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Continuing Care Retirement Communities


The typical Continuing Care Retirement Community (CCRC) is a community complex consisting of apartments, cottages or combinations of residential independent and group living units, a health care facility, and other amenities, usually combined in one central location. The CCRC provides services that may include housekeeping, dining rooms, recreation areas and miscellaneous service shops, and, in some cases, local transportation. The facility is also often a licensed home for adults and licensed nursing facility. Continuing care retirement communities provide the above mentioned services, under an agreement effective for a period greater than one year, and subsequent to payment of an entrance fee.

Is a CCRC right for you?

CCRCs address a major concern for older people, namely, how they will get continuing care if their health fails. For couples, if one partner has to be confined to the nursing unit, the other can continue to stay conveniently nearby in the CCRC.

Additionally, many elderly individuals regard a CCRC as a way of relinquishing those duties associated in the upkeep of an owned house or rented apartment. The CCRC usually provides all maintenance for the residential units, including the grounds, does housekeeping and (some) laundry, pays for all utilities (excluding the telephone) and provides security services.

A CCRC is generally available to and populated by those individuals who are aged 65 and over. CCRCs provide an environment where older adults can share common interests and activities.

What services are generally provided by CCRCs?

As a resident ages it is the intent of a CCRC to meet a resident's basic needs including shelter, food and care. The range of services, however, offered by CCRCs is not standardized throughout the industry. Services offered may vary from one CCRC to another and so may the extent to which services offered are fully (or partly) covered by the regular fees.

Available health care services also vary from community to community. Some communities offer unlimited care at no additional cost, while others involve fee-for-service and/or deductibles. Home health services for independent living residents may or may not be included in the contractual agreement. See the CCRC Checklist included in this section for questions to ask about the services provided.

Paying for CCRC Services

Continuing care retirement communities vary widely in the way in which residents are required to pay for the care they need. The American Association of Homes for the Aging identifies three basic types of CCRCs:

Entrance fees at Type A communities are usually the most expensive, followed by Type B, with Type C entrance fees being the least costly.

A community may offer all three types of arrangements, as well as a month-to-month contract in which the resident pays for the specific services provided and is not guaranteed priority access to additional services.

A CCRC is an investment. When an elderly individual seeks occupancy at a CCRC, a contract is drawn between the CCRC and the prospective resident to define each party's financial and service obligations, which should include termination terms and other relevant conditions. Upon completion of this contract the resident pays a lump sum "entrance fee" prior to or at occupancy and a monthly charge thereafter. (This entrance fee is usually nonrefundable, in all or in part. In some CCRCs certain funds are held in escrow. These funds are part of the entrance fees and are refundable.) Several factors (e.g., size of the living unit taken, CCRC location, and the quality and scope of the services and amenities, construction date and cost, etc.) affect the amount of the entrance fee paid.

Qualifications for CCRC Residency

All CCRCs have entrance requirements which a prospective resident must meet. These mainly deal with the applicant's health and financial status. Minimum age (usually 65) and the capacity to live independently are usually basic requirements.

A personal health history and physical examination performed by the applicant's doctor or the CCRC physician is usually required. This information is used by the CCRC to determine the possible future health care needs of the applicant.

An extensive financial disclosure statement must generally be submitted and is subject to verification by the CCRC. The prospective resident may be required to list assets and income by type. From this information the CCRC determines whether or not the applicant has enough income and assets to cover the entrance fee and the monthly service fees (at current rates and at estimated rates as well). Typically the resident must make one additional financial commitment. He must agree to make every effort to preserve and maintain assets and income and to take no action to impair the ability to meet the financial obligation to the CCRC.

Insurance coverage may be required. The applicant may need Medicare Parts A and B or comparable insurance, and perhaps a supplementary health insurance policy and/or long- term care insurance. Residents are responsible for personal property and liability insurance coverage plus auto insurance, if they own cars.

Use this checklist as you consider residency at a Continuing Care Retirement Community. The checklist will help you compare communities you are considering.

Paying for Residency

The CCRC Organization

The Community's Financial Condition

Shelter, Services and Care

Signing the Contract

Information for this page was provided by the Northern Virginia Long-Term Care Ombudsman Program and the Fairfax County website.