Continuing Care Retirement Communities (CCRCs): An All-in-One Senior Living Option

Danny Szlauderbach
By Danny SzlauderbachJune 24, 2020
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Continuing care retirement communities (CCRCs) are retirement communities with accommodations for independent living, assisted living, and nursing home care. An aging adult can spend the rest of their life in a CCRC — sometimes called a life plan community — moving between levels of care as needed.

Most people would prefer to age in place, meaning continuing to live at home throughout their senior years. Because they offer so many types of care in one location, CCRCs allow a different kind of aging in place — even if residents aren’t living in their original residence.

“CCRCs are great for people who only want to move once,” says Kyla Jones, regional manager at A Place for Mom. “They do have to move to a different area, but it’s ultimately the same place.”

When choosing a CCRC, it’s important to look at services offered, the possible benefits and disadvantages, the costs, and the contractual obligations of the CCRC.

What is a CCRC?

To be defined as a CCRC, a retirement community must offer independent livingassisted living, and nursing home care all in one campus (acute care takes place at nearby hospitals).

Depending on the community, living spaces can include houses, cottages, clusters, townhouses, duplexes, and apartments.

Although settings vary, most CCRCs feature:

  • A common dining room
  • Activity centers
  • Gyms
  • Outdoor recreation often including swimming pools
  • Social events, including outings to events such as theaters or museums

Life care communities and other names for CCRCs

Some other names for CCRCs include:

  • Life care communities
  • Life plan communities
  • Lifetime communities
  • Continuing care communities

Pros and cons of CCRCs or life plan communities

Living in a CCRC can lessen worry for both the resident and their loved ones. Health and wellness centers offer senior living activities to help all seniors lead a more active life. This engaging, community-centered lifestyle can help keep residents healthy, and it’s also beneficial for widows or widowers.

CCRCs can be a good option for couples with different care needs. While they may not live in the same apartment, they’re nearby and may be able to eat and socialize together.

Outside of a CCRC, elderly adults often need someone to help with tasks like lawn mowing, trips to the grocery store and appointments, and meal prep. CCRCs usually offer these services (depending on the monthly maintenance contract):

  • Meals
  • Transportation
  • Lawn care
  • Gardening
  • Garbage and snow removal
  • Housekeeping
  • Social activities
  • Laundry
  • Some utilities
  • Health monitoring services
  • Emergency call monitoring
  • Security

However, CCRCs aren’t right for everyone. Deciding health care options for the rest of one’s life and committing to lifelong financial obligations is a big decision. Residents also need to be comfortable with both the health care continuum and the monetary responsibility of living in a CCRC.

“CCRCs are more expensive than other types of senior living and often start with a large buy-in,” Jones says. “They will also sometimes advance people up to a higher level of care, like assisted living to a skilled nursing facility, sooner than a community that doesn’t offer skilled nursing.”

How much do continuing care communities cost?

Choosing to live in a CCRC can be an expensive senior living option. Payment plans differ, but a large entrance fee is usually required. This fee can be as little as $10,000 and as much as $500,000.

Residents must also pay a monthly maintenance fee, which can range from roughly $200 to more than $2,000. A contract between the resident and the CCRC spells out what the monthly maintenance fee covers, as well as health care coverage and costs (see CCRC Financial Facts, below).

When you commit to a CCRC or life plan community, you usually sign a continuing care agreement. A lawyer or financial advisor should review this document first, as it is a legal contract between the resident and the CCRC.

The continuing care agreement should cover:

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  • Residences
  • Fee schedules
  • Health care coverage
  • Cancellations and refunds
  • Services
  • Insurance requirements
  • Conditions for transfer within the community to other levels of care, plus a description of the CCRC’s responsibility should a resident become unable to pay fees

Every contract should have a clause about refundability. A person who leaves a CCRC often loses part or all of the entrance fee, depending on how long they lived at the CCRC.

There are typically three fee schedule options at a CCRC:

  1. Extensive contracts:
    This is the most expensive agreement, and it gives residents unlimited access to health care with little or no increase in the monthly maintenance fee.
  2. Modified contracts:
    This contract offers residents unlimited access to health care, but residents pay for health care as needed, with monthly maintenance fee increases to cover this. Often the health care costs are offered at discounted rates.
  3. Fee-for-service contracts:
    Residents pay for all health care costs separately. Although this can initially be the least expensive contract, it can be quite costly if a resident eventually has extensive health care needs.

Continuing care retirement communities may also offer residents a certain number of skilled care days each month without raising the monthly maintenance fee. This is sometimes part of the modified contract schedule option.

What to look for in a CCRC facility

Beyond the continuing care agreement, potential residents should fully explore the details of each CCRC they are considering.

Traditionally, continuing care retirement communities were not-for-profit organizations; today some CCRCs have for-profit business structures. If the CCRC is for-profit, the business might be sold someday. If there is a possibility of sale, consider how that would that affect a resident’s contract.

Some continuing care retirement communities are accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF), which has the nation’s only accrediting body for continuing care retirement communities — the Continuing Care Accreditation Commission, also known as CARF-CCAC. Accreditation is a lengthy process that must be renewed every five years. If a CCRC is accredited, there’s an annual and ongoing reporting process during the five-year term.

When visiting CCRCs, keep in mind these important questions:

  • What happens when assisted living and nursing home facilities are full?
  • Does the CCRC have a reciprocal agreement with nearby communities?
  • How well is the staff trained? Do staff members go through criminal background checks?
  • What is the staff-to-patient ratio in each living setting?
  • Does the CCRC appear to be well-maintained, clean, and safe?
  • Is there an Alzheimer’s unit or memory impairment services?
  • How can a resident participate in the organization’s decision making? Is there a role for residents who wish to be involved?
  • Does the CCRC culture match the resident? Is it a formal environment, with a blazer required in the dining room, or a casual atmosphere?

Try to explore the full range of health and wellness activities and social events, both on-campus and off. And don’t just look at the independent living quarters: Also visit the assisted living and nursing home facilities.

How do I find a continuing care retirement community?

A Place for Mom’s Senior Living Advisors can share information about CCRCs and other senior living options in your area. They can also help assess your family’s specific situation to figure out the right fit for your loved one — all at no cost to you.

Danny Szlauderbach
Danny Szlauderbach