How to decide on a CCRC

[braumeister]

I've decided to get serious about looking for a CCRC for my declining years, and have been doing some intensive research online.
Today I visited the third one on my list. Four more to go, but the list is open-ended so it will likely get longer.

It's a very interesting experience. All the places on my list seem very nice and I could see myself living in any of them, but there are clear pluses and minuses to each. Location, cost, amenities, policies, etc., etc.

Being naturally kind of a research-oriented person, I rather enjoy the search process but I'm sure it's more difficult for some. In addition, my list includes five different states in different parts of the country, so it's not quite as simple as I'd like.

What criteria do you think you would use to decide if you were looking for such a place? And if you are already in a CCRC, was there one tie-breaking criterion that sold you on it?

 

[Walt34]

One of the issues I've read about is to ask "Under what conditions can I be kicked out?"

Heaven forbid, but what if a stroke changes you from the easy-going pleasant fellow you are to an angry, hostile and violent oaf? What do they do with you?

 

[tulak]

Not specific to CCRC, but location is important for me. Specifically, I want a good amount of amenities within walking distance. Grocery stores, restaurants, and a nice walkable area.

These are important criteria for me now and I’m sure they’ll be more important when I’m older. Ideally wherever I live will never require a car for daily living.

 

[MichaelB]

One of the issues I've read about is to ask "Under what conditions can I be kicked out?"

Heaven forbid, but what if a stroke changes you from the easy-going pleasant fellow you are to an angry, hostile and violent oaf? What do they do with you?

They throw you out. More likely, if you go to a hospital for an overnight condition, they refuse to accept your return. Then you’re really stuck, because you have no time to look for alternatives and have to take the first available option, which assuredly is not a place you would choose.

 

[njhowie]

Location, cost, amenities, policies, etc., etc.

That was the exact order we used for mom. I'll give you our first hand experience for whatever value it may be to you.

What you want to be careful with as you visit/interview places is what kind of commitment is necessary? Are you signing up for some minimum period? Is there a buy-in amount that you have to pay up front? Non-refundable community/improvement fee? What happens if you move in and then in a few months you realize it's not the place for you? Do you get 100% of your buy-in back? What happens when you pass away? I don't know how most places work, but at mom's place they offer "traditional" and "refundable" buy-in fee options. I'm sure the amount of the buy-in would be affected by which option is chosen.

The first place we put mom in back in February was specifically assisted living. She had it in her head that she wanted assisted living. Clearly she had misunderstanding of what assisted living entailed and it was much more than she needed - she was the youngster in the place. After 3 months there and having received denial from her LTC insurer, we moved her out and to the place she's in now, which is less than half the price of the assisted living. She's been there almost 6 months now and likes it much better.

The new place has independent living (where she is now), and they offer higher levels of care if/when she needs it. I think the place was having difficulty filling their property because their buy-in was pretty expensive. So they were also offering rental as an option, which is what we went with. If she would have done the buy-in, it would have reduced the monthly fee by about $800 in comparison to what she's paying in rent. I think the buy-in for her unit was something in the $180k area. I don't know all the details surrounding the buy-in - since we never intended to go that route, we didn't investigate any further.

Here is the website for where she is now for informational/comparison purposes:
https://monroevillageonline.org/

 

[Bamaman]

My mother went into a 1 bedroom apartment in a CCRC. Cost her $170K security deposit and $2050 a month including 20 meals a month in the nicest restaurant in the city.

Unfortunately we had to have 24/7 help watching her and driving her to doctors. She was seriously going thru her money.

After she passed, we got back 90% of the $170K security deposit.

She would have been just as happy in an assisted living apartment with their LPN's dispensing her medicine. CCRC's are luxury accommodations.

 

[audreyh1]

I've decided to get serious about looking for a CCRC for my declining years, and have been doing some intensive research online.
Today I visited the third one on my list. Four more to go, but the list is open-ended so it will likely get longer.

It's a very interesting experience. All the places on my list seem very nice and I could see myself living in any of them, but there are clear pluses and minuses to each. Location, cost, amenities, policies, etc., etc.

Being naturally kind of a research-oriented person, I rather enjoy the search process but I'm sure it's more difficult for some. In addition, my list includes five different states in different parts of the country, so it's not quite as simple as I'd like.

What criteria do you think you would use to decide if you were looking for such a place? And if you are already in a CCRC, was there one tie-breaking criterion that sold you on it?

Interesting that you are looking at far flung locations.

Are you looking at not-for-profit as well as for-profit CCRCs?

Is this for a couple?

 

[Jerry1]

My first criteria would be location. I’d want it to have the weather I like and I’d want it to be near my family. Ideally, it would be close to family, but within an hour or so would be my goal. It’s not like they will come visit every day or week, but I’d like it not to be a burden for them to visit. For weather, I don’t need it to be warm like Florida/Arizona but a mild winter would be a big plus.

 

[ocean view]

One of the issues I've read about is to ask "Under what conditions can I be kicked out?"

This.

I’ve shared on another CCRC thread that DM has been at hers for 30 years and I thought there were no evictions. However, recently Mom told me that the woman across the hall in independent living was moved into the memory care area of assisted living, while her husband remained in their apartment. Apparently, the woman was an escape artist and broke out of memory care twice. She climbed out ground floor windows. After the second time she got evicted. She was moved to another facility in the area. How unfortunate for them as they assumed they would be able to age together, at least at the same facility.

 

[SecondCor521]

My Dad's in a CCRC nearby.

Almost all of the residents there have at least one adult child living within an hour or so. Family ties seem to be the strongest determiner. Maybe something for you to consider since you're looking at different states. I visit once a week, and I'm probably one of the most frequent visitors of the residents who have family nearby.

Price and amenities are next. His place is expensive but paradoxically a good value; other places are cheaper but provide disproportionately less in amenities.

If you're younger, I'd look at access to airports for travel. If you're older, I'd look at access to hospitals / doctor's offices / pharmacies.

My Dad's place has individual houses, duplexes, apartment style, assisted, and memory care. I like that all of those options are available. They do shift people around as needs change. My Dad is in an apartment now, but assisted might be in his future.

His place is owned by a corporation. They raise rents every January like clockwork, and will continue to do so as long as there is a waiting list (currently ~6 months). Residents gripe but don't move out.

My Dad didn't do the buy-in thing; he's been renting there for about 15 years. They took the equity from their house and put it in the market instead. I think they're ahead of the game, and they had more flexibility that way if they decided they didn't like it.

 

[Scuba]

I think one of the most important decisions is what type of contract you want. If you want a Type A CCRC contract, the availability will be much more limited and will likely have longer waiting lists.

Assuming there are both not-for-profit and for-profit options of similar quality, I’d lean towards a not-for-profit option. They will typically not kick you out for financial reasons if you legitimately run out of money. A for-profit will not allow you to stay if you can’t pay.

 

[braumeister]

The ones I'm looking at are all not for profit, and have waiting lists ranging from two years to five years. I'm fine with that, because five years from now is about when I can see myself making the decision.

Everything mentioned so far is already on my checklist, so I seem to be on the right track.

Having done a lot of online research, I'm finding it very interesting how the in-person visits are going. Some places make me happier than I expected, others a bit less so. It's such a big decision that I can't see how anyone can make it easily, but apparently many do.

 

[latexman]

FIL and MIL have been in a CCRC for 5-10 years. FIL is in a 1 BR apartment. MIL is in memory care unit. FIL's most frequent complaints are about the food and MILs care. I get it. Day, after day, after day, eating the same revolving menu and seeing the same care workers. I eat and visit there infrequently, and it's fine, to me. But he is there every day/hour/minute and is super focused on every little detail. He makes mountains out of mole hills, and I nod and smile. One of these days, I may be in his shoes.

 

[njhowie]

But he is there every day/hour/minute and is super focused on every little detail. He makes mountains out of mole hills, and I nod and smile. One of these days, I may be in his shoes.

LOL - I could have written this.

 

[ocean view]

When you plan your visits, ask if you can stay for a few days. My mom’s CCRC has guest apartments where prospective residents can stay for 2-3 days for a nominal fee. While there you’ll eat in the dining room, participate in activities, talk with the residents, etc.

 

[HarryHawk]

My wife and I will be moving into a CCRC. What closed the deal for us is it is a brand-new project being built by a non-profit that has been in service to the community for 75 years. It is in a small town which has alot of to do and is on the shores of Lake Michigan.

We are able to specify most aspects regarding the finish of our cottage, i.e. overall layout, paint, flooring, cabinets, bath configuration, etc.

Since it's a brand new community, everyone are our new neighbors.

Frankly speaking, I feel good that our living quarters did not become available as a result of the unfortunate demise of the previous inhabitant.

 

[SecondCor521]

When you plan your visits, ask if you can stay for a few days. My mom’s CCRC has guest apartments where prospective residents can stay for 2-3 days for a nominal fee. While there you’ll eat in the dining room, participate in activities, talk with the residents, etc.

Emphasis added. Excellent idea.

Talking with the residents will give you the real scoop, compared to the marketing tour from the staff.

Although residents' opinions will vary, they'll still be unvarnished.

 

[nwsteve]

Emphasis added. Excellent idea.

Talking with the residents will give you the real scoop, compared to the marketing tour from the staff.

Although residents' opinions will vary, they'll still be unvarnished.

+1 These stays will allow you to explore things like residents' real experience with situations that may concern you. For example, up thread, how often someone has been told to leave.
Based on our experiences in our three years in a Type A CCRC, I would encourage questions around daily event living. For example, if there are limitations on what you can do around your unit. What things work well at the property and what seems to create problems. In the latter category, we learned our deck wiring is not of high enough amp to carry the load for the deck grill we would have gotten. Apparently, a common problem with this property's original construction and only an issue if you happen to really like deck grilling (gas grills are prohibited which is disclosed in our contract).
Try to have read through the property's contract so you can ask how any issues of concerns are enforced--absolute versus situational.
The contract is your guide to a lot of the lifestyle questions you might have. Yes, it is your unit but like many HOAs there are "rules"--be sure you know them and how they are enforced. Try to get copies of the last few residents' meetings and see what topics are generating heat. Each property has its own personality driven by the nature and age of its residents

 

[Silver]

DH and I are planning to move into a nearby CCRC within the next 6-9 years. We are not yet on a waiting list.

One question I want to ask during a pre-application visit is if residents are allowed to change units/apartments once they have signed a contract and moved in. Perhaps a unit becomes available in the future with a better view or more desirable outdoor space, or one spouse has died and the remaining resident wants a smaller apt. This would entail signing a new contract, so I'm not sure how enthusiastic CCRC administration would be.

Has anyone asked about this during your vetting of CCRC's?

 

[braumeister]

DH and I are planning to move into a nearby CCRC within the next 6-9 years. We are not yet on a waiting list.

One question I want to ask during a pre-application visit is if residents are allowed to change units/apartments once they have signed a contract and moved in. Perhaps a unit becomes available in the future with a better view or more desirable outdoor space, or one spouse has died and the remaining resident wants a smaller apt. This would entail signing a new contract, so I'm not sure how enthusiastic CCRC administration would be.

Has anyone asked about this during your vetting of CCRC's?

I did ask that question on one of my visits. The answer was that it almost never happens, but would certainly be OK. There would be an additional one time charge, because the policy is to do a complete renovation whenever someone moves out, so you would have to wait for that to be done before you could move in.

 

[OldShooter]

I would ask to see financials. If the CCRC is a standalone nonprofit you can also register at guidestar.org and review their tax returns. If you aren't comfortable reviewing financials ask your CPA or some other financial professional to help you. The nicest place in the world will not be so nice if they run out of money.

 

[braumeister]

I would ask to see financials.

I agree that's most important. All the places I'm considering have very solid financials.

 

[ChrisC]

I agree that's most important. All the places I'm considering have very solid financials.

What are solid financials? Today's solid financials, might become yesterday's harbinger of financial woes, or tomorrow's inadequate financial cornerstones. I plan for the worse and hope for the best. So if you plan like me, you really need to think hard about whether today's business model for the CCRC you might be considering will provide a solid measure of comfort that it will meet all your expectations for the worse case scenario for you 15-20 years down the road, when, if you're a couple, one or two of you might be sidelined in the skilled nursing wing of the CCRC for a very long goodbye.

If you are considering that Type A Contract CCRC, then you best be looking past today's financials and discern whether that CCRC can last a long, long time with that business model, if the aging population on campus might crash the skilled nursing wing there -- not a problem, I suppose for a new CCRC but could be a major problem for a seasoned CCRC, where a sizeable population of its residents are in the no-go years taxing the home care, assisted living, or skilling nursing capacity of the CCRC. I don't know if there's a CPA in the world that could adequately assess whether long term liabilities of a CCRC with Type A Contracts would be met by the current financial balance sheet and projected revenues of a CCRC. The only assurance that I would have against a CCRC not running into some financial problems in the foreseeable future is a 95% plus occupancy level and a long waitlist for new residents!

There are many intangibles and personal preferences that weigh in the decision to take up permanent and likely your last residence at a CCRC. The most important one for us, assuming the CCRC is not likely to go bankrupt in 20 years, is "fit." Could we see ourselves on this campus, with its amenities, with its campus grounds, with its meal plans, with the people that are currently there and those likely to come after us, and with the housing we take up there -- a good fit for us?

We're on the 4 year plus waitlist for 2 CCRCs (paid with a modest refundable deposit, which entitles us to lunch and dine on the CCRCs' campus) and, aside from financial strength of these CCRCs -- they both appear to be very strong currently and going forward indefinitely -- and the fit for them for us is quite different. It's not likely we'll be in one of these CCRCs in the new few years (and we will have likely been on one waitlist for over 7 years). Meanwhile, we enjoy currently aging-in-place at our present home and occasionally touring the CCRCs.

 

[OldShooter]

What are solid financials? ...

As you say, there are no guarantees. But reviewing financials, especially the tax returns, can find red flags. For example:

1) What is going out the door to executive salaries? Is this a cash cow paying above-market rates or do the numbers look reasonable?

2) What does the top management and board look like? A lot of family members feeding at the trough? Directors with possible conflicts of interest or are they independent and separately researchable?

3) What do the assets, particularly the investments look like? Invested in hedge funds and "alternative" assets or a more conventional and conservative portfolio?

4) What does the cash flow look like? Are current expenses adequately covered by current income. There are some standard measures like "Quick Ratio" that can be checked.

5) Where does the expense money go? If the CCRC is buying services from a wholly-owned for-profit corporation that is a place where a lot of bad stuff can be hidden.

An audit report can be interesting, too, starting with the footnotes in the back. A qualified or adverse opinion is a huge problem, of course, but a pattern of unusual accounting practices could be a cause for concern.

All this is just amateur stuff; I'm sure there are CPAs here who could weigh in. Current financials are, as you say, not a perfect view of what might happen over 20 years, but if the current stuff is a little stinkly that should be a red flag.

 

[ChrisC]

An audit report can be interesting, too, starting with the footnotes in the back. A qualified or adverse opinion is a huge problem, of course, but a pattern of unusual accounting practices could be a cause for concern.

All this is just amateur stuff; I'm sure there are CPAs here who could weigh in. Current financials are, as you say, not a perfect view of what might happen over 20 years, but if the current stuff is a little stinkly that should be a red flag.

Red Flags can be discerned from audited financial statements that detect current problems, but you can't know if the current business model of a CCRC, as applied to a particular CCRC, will withstand the test of time, with potential future problems (including perhaps another pandemic, an Alzheimer's endemic afflicting seniors, or advances in medical science prolonging mortality in skilled nursing care). Many of these CCRCs have a lot of long-term debt on their balance sheets as well, which a drop in occupancy levels (like caused by a pandemic or negative news about its operations) could render them insolvent quickly -- another red flag. As was evidently the case with this luxury CCRC in Dallas this year. https://www.prnewswire.com/news-rel...a-sustainable-financial-future-301525911.html (I can't get past the pay-wall for the Dallas Morning News which has articles on this CCRC.)