Moved into CCRC today

[braumeister]

- Almost everyone wants to “age in place” as a first choice but, almost none of us have the financial resources to do so in circumstances that involve a long, slow decline, which is the scenario for which most of us are trying to plan.

Another point that I feel is often neglected by those calculating a cost/benefit ratio is that some of us have no dependents, so no need to leave a legacy. To my mind that argues in favor of a Type A CCRC, assuming you can handle the cost.

I certainly understand those who have other viewpoints, but in the past year I have spoken with a couple of people in their 90s who have been living in their CCRCs for decades, and are absolutely delighted with their lifestyle. For some, it's a great decision.

 

[RetiredHappy]

For those of you counting on Long Term Care Insurance--I am battling my mothers long term care insurance company right now and so far I am losing. Mother is in her 90s, has dementia and heart failure, has caretakers several times a day and needs to move to memory care but her long term insurance company is dragging their feet and refusing to pay. i have spend many hours on this and am probably going to have to hire a lawyer who specializes on this. I have another thread on this issue.

It is possible to pay in more on long term care insurance than you will get in return--my mother has. She has had the policy for about 40 years. The policy only pays $250 a day for 3 years. Her premiums have skyrocketed and she has now paid in more for premiums than the policy will ever pay out.

My mother is in a nice CCRC but unfortunately it is not a Class A Lifecare CCRC, it is the pay as you go type of CCRC so I need to get the LTC policy to pay so she can move into memory care. I am at my wit's end.

I hear you and I remember your thread. In the 8 years that we had our business, there was not a client of ours who had not been successful in getting the LTCI pay for their care. They have specific requirements, 2 ADLs, a completed Plan of Care by a care manager specifying the ADLs that are required for assistance etc. A doctor's letter and a couple of items. I do feel that in your mother's case, the CCRC has not been helpful in getting the claims to come through. I think someone else has suggested a possible problem with your mother's case as the LTCI being in your father's name as the primary holder and filed under his name. I don't know but it is unusual from our experience.

 

[ChrisC]

Just a few comments (IMHO) on posts above:

- Discussions about CCRCs, LTCI, etc are really discussions about how to manage the last phase of our lives; specifically, how we guard against asset depletion and ending up in a sad, terrible Medicaid facility or worse.

- Almost everyone wants to “age in place” as a first choice but, almost none of us have the financial resources to do so in circumstances that involve a long, slow decline, which is the scenario for which most of us are trying to plan.

- With rare exception, LTC insurance is not really “insurance”; it’s a rebate of your premiums after you satisfy the insurance company’s ADL requirements. So, comparing it to a CCRC (Type A) Life Care contract is marginally useful.

- There is no ‘free lunch’ on this issue. We either pay in advance: 1, Life Care contract, which also comes with a bit of risk; 2. LTCI, which prepays for a few years of care but, is basically getting your own money back; or, 3. Go naked and hope for a short morbidity before death.

BTW, if you check the ‘sticky posts’, you’ll see that I’m a CCRC advocate. But, that’s largely because it fits our situation. YMMV.

I think you distort a few issues here. Disclaimer: I have LTCi, waitlisted on two CCRCs, and can easily age in place given our financial resources and in a home that was customized for a disabled child and perfect for aging seniors, with 2 bedrooms on the ground floor, wheelchair accessibility to every corner of the house, an elevator, zero entry in-ground pool, ramps or lifts to enter every access point, and, in fact, for several months we accomodated my disabled MIL and BIL in our home.

First, Medicaid facilities are not all terrrible. Some are, and some aren't. I know first hand from having my mother in a Medicaid facility for 11 years; and many Medicaid facilities are private-pay first and Medicaid admit later when it becomes unaffordable for the resident to private pay (i.e. you run out of money and become impoverished.) Right now, we're looking for a skilled nursing facility in our area for BIL and the best one is a Medicaid facility with a restricted number of Medicaid beds, but most beds are private pay. And the difference in treatment is that private pay affords you more privacy -- semi-private room residence.

Second, if you have the resources to take up space in a CCRC you'll likely be able to age in place. If you have LTCi, you're likely in a better position to age in place at home if your LTCi covers home care, as does mine.

Third, LTCi is insurance; comparing it to a CCRC-Type A appears legitimate, as this major CCRC does (at least in Matthews, NC) when offering Type A contracts, and Type B and C contracts with discounts for LTCi: https://www.actsretirement.org/. And BTW, my LTCi works well with the Type B or C contracts.

 

[harllee]

I hear you and I remember your thread. In the 8 years that we had our business, there was not a client of ours who had not been successful in getting the LTCI pay for their care. They have specific requirements, 2 ADLs, a completed Plan of Care by a care manager specifying the ADLs that are required for assistance etc. A doctor's letter and a couple of items. I do feel that in your mother's case, the CCRC has not been helpful in getting the claims to come through. I think someone else has suggested a possible problem with your mother's case as the LTCI being in your father's name as the primary holder and filed under his name. I don't know but it is unusual from our experience.

I have quit working on mother's LTC insurance for the last 6 weeks while I moved into the CCRC. I need to get back on it. I "think" the company has finally admitted she is an insured after months of going back and forth. Now they keep losing my faxed POA, losing the faxed doctor's letter, losing the faxed information sent by the CCRC etc. In my opinion they are stalling in the hope mother will die or I will give up.

 

[Huston55]

I think you distort a few issues here. Disclaimer: I have LTCi, waitlisted on two CCRCs, and can easily age in place given our financial resources and in a home that was customized for a disabled child and perfect for aging seniors, with 2 bedrooms on the ground floor, wheelchair accessibility to every corner of the house, an elevator, zero entry in-ground pool, ramps or lifts to enter every access point, and, in fact, for several months we accomodated my disabled MIL and BIL in our home.

It seems we agree on this part of my post: "Discussions about CCRCs, LTCI, etc are really discussions about how to manage the last phase of our lives; specifically, how we guard against asset depletion..."

No distortion intended; it's simply my view on how to address the basic issue. I prefer the CCRC approach because it's a better way to address the tail risk that is financially catastrophic to most of us.

I applaud that you've clearly planned for this stage of life (you have LTCI, intend to enter a CCRC, and have a home that provides physical access). However, that's a very different thing than having "the financial resources to do so [age in place] in circumstances that involve a long, slow decline." The cost of bringing AL or SN care to your home, which is what would be required, goes well beyond modifying one's home and dwarfs the already high cost of an AL or SN facility. For example, my neighbor's husband (mid 70s) had a stroke 7 yrs ago; very common since cardio-vascular disease is our #1 killer. He's still there mentally and has decent quality of life but, requires a wheelchair and needs continuous home care. The cost for that is 3-4 times the monthly cost of a SN facility here (ie: $30-40k/month). I live in California but, the ratios will be the same wherever one lives. Fortunately, they are very well off and can afford "home care". But, I certainly couldn't, nor could the vast majority of those on this forum.

First, Medicaid facilities are not all terrrible. Some are, and some aren't. I know first hand from having my mother in a Medicaid facility for 11 years; and many Medicaid facilities are private-pay first and Medicaid admit later when it becomes unaffordable for the resident to private pay (i.e. you run out of money and become impoverished.) Right now, we're looking for a skilled nursing facility in our area for BIL and the best one is a Medicaid facility with a restricted number of Medicaid beds, but most beds are private pay. And the difference in treatment is that private pay affords you more privacy -- semi-private room residence.

You're correct that not all Medicaid facilities are terrible. My DM was in one for the last few years of her life, and it was adequate. BTW, that was after DM tried to "age in place" with a home health worker, in a single level mobility-adapted home, followed by my DS/BIL trying to care for her at their house; neither worked well or for very long. My real point here is that I think we all want to be able to 'choose' where we are; I know I do. And, I want to do my best to make those choices in a way that does not involve asset depletion, which is required for Medicaid.

Second, if you have the resources to take up space in a CCRC you'll likely be able to age in place. If you have LTCi, you're likely in a better position to age in place at home if your LTCi covers home care, as does mine.

Absolutely incorrect. The cost of "aging in place" dwarfs the cost of living in an AL or SK facility. See above.

Third, LTCi is insurance; comparing it to a CCRC-Type A appears legitimate, as this major CCRC does (at least in Matthews, NC) when offering Type A contracts, and Type B and C contracts with discounts for LTCi: https://www.actsretirement.org/. And BTW, my LTCi works well with the Type B or C contracts.

I'm not sure I understand the point here. I viewed the website, and it really doesn't tell me much. Perhaps you can expand. What I do know is that a CCRC will be thrilled that a prospective resident has LTCI; just like they'll be thrilled that one has other sources of income (SS, pensions, great primary & secondary health care, etc.). That makes you a lower risk prospect and, frankly, deserves some level of discount.

 

[Alex The Great]

So far as it looks to me CCRC would experience the same issues as LTCI. The cost of care is rising and someone have to pay for it. It looks like CCRC charge some money in advance and if you are lucky these money will substitute that loss. But if not who is going to pay the rest? Someone must otherwise CCRC will go bankrupt.
As regarding Type A facilities: I wonder how do you know which type of contract they offer? I did some brief research on web and only a few actually reveal what do they actually have. Others just have the usual sales articles, may be some pricing and that's it. Are there at least some indicators to suspect this is really Type A facility?

 

[braumeister]

As regarding Type A facilities: I wonder how do you know which type of contract they offer?

You simply ask. Every one I've talked with (quite a number in the last year or so) was very up front about it.

 

[harllee]

So far as it looks to me CCRC would experience the same issues as LTCI. The cost of care is rising and someone have to pay for it. It looks like CCRC charge some money in advance and if you are lucky these money will substitute that loss. But if not who is going to pay the rest? Someone must otherwise CCRC will go bankrupt.
As regarding Type A facilities: I wonder how do you know which type of contract they offer? I did some brief research on web and only a few actually reveal what do they actually have. Others just have the usual sales articles, may be some pricing and that's it. Are there at least some indicators to suspect this is really Type A facility?

As I am finding out with my mother's Long term care insurance a major problem is getting the LTCI to pay. Mother's insurance company is giving me the run around (claiming they can't find her policy, losing faxes I send them, denying coverage etc). When you are in your 90s who is going to be able to spend all the hours and hours required to get the company to pay up?

 

[ChrisC]

I applaud that you've clearly planned for this stage of life (you have LTCI, intend to enter a CCRC, and have a home that provides physical access). However, that's a very different thing than having "the financial resources to do so [age in place] in circumstances that involve a long, slow decline." The cost of bringing AL or SN care to your home, which is what would be required, goes well beyond modifying one's home and dwarfs the already high cost of an AL or SN facility. For example, my neighbor's husband (mid 70s) had a stroke 7 yrs ago; very common since cardio-vascular disease is our #1 killer. He's still there mentally and has decent quality of life but, requires a wheelchair and needs continuous home care. The cost for that is 3-4 times the monthly cost of a SN facility here (ie: $30-40k/month). I live in California but, the ratios will be the same wherever one lives. Fortunately, they are very well off and can afford "home care". But, I certainly couldn't, nor could the vast majority of those on this forum.

I can assure you we have financial resources to cover $30-40K per month of skilled nursing care at home for at least 20 years without impoverishing ourselves. It helps to have pensions and social security (COLA protected) that throw off $17.5K monhly income, a sizeable investment and retirement portfolio, in which we could draw down, and the cost of a significant portion would be medically deductible. But this is, quite obviously, at the extreme and North Carolina where I live is much cheaper than CA where you live.This is also beside the point -- not many, including me, want to have a mini-hospital, skilled nursing facility in their home for 20 years; the likely case is that if your really need skilled nursing, you're going to outsource that to the facility for residency and medical/long term care. If you're a couple, the idea of having a mini-hospital in your home, except for stupid, ultra high net worth people with $50million plus net worth, seems insane.

Absolutely incorrect. The cost of "aging in place" dwarfs the cost of living in an AL or SK facility. See above.

See above.

I'm not sure I understand the point here. I viewed the website, and it really doesn't tell me much. Perhaps you can expand. What I do know is that a CCRC will be thrilled that a prospective resident has LTCI; just like they'll be thrilled that one has other sources of income (SS, pensions, great primary & secondary health care, etc.). That makes you a lower risk prospect and, frankly, deserves some level if discount.

The point here is that some CCRCs, if you were to drill deeper in the pricing provided for the Matthews Glen CCRC in this network of CCRCs linked in that website, you'll see that it prices Type A coverage (which provides the all inclusive package of LTC) and modifed Tyoe B and C coverages, with or without LTCi -- these distinctions show the value it places on LTCi and what it risk adjusts for the potential of the CCRC being on the hook for LTC.

Look at the consolidated audited financial statements of the Acts Retirement-Life Communities, where there is an actuarial basis and assumptions for costing out long term care expenses that the CCRC will incur -- this is the same exercise that insurance underwriters would do for LTCi.

 

[Huston55]

So far as it looks to me CCRC would experience the same issues as LTCI. The cost of care is rising and someone have to pay for it. It looks like CCRC charge some money in advance and if you are lucky these money will substitute that loss. But if not who is going to pay the rest? Someone must otherwise CCRC will go bankrupt.
As regarding Type A facilities: I wonder how do you know which type of contract they offer? I did some brief research on web and only a few actually reveal what do they actually have. Others just have the usual sales articles, may be some pricing and that's it. Are there at least some indicators to suspect this is really Type A facility?

Alex-

Try reviewing this post from the E-R.org stickies/FAQs. It applies to CCRCs in general but, has a NorCal orientation, which should be even more applicable to you. It is a good starting point.

Best!

https://www.early-retirement.org/forums/f47/ccrc-reference-material-faqs-86124.html

 

[bmcgonig]

Like others I love the idea of aging in place. However even if we leave out the financial issues I don’t think it’s guaranteed to work. When we’re younger and healthier managing the care that we may need to hire is pretty simple. If someone doesn’t show up you call someone else. Maybe you use an agency so that they send another person when the person that usually comes is sick or on vacation. If you don’t use an agency then you’re hoping that the help gets a replacement. You pay them every month whatever they bill you and you’re good at figuring out your bills and checking account etc.

Unfortunately most or many of us will reach a stage where we are not that good at doing the above. Especially if you’re alone and no spouse left or no children to step in to help. You’re 90 yrs old and this stuff is just a little more complicated every year. Managing my own home care is not a situation I want to be in when I’m quite old. So yes, there’s going to be a lot of years while in a CCRC that I don’t need it. But there are potentially a few after that where i definitely will need it. So that’s another tail risk that I’m trying to account for.

 

[bmcgonig]

You simply ask. Every one I've talked with (quite a number in the last year or so) was very up front about it.

It is kind of silly that sometimes you really have to search the website and still not know if it’s Type A or not. They really want to force you to contact them with questions.

And don’t get me started on their reticence regarding disclosing fees.

 

[RetiredHappy]

Regarding if you are 90 yrs old and this stuff gets more complicated, the option of going into Type B/C AL and SNF is still there when you are at that stage. I just don't want to go into a Type A CCRC when I am still healthy and independent. I know that I am much happier to be home. Having sufficient LTCI and other financial resources allows you to have options. To me, Type A CCRC is a life sentence / commitment (which sounds better )which I am not willing to take on when I am still independent, healthy and mentally alert.

 

[Koolau]

For those of you counting on Long Term Care Insurance--I am battling my mothers long term care insurance company right now and so far I am losing. Mother is in her 90s, has dementia and heart failure, has caretakers several times a day and needs to move to memory care but her long term insurance company is dragging their feet and refusing to pay. i have spend many hours on this and am probably going to have to hire a lawyer who specializes on this. I have another thread on this issue.

It is possible to pay in more on long term care insurance than you will get in return--my mother has. She has had the policy for about 40 years. The policy only pays $250 a day for 3 years. Her premiums have skyrocketed and she has now paid in more for premiums than the policy will ever pay out.

My mother is in a nice CCRC but unfortunately it is not a Class A Lifecare CCRC, it is the pay as you go type of CCRC so I need to get the LTC policy to pay so she can move into memory care. I am at my wit's end.

Have you contacted the state insurance bureau or whatever it's called? They can pressure an insurance company to pay.

So sorry you are still fighting the insurance co. on this. It's beyond evil to deny payments once the patient meets the requirements.

By the way, what is the name of the insurance co.?

 

[bmcgonig]

For those interested in pricing these places and who isn’t

Here’s a company called VI that has about a dozen upscale places around the country. Palo Alto one bedroom 800 sq ft, entrance fee with 0 return ranges from 1m to 1.5m.

They talk about being Life Care Type A, and they openly show their fees. No idea about waiting lists. You can search the website to see all the places and how much they charge

https://www.viliving.com/resources/about-life-plan-communities

Another one in Florida is about a third of Palo Alto

https://www.viliving.com/locations/fl/naples-bentley-village/floor-plans-pricing/pricing

 

[Calico]

It is kind of silly that sometimes you really have to search the website and still not know if it’s Type A or not. They really want to force you to contact them with questions.

And don’t get me started on their reticence regarding disclosing fees.

I have researched several CCRC's in my area over the last few years. I am 67, so hopefully won't have to make the decision for a good many years.

When I find a CCRC of interest, I search for "CCRC name" and "disclosure statement."

In every case, this brings up the disclosure statement, which in turn details:

the buy-in fees
the monthly fees
the type(s) of contract (sometimes the actual contract is shown)
the services included in the monthly fee
the services available at additional cost
the annual increase in monthly fees for past five years
reams of financial information about the facility; reserves;
expenditures, etc.
the names of the board of directors
any expansion plans underway

I use the CCRC websites to get a very general overview of each place (activities; floor plans; number of residents, etc). But I never contact the sales and marketing office of the CCRC for financial information, because I would be inundated forever with their glossy marketing materials. (Bleccch)

I plan to do lots of financial due diligence and narrow down the possibilities before I ever listen to a single sales pitch.

 

[braumeister]

It is kind of silly that sometimes you really have to search the website and still not know if it’s Type A or not. They really want to force you to contact them with questions.

And don’t get me started on their reticence regarding disclosing fees.

Well, I went about it differently. To me it was more important to first look at where I might be happy and only then eliminate the ones with contracts or fees that didn't work well for me.

1. identified parts of the country where I would be comfortable spending my final years. Climate, access to cities, transportation, etc.
2. found CCRCs in those areas that looked attractive based on their websites.
3. contacted those and got their brochures, housing types, fee structure, contract types, etc. Easy to do and they are always happy to send you everything they have.
4. researched their financial situation. Also easy to do and occasionally eye-opening.
5. narrowed my choices down to a few, visited them, and talked with both staff and residents. That was enjoyable and extremely useful.
6. put myself on the wait lists for my top choices.

I'm currently on the list at four different, widely separated places, and believe I would be happy at any of them.

But I understand that we all go about such decisions in our own way. This is just how I looked at it.

 

[harllee]

Have you contacted the state insurance bureau or whatever it's called? They can pressure an insurance company to pay.

So sorry you are still fighting the insurance co. on this. It's beyond evil to deny payments once the patient meets the requirements.

By the way, what is the name of the insurance co.?

I probably will have to contact the NC Dept of Insurance. The company is MetLife. The original policy was Prudential and MetLife took over.

 

[joesxm3]

On a related note. Long ago I programmed an adjuster computer system for auto claims that guided them step by step. One of the steps was to stall for a month then evaluate likelihood of being sued before paying the fair amount calculated in step one. This was a well known major company.

 

[harllee]

To get back on the topic of my moving into a CCRC. Today the activities for the month of August were available to be reserved and DH and I signed up for many things both in house and out. There are several trips to local restaurants, a 4 day trip to Charlottesville, trips to museums, lectures, movies, happy hours, dance classes, fitness classes, discussion groups, games nights, ukulele classes, poetry classes. More than we can possibly do but we are going to give it a try!

 

[bmcgonig]

Regarding if you are 90 yrs old and this stuff gets more complicated, the option of going into Type B/C AL and SNF is still there when you are at that stage. I just don't want to go into a Type A CCRC when I am still healthy and independent. I know that I am much happier to be home. Having sufficient LTCI and other financial resources allows you to have options. To me, Type A CCRC is a life sentence which I am not willing to take on when I am still independent, healthy and mentally alert.

I do see your point about waiting. However in many cases a crisis occurs that precipitates your having to find something quickly. Then the good places are full, and you need to move. And that’s assuming you are healthy enough to manage anything if this crisis does occur.

Yes, some people time it perfectly…hopefully you’ll be that person.

 

[RetiredHappy]

I do see your point about waiting. However in many cases a crisis occurs that precipitates your having to find something quickly. Then the good places are full, and you need to move. And that’s assuming you are healthy enough to manage anything if this crisis does occur.

Yes, some people time it perfectly…hopefully you’ll be that person.

Or hopefully, I will never get to that stage/level. With our business, about 5% of the people whom we took care of actually went on to AL or SNF. The rest, were alive and kicking for a long time, and the ones who passed stayed home. Some of the people who moved into AL or SNF, continued to received care from us, with reduced hours. They wanted the companionship and additional care that were provided by our caregivers.

 

[bmcgonig]

I have researched several CCRC's in my area over the last few years. I am 67, so hopefully won't have to make the decision for a good many years.

When I find a CCRC of interest, I search for "CCRC name" and "disclosure statement."

In every case, this brings up the disclosure statement, which in turn details:

the buy-in fees
the monthly fees
the type(s) of contract (sometimes the actual contract is shown)
the services included in the monthly fee
the services available at additional cost
the annual increase in monthly fees for past five years
reams of financial information about the facility; reserves;
expenditures, etc.
the names of the board of directors
any expansion plans underway

I use the CCRC websites to get a very general overview of each place (activities; floor plans; number of residents, etc). But I never contact the sales and marketing office of the CCRC for financial information, because I would be inundated forever with their glossy marketing materials. (Bleccch)

I plan to do lots of financial due diligence and narrow down the possibilities before I ever listen to a single sales pitch.

Thanks for that tip regarding the disclosure.

 

[bmcgonig]

Well, I went about it differently. To me it was more important to first look at where I might be happy and only then eliminate the ones with contracts or fees that didn't work well for me.

1. identified parts of the country where I would be comfortable spending my final years. Climate, access to cities, transportation, etc.
   
2. found CCRCs in those areas that looked attractive based on their websites.
   
3. contacted those and got their brochures, housing types, fee structure, contract types, etc. Easy to do and they are always happy to send you everything they have.
   
4. researched their financial situation. Also easy to do and occasionally eye-opening.
   
5. narrowed my choices down to a few, visited them, and talked with both staff and residents. That was enjoyable and extremely useful.
   
6. put myself on the wait lists for my top choices.
   

I'm currently on the list at four different, widely separated places, and believe I would be happy at any of them.



But I understand that we all go about such decisions in our own way. This is just how I looked at it.

That’s a good approach.

 

[Calico]

Thanks for that tip regarding the disclosure.

Enjoy your detective work!