we were still healthy, we'd want to follow them (which they would welcome). Not sure we can arrange a buy-in package where we could do that and receive enough of a refund that the financial beating wouldn't be too painful. All in all, we like the CCRC concept. The cost predictability of a Type A contract is appealing. But we can self-insure for LTC, so it isn't a must. It's really confusing. We found out that one place that we weren't too keen on wasn't even taking waiting list applicants (requiring the $1k deposit) because they already had more folks on the list than they'd be able to accommodate for years. So...... we're not too keen on the place yet it's wildly popular. Go figure! Edit: Just back from Amazon. Ordered the book you suggested and also Find the Right CCRC for Yourself or a Loved One OP - sorry for the hijack.......

A couple of observations:
As you have already discovered there is no single model. Almost every CCRC has its own idiosyncrasies. Our target property has no meal plan so everything in the restaurant is ala cart albeit at very reasonable prices. The sister property monthly fee includes a $600/mon food allowance. When trying the restaurant, we saw a lot of folks taking food back to their unit--some because portions were large but we suspect they were also trying to "burn" their meal allowance. We like that there is no mandatory meal plan.

As far as age to enter--very individual decision. One resident pointed out that early entry gives you the advantage of a longer amortization time of the entry fee as well as allowing you to get the benefits of the CCRC for a longer time period. We will be 71 when we enter--4 years earlier than our target but given property appreciation in the area, ideal location to reach our DD and GK and elderly (94) parent and new build promos for filling, it is right for us.

In terms of wait list deposits. One other option is if you fine THE place and they don't have a wait list consider making a full deposit (typically 10%). The actual deposit usually puts you at the top of the list for open units just behind current residents. The deposit says we are committed and you usually get to participate in many of the CCRC programs and use some facilities like gym, etc. (Obviously, you need verification of the specifics)

Given the incredible variations in CCRC programs and pricing of services, going to a CCRC is not for the bashful. You really have to explicitly ask and more importantly inspect the actual docs you will be signing. It also helpful to talk with some of the longer term residents and ask what they seen happen regarding any area of concern. One of my favorite questions for a resident is "What one thing do you wish was different for residents" Answers can identify potential areas that may be of concern or just be a nit.

The CCRC we are going to provided very specific docs and language regarding how fees are set. For example in ours the monthly fee is driven by number of sq ft in unit and number of occupants. Ask to see the actual Resident agreement and Disclosures.

Research and detail probing are your best options for avoiding disappointment and unexpected costs. Be sure to talk with some of the resident leadership on the property's resident council. Find out what keeps them up at night and how they characterize the relationship with property management.
After all, you will be spending the rest of your life there, why wait to find out later on things critical to you.

[youbet]

Thanks nwsteve! Really appreciate your comments and advise.

When the two books we ordered arrive, we'll dive right in and, in combination with everything we're reading here, get more organized with our questions and research. No doubt, we've been too loosey-goosey in defining our objectives and structuring the process of educating ourselves. Likely, the tours and presentations we've attended so far have only touched the surface of what we need to know and understand.

[Spock]

Quote:

Originally Posted by nwsteve We are the process of making the move to a Life Care (Type A) CCRC.....

Is this the same "Life Care" company?
Life Care Center of Tucson

We had my mom in the above facility for rehab after a stroke, directly across the street from the hospital, high ratings, etc. The place was absolutely terrible. Facility Dr was a quack that I had to print off medication web-info were the mfgr explicitly stated not to use their med (and their TV commercials say not to use their med (a blood thinner) on heart valve replacement patients. Facility was on constant c-diff "lock down" and there was plenty of evidence where they didn't clean up the floors from c-diff "incidents" etc.


Not trying to rain on your choice, just extremely interested in finding out if some of these wonderful CCRC facilities you all are describing are truly the promised land or if its like every other "the quality of care depends on who they hired last week".

[Spock]

When "investing" these large down payments/deposits at CCRC's, what are the protections that the company doesn't go bankrupt or other business fraud and poof the $ are gone?

[kimcdougc]

Quote:

Originally Posted by Spock When "investing" these large down payments/deposits at CCRC's, what are the protections that the company doesn't go bankrupt or other business fraud and poof the $ are gone?

This would be my concern.

[nwsteve]

Quote:

Originally Posted by Spock Is this the same "Life Care" company? Life Care Center of Tucson We had my mom in the above facility for rehab after a stroke, directly across the street from the hospital, high ratings, etc. The place was absolutely terrible. Facility Dr was a quack that I had to print off medication web-info were the mfgr explicitly stated not to use their med (and their TV commercials say not to use their med (a blood thinner) on heart valve replacement patients. Facility was on constant c-diff "lock down" and there was plenty of evidence where they didn't clean up the floors from c-diff "incidents" etc. Not trying to rain on your choice, just extremely interested in finding out if some of these wonderful CCRC facilities you all are describing are truly the promised land or if its like every other "the quality of care depends on who they hired last week".

Fortunately NOT! We are moving to a property near Tacoma, WA--Gig Harbor--Heron's Key.

Edited to Add: I do think your observation is fair regarding staffing. Many years ago, I did executive search for the LTC industry--at that time the talent pool was pretty shallow. It took us a while to convince our client to start incorporating talent from the broader hospitality industry to bring some fresh blood into the industry.

[Sunset]

Quote:

Originally Posted by nwsteve Fortunately NOT! We are moving to a property near Tacoma, WA--Gig Harbor--Heron's Key. Edited to Add: I do think your observation is fair regarding staffing. Many years ago, I did executive search for the LTC industry--at that time the talent pool was pretty shallow. It took us a while to convince our client to start incorporating talent from the broader hospitality industry to bring some fresh blood into the industry.

Thanks for providing this concrete example.
It looks rather nice.
Their videos were carefully scripted, as would be expected. I'm sure the kitchen is a lot more hectic during a real meal time than what is shown.

[bada bing]

Quote:

Originally Posted by nwsteve Fortunately NOT! We are moving to a property near Tacoma, WA--Gig Harbor--Heron's Key. Edited to Add: I do think your observation is fair regarding staffing. Many years ago, I did executive search for the LTC industry--at that time the talent pool was pretty shallow. It took us a while to convince our client to start incorporating talent from the broader hospitality industry to bring some fresh blood into the industry.

Welcome to Heron's Key !

I moved my mother (86) into Heron's Key a little over a year ago. I visit there
about once a month to check up on her. She is very happy with the choice so
far. Our family are long time Gig Harbor residents, I graduated from high
school there, although I moved away shortly after. Gig Harbor has changed
enormously in 40 years.

If there are any questions you have about Heron's Key from a somewhat
objective 3rd party (me), I know a little about how the contractual stuff
works. After seeing the place, I have it (or a similar place) as a potential
option for myself when the time comes .

Perhaps you'll run into me sometime in Spinnakers or Siren's grill while I'm
visiting my mom. I'm a tall 6'4" ~60y.o., blond haired, blue collar looking sort
of fellow. If you see me around, say hi.

[PawPrint53]

Quote:

Originally Posted by nwsteve What we like is that with the type As we seen, both spouses do not have to move if only one has the need.

Friends moved into a CCC where they rented a house, but could then go into an apartment or assisted living as needed as is typical. However, included in the fine print was that if a person had two falls where assistance was needed, then that person had to go to assisted living while the other person stayed in the house. It was incredibly expensive maintaining the CCC home and having one person in assisted living. My friends moved because that wasn't something they could afford, especially since the husband had the onset of a dementia, and they knew that memory care would be needed in the future.

[nwsteve]

Quote:

Originally Posted by PawPrint53 Friends moved into a CCC where they rented a house, but could then go into an apartment or assisted living as needed as is typical. However, included in the fine print was that if a person had two falls where assistance was needed, then that person had to go to assisted living while the other person stayed in the house. It was incredibly expensive maintaining the CCC home and having one person in assisted living. My friends moved because that wasn't something they could afford, especially since the husband had the onset of a dementia, and they knew that memory care would be needed in the future.

This issue is one example where detail attention to a CCRC's docs is critical--not all CCRCs handle this event the same way. The CCRC we are headed for does not require you to pay for the additional space beyond the actual meals which is required by state to be served in Assisted/skilled nursing units. Suspect the property is not a Life Care (Type A) CCRC.

[youbet]

Quote:

Originally Posted by PawPrint53 Friends moved into a CCC where they rented a house, but could then go into an apartment or assisted living as needed as is typical. However, included in the fine print was that if a person had two falls where assistance was needed, then that person had to go to assisted living while the other person stayed in the house. It was incredibly expensive maintaining the CCC home and having one person in assisted living. My friends moved because that wasn't something they could afford, especially since the husband had the onset of a dementia, and they knew that memory care would be needed in the future.

As nwsteve said, it sounds as though the property your friends were living at was not a LifeCare facility. With a type A, LifeCare contract, the person needing full residential assistance would have moved to assisted living and the spouse would have stayed in the independent living home with the only increase in cost being for additional meals for the assisted living person.

It's complicated. Don't assume one CCRC is operating the same as another. Each type, A, B or C, has it's pros and cons. And there are differences within types. As mentioned earlier, DW and I are a bit dizzy from trying to understand all the ins and outs. We just had a couple of books delivered yesterday and are taking a brief time-out to read them before jumping into the frey again.

[Gearhead Jim]

A side note on a CCRC-


We went to the sales pitch at a big, fancy, and long time CCRC. We didn't want to move there but wanted the education from watching the spiel. The entrance costs were shockingly high when coupled with the monthly fee, but of course you are somewhat pre-paying for your future, so we thought.


Since we both have LTC insurance for 5 years with a high monthly payout, inflation adjusted, we figured that would get us a sizeable reduction in the costs at the CCRC if we assigned the insurance to them. The reduction they would provide was minimal, making the whole package a very poor deal.

[harllee]

The CCRC where we are on the waiting list (Type A Life Care) actively discourages those with long term care insurance from moving in (which suits us just fine since we do not have LTCI). The folks at the CCRC say that LTCi, all the red tape and the difficulty collecting is more trouble than it is worth in their opinion.

[ChrisC]

Another side note on a CCRC.

The CCRC we've been carefully reviewing would work exceptionally well with my LTCi, which covers 5 years with a 90 day waiting period. It also has equity ownership. https://www.thecypressofcharlotte.com/