How to decide on a CCRC

[bmcgonig]

Like the residents mentioned here: https://www.charlottemagazine.com/h...es-big-changes-within-retirement-communities/

Good article.

 

[harllee]

Don't wait too long to go into the CCRC! My DH and I have been on the wait list for our chosen CCRC for 10 years. We have finally gotten to the top of the list but DH (age 71) has recently developed a new health issue that may keep him from qualifying to move into the CCRC. All our plans may be down the drain.

 

[braumeister]

Don't wait too long to go into the CCRC! My DH and I have been on the wait list for our chosen CCRC for 10 years.

This is probably good advice. The ones at the top of my candidate list all have wait lists that go out from three to six years. And of course the wait list varies considerably depending on exactly what sort of accommodation you are looking for.

There are only so many of each floor plan, and it's impossible to predict when one will become available. I was visiting one and they had a wall covered with photos of their past residents who were centenarians!

 

[Time2re]

Don't wait too long to go into the CCRC! My DH and I have been on the wait list for our chosen CCRC for 10 years. We have finally gotten to the top of the list but DH (age 71) has recently developed a new health issue that may keep him from qualifying to move into the CCRC. All our plans may be down the drain.

This is the best advise of this entire thread! We are in the exact same situation, and don’t have a viable backup plan.

 

[ncbill]

With respect to LTCi and all the horror stories relayed on this site, I feel that by transferring that to the CCRC I will not have to argue as to whether I need extra care or not. I don’t 100% trust the LTCi companies to deliver, and don’t want to be negotiating with them when I’m 90 years old.

IIRC, a LTCi insurance person posted over on Bogleheads pointed out you have whatever home care service you hire file the paperwork for LTCi claims since they're familiar with the process.

 

[ChrisC]

What's the likelihood you'll need skilled nursing care?

When my last relative was dying from terminal cancer I moved her from a semi-private room on a custodial hall of a cross-town nursing home (very different from the Medicare rehab private room she was on earlier in the same facility) to a private room in an ALF just around the corner from my home.

She was already under Hospice care but was a while lot happier in the ALF.

At half the cost versus the nursing home.

In the context of this thread on CCRCs, you rather not immediately need skilled nursing care because that would likely be disqualifying for entry into most, if not all, CCRCs which require an ability to live independently without caregiver assistance for most activities of daily living. You rather be 5 years too early than 5 minutes late on your decision to enter a CCRC with the onset of a disabling condition.

But on your broader question of when you need skilled nursing care for long term custodial care, I think it depends on the level and type of impairment and the level of support family members, friends and other support groups can and are willing to provide to the impaired person. In our family, we have a 100 year old WWII veteran (served in Europe), with dementia, being taken care of by his 95 year old wife, at home, with tremendous daily assistance from the VA and nearby children to pitch in to help both of them (and those far away, visit for a month at a time) staying in the home. This WWII Veteran is functioning at a high level except for his dementia (and has a genial and happy demeanor). The toll on his wife has not been detrimental to her health, her faith and her outlook on life, but if she were to become absent from his care -- it's very likely he would require residence in an assisted living (and memory care unit) or in a skilled nursing facility -- no one else is capable of being the major family caregiver. We also know a 103 year old World War II Veteran (served in the Pacific) who until 10 years ago lived independently by himself 15 years after his spouse passed and who used to go around when he was fully lucid saying "I'm walking living history ... don't you want to talk to me. I survived Guadalcanal." Like the Vet in my family, the mind of this other Vet is completely gone from dementia but he is not high level functioning. His 70 year plus daughter and son-in-law home care him with tremendous assistance from the VA, but the toll on them is excruciating.

People can get by with home care or care in an assisted living facility for a very long time if the care is just for custodial purposes -- but dementia, Alzheimers, and other cognitive impairments, where the afflicted wanders around or poses a danger to himself or others, represents a risk that requires confinement and close supervision. Skilled nursing care might be the only practical avenue when one has aggravating impairments like incontinence in addition to eating or mobility issues that prevent high level functioning.

Right now, we have my BIL in an assisted living facility and he's been there for 5 years with MS; it might be a matter of a few years when this facility would not be suitable for him at higher levels of care, as his physical limitations and cognitive abilities become more impaired. Then again, his neighbor across the hall from him has MS, completely wheel-chair bound, and it's likely that her current unit will be her last living space.

 

[ncbill]

In the context of this thread on CCRCs, you rather not immediately need skilled nursing care because that would likely be disqualifying for entry into most, if not all, CCRCs which require an ability to live independently without caregiver assistance for most activities of daily living. You rather be 5 years too early than 5 minutes late on your decision to enter a CCRC with the onset of a disabling condition.

But on your broader question of when you need skilled nursing care for long term custodial care, I think it depends on the level and type of impairment and the level of support family members, friends and other support groups can and are willing to provide to the impaired person. In our family, we have a 100 year old WWII veteran (served in Europe), with dementia, being taken care of by his 95 year old wife, at home, with tremendous daily assistance from the VA and nearby children to pitch in to help both of them (and those far away, visit for a month at a time) staying in the home. This WWII Veteran is functioning at a high level except for his dementia (and has a genial and happy demeanor). The toll on his wife has not been detrimental to her health, her faith and her outlook on life, but if she were to become absent from his care -- it's very likely he would require residence in an assisted living (and memory care unit) or in a skilled nursing facility -- no one else is capable of being the major family caregiver. We also know a 103 year old World War II Veteran (served in the Pacific) who until 10 years ago lived independently by himself 15 years after his spouse passed and who used to go around when he was fully lucid saying "I'm walking living history ... don't you want to talk to me. I survived Guadalcanal." Like the Vet in my family, the mind of this other Vet is completely gone from dementia but he is not high level functioning. His 70 year plus daughter and son-in-law home care him with tremendous assistance from the VA, but the toll on them is excruciating.

People can get by with home care or care in an assisted living facility for a very long time if the care is just for custodial purposes -- but dementia, Alzheimers, and other cognitive impairments, where the afflicted wanders around or poses a danger to himself or others, represents a risk that requires confinement and close supervision. Skilled nursing care might be the only practical avenue when one has aggravating impairments like incontinence in addition to eating or mobility issues that prevent high level functioning.

Right now, we have my BIL in an assisted living facility and he's been there for 5 years with MS; it might be a matter of a few years when this facility would not be suitable for him at higher levels of care, as his physical limitations and cognitive abilities become more impaired. Then again, his neighbor across the hall from him has MS, completely wheel-chair bound, and it's likely that her current unit will be her last living space.

Most "memory care" places are simply locked ALFs.

My relative was so weakened by their terminal cancer the only thing they could do was to feed themselves...everything else required assistance from staff.

But even with paying for that level of assistance their private room in an ALF was half the cost of their previous semi-private skilled nursing bed.

The one I used said the only medical conditions they couldn't handle were continuous IV therapy & heavy-duty wound care (e.g. debridement of pressure sores)

So I don't see a need for skilled nursing care for nearly all of us.

And ALFs are more numerous & much more pleasant environments than any skilled nursing facility I've ever seen.

 

[ChrisC]

Most "memory care" places are simply locked ALFs.

My relative was so weakened by their terminal cancer the only thing they could do was to feed themselves...everything else required assistance from staff.

But even with paying for that level of assistance their private room in an ALF was half the cost of their previous semi-private skilled nursing bed.

The one I used said the only medical conditions they couldn't handle were continuous IV therapy & heavy-duty wound care (e.g. debridement of pressure sores)

So I don't see a need for skilled nursing care for nearly all of us.

And ALFs are more numerous & much more pleasant environments than any skilled nursing facility I've ever seen.

I think we're talking pass each other, where you're focusing on care that might be given to terminally ill people, instead of long term custodial care for people who are not terminally ill. I agree that most of us might not need skilled nursing care, which requires the presence of a registered nurse to care for residents and it's care short of requiring hospitalization for sustaining life systems.

The CCRCs I've seen have both assisted living rooms and skilled nursing beds all under one "health center wing," with the preponderance decidedly skewed towards nursing beds. And the differential in per diem cost between the two types is not very significant at these CCRC for "modified or Type B contracts. So, perhaps many of us will never need skilled nursing care, but it seems 10-15 percent of the population at CCRCs are in skilled nursing beds, which I assume these residents really need that care, especially those in Type A contracts, where the incentive for the CCRCs that have those contracts would be to keep residents in the independent living units or administer home care.

 

[ncbill]

I think we're talking pass each other, where you're focusing on care that might be given to terminally ill people, instead of long term custodial care for people who are not terminally ill. I agree that most of us might not need skilled nursing care, which requires the presence of a registered nurse to care for residents and it's care short of requiring hospitalization for sustaining life systems.

The CCRCs I've seen have both assisted living rooms and skilled nursing beds all under one "health center wing," with the preponderance decidedly skewed towards nursing beds. And the differential in per diem cost between the two types is not very significant at these CCRC for "modified or Type B contracts. So, perhaps many of us will never need skilled nursing care, but it seems 10-15 percent of the population at CCRCs are in skilled nursing beds, which I assume these residents really need that care, especially those in Type A contracts, where the incentive for the CCRCs that have those contracts would be to keep residents in the independent living units or administer home care.

OK, but even at the CCRCs I've seen their skilled nursing rooms have all been in an area segregated from independent/assisted living rooms.

Though CCRCs do have nicer (& often private) skilled care rooms versus stand-alone nursing homes where shared rooms are the rule.

Still cheaper to spend your remaining years in a private room at a (non-CCRC) ALF.

 

[braumeister]

As I've mentioned, I've been spending an enormous amount of effort lately trying to work out where I might like to go, and have whittled my initial list of seven places down to five now.

I'm already on the waiting list at two of them, and will probably go on the list at a couple more. Since they all have waiting lists that are years long, it's nothing that has to be done quickly, and all the application fees are fully refundable.

One interesting thing I've noticed that might be useful for others:

These are all CCRCs with Type A contracts (among others) and that is what I've focused on. Both the entrance fees and monthly fees are very different from one another and it's kind of confusing when you first look at them.

So I made a spreadsheet. What else would one of us do?
For each of the five CCRCs, I picked the most likely type of residence I would want, and put in the entrance fee and the monthly fee. Then I raised the monthly fee by a generous inflationary increase and worked out the total cost for a fifteen year stay.

Much to my surprise, they all came out to fairly similar totals. So I think that means you don't have to get too wrapped around the axle looking at the fees (which I was doing) because in the end there really isn't all that much difference. They just have different systems but for the customer the only significant part is how much you're willing to put up for the entrance fee.

I'm still at least a few years away from moving to one, but I think it's smart to learn as much as I can before making a final decision.

 

[MichaelB]

So I made a spreadsheet. What else would one of us do?
For each of the five CCRCs, I picked the most likely type of residence I would want, and put in the entrance fee and the monthly fee. Then I raised the monthly fee by a generous inflationary increase and worked out the total cost for a fifteen year stay.

Much to my surprise, they all came out to fairly similar totals. So I think that means you don't have to get too wrapped around the axle looking at the fees (which I was doing) because in the end there really isn't all that much difference. They just have different systems but for the customer the only significant part is how much you're willing to put up for the entrance fee.

I'm still at least a few years away from moving to one, but I think it's smart to learn as much as I can before making a final decision.

Interesting. So, they are like health insurance policies. Different combinations of premium, deductible and total out of of pocket, but ending up in the same cost ballpark.

 

[braumeister]

Interesting. So, they are like health insurance policies. Different combinations of premium, deductible and total out of of pocket, but ending up in the same cost ballpark.

Yes, I've always thought that a Type A contract included the equivalent of a LTC policy. I commented as such to one of them and the guy's face lit up and he said "Exactly!".

 

[nwsteve]

Yes, I've always thought that a Type A contract included the equivalent of a LTC policy. I commented as such to one of them and the guy's face lit up and he said "Exactly!".

+1
We are current CCRC residents and have been for 3 years so far. The prepaid LTC component is very much what sets Type A apart. During the 3 years we have been at our CCRC, the couples that have lost a spouse are universally thankful they had the support of community CCRC brings as well as the benefits of having an "all-in" environment for final care.

 

[davismills]

We're childless over planners and are scheduled to move into our CCRC apartment in late 2024. We took care of two parents for over 12 years and we've "seen the movie".

It's a 2-bedroom unit (1950 sq ft) with a study and a one car garage and is currently being built. The price was around 320K with monthly fees around $3800. We have put down 10 percent and the upfront cost is now fixed.

It's a modified type B contract with food being "pay as you go". The food thing was important as we both enjoy our own prepared meals and would probably not eat in the three restaurants anyway. The option is there, however, for the inevitable difficult times.

We toured 6 different communities and settled on this one for a number of reasons to include proximity to excellent healthcare (Duke University Hospital is 40 miles away) and the fact that North Carolina is where I was born with some extended family near us. We also like the fact that this community is closely bound to Elon University and the cultural that it provides.

It's not cheap by any means and I still grapple with our decision to go "ugly early". I'm 68 and the love of my life is 69.

 

[bmcgonig]

We're childless over planners and are scheduled to move into our CCRC apartment in late 2024. We took care of two parents for over 12 years and we've "seen the movie".

It's a 2-bedroom unit (1950 sq ft) with a study and a one car garage and is currently being built. The price was around 320K with monthly fees around $3800. We have put down 10 percent and the upfront cost is now fixed.

It's a modified type B contract with food being "pay as you go". The food thing was important as we both enjoy our own prepared meals and would probably not eat in the three restaurants anyway. The option is there, however, for the inevitable difficult times.

We toured 6 different communities and settled on this one for a number of reasons to include proximity to excellent healthcare (Duke University Hospital is 40 miles away) and the fact that North Carolina is where I was born with some extended family near us. We also like the fact that this community is closely bound to Elon University and the cultural that it provides.

It's not cheap by any means and I still grapple with our decision to go "ugly early". I'm 68 and the love of my life is 69.

Is this one in the process of being built? If so then probably a lot of ugly earlies along with you? I like that term [emoji16]

 

[braumeister]

I started this thread back in October and got lots of good input. You folks are great. I feel that I’ve finished the process now, so I thought I’d wind it up with a report.

I spent almost an entire year on my research. There are lots of sites that list CCRCs, but they all have certain biases so you should use as many sources as you can to find ones that are skipped in some of the lists. I found several dozen that looked interesting (all not for profit), narrowed that down to check out over a dozen online, and visited seven in person. Narrowed those down to my top four, and got on the waiting list at all four. They all have long waiting lists, generally in the 5-7 years range for the type of accommodation I want (which suits me fine). I think that speaks well for the quality of what they offer.

These are all extremely nice places IMO and I think any of them would be fine for “the rest of my life”.
One is Type A, two are Type B, and the fourth is kind of a hybrid A/B so that is certainly a difference. I made sure I could afford any of them.

A few takeaways from my searching:

• Look for a place that is big enough to offer the amenities and the community that you want. If it’s too small, it may be very nice but also very limited. I think it should have about 500 residents as a bare minimum, preferably many more. It should also offer the full range: independent, assisted, memory care, nursing care, etc.
  
  
• Talk to some of the people who live there. If they are enthusiastic about it and seem like folks you would like to associate with, then it should work for you.
  
  
• When considering location, I found two points to be important. What is the climate like, and how far to the nearest large city and airport. I knew I didn’t want to live too far north or too far south, because snow is a nuisance and I don't tolerate heat well. Most of the good places I found seemed to be too far south for my liking, and some were only near small cities with limited options. My final four are all in the right climate zone for me, and although widely separated from one another, I’m a military retiree and used to picking up and moving someplace new. They are anywhere from 31 to 66 miles from a major airport.
  
  
• It’s not hard to vet a CCRC’s viability, but you should certainly scrutinize their financial records carefully to avoid surprises down the line. Also get a copy of the contract you would sign when moving in.
  
  
• Do your own spreadsheet to figure out the finances, since they mostly quote their prices in some unique way. What I found is that when I looked at the total cost of entrance fee, monthly fee, extra fees, and what is included/excluded, the bottom line for 10-15 years total cost at any of them was not far from even, after adjusting for regional cost of living differences. So they are actually competitive with each other, but they present the costs differently.

I hope this summary will be useful for anyone considering this sort of thing.

 

[harllee]

Thanks for the update braumeister. DH and I are moving into a CCRC this summer, just a few miles from where we live now. It is a very nice nonprofit Type A. It is expensive, but to us it is worth it. We are in our early 70s and have been on the waiting list 10 years. DH has developed some health issues and we were concerned that he would not pass the health requirements but in the end he did. He had to meet personally with the medical director. The admissions process is stringent--financial statements, complete medical records, cognitive test and in DH's case an in person meeting with the health director. We are grateful we were accepted--we know several people who were rejected by this CCRC due to health problems.

 

[imnontrad]

Out of curiosity, is Falcons Landing near DC on your list? If so, what are your impressions of it?

 

[HarryHawk]

Looking forward to moving into our CCRC in June of 2024. The development is currently being built. It is already pretty much sold out. Our unit is a stand alone "cottage". The development also has duplexes and apartments. Will also have a memory care building on the campus.

It's nice that it will be an all new development from my perspective. All the neighbors will be new neighbors. To be honest, I'm not sure how I would feel about moving into a unit that had luckily became available because someone had just passed last week.

Only thing I'm not looking forward to is moving, we've been in our current house for over 40 years.

 

[Time2re]

Great info. We started our search just over a year ago, got on a 1 yr-18 month wait list. A perfect until came available early and we moved in March 1. Still getting settled. Learned so much here about ccrc, we are happy with our decision. Research is critical!

 

[bmcgonig]

I started this thread back in October and got lots of good input. You folks are great. I feel that I’ve finished the process now, so I thought I’d wind it up with a report.



I spent almost an entire year on my research. There are lots of sites that list CCRCs, but they all have certain biases so you should use as many sources as you can to find ones that are skipped in some of the lists. I found several dozen that looked interesting (all not for profit), narrowed that down to check out over a dozen online, and visited seven in person. Narrowed those down to my top four, and got on the waiting list at all four. They all have long waiting lists, generally in the 5-7 years range for the type of accommodation I want (which suits me fine). I think that speaks well for the quality of what they offer.



These are all extremely nice places IMO and I think any of them would be fine for “the rest of my life”.

One is Type A, two are Type B, and the fourth is kind of a hybrid A/B so that is certainly a difference. I made sure I could afford any of them.



A few takeaways from my searching:

• Look for a place that is big enough to offer the amenities and the community that you want. If it’s too small, it may be very nice but also very limited. I think it should have about 500 residents as a bare minimum, preferably many more. It should also offer the full range: independent, assisted, memory care, nursing care, etc.
  
  
  
  
  
• Talk to some of the people who live there. If they are enthusiastic about it and seem like folks you would like to associate with, then it should work for you.
  
  
  
  
  
• When considering location, I found two points to be important. What is the climate like, and how far to the nearest large city and airport. I knew I didn’t want to live too far north or too far south, because snow is a nuisance and I don't tolerate heat well. Most of the good places I found seemed to be too far south for my liking, and some were only near small cities with limited options. My final four are all in the right climate zone for me, and although widely separated from one another, I’m a military retiree and used to picking up and moving someplace new. They are anywhere from 31 to 66 miles from a major airport.
  
  
  
  
  
• It’s not hard to vet a CCRC’s viability, but you should certainly scrutinize their financial records carefully to avoid surprises down the line. Also get a copy of the contract you would sign when moving in.
  
  
  
  
  
• Do your own spreadsheet to figure out the finances, since they mostly quote their prices in some unique way. What I found is that when I looked at the total cost of entrance fee, monthly fee, extra fees, and what is included/excluded, the bottom line for 10-15 years total cost at any of them was not far from even, after adjusting for regional cost of living differences. So they are actually competitive with each other, but they present the costs differently.
  

I hope this summary will be useful for anyone considering this sort of thing.

Is Not For Profit necessarily better than For Profit. I think I read here once that there were pros and cons for both?

How do you go about assessing the financials? Just on your own or with professional help?

 

[braumeister]

Out of curiosity, is Falcons Landing near DC on your list? If so, what are your impressions of it?

It was on my initial list, but didn't make the short list. Too many negatives for that area for me. I lived not far a long time ago and didn't like it much then either!

 

[braumeister]

Is Not For Profit necessarily better than For Profit. I think I read here once that there were pros and cons for both?

I'm not familiar with those arguments.

How do you go about assessing the financials? Just on your own or with professional help?

You can ask the facility for their financials, but in most cases I was able to find them on a national or state website. It's not hard to read through them and understand their financial health.

 

[bmcgonig]

You can ask the facility for their financials, but in most cases I was able to find them on a national or state website. It's not hard to read through them and understand their financial health.

What about not-for-profit versus for-profit?

Thanks

 

[Scuba]

I started this thread back in October and got lots of good input. You folks are great. I feel that I’ve finished the process now, so I thought I’d wind it up with a report.



I spent almost an entire year on my research. There are lots of sites that list CCRCs, but they all have certain biases so you should use as many sources as you can to find ones that are skipped in some of the lists. I found several dozen that looked interesting (all not for profit), narrowed that down to check out over a dozen online, and visited seven in person. Narrowed those down to my top four, and got on the waiting list at all four. They all have long waiting lists, generally in the 5-7 years range for the type of accommodation I want (which suits me fine). I think that speaks well for the quality of what they offer.



These are all extremely nice places IMO and I think any of them would be fine for “the rest of my life”.

One is Type A, two are Type B, and the fourth is kind of a hybrid A/B so that is certainly a difference. I made sure I could afford any of them.



A few takeaways from my searching:

• Look for a place that is big enough to offer the amenities and the community that you want. If it’s too small, it may be very nice but also very limited. I think it should have about 500 residents as a bare minimum, preferably many more. It should also offer the full range: independent, assisted, memory care, nursing care, etc.
  
  
  
  
  
• Talk to some of the people who live there. If they are enthusiastic about it and seem like folks you would like to associate with, then it should work for you.
  
  
  
  
  
• When considering location, I found two points to be important. What is the climate like, and how far to the nearest large city and airport. I knew I didn’t want to live too far north or too far south, because snow is a nuisance and I don't tolerate heat well. Most of the good places I found seemed to be too far south for my liking, and some were only near small cities with limited options. My final four are all in the right climate zone for me, and although widely separated from one another, I’m a military retiree and used to picking up and moving someplace new. They are anywhere from 31 to 66 miles from a major airport.
  
  
  
  
  
• It’s not hard to vet a CCRC’s viability, but you should certainly scrutinize their financial records carefully to avoid surprises down the line. Also get a copy of the contract you would sign when moving in.
  
  
  
  
  
• Do your own spreadsheet to figure out the finances, since they mostly quote their prices in some unique way. What I found is that when I looked at the total cost of entrance fee, monthly fee, extra fees, and what is included/excluded, the bottom line for 10-15 years total cost at any of them was not far from even, after adjusting for regional cost of living differences. So they are actually competitive with each other, but they present the costs differently.
  

I hope this summary will be useful for anyone considering this sort of thing.

Excellent post. Thanks for sharing,