Continuing care retirement communities in the United States

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A continuing care community, also known as a life-care community, is a type of retirement community. In the U.S. where a number of aging care needs, from assisted living, independent living and nursing home care, may all be met in a single residence, whether in an apartment in a congregate housing facility, a room or apartment in an assisted living facility, and in a skilled nursing home. These various levels of shelter and care are housed on different floors or wings of a single high-rise building or in physically adjacent buildings, such as garden apartments, cottages, duplexes, mid- and low-rise buildings,or spread out in a campus setting. The average CCRC in the United States contains just over 330 units, made up of 231 independent or congregate living units, 34 assisted living beds, and 70 skilled nursing home beds. On average, an older resident in the United States will live in the congregate living facility for just over three years, the assisted living facility for one year, and the skilled nursing facility for nine months (America Seniors Housing Association, 2002).

Typically, elderly candidates move into a continuing-care retirement community (CCRC) while still living independently, with few health risks or healthcare needs, and will remain there until end of life.[1]

As patrons progress in age, and medical needs change, the level of nursing care and service increases proportionally in response. In such a way, the needs of patrons are consistently monitored and catered to, particularly as those needs become more intensive. If greater illness or injury warrants hospitalization, the patron may return to his or her residence after recovery, and should receive appropriate treatment and care.

Continuing-care communities are ideal for seniors that may be living in isolation, and would like to be immersed in a hospitable environment with other people of the same age. Typically, a range of activities and amenities are provided for both recreation and resource. However, CCRCs are costly, and vary widely in entrance and recurring fees.[2]

Types of contracts[edit]

Often, a life-care contract is required, and the stipulations within such contracts can also vary in terms of service. Contracts typically specify the shelter arrangements, residential services, personal and health care, and nursing care that they are guaranteed during their stay in the CCRC. These agreements also specify the present costs to the residents of living in its community and using its resources, the conditions under which costs may be increased, and the conditions under which residents must transfer among its levels of care. These contracts are designed to protect the rights of the older residents, but they also give the owners of CCRCs considerable influence as to what long-term care benefits older residents receive.

The American Seniors Housing Association (ASHA) distinguishes three principal contract types: life care (also known as extensive or all-inclusive); modified; and fee-for-service (ASHA, 2002). These contracts reflect the differences in the way CCRCs charge for personal assistance and nursing care and the extent to which they guarantee the availability of this care without additional costs to residents. In practice, CCRCs will often offer residents contract arrangements that represent a blend of these three contract types. A very small percentage of CCRCs also offer their residents the opportunity to own their units.

Life Care and Modified Contracts - CCRCs offering either life care or modified contracts guarantee their residents shelter, residential services, and amenities along with personal assistance and nursing care for the rest of their lives in return for an initial entrance fee and a monthly payment schedule. CCRCs usually offer these contracts to seniors who initially occupy their congregate or independent living units. The entry fees may be nonrefundable or partially refundable depending on the length of the resident's stay. Life care and modified contracts differ financially in an important way:

  • Under the life care contract, residents who move to the assisted living or nursing home accommodations of the CCRC continue to pay a monthly fee similar to what they had for their independent living accommodations. CCRCs agree to increase these fees only to compensate for normal operating costs increases.
  • Under the modified contract, when residents move to a higher level of care, the CCRC agrees to charge the independent living rate for only some specified time period, after which residents must pay either a full or a discounted per diem rate.

Fee-for-Service Contracts - Fee-for-Service contracts often do not require an entrance fee. Under this plan, residents receive priority or guaranteed admission to the CCRC's higher levels of care, but they are not entitled to any discounted health care or assisted living services. Rather, on entering a CCRC's assisted living facility or nursing home, they pay the regular and usually higher price per diem market rate. Older residents admitted directly into a CCRC's assisted living facility or nursing home would typically sign fee-for-service contracts.

Types of assistance and care[edit]

It is important for any considering such contracts to have an elder law attorney review its terms and ensure legitimacy.[3]

Potential patrons, or their current caregivers, should inquire about licensing reports, prior inspections and verified complaints to help inform their opinion of a particular CCRC. It is also advisable for potential patrons and their caregivers to have open discussions with current residents and receive their opinions on the CCRC in question.

A list of accredited CCRCs can be procured from the Commission on Accreditation of Rehabilitation Facilities.[4]

See also[edit]


  1. ^ Continuing Care Retirement Communities (CCRCs)",
  2. ^ Continuing Care Retirement Communities (CCRC)",
  3. ^ Nell Bernstein, "Continuing-Care Community Contracts and Fees,", November 2008
  4. ^ "Accreditation". CARF International. Retrieved April 3, 2014. 

External links[edit]