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Ccrc--good bad and ?
Old 03-27-2017, 09:11 PM   #1
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Ccrc--good bad and ?

Based on a suggestion in the current LTC thread and personal need to hear a robust discussion regarding the "wisdom" of using CCRC, here is the thread for all the variables to be hopefully debated.

We have been in the research stage for a while but still at least 5 years out from making a move. We have toured 3 properties and talked to at least four CCRCs. Most are Type A contracts, so called "life care" which involve an upfront fee and then an ongoing monthly "use fee") pretty comparable to what you would pay for rent and living expenses). All but the newest CCRC offer a reservation on their wait list 1000-2000 mostly refundable. We are seriously looking to pursue this choice once we settle on the choice. Our leading property currently has a 3 year wait list. (btw there is no penalty to passing a turn and waiting for just the right unit. One property shared a story where one client was 92 and still was waiting until got a "bit older".

We have seen properties which provide up to a 100% refund of the Entrance Fee but with a very steep premium over what they called a "Traditional Plan" which any refund is a prorate declining amount going to 0 refund after 5 year. For a 2 bedroom 1100 sq ft cottage, entrance fee min is 455K, plus monthly 5100 for a couple. What you get for that is a facility on a large campus in a urban Puget Sound area which includes large pool and workout facility as well as $600/month for use in any of the 3 dining options onsite.
If you should have to move from Independent living to Asst Living or Skill nursing your costs do not change except for a relatively small bump for the three meals served. Plus one partner that does not move has no bump in expense. This ability to move up the nursing care spectrum option at no additional cost is the biggest selling point for "Life Care". Because Life Care properties are deemed to provide "prepaid" medical, you are also able to deduct as medical expense 33-45% of monthly expenses.

Most of the properties we have checked out are in King Co, WA (Seattle). The one CCRC we checked out in Spokane was much less but was a Type B. it was not only less expensive, it also included 10 days/month in the Skill Nursing unit without any additional charge (Medicare will pay the full excess think recovery after a joint replacement).

Only problem is DW wants any living choice at this stage of life be located to be convenient to DD and DGKs, So we many need to be on Westside--Yucck.

Here is an article from NY Times that covers some of the challenge points--https://newoldage.blogs.nytimes.com/2009/12/03ccrc-fees-prepare-to-be-bewildered/?_r=2

Like many choices in retirement, besides the money, the right answer is very dependent on life choice variables, where do you want to live, how large of a unit, do you want any of the entrance fee refundable to heirs and if so how much.
I have found in my research a great FAQ style of CCRC appraisal but I need to find which computer I saved it.
Looking forward to hearing insights from others who are looking at the CCRC option
Nwsteve
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Old 03-28-2017, 12:25 AM   #2
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I am also considering CCRC for a lifestyle choice. I may be a few years behind you in considering the options, but would love to see any research you care to share. My Grandmother belonged to a CCRC in Florida but decided to move back the the Chicago area when she was older, so left that one and bought into one in Chicago. I don't know how that transfer worked, but she was very happy at both places. Much easier to get family to visit in Chicago, but plenty of social life in both places. She went to assisted living and back to independent living several times and really appreciated that it was all one unified experience.
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Old 03-28-2017, 09:11 AM   #3
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Curious approximate age people are starting to get serious about this kind of transition in living arrangements?

Obviously it varies based upon personal physical make up.

One of the lessons I learned from my parents was that You need to be ahead of the curve on this process. Something they were not, which left it to their children to do.
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Old 03-28-2017, 09:38 AM   #4
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My parents, father now 97, mother passed away at 89, live in a CCRC. I've watched them enjoy this type of living for years and seen the amenities. I am almost 67 and have been on a "list" at a CCRC 60 miles from my home for 17 months. Most other people on the list are older than I. I'm still waiting for a certain apartment configuration, but have been called to see 2 apartments which I refused. All apartments , when vacated, are fully remodeled to current styles, before a new resident moves in. There is the initial fee (buy in) plus a monthly "maintenance " fee according to the square fee of the apartment. Included in the maintenance fee is one meal (either lunch or supper) daily, cleaning every 2 months, gym, libraries (2), transportation to local grocery, pharmacy, mall etc. Affiliated with the 2 local universities who come in and provide plays, music programs, educational seminars etc. Too many things to list. I'm very happy with my choice.
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Old 03-28-2017, 10:56 AM   #5
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Curious approximate age people are starting to get serious about this kind of transition in living arrangements?

Obviously it varies based upon personal physical make up.

One of the lessons I learned from my parents was that You need to be ahead of the curve on this process. Something they were not, which left it to their children to do.
Of the properties we have checked out so far, average entry age is 75-76. Overall population average age depends on how new the property is--the older the property, the higher the average age. At the most "mature" property we checked out average age was near 80. At a presentation given by this location, they made a comment that residents are living longer than anytime in the history of the location.

Well managed properties are an actuary's dream. Size of entry fee, refund options, mix of Assisted Living, Skill Nursing, operating effectiveness and size of reserves being carried are just a few of the variables.
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Old 03-28-2017, 11:06 AM   #6
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You don't say how old you and your DW will be in 5 years.

My BIL and SIL are both 65 and moved into a nice CCRC with a reasonable buy-in. The downside is that they are so much younger than all the other residents and my BIL thinks it was too early. He's so bored that he built a woodshop behind his house so he will have something to do. Most of his neighbors are home bound or getting custodial care. The most 'happening' place at the facility is the dog park.
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Old 03-28-2017, 11:15 AM   #7
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Okay, found the link to an excellent white paper on the CCRC living--put out by American Senior housing organization.

https://www.seniorshousing.org/filep...whitepaper.pdf

This actually links to a pdf so it may take a while to load. Warming it is long and uses a FAQ style of covering the topic. Suggest a quick scan for the FAQ that best suits your interest.
Nwsteve
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Old 03-28-2017, 12:05 PM   #8
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At the most "mature" property we checked out average age was near 80. At a presentation given by this location, they made a comment that residents are living longer than anytime in the history of the location.

Well managed properties are an actuary's dream. Size of entry fee, refund options, mix of Assisted Living, Skill Nursing, operating effectiveness and size of reserves being carried are just a few of the variables.
I'm a retired actuary (Property-Casualty, not Life, but still understand basic Life concepts) and I'm not surprised that residents are living longer. First, only people who expect a lengthy old age buy into a CCRC. Second, they're getting 3 squares a day, social interaction, maybe exercise classes, etc. so their quality of life is improved. It's scary because one of the variables that goes into calculations on financial viability is an assumption on the extent of new entry fees, which can happen only when someone vacates their unit, either through death or permanent transfer to the skilled nursing facility. If the entry fees were set at an inadequate level in the first place, the CCRC's finances could become shaky. Finances could also be jeopardized if people in the skilled nursing facility lived longer than anticipated.

I'm still leaning towards an Assisted Living type place, then making a decision on Skilled Nursing Facilities only if it actually gets to the point that I need one.
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Old 03-28-2017, 12:09 PM   #9
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I'm still leaning towards an Assisted Living type place, then making a decision on Skilled Nursing Facilities only if it actually gets to the point that I need one.


What's your reasoning behind this inclination?
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Old 03-28-2017, 12:12 PM   #10
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Originally Posted by nwsteve View Post
Okay, found the link to an excellent white paper on the CCRC living--put out by American Senior housing organization.

https://www.seniorshousing.org/filep...whitepaper.pdf

This actually links to a pdf so it may take a while to load. Warming it is long and uses a FAQ style of covering the topic. Suggest a quick scan for the FAQ that best suits your interest.
Nwsteve
That was an interesting read.
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Old 03-28-2017, 02:14 PM   #11
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Originally Posted by nwsteve View Post
Based on a suggestion in the current LTC thread and personal need to hear a robust discussion regarding the "wisdom" of using CCRC, here is the thread for all the variables to be hopefully debated.

We have been in the research stage for a while but still at least 5 years out from making a move. We have toured 3 properties and talked to at least four CCRCs. Most are Type A contracts, so called "life care" which involve an upfront fee and then an ongoing monthly "use fee") pretty comparable to what you would pay for rent and living expenses). All but the newest CCRC offer a reservation on their wait list 1000-2000 mostly refundable. We are seriously looking to pursue this choice once we settle on the choice. Our leading property currently has a 3 year wait list. (btw there is no penalty to passing a turn and waiting for just the right unit. One property shared a story where one client was 92 and still was waiting until got a "bit older".

We have seen properties which provide up to a 100% refund of the Entrance Fee but with a very steep premium over what they called a "Traditional Plan" which any refund is a prorate declining amount going to 0 refund after 5 year. For a 2 bedroom 1100 sq ft cottage, entrance fee min is 455K, plus monthly 5100 for a couple. What you get for that is a facility on a large campus in a urban Puget Sound area which includes large pool and workout facility as well as $600/month for use in any of the 3 dining options onsite.
If you should have to move from Independent living to Asst Living or Skill nursing your costs do not change except for a relatively small bump for the three meals served. Plus one partner that does not move has no bump in expense. This ability to move up the nursing care spectrum option at no additional cost is the biggest selling point for "Life Care". Because Life Care properties are deemed to provide "prepaid" medical, you are also able to deduct as medical expense 33-45% of monthly expenses.
...
Nwsteve
So the cost could be interpreted as 5100 x 12 = $61,200 plus 455k * .04 = $18,200 for a total minimum expense of $79,400 per year and they get to keep your $455k when you die. I think the assisted care facility I would look into first is not more than that and I would enter at a later time which would suit me. I also would not have to fork over the $455k which would suit my heirs. I am not saying one is better than the other. It would be a personal decision depending on what you want.
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Old 03-28-2017, 02:15 PM   #12
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Can anyone explain to me how owning a LTC policy (I do) works with a CCRC? If you move into the "independent" living of a CCRC, does the LTC kick in? Or, once you need to move from the "independent" side of the CCRC to the "assisted" side, does it then kick in?
My questions are basic because I haven't investigated this yet. I think when I retire in a number of years I'll get serious about putting a deposit down somewhere. Thanks.
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Old 03-28-2017, 02:18 PM   #13
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Can anyone explain to me how owning a LTC policy (I do) works with a CCRC? If you move into the "independent" living of a CCRC, does the LTC kick in? Or, once you need to move from the "independent" side of the CCRC to the "assisted" side, does it then kick in?
My questions are basic because I haven't investigated this yet. I think when I retire in a number of years I'll get serious about putting a deposit down somewhere. Thanks.
As I understand LTC insurance, to qualify you will need assistance to carry out a minimum number of "activities of daily living". Nords documents well the battle he had with the insurer over his father's situation. Nords prevailed, but it was a battle.
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Old 03-28-2017, 02:32 PM   #14
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One can only imagine the battle when one is on one's own, without a Nords to act as advocate.

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As I understand LTC insurance, to qualify you will need assistance to carry out a minimum number of "activities of daily living". Nords documents well the battle he had with the insurer over his father's situation. Nords prevailed, but it was a battle.
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Old 03-28-2017, 02:38 PM   #15
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So the cost could be interpreted as 5100 x 12 = $61,200 plus 455k * .04 = $18,200 for a total minimum expense of $79,400 per year and they get to keep your $455k when you die. I think the assisted care facility I would look into first is not more than that and I would enter at a later time which would suit me. I also would not have to fork over the $455k which would suit my heirs. I am not saying one is better than the other. It would be a personal decision depending on what you want.
In my experience, assisted living facilities have a fairly narrow range of "assistance", so in additional to your personal decision the ability to be accepted into and stay in an assisted living depends upon your cognitive and physical capabilities.

Many/most assisted living facilities have lower rates because they do not employ any licensed staff. This means you need to be able to assume 100% responsibility for taking any medications you require because the staff cannot administer meds. There may or may not be any PT/OT/speech staff, but they may transport you to a facility to receive those services and then you wait for 3-5 hours to be picked up to return "home'.

If you are believed to be a fall risk (falling just one time may be enough) they can force you to be discharged because their risk management department doesn't want the liability of a fracture from a fall. The next step is a skilled nursing facility.

The larger AL facilities may have an activities director providing some distraction group activities, but many of the smaller AL's do not. Watching TV and hoping the local library truck drops off some new books is about all there is.

I have experienced two AL's facilities as described while helping family members. They provided meals and a room....very little else. Sometimes some help with bathing and/or a shower. I'm sure there are several levels of AL's like everything else, but they are going to be costly.

We have decided to enter a CCRC around age 75yrs (10 years from now) and are planning for that.
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Old 03-28-2017, 02:41 PM   #16
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Can anyone explain to me how owning a LTC policy (I do) works with a CCRC? If you move into the "independent" living of a CCRC, does the LTC kick in? Or, once you need to move from the "independent" side of the CCRC to the "assisted" side, does it then kick in?
It depends on the contract with that CCRC. As described, some have "level expenses" no matter the level of care from independent living to full-blown nursing care.

Others, like the one my mother was in and later FIL in a different one, charged according to the level of care, if any, that the resident receives. So the independent living houses/apartments were cheapest, assisted living considerably more, and full nursing care the most expensive. My mother went from ~11 years of independent living to six months of assisted living, and had resources to pay for about ten years of that and perhaps three or four of full nursing care, but never went beyond assisted living. FIL spent one day in independent living and ~10 months in full nursing care, at between $9k and $14k per month.

One key thing to watch out for with the latter arrangement is "What happens if my funds are exhausted on nursing care?" Many places use the aggregate entrance fees to pay for that and will accept whatever Medicaid pays, and things go on as before. This was the arrangement where my mother and FIL were staying but the entrance fee or monthly rent is significant. He didn't have an entrance fee but did have to show that he had the resources to pay for two years of assisted living/nursing care. I forget the exact formula.

Others will not accept Medicaid and will "kick the patient to the curb" or more accurately place them in one of those dismal places where they will accept what Medicaid pays. That might be thousands of miles away.

I recently turned 67, DW is 60, and we've been on a waiting list for about three years now since shortly after FIL passed. I don't expect to actually move for perhaps 5-8 years since they really don't want you there before age 70 and in fact there is an extra charge per year for anyone under that age.

We continue to look around at other options from time to time.
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Old 03-28-2017, 02:43 PM   #17
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What's your reasoning behind this inclination (choosing nursing home when/if needed)?

First, I may not need it. DH died at 78 of leukemia and was really sick only the last 2 months. Mother died at 85, metastatic cancer, also at home with hospice care. Dad is 86, still mentally alert and decent physical shape.

Second- in a CCRC you pay more in reliance on the promise of skilled nursing care when you need it, which may be 20 years hence. I'd prefer to save my money and choose what works best if I get to that point.
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Old 03-28-2017, 02:47 PM   #18
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As I understand LTC insurance, to qualify you will need assistance to carry out a minimum number of "activities of daily living". Nords documents well the battle he had with the insurer over his father's situation. Nords prevailed, but it was a battle.


Don't have, nor will we buy, LTC insurance. My experience, with both of my parents, however, was that dealing with MetLife for their LTC insurance was a piece of cake. The biggest hassle was just having to re-certify the facility every year.

In the case of my parents, it was one of their best financial "investments"... sadly.
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Old 03-28-2017, 02:53 PM   #19
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Based on your description, one wonders what is the point.

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In my experience, assisted living facilities have a fairly narrow range of "assistance"...

Many/most assisted living facilities have lower rates because they do not employ any licensed staff. This means you need to be able to assume 100% responsibility for taking any medications you require because the staff cannot administer meds. There may or may not be any PT/OT/speech staff, but they may transport you to a facility to receive those services and then you wait for 3-5 hours to be picked up to return "home'.

If you are believed to be a fall risk (falling just one time may be enough) they can force you to be discharged because their risk management department doesn't want the liability of a fracture from a fall. The next step is a skilled nursing facility.

The larger AL facilities may have an activities director providing some distraction group activities, but many of the smaller AL's do not. Watching TV and hoping the local library truck drops off some new books is about all there is.

I have experienced two AL's facilities as described while helping family members. They provided meals and a room....very little else. Sometimes some help with bathing and/or a shower. I'm sure there are several levels of AL's like everything else, but they are going to be costly.

.
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Ccrc--good bad and ?
Old 03-28-2017, 03:05 PM   #20
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Ccrc--good bad and ?

Quote:
Originally Posted by Silver View Post
In my experience, assisted living facilities have a fairly narrow range of "assistance", so in additional to your personal decision the ability to be accepted into and stay in an assisted living depends upon your cognitive and physical capabilities.

Many/most assisted living facilities have lower rates because they do not employ any licensed staff. This means you need to be able to assume 100% responsibility for taking any medications you require because the staff cannot administer meds. There may or may not be any PT/OT/speech staff, but they may transport you to a facility to receive those services and then you wait for 3-5 hours to be picked up to return "home'.

If you are believed to be a fall risk (falling just one time may be enough) they can force you to be discharged because their risk management department doesn't want the liability of a fracture from a fall. The next step is a skilled nursing facility.

The larger AL facilities may have an activities director providing some distraction group activities, but many of the smaller AL's do not. Watching TV and hoping the local library truck drops off some new books is about all there is.

I have experienced two AL's facilities as described while helping family members. They provided meals and a room....very little else. Sometimes some help with bathing and/or a shower. I'm sure there are several levels of AL's like everything else, but they are going to be costly.

We have decided to enter a CCRC around age 75yrs (10 years from now) and are planning for that.


My experience was the exact opposite with the AL facility my parents lived in (mom four years/ dad seven years). They handled meds, there was a nurse (several) on duty, lots of activities, assisted bathing. Now you paid extra for meds help or bathing assistance for example. There were three levels of care, with varying costs, based upon how much assistance you needed.

As to falling risk, it was again not an issue at all beyond the facility protocol, no matter nature of fall, to send the patient to the hospital to be checked out. (Don't ask how I know... too many times.)

Facility was initially Brighton Gardens and then the location was Sunrise: and the policies didn't change. Indeed, both had a philosophy of aging in place and were not quick to ask people to leave, which was very important to me.
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