What Is a Continuing Care Retirement Community?
A continuing care retirement community is an organization that provides housing and health care to older adults throughout their remaining years, including all care except acute care (hospitalization) and sub-acute care such as ventilator care.
Most often this housing and health care is provided on a campus where there are cottages, apartment buildings, an assisted living building, a nursing home, and often an outpatient clinic. There is usually also a community center with dining rooms, an auditorium, exercise facilities, and various other amenities such as a branch bank, a library, a swimming pool, and craft rooms.
The entire community is usually wired with emergency call systems that provide rapid on-campus support when a resident falls or has an adverse health event.
There are buses and vans that take residents who can no longer drive to stores, to concerts and other entertainment, and to doctor’s offices.
A housekeeping staff provides regular housecleaning in residents’ homes as well as the common areas, a maintenance staff keeps the physical plant in good condition, and a dining staff prepares and serves meals – usually just lunch and dinner, but many communities have now opened a café that makes breakfast to order and short-order lunches for more informal dining and hanging out. The monthly fee usually covers a certain number of meals a month, although residents in cottages and apartments have kitchens and still have the option of cooking their own meals.
Residents are expected to enter the community in relatively good health and many of them contribute to the life of the community as volunteers in interest groups, clubs and formal committees such as the resident association. There are usually also committees (such as a dining committee) that give advice and feedback about the operation and life of the community. Usually there are also resident-led fundraisers to build an assistance fund for people who outlive their resources.
There is a staff that manages the operations of the community and helps residents and families navigate the complexities of moves, changes in health status, and various issues that arise as one ages. This is especially important for residents who have no children or whose children do not live close by.
The bonds of friendship that develop in a retirement community also provide a web of support that – together with the paid staff of the community – make the inevitable crises and losses of old age much more manageable, more successful, and less lonely than living in a single family house. Friends and support staff are close by 24 hours a day, 7 days a week.
The financial cost of joining a retirement community varies from community to community, and many different options have developed over the years. Often there is a substantial entry fee which may or may not be refundable. In addition, there is a monthly fee that covers housing, some meals, regular housekeeping, all maintenance, most utilities, most transportation, and many activities. The entry fee and monthly fees from the independent living phase are often used to subsidize discounted rates for stays in assisted living and skilled nursing levels of care. Many non-profit communities also have a “resident assistance fund” that covers healthcare and other costs if a resident outlives their resources despite responsible money management. This prevents residents from being transferred to a less desirable assisted living or skilled nursing facility off campus late in life.
For people who cannot afford a market-rate CCRC, there are some rental-model retirement communities that do not require an entry fee. And there are low-income apartment buildings (funded by the federal HUD 202 program) that have paid managers who assist residents in maintaining independence for as long as possible.
Some CCRCs include HUD 202 federally-subsidized apartments on their campuses to accommodate low-income people. Other groups have multiple campuses, some of which are full entry-fee CCRCs and others of which are HUD 202 buildings that do not include healthcare facilities but do have support staff.
Ownership of CCRCs can be for-profit or not-for-profit. Many church groups, fraternal organizations, and civic leaders have developed not-for-profit CCRCs that have been successful for 20 years or more. For-profit corporations have developed CCRCs in more recent years, and these tend to be less likely to extend benevolence to residents who outlive their resources.
A recent development – stimulated by market demand for staying home as long as possible — is the concept of a “CCRC at Home”. This involves paying an entry fee and a monthly fee and getting various supports in one’s own home from the staff of a CCRC. It usually includes the option of getting preference for a stay in the CCRC’s assisted living or skilled nursing facility if needed. A typical monthly fee at this point in time is around $800 (plus a sizable entry fee).
The down-side of doing this is that one may not easily develop the friendships and support network that one gets by living on campus. And isolation and loneliness may become an issue as one becomes less able to get out and socialize in the general community. There is also the problem that by deferring the downsizing and closing down of a larger home, one is sometimes too debilitated to be able to choose thoughtfully what to bring to a smaller apartment when the time comes for more care. However “CCRC at Home” can be a good option for people who have loved ones close by who have time and willingness to provide increasingly more companionship and support on a regular basis.