Continuing care retirement communities (CCRCs) are sometimes called life care communities or continuing care communities. These types of communities offer seniors assisted living and nursing care as well as social and recreational opportunities.  Medical services, physical therapy, and other rehabilitation services are conveniently located so residents can move from one level of care to another without leaving the community. CCRFs are a good choice for couples because they can remain in close proximity even if their health needs differ.  

Urban CCRCs may have a campus (like a college campus) or occupy an apartment building with dining rooms, a health club, a library, and other communal spaces. Different levels of care such as independent living, assisted living, and nursing care may be located on different floors. Many new CCRCs are located in suburban or exurban areas. These communities may also have pools, tennis courts, a golf course, community centers, and other amenities. With landscaping, manicured lawns, and paved sidewalks they look like any other housing development.  A woman I know says the only difference between her development and her parents’ CCRC is that the bikes in her parents’ neighborhood are three-wheelers.

Living Spaces

The single-family homes, town houses and apartment buildings offer large rooms, lots of closets, spacious bathrooms and gourmet kitchens. The homes are designed for senior living, so rooms are large enough to accommodate scooters or wheelchairs and other health care equipment. Bathrooms and kitchens have safety features, emergency-call systems, and are handicapped-accessible. Housekeeping, gardening and maintenance, and home health care services are supervised by the CCRC and are included in the contract or available for an additional cost.

Assisted Living

Sometimes assisted living services are provided in the resident’s own home or, if they need additional support services, in separate facilities that have apartment-sized rooms. CCRC assisted living facilities are designed for gracious living, with communal rooms for dining and entertaining, and social and recreational activities. Often residents bring their own furnishings when they move into a facility.

Contracts for Continuing Care Communities

Buying into a CCRC is costly. Residents are expected to move in while they are independent and able to enjoy the social, recreational, and cultural opportunities. Most require entry fees or down payments, and then charge a monthly fee that covers rent, communal and home maintenance services, meals and, if nursing care is included in the contract, a payment toward future nursing care expenses. However, residents are buying a lifetime guarantee of shelter and nursing care.

The contract should include details on the housing and care obligations of the CCRC, as well as its costs. There may be clauses governing transfer from one level of care to another. Review the contract with a lawyer before you write a check. Generally, CCRC contracts follow one of the following standard forms, depending on how residents pay for nursing and long-term care. 

The three most common fee schedules for continuing care residential communities are extensive contracts, modified contracts, and fee-for-service contracts.

1. Extensive Contract
   This contract covers shelter, residential services and amenities, and unlimited long-term nursing care that residents pay in monthly installments. The nursing care portion of the monthly payments may be adjusted over time for inflation and increased operating costs, but the rent remains the same. This way, nursing care costs are spread among all residents.
   
2. Modified Continuing Care Contract
   This contract provides shelter, residential services and amenities, plus a limited amount of nursing care.  Residents can purchase unlimited additional nursing care after they receive the maximum. Costs of additional care are paid on a daily or monthly basis.
   
3. Fee-for-Service Contract
   This contract covers shelter, residential services, and amenities. Emergency and short-term nursing care is usually included, but long-term nursing care is guaranteed only at daily rates.

Considering a Continuing Care Residential Community

Buying into a CCRC is similar to buying a home. Cost, location, and lifestyle are major considerations. The decision involves careful planning, especially if you are just entering into retirement or planning ahead. 

Cost

The costs of living in a CCRC vary depending on the location and the amenities and services provided. Most communities require an entrance fee and monthly payments. These fees can range from lows of $20,000 to close to $400,000. Monthly payments can range from $200 to $2,500, on average. In some places, residents own their living space, and in others the space is rented. In some communities, the entrance fee may be partially refundable.

Entry Requirements

Some CCRCs are affiliated with a specific ethnic, religious, or fraternal order, and membership may be a requirement. The majority of CCRCs require potential residents to have a medical examination to assess their physical and mental status. Selected pre-existing conditions may cause a CCRC to refuse an applicant. Some CCRCs require residents to have both Medicare Part A and B. Naturally, residents must also be able to cover the cost of the entrance fee and monthly payments.

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