..Life Care
   

Introduction

"Life Care" is another name for a Continuing Care Retirement Community, or "CCRC." As the name suggests, a CCRC is a retirement community that provides a full spectrum of health care options for residents, from total independence to total care in an on-site skilled nursing unit.

CCRCs strive to provide an optimum mix of independence, comfort and security for their residents. Most residents enter in their 70's, with the average age being about 75. Due to the need to control health care costs, residents must be relatively healthy at the time they join. As a result, most CCRCs have a substantial community of healthy and active residents who participate in both structured and unstructured activities, and who provide opportunities to interact socially with peers.

CCRCs also have special advantages for married couples who are concerned about being separated by illness. A certain amount of assistance is available in a CCRC without moving from the main residential areas. Such assistance may be provided by nursing staff or home health aides employed by the facility. (Policies for providing home care vary from one facility to the next, so it is important to review your contract carefully with respect to such services if you are considering joining a CCRC.)

If the health of one spouse declines to the point that he or she cannot live independently, higher levels of care are available without moving from the community. The ill spouse may have to move to a different building or unit within the same building, but he or she will remain close at hand.

Criteria for Suitability

A CCRC will work for you if:

  1. You and your spouse presently do not need any medical or personal care assistance on a daily basis;
  2. You have the resources to purchase a unit and to pay the monthly maintenance fee;
  3. You and your spouse don't want to move again for the rest of your lives, regardless of changes in your health; and
  4. You and your spouse enjoy the company of other seniors for meals, activities and socializing.

Facilities and Services

The physical layout of CCRCs varies greatly, but all have primary residential areas, assisted living and a skilled nursing center.

Primary residential areas range from high-rise apartments to garden apartments, townhouses, cottages and even single-family homes. The majority offer low-rise condominium residences. Some facilities include recreational amenities, such as a pool, tennis courts or function rooms. Virtually all CCRCs have common areas and a common dining room.

Assisted living in a CCRC refers to services, either in the apartment or in a separate part of the facility, to help the individual with daily activities which do not rise to the level of medical care. Typical examples are help with walking or personal care. Most CCRCs provide a limited amount of such assistance to residents in their regular apartments, but they will move the person to unit designed especially for assisted living if their need for assistance reaches a certain level.

Assisted living units are usually studios without separate kitchens (though perhaps with a refrigerator and sink), and they are smaller than the primary residential units. They often have an institutional appearance that is not present in the primary residential areas. The services needed by the individual, however, are ready at hand, and he or she usually continues to have full access to the common areas of the CCRC.

Virtually all CCRCs include a "health center," which essentially is an on-site nursing home, to provide skilled nursing care for residents with extensive medical needs. Some CCRC health centers may have special units or programs for residents suffering from Alzheimer’s disease, while others may cooperate with local adult day health programs to provide special services for such persons.

CCRC nursing units are regulated by the same state agencies as nursing homes, and they operate the same in most respects. The level of staffing and the quality of care in a CCRC nursing unit may be greater than in an average nursing home. This is due in part to the self-imposed standards of most CCRCs, and in part to the fact that residents in the health center have friends and spouses close at hand in other parts of the community to lobby for high quality of care.

Costs

CCRCs are pricey. Most require an initial buy-in that relates very generally to the average cost of private housing in the area. For example, CCRCs in the urban Northeast typically require a buy-in of $200,000 or more. Facilities outside of urban areas, or in other parts of the country, usually have lower buy-ins.

Buy-ins are not the same as purchasing a condominium unit. While there may be some communities that do actually sell units to new residents, most are set up either as rental arrangements or as cooperatives in which residents have certain rights of use and occupancy, but do not own any part of the physical structure.

Many CCRCs offer estate planning options that allow anywhere from 50% to 100% of the buy-in to be returned upon death and distributed to heirs in accordance with the individual’s Will, or to beneficiaries named directly in the CCRC contract. Estate planning options should be explored carefully, and always with the assistance of an attorney, so that you are sure of exactly what is offered. Some facilities may reduce or eliminate completely the refund of your buy-in after a fixed number of years, or based upon the level of health care services you require. You should understand clearly what the policies are before you join a CCRC.

On top of the buy-in for CCRCs are monthly fees that may range from $1,000 to $2,000 or more for each unit. Many facilities have two or three fee structures, each keyed to the amount of the buy-in, which allows those with fewer savings but higher income to pay a lower buy-in in exchange for higher monthly fees, and vice versa. Monthly fees also may change on the basis of the amount of health care services you receive. There has been a trend in recent years toward pure rental agreements, where the cost depends entirely upon the level of health care or other services that are being provided.

CCRCs generally do not accept Medicaid funding, although a few may accept such payment for residents who move permanently to the nursing care section of the facility. This is especially so for facilities that operate strictly as a rental arrangement.

Despite the cost (or more likely, because of it), the benefits of a CCRC are substantial. The amenities and the lifestyles usually are very appealing.

For an in-depth review of CCRCs, ElderNet recommends any readings by Lawrence A. Frolic, Professor of Law at the University of Pittsburgh School of Law, published by Warren Gorham & Lamont.

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