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Continuing Care Retirement Communities - An Overview

Continuing Care Retirement Communities (CCRCs) offer a broad based combination of housing and care services, including active independent senior living, assisted living, memory and Alzheimer's care and nursing care, generally at one location.

As a resident moves through the various stages of health, he or she can continue to reside in one location.

The primary difference between continuing care retirement communities and assisted living (residential care facilities for the elderly) is that continuing care facilities emphasize the continuity of care throughout the aging spectrum. Assisted living communities on the other hand would require that a resident relocate should he or she require more intensive health and nursing care.

Programs offered by continuing care retirement communities are designed to meet the physical, social, and mental/emotional needs of the individual throughout his or her stay. Services can include prepared and served meals, housekeeping, personal care, and transportation as well as structured activities are generally available and tailored to meet the individual's needs

Many communities offer or encourage preventive health care with multidisciplinary and coordinated care that encourages regular medical exams, solid nutritional choices, regular exercise, and, for those in need of more intensive care, the provision of available specialists in areas that include evaluation, counseling, and social services for the resident and their relatives.

Property Type Overview:

Continuing care retirement communities provide a broad range of housing and personal and health care options for seniors.

Many communities are similar to college campuses with numerous low rise buildings that vary in size from small low-rise facilities to larger high-rise apartment type buildings. The trend of continuing care facilities especially in suburban areas is toward campus-type communities.

A wide range of housing options includes small and large apartments, cottages, town homes, cluster homes and single-family homes.

The adaptive features and type of unit that the senior lives in is partially determined by his or her level of physical and cognitive independence.

For example:

  • The independent living units typically include some safety features such as grab bars and a monitored emergency call system.

  • The assisted living units often consist of small studios or one-bedroom apartments with scaled down kitchens. Often group dining areas and common areas for social and recreational activities are available. Residents in these units are usually ones who want as much independence as possible but need some assistance in daily living activities.

  • Nursing care accommodations usually consist of one-room units with a bathroom and shared by two or more persons. Here, residents receive skilled nursing care (short term or long term). In some cases, seniors move back to assisted or independent living; e.g. if rehabilitative therapy sufficiently improves their physical abilities

Health Care / Medical services provided to Residents:

A large variety of services, including assisted living, medical, and skilled nursing, are generally offered at one location. As a resident moves through various stages of health, he or she has the option of continuing to reside in one community.

Typical Cost:

Continuing care retirement communities can be quite costly and beyond the reach of many seniors. Entrance fees can be sizeable. Some deposit fees are often refundable depending on the facility and their contracts. Monthly fees, also usually required, generally range from $3,000 to $9,000 based on the level of care provided.

Contract Types:

Often you'll be able to choose from three different fee schedules:

  • Extensive contracts - With this contract type, you pay for unlimited care at the outset of the contract. This type of contract is designed so that there is no significant increase in monthly fees during the course of the individual's stay at the facility.

  • Modified contracts - A second way of paying fees is to select a contract that includes a predetermined amount for health, medical, and long-term care after which the individual is responsible for paying any additional services.

  • Fee-for-service contracts - A third way of paying for service is the pay-as-you-go plan. Residents will be charged for services as they are provided. Although this is the least expensive plan initially, rising long-term nursing care costs may counterbalance early cost savings.

The contracts offered by continuing care retirement communities can be very complicated. Consult with your accountant and attorney regarding questions and concerns.

The State of California has an overview of specific laws that apply to Continuing Care Retirement Center contracts at:

Many facilities may require that a prospective resident submit to a cognitive and physical exam before their application can be approved. Certain pre-existing conditions may result in an individual's application being denied or the cost of the contract being reassessed. Some communities might require that applicants have Medicare and most require proof that the individual will be able to afford the monthly fees of the community or facility.

Continuing care retirement communities may be affiliated with certain ethnic, religious or fraternal groups. Some may limit entrance based on an individual's affiliation with the group, but most continuing care retirement communities are open to all who can afford them and who pass their medical exams.