That ability to remain in one area while increasing the level of care being accessed provides a degree of security that doesn’t exist within “normal” senior housing options and is the appeal for many individuals. In addition, many spouses have been disappointed when one or the other of them has had need for services that weren’t provided in a community or required a move, effectively separating the spouses. Those situations are less likely to occur in a CCRC.
The problem with a CCRC is that doing so has meant choosing to pay large entrance fees and then monthly fees for the duration of an individual’s residence. Those upfront fees might easily be in the hundreds of thousands of dollars (some have entrance fees well over $1 million). The monthly charges may be several thousands of dollars extra (the current range is between about $2,500 and $4,000) and then most communities add additional charges for services, pricing them out of the reach of most individuals within the greater community. Depending upon the community, residents either own or rent their living space. Some communities make their entrance fees at least partially refundable but refund levels often increase the costs.
Originally, CCRCs defined their average entrance fee as a value equal to the average home value in the community. The point was to allow people within the community to sell their home and turn right around and buy into a CCRC. Then home values increased but not nearly as much as construction fees and suddenly people could sell their homes and then have to put up additional money to make the entrance fee. Developers focused on higher income families and the focus for prices shifted to the median value of the upper half of the homes in the community.
Then, even that didn’t work. Construction prices continued to rise faster than housing prices and now entrance fees exceed the upper-half median home value. So, because people and investors became leery of the costs, CCRCs began looking at other options. One way to cut costs was to look outside the CCRC for services that were already provided within the community. Using skilled nursing care from a nearby facility and possibly creating a partnership for services that were desirable but otherwise outside of the scope of the CCRC are examples. Some CCRCs chose to go that route with their skilled nursing but other options included doing so for pools, gyms or spas. One Palo Alto CCRC gives each resident a full membership to a nearby community center as part of their monthly fees.
CCRCs are not for everyone. On top of the affordability issue, once you move in, you’re essentially giving up the right to move again. You’re also giving up the right to make your own determination as to when you need additional services. However, for people who are beginning to feel socially isolated, a CCRC provides a way to make new friends and become engaged in group activities and helps to eliminate undesirable moving.
The time to consider moving into a CCRC is when you are healthy. The least expensive options are when you need the least amount of services. Most CCRCs require potential residents to undergo a medical examination and can refuse you admittance based on your physical or mental health.
You need to make an honest appraisal of services you’ll likely need in the future and ensure they are available. Check out all the levels of care provided by the CCRC to ensure you feel comfortable with the level of care and professional service available.
The point of CCRCs is to be an active part of the community. It may be that living in a CCRC is not an option for you at this time or maybe not ever. However, CCRCs often provide community services that benefit the surrounding neighborhood. Those services may involve educational opportunities, exercise options and even health care options. It’s possible that after making use of those services for a while, the idea of moving into a CCRC will become less daunting.
Types of CCRCs
- Type A: New residents pay an entrance or buy-in fee, plus a monthly fee that’s guaranteed (although it will be adjusted for inflation). For individuals at this level, the carrot is that prices remain stable and choosing this option acts similar to a long term care insurance plan.
- Type B: Entrance fees and initial monthly fees are somewhat lower but monthly fees rise as the level of care increases.
- Type C: You pay a lower entrance fee but you pay market rates for level of care.
A final option is occasionally available. That option is to essentially become a renter. There are no guarantees that as your care needs increase that you’ll be able to move within the community and you pay market rates for level of care.
Refunding entrance fees for individuals who either die or choose to leave run the gamut from the community offering little or no options to a selection of options with the greater percentage of refund matched with an increase in the entrance fee.
It is difficult to create a single document that covers the costs of CCRCs in any sort of usable format as each CCRC uses different methods to determine costs. If you are determined to try to live in a CCRC, visit multiple CCRCs, learn as much as you can about costs (some are very good at offering classes to help you determine how to read a contract and what the costs are) and talk to current residents.
Almost 80 percent of CCRCs are non-profit. Choosing a non-profit is likely to keep your costs down but it isn’t guaranteed. If finding an affordable CCRC is important to you, look for non-profits that have partnerships with others in the community that can provide some of the costlier amenities such as skilled nursing. Those partnerships can help lower your bottom line while still providing services that you may find desirable.
If you are sure the move is a good one for you and feel you are in good health, eliminating some of the refund options can cut your costs by as much as 10 percent or more.
Another option is to hire an elder law attorney. Not only can the contracts be confusing but an elder law attorney can help you with the contract and may be able to negotiate some of the fees.
In addition, some CCRC models allow you to write off some of the expense of the CCRC.
For more information on CCRCs, contact us at firstname.lastname@example.org for a white paper on CCRCs.