Should I Really Move Into a CCRC?

The decision to move into a Continuing Care Retirement Community or not represents one of the most important decisions a person can make in their lifetime. The relationship between a CCRC and a resident is expensive, lengthy, highly personal, and complex. In the following exchange, we explore some of the more important considerations. For more detailed information about CCRC’s check out CANHR’s special web page: www.canhr.org/CCRC/

Peace of Mind

Pro: Availability of access to a continuum of care creates peace of mind, a sense of security, and relieves the burden on children and family to make decisions about meeting the health needs of their loved ones as they age.

Con: For continuing care “peace of mind,” residents have to pay an enormous 6-figure entrance fee that often represents virtually all the savings for a middle class person.  Additionally, the long-term commitment severely impedes consumers’ primary power: taking their business elsewhere.

Entrance Fees

Pro: Entrance fees are sometimes fully refundable within the first 90 days of entry and partially refundable within the first 50 months.  Some contracts allow for up to a 90% refund once the unit is vacated and the unit is reoccupied. Entrance fees also provide the main source for maintaining the campus and paying for capital improvements.

Con: The entrance fee may be refundable but there are often restrictions (refund predicated on re-sale) and limited “reserves” requirements, meaning the CCRC might not have your money when you need it. Residents can feel trapped if they’re unhappy in their community.

Monthly Fees

Pro: CCRCs provide a wide array of options for dining, activities, and wellness programs.  Higher levels of care are provided at a discount compared to persons coming in from the outside. 

Con: Despite the expensive buy-in, residents must pay a pricey monthly fee or else they will be evicted. The monthly rates can be and are increased from year to year, at the sole discretion of management.

Access to Services

Pro: Over 70% of all CCRCs provide a continuum of care on campus. Access to levels of care usually on the same campus (i.e. independent living, assisted living, possibly memory care, skilled nursing) is spelled out in the contract providing a guarantee. This makes it convenient for spouses with different care needs to stay close and for friends to visit.

Con: Residents requiring assisted living or nursing home services are sometimes required to go off-site to receive them.  This can be quite disruptive, separating couples and making visiting very difficult.

Self Determination

Pro: Applicants can choose from a range of options for independent living with the entrance fee and monthly rental fees depending on size and location of the unit. Increasingly, CCRCs are offering services in the independent units that support aging in place. Such services might be covered by long-term care insurance.

Con: Residents have virtually no control over where they are going to live within the CCRC once they’ve moved in. Residents have almost no rights to contest being moved to a different (more expensive) level of care or to a different room within a level care.

Rights

Pro: There are very few complaints by residents regarding the accessibility and quality of care in CCRCs. Residents’ rights are spelled out in the contract, and all contracts are reviewed by the state regulatory agency.

Con: Residents’ rights are underwhelming and enforcement of regulatory standards by the Department of Social Services is almost non-existent. This imbalance is exacerbated by contracts giving CCRCs almost total control over costs and life within the community.

Other Considerations

Pro: Living in a community offers many opportunities for engagement and socialization - a powerful antidote to isolation and loneliness.

Con: Institutional life can create dependency and a sense of being over-scheduled. Living in a peer-aged community can feel unnatural and can sometimes support cliques, further isolating residents.

Pro: Witnessing people aging with grace and dignity as they cope with physical and mental diminishments provide peer role models.

Con: Surrounded by decline and death can be depressing. Some CCRCs frown on walkers and wheelchairs in the dining areas or other displays of infirmity as it detracts from marketing appeal.

Conclusion

CCRCs have a lot to offer the people who can afford them. But the availability of guaranteed services cost a lot more than dollars.  Residents give up control over most critical decisions in the CCRC contracts and have few legal protections.  Be careful!