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Choosing a Continuing Care Retirement Community – Keystone Elder Law Mechanicsburg, PA

A previous article presented some of the reasons why a few local residents of continuing care retirement communities (CCRC) chose to move from their homes. If you are considering a move to a retirement community, here are some of their tips to help you make a decision and choose the right community for you.

The most basic considerations for any community are the location, size, cost, and care services. Are you looking for a community in a city or suburban setting, which is close to shopping, entertainment venues, educational opportunities, medical care, and/or family? If you prefer the outdoors instead, a rural setting may be more comfortable.  The size and layout of a community are also personal preferences.  Some folks feel more at home in a smaller, more intimate setting while others may prefer the amenities and bustle of a larger community.  Types of living accommodations may include the house-like settings of individual cottages, or apartments in a single story building or high-rise. If two spouses each require a different level of care, it may be important to think about whether multiple levels of care are provided in a single building or are located across campus from each other.  How easy is it to get back and forth between the two?

Costs for CCRCs include entrance fees and monthly maintenance fees. Generally there are three types of contracts which may be offered.  An Extensive or Type A contract involves a larger entrance fee and higher monthly fees with unlimited lifetime access to any level of care.  If an individual enters at the independent living level and eventually needs a higher level of care, there is little or no change in the monthly fee.  These types of communities are sometimes called Life Care Communities. All Life Care Communities can also be called CCRCs, but not all CCRC’s are Life Care Communities.  With a Modified contract, residents receive a discounted rate for independent living plus a limited amount of personal care or skilled nursing care is included with the entrance and monthly fees.  Once an individual needs personal care or skilled nursing beyond the included amount, they are billed a daily rate for care.  A Fee for Service contract is a rental contract in which the entrance and monthly fees for independent living residents are lower than with an extensive contract, but when personal care or skilled nursing are needed, billing changes to a daily rate.  Most CCRCs in the central PA area offer Fee for Service contracts.  Some offer a higher monthly maintenance fee without the entrance fee, and many communities also offer a prorated refund policy for those who leave the community within a certain period of time after moving in.

The levels of care which are available within a community are important as you consider your own health status and the likelihood of developing an acute or chronic condition which may require additional supports. Not all CCRCs offer a full continuum of services including independent living, personal care/assisted living, and skilled nursing. If the community you choose is unable to provide a certain level of service, you may be required to move again. Communities should also have procedures for moving between levels of care.  Consider whether or not accommodations are available to move to a higher level of care if additional help is required on a temporary basis. What factors are taken into consideration with regard to assessing the need for a permanent move to a higher level of care?  Who participates in this decision?  Knowledge about the requirements and processes for how transitions occur can prevent surprises later on.

Research about the types of medical services which are available to independent living residents is also essential, since many people choose to move to a CCRC for the availability of care. The extent of these services may vary among communities. Do you want to be able to see a physician on campus? If you fall and aren’t injured, but you cannot get up, are staff available to assist you?  If a minor injury occurs, or a sudden illness develops, will the community provide licensed staff members to assess you and provide basic treatment recommendations?  Are these services available 24 hours/day or only on certain days during certain times?

If you work with a financial advisor and/or an elder law attorney, it would be wise to discuss your desire to move to a CCRC with these professionals early in your search process so that you can benefit from their expertise. CCRCs are not affordable for everyone, so financial guidance may be especially helpful if you are unsure about whether or not your assets will be sufficient for a particular community or retirement communities in general.

Beyond these basic considerations of location, size, cost, and care services are many additional variables which help make communities feel unique. Our CCRC insiders will share some additional areas to explore and questions to ask next week.

Karen Kaslow, RN