Estate Planning and Business Law

What are Continuing Care Retirement Communities [CCRC]?

Continuing Care Retirement Communities or CCRCs, are retirement communities with accommodations for independent living, assisted living, and nursing home care, offering residents a continuum of care. A person can spend the rest of his or her life in a CCRC, moving between levels of care as needed. People in the senior housing industry call this "aging in place," although it does require leaving one's original residence.

Beyond the continuing care agreement, potential residents need to fully explore the details of each CCRC they are considering. Traditionally, continuing care retirement communities were not-for-profit organizations; today some CCRCs have for-profit business structures. If the CCRC is for-profit, the business might be sold someday. If there is a possibility of sale, how would that affect a resident's contract?

Some continuing care retirement communities are accredited by CARF-CCAC, a lengthy process that must be renewed every five years. If a CCRC is approved, there is an annual and ongoing reporting process during the five-year term. "[If a CCRC has accreditation, it means] the organization is constantly self-examining what's working and meeting a third party set of standards," says Sue Matthiesen, managing director of Aging Services at the Commission on Accreditation of Rehabilitation Facilities (CARF). "The organization is very, very focused on the highest levels of performance, financial solvency, and good business practices."

When visiting continuing care retirement communities, try to keep these important questions in mind:

  • What happens when assisted living and nursing home facilities are full?
  • Does the CCRC have a reciprocal agreement with nearby communities?
  • How well is the staff trained? Do staff members go through criminal background checks?
  • What is the staff-to-patient ratio in each living setting?
  • Does the CCRC appear to be well-maintained, clean, and safe?
  • Is there an Alzheimer's unit or memory impairment services?
  • How can a resident participate in the organization's decision making? Is there a role for residents who wish to be involved?
  • Does the CCRC culture match the resident? Is it a formal environment, with dinner jackets required in the dining room, or a casual atmosphere?

Try to explore the full range of health and wellness activities and social events, both on-campus and off. And don't just look at the independent living quarters. Also visit the assisted living and nursing home facilities. "You don't want to move into a CCRC without having really looked at all the services, being very upfront and honest with yourself during the process," says Matthiesen.

Types of Contracts

There are three basic types of contracts for CCRCs:

  • Life Care or Extended Contract: This is the most expensive option, but offers unlimited assisted living, medical treatment and skilled nursing care without additional charges.
  • Modified Contract: This contract offers a set of services provided for a set length of time. When that time is expired, other services can be obtained, but for higher monthly fees.
  • Fee-for-Service Contract: The initial enrollment fee may be lower, but assisted living and skilled nursing will be paid for at their market rates.

It is very important to review with your loved one each option as well as the long-term financial plan to support them. Often, charges above and beyond the entrance cost and monthly fees arise. Ensure that everyone understands just how much money will be needed to support this housing option.

Also, make sure the facility they are considering will be financially viable over the long term. Get assurance that 10 to 15 years down the road your loved one’s CCRC will still be operating and able to provide them with the care they’ve already paid for.

If you have any questions regarding CCRC’s contact Ivette M. Santaella at Blackwell, Santaella & Jahangiri, LLP, an estate planning and business planning law firm based in San Ramon, Danville, Dublin and Pleasanton and serving the entire San Francisco bay area. Ivette has been trained on reviewing CCRC contracts which require an understanding of this industry.

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