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What Are Continuing Care Retirement Communities?
Continuing care retirement communities (CCRCs) combine residential accommodations with health services for older adults. As a senior’s health status changes, CCRCs provide a continuum of care, from independent living to assisted living to skilled nursing care.
This means individuals don’t need to move out of the retirement community as their needs increase. Couples can remain near each other if one becomes ill and requires more care than the other, and residents can create meaningful bonds over time.
CCRCs offer various rooms and apartments in a campus-like or urban high-rise setting for independent or assisted living and a separate wing for short-term or long-term skilled nursing care. Applicants must meet admission criteria. This guide explores continuing care retirement communities in depth, including how they work, how much they cost and how to find a local community.
Key Takeaways
- Understanding How CCRCs Work: Overview of different continuing care retirement communities contract types and levels of care, including independent living, assisted living and skilled nursing.
- Typical CCRC Services: Information about services often included under different contract types and examples of facility amenities for residents’ recreation.
- When to Consider Moving to a CCRC: Insights into signs that it may be time for individuals to start planning their move to a continuing care retirement community.
- Pricing and Payment Methods: Details about pricing structures, including up-front and ongoing monthly fees, and guidance on paying for various care settings within a community using financial assistance programs and private resources.
How Do Continuing Care Retirement Communities Work?
Retirement communities have admission criteria that normally specify a minimum age and level of health for incoming residents. To comply with legal provisions in the Housing for Older Persons Act of 1995, the youngest age at which someone can move into a CCRC stands at 62, although communities may also set older minimum ages.
CCRC Contract Types
Although people sometimes refer to continuing care retirement communities as life care communities, they differ. Life care is a subset of continuing care available through one of three types of continuing care contracts offered at a continuing care retirement community.
In general, CCRCs offer three types of contracts:
- Type A contracts provide extensive or full life care service.
- Type B contracts provide modified or continuing care service.
- Type C contracts are fee-for-service arrangements that provide continuing care service.
Type A contracts provide the most comprehensive support, including residential services, amenities and long-term nursing care without an increase in monthly fees. Type B and C contracts cover residential services and amenities but limit nursing care, often requiring extra fees.
CCRCs vs. Life Care Communities
Life care communities are CCRCs operating under Type A contracts but with one distinct difference. Like standard CCRCs, a life care community offers a continuum of care to a resident for life. However, if residents become financially unable to pay their monthly care fees, the community subsidizes their costs. Residents continue to receive the same access to services with no interruption in care or change in priority status, regardless of their personal financial situation.
Levels of Care
Whether a continuing care retirement community is strictly a life care community or offers all three contract types, most communities have independent living housing, assisted living housing and a skilled nursing facility to provide three distinct levels of care.
Independent Living
This provides the least care, similar to a stand-alone independent living community. Residents usually start their lives in a continuing care retirement community while they’re still active and have no support needs. Independent living apartments or homes generally have a full kitchen and standard amenities. Many CCRCs also offer meals in a communal dining room and various engagement and enrichment opportunities.
Assisted Living
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This provides support with activities of daily living, with similar services as an assisted living facility. Seniors may be asked to move to a new apartment within the community as their needs change.
Skilled Nursing Services
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This provides the highest level of care in a continuing care retirement community. Seniors may receive long- or short-term services, depending on their needs. Services are similar to those in nursing homes. If residents develop health care needs, a CCRC delivers such care on-site, unlike assisted living communities. Seniors temporarily move to the skilled nursing wing until they recover, then return to their assisted or independent living residence. Conversely, those who require ongoing or end-of-life care permanently move to the skilled nursing unit.
Continuing Care Retirement Community Services and Amenities
Most CCRCs provide 24/7 security service and an emergency call system to all residents. Many also offer diverse amenities and services. Monthly fees cover most services for contract types A and B. However, those with type C contracts may have additional fees for certain services.
Under typical type A or B continuing care contracts, basic services generally include:
- Three meals daily
- Weekly housekeeping
- Laundered linens and towels
- Banking and postal services
- On-site social, recreational and educational activities
- Scheduled transportation and outings
Contracts may also include health care services, such as:
- Access to an on-site doctor by appointment
- House calls during an illness
- Meal delivery during an illness
- Daily van service to an off-site hospital
- The option to retain services under a separate medical plan, with certain provisions
Many CCRCs have diverse amenities, such as:
- Fitness center
- Salon
- Arts and crafts room
- Convenience store
- Movie theater
- Library
- Dog park
- Garden
- Golf course
- Tennis court
- Swimming pool
Who Should Consider a Continuing Care Retirement Community?
CCRCs may suit older adults who value security. No matter how your loved one’s health changes, their needs will be met and they’ll never have to move. Residents also benefit from social connections and recreational activities.
On the other hand, joining a continuing care retirement community requires residents to hand over a large chunk of their assets to secure a spot. Furthermore, CCRC administrators play a significant role in deciding when your loved one needs to move from one level of care to the next, which can remove independent decision-making.
For further information, see our article, Who Should Consider a CCRC?
Key Signs That It May Be Time to Consider a CCRC
Even if your loved one isn’t ready to move out of their home, finding what’s available locally will still help them prepare for a future move. Because most seniors relocate to a continuing care retirement community while still relatively independent, planning is essential. While helping your loved one with their continuing care decision, consider the following signs that it may be time to start looking for a CCRC:
- Increasing Difficulties with Chores: If you or a loved one find daily chores and maintenance more of a struggle, settling into a continuing care retirement community early allows you or your loved one to enjoy the independent living aspects before requiring greater day-to-day support.
- Loneliness: Social isolation and loneliness impact long-term health. CCRC residents have a private living space alongside communal amenities, leisure activities and opportunities to meet new people.
- Desire for Stability: Choosing a CCRC makes it less likely that you or your loved one will need to move following a change in care needs. This offers stability and familiarity.
- Safety Concerns: CCRCs provide regular safety checks, and residents can call for help 24/7 with an easily accessible emergency call system. On-site support staff enhance reassurance for seniors and their loved ones.
Remember: Many CCRCs have long waitlists. Individuals should expect to wait between six months and two years for sought-after CCRCs. However, this gives plenty of time to prepare for a move, including downsizing.
How Much Do CCRCs Cost and How Can I Pay?
Continuing care is an expensive option, but if your loved one can afford it, their needs will be met for the rest of their life. Precise costs and payment arrangements vary widely among CCRCs.
- Home Ownership in CCRCs: In some CCRCs, residents purchase their units. In others, they rent them.
- CCRC Entrance Fees: New residents typically pay a significant upfront entrance fee. These admission fees range from $20,000 to $550,000-plus.
- Return of Entrance Fees: Entrance fees may be nonrefundable, refundable on a declining basis over time, partially refundable or fully refundable, depending on the CCRC’s policy.
- Monthly Service Charges: Residents pay a monthly service fee for the duration of their residence. These monthly expenses vary among communities, accounting for housing size, facility amenities, services and contract type. They typically range from $500 to $4,000, with potential supplemental charges.
- Impact of Contract Types on Costs: Contract types significantly impact monthly fees. All contracts cover housing, meals, base services and amenities, but the amount of medical care varies widely. Extra fees apply for specific services under contract types B and C. Additionally, some facilities waive admission charges for those with type C contracts.
| Type A Contracts | Type B Contracts | Type C Contracts | |
|---|---|---|---|
| Entrance Fee Requirement | Charges an entrance fee | Charges an entrance fee | May waive entrance fee |
| Monthly Fee Comparison Per Contract Type | Most expensive monthly fees | Mid-range monthly fees | Least expensive monthly fees |
| Additional Fees for Extra Services | Fixed lifetime inclusive fees (barring periodic inflationary impacts) | Daily or monthly supplemental charges for extra care | Fee-for-service contract, with pricey daily rates |
| Amount of Medical Care Included in Base Fees | Unlimited nursing care at limited or no extra cost | Limited medical care, with extra charges after a specified number of days | Little to no medical care, except emergency services |
Understanding your continuing care contract is vital: A continuing care retirement community represents a long-term commitment and a significant financial investment. Because CCRC contracts are long, detailed and complex, you may benefit from consulting an elder law attorney.
Paying for CCRCs
Contracts cover how residents will pay continuing care retirement community fees. Care levels and living settings affect payment options as public funding only covers particular services for eligible seniors. Moreover, many facilities don’t accept Medicaid. While researching CCRCs, be sure to ask about accepted payment types.
| Independent Living | Assisted Living | Skilled Nursing | |
|---|---|---|---|
| Medicare | No | No | Yes |
| Medicare Advantage | No | No | Yes |
| Medigap | No | No | Yes |
| Medicaid/ HCBS Waivers | No | In some states | Yes |
| VA Benefits | No | Yes | Yes |
| Long-Term Care Insurance | No | Yes | Yes |
| Private Funds | Yes | Yes | Yes |
How Do I Find a Continuing Care Retirement Community?
These tips can help you identify the most appropriate continuing care retirement community for you or your loved one:
- Enter your zip code into our Continuing Care Retirement Directory on this page or search by state or popular city.
- Compare ratings and read reviews.
- Schedule community tours.
- Apply for waiting lists.
Although continuing care retirement communities often cost more than other care settings, they provide a stable environment and continuity of care as seniors’ needs change. This brings peace of mind to many older adults planning their future long-term care needs. Individuals should carefully consider contract types, inclusive services and funding options when deciding whether a CCRC offers the best fit for their future.