CCRC Reference Material/FAQs


Thinks s/he gets paid by the post
Jul 30, 2011
The Bay Area
I think this topic is very important and, personally, it's timely. Although it's many years in the future for DW & me, a CCRC (likely a "Life Care" contract) is our current plan for later in life.

I think it's important to lay some basic groundwork so we have a common reference point when discussing CCRCs, and the many options & variables available within the CCRC universe, including: levels of care, for-profit or not-for-profit, contract types, financial qualifications, certifications, etc. And, that doesn't even get us into discussions of "quality" of care, which is also extremely important.

I've decided to structure this post like a FAQ because, that seems most useful for readers and, honestly that's how my little brain works. Note that since I live in California, several of the links & references are for California; however, most of the information is applicable to any state and, the methodology/terminology seems to be largely universal.

I think subsequent posts with additions/edits to this CCRC FAQ would be most useful if done in the same format & continuing the numbering system.

1. So, what's a CCRC?

Here's what I I think is a useful definition for a Continuing Care Retirement Community (CCRC); it's from the California Advocate for Nursing Home Reform (CANHR).

"Continuing Care Retirement Communities (CCRCs) offer housing, meals, transportation, activities, and provide a continuum of care including assisted living and nursing home care, usually in one location, and usually for the individual’s lifetime. Increasingly, CCRCs have health clinics, wellness programs, and specialized dementia care services."

Note my emphasis on "continuum of care" and "usually in one location", which I think is the distinguishing feature of CCRCs when compared to other senior living/care facilities. In other words, a CCRC can provide Independent Living (IL), Assisted Living (AL), Skilled Nursing Care (SNC), and Memory Care (MC) all in one location or on one campus.

The CANHR document is independent of the CCRC industry and is full of great info; the link to the CANHR site is below, from there you select the PDF document entitled: "Continuing Care Retirement Communities: Is One Right for You? (2009)".

Continuing Care Retirement Communities (CCRC) – CANHR

Also see this Wikipedia page:

2. Why should I select a CCRC versus other options like: aging in place at home, Living with Relatives, Assisted Living, Nursing Home, Hospice, etc.?

The answers to this question are as individual as each of us but, here are some of my reasons for planning to select a CCRC:
- Continuum of care provided in a single location; and, in a single community
- Ability to transfer late life/end of like health care risk to the CCRC (only with a "Life Care" contract; also call "Type A" contract)
- Control; ability to "move" to a CCRC community instead of "being transported" to assisted living or nursing care.
- Ability to make friends and establish a personal network while still relatively independent

Here's a good Kiplinger article profiling an older couple who moved to a CCRC, and outlining many of the factors to consider.

Retire in Style at a CCRC Continuing Care Retirement Community

3. What levels of care do CCRCs provide?

Typically, they provide: Independent Living, Assisted Living and, Skilled Nursing Care, in ascending order of care. "Memory Care" is also a specialty feature available in many CCRCs. All levels of care are normally provide at one location or on one campus.

4. What kinds of contracts are there to enter a CCRC?

There are three basic kinds of contracts, with variables available for many of their features, which can result in dozens of variations. These three basic contract types are described below(note that only "Life Care" or "Type A" contracts completely transfer risk to the provider).

A. Life Care Contract (Also referred to as “Extensive” or “Type A” Contracts): Establishes a standard monthly fee rate for all levels of care with only annual monthly rate increases allowed and guarantees care for life, even if the resident’s funds become inadequate to cover the full costs of future services and care. Care services include primary and acute care, and higher levels of care (i.e., assisted living and nursing home care) that must be provided on site or adjacent to the facility. This is usually the most expensive option, with high entrance fees, and in some instances requires the transfer of most of one’s assets to the facility and high monthly rates. Entrance fees are usually not refundable beyond the 90-day trail period. It offers the most security as it transfers future risks to the CCRC provider for agreed upon fees

B. Modified Contracts (Also referred to as “Type B” Contracts): This option involves entrance fees and monthly fees with a guarantee of access to higher levels of care usually at a reduced rate or for a set period of time before market rate fees come into play. There might be options for full, partial or proportional refunds of entrance fees. The modified contract is usually less costly than the Life Care Contract from an entrance fee and monthly fee standpoint, but the resident shares the risk of future care costs with the provider.

C. Fee-for-Service Contract (Also referred to as “Type C” Contracts): This option involves entrance fees and monthly fees with a guarantee of access to higher levels of care. There might be options for full, partial or proportional refunds of entrance fees, and some discounts on monthly fees compared to non-CCRC contract residents. Residents pay for higher levels of care at the prevailing market rate. The resident assumes the risk of future level of care costs directly.

Here's another good reference on the types of CCRC contracts:

Three Types of Contracts CCRCs Offer Prospective Residents

5. What's the difference between "for profit" and "not for profit" CCRCs?

In California, the vast majority (>80%) of CCRCs are "not for profit", which is supposed to mean that they prioritize residents' needs over profits. I cannot say whether that's true or not. There also seems to be some blurring of the border because some "not for profit" CCRCs are managed by private entities. So, it seems that what's probably more important is quality of care and fiscal soundness.

6. How do I evaluate CCRCs & select one?

Here are some of the key factors to evaluate & suggestions on how to evaluate them.

A. Quality of Care: check state inspection reports & other industry overview websites which are public and available online. Examples below:
- California Dept of Social Services:
- Lucille's List ( Inspection Reports | Lucille's List ).
- Kiplinger: a good overview of some key topics to consider.
Risks and Rewards of Moving to a CCRC

B. Financial Soundness of the CCRC: ask for copies of audited financial reports. You can also find the CCRC's (or parent organization's) IRS Form 990 on-line, which contains basic financial info (assets, liabilities, cash flow, top executive salaries, etc.). Other key metrics are: occupancy >90% and, having fees which cover ongoing operating expenses (not having to dip into "entry fees" to pay ongoing operating expenses).

C. Cost: here's a great website with average state-by-state and city-by-city costs for various levels of care

D. Rules-Pay careful attention to these items:
- Level of Care transfer rules
- Self Determination rights
- Atmosphere of respect & dignity
- The experience & transparency of management

7. How do I know if I will qualify for entry into a CCRC?

- Financial: You first have to decide what type of contract (A, B or C) you want. But, a common rule of thumb used by the CCRCs to evaluate potential residents is that monthly income must be at least (Monthly CCRC Fee X 1.6) and assets of 2X the Entry Fee. This is just a rough rule of thumb.

-Physical: Typical is an assessment from your doctor that you can perform all the Activities of Daily Living (ADLs), like eating, dressing, using the toilet, etc. Plus, some locations require a mental acuity test.

8. What is the optimum (or most common) age to enter a CCRC?

Personally, I think this is a very individual decision. However, on the "young" end, most CCRCs seem to have a minimum age of 60 or 65 to be eligible. On the "old" end, it's beneficial (sometimes required) to enter the CCRC in "Independent Living." So, that's likely 70s or 80s for many/most; the average national CCRC entry age is 80.

9. When researching to confirm if a CCRC is the right choice for your situation, it's important to understand the pros, cons & current topics of interest on this subject. In my research, I've found that advocacy organizations provide very useful info in all three of these areas. We are in California, which is the focus of our research but, I expect most states have similar advocacy organizations applicable to your location. Links for three of them are below.

What I've learned so far is that, in California, there is a substantial body of law protecting CCRC residents' rights regarding: level of care transfer rights, CCRC financial disclosure/transparency, informing CCRC residents, CCRC resident participation, procedural & legal protections, etc.

It's advisable to find similar advocacy organizations for your state/location.
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