Guide>What about a CCRC?>LITTLE SECRETS

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CCRCs have their little secrets they keep from potential residents. Here are some of the secrets they often fail to mention.

It’s complicated

Despite what we say, selecting a CCRC is complicated.

You see terms such as active adult communities, 55+ living communities, senior living, independent living communities. assisted living facilities, skilled nursing facilities, continuing care retirement communities, life plan communities, etc. Each facility uses different terms, offers different services, and has different pricing structures so it is difficult to compare services, prices, and total costs. They all advertise the same amenities and services and each one says it is the best one. Even if you know that you want to move to a CCRC, it will take a lot of time, research, and effort to find one that best suits your needs.

It’s smoke and mirrors

It all seems too good to be true, and sometimes it is. 

First impressions count so many facilities invest a lot of money in attractive touches, such as fancy furniture, artwork, and flower displays for their lobbies. However, these decorations do not necessarily speak to the quality of care offered at the facilities or to the quality and upkeep of the facilities. It is like the castle in the Wizard of Oz. Everything in the lobby looks grand and glorious, but when you pull back the curtains and look through the smoke you see it is all an illusion.

Staff and residents know who the marketing agents are and they know that anyone walking with them is probably a prospective resident so they know to be on their best behavior. Remember marketing agents are salespersons; their job is to get you to sign a contract. They are not going to volunteer any information that will jeopardize a sale.

Prospective residents and their families should look beyond the décor and the glossy brochures. Activities and staffing levels may vary according to the time of day, so visit more than once and at different times. Make sure one visit includes a meal in the dining hall. A meal can help you judge the quality of the food and how the staff interacts with residents.

Staff stability is an important consideration when choosing a CCRC. Continuity of care is important for older people, especially those with dementia who can become disoriented adjusting to too many new faces. However, turnover is high among the staff at most CCRCs since the work is difficult and low-paying. Ask the CCR representative about staff turnover and, when meeting staff, casually ask how long they have been working at the facility.

Ask to talk to the facility’s top executive, and take it as a bad sign if a brief meeting is declined. The CCRC is only as good as those who lead it.

Fees, what fees

Our fees are not a secret, but they are a subject we prefer to not discuss until we have you hooked. 

Go to a CCRC website and see all the beautiful facilities and happy people, but don't expect to find any information about their fees. Call or email and you may get them to send a copy of the fee structure but you may have to put up with a sales pitch about how it is all dependent on your situation so you need to come in for a visit so they can discuss it with you.

Some states, such as North Carolina, require CCRCs to file their disclosure agreements with the state annually. Some states, such as North Carolina, post these disclosures online for public viewing. The disclosures have the most recent fee structures and other financial information about the CCRCs.

No matter what we say about a yearly evaluation of costs with possible fee increases, there will be a LARGE fee increase EVERY year. 

Fees are typically outlined in the contract residents sign when they join and there is mention of possible fee increases, but the impact of these fee increases on your finances is usually not pointed out by marketing agents. After a few years of living at a CCRC, many CCRC residents are shocked by how much they are currently paying per month.

The monthly or daily fees for living in a CCRCs rises about 4% per year, no matter what the inflation rate is or the national economy. Many facilities charge additional fees for services such as meal delivery, non-medically related transportation, extra cleaning, and even valet snow removal from cars parked in the outside lot. All these little fees add up over time. The fee structures vary from place to place and can get confusing. For example, some CCRCs include medication management for up to five different prescriptions at no extra charge, while others might charge per prescription.
In recent years, consumer demand has driven a trend toward “a la carte” pricing. Residents have a lower monthly fee for basic services and pay extra for other services as they use them.

CRCC ratings, what ratings?

Good luck finding any kind of ratings for CCRCs, they are scarcer than a hen's teeth. 

Since skilled nursing facilities are federally regulated, you may go to the Medicare.gov website and use the “Nursing Home Compare” link to see the ratings for skilled nursing facilities throughout the country.

Assisted living facilities and CCRCs are state-regulated and many states do not post inspection records online. During a visit, prospective residents can ask to see a facility’s licensing survey, a document that is completed when state regulators assess compliance with licensing requirements. Just make sure to keep any listed violations in perspective. The types of violations matter more than the number of violations. A high number of incident reports at a skilled nursing facility is not necessarily a sign of subpar care; it might just be because the facility is taking care of some of the most difficult patients.

Be careful what you sign

You may think you are just signing for a relative, but you may be agreeing to be accountable for the relative’s bills. 

Often, the person signing the contract for a skilled nursing or assisted living facility, or even a CCRC, is the new resident’s power of attorney. By the time the relative enters these facilities, he or she may be experiencing cognitive decline and, legally, the person no longer has the capacity to make financial or medical decisions for him or herself. Thus, the power of attorney signs the contract on the resident’s behalf.

This means the person with power of attorney will have access to the older adult’s funds and will make payments on his or her behalf. However, if the signer is not careful, he or she could inadvertently sign as a guarantor who is personally responsible for making payments if the resident runs out of money. Failure to pay could result in legal actions, which could damage the guarantor’s credit. Also, the facility could take steps to evict the resident if payments stop.

The best way to ensure this won’t happen is to sign the resident’s name as the responsible party on the contract, and after that write “by [name of agent] acting as power of attorney,” followed by the date.

Tax deductions

Yes, some of our fees may be tax-deductible. 

It is not a secret, but many CCRCs don’t advertise it. While some CCRCs inform prospective residents about this benefit, most do not; they do not want to be in a position of giving tax advice that may cause them legal problems.

Taxpayers who are 65 and over who itemize their deductions can deduct medical and dental expenses exceeding 10% of their adjusted gross income. These medical expenses include certain nursing services, such as bathing and changing dressings, whether those services are provided in the home or in a care facility. It also includes part of the fees paid at CCRCs that offer lifetime plans; a portion of the fees is considered a payment for providing medical services and a prepayment for future medical care. This portion of the fee that is deductible is determined by the CCRC’s auditors and can vary from facility to facility. The portion that may be claimed as a deduction is provided to residents by the CCRC each tax year.

Medicare and Medicaid

We accept Medicare and Medicaid, but not if we can avoid it

Medicare pays for the first 3 months of skilled nursing under certain conditions. But the skilled nursing facility must have Medicare-certified beds. Most facilities only have a few of these certified beds, so, even if you qualify for one, one may not be available when you need it so you must pay the normal daily fee for the facility yourself.

Medicaid pays certain long-term care costs for people who have exhausted their assets and meet strict income criteria, i.e. they are broke. Facilities receive less compensation from Medicaid than they do from residents who pay out of pocket, which makes Medicaid-eligible residents less desirable from a financial standpoint. Thus, facilities typically strictly screen prospective residents by requesting documentation to show they have enough money to pay for their stay for their expected lifespan. CCRC have actuaries that determine how much money you must have available for entry into the CCRC to ensure the CCRC does not lose money.

Facilities that take Medicaid cannot refuse someone just because they are on Medicaid. But many states have only a fixed number of what are known as Medicaid-waiver slots allotted for assisted living residents in a specific geographic area. The problem with this structure is that when self-paying residents run out of money they are sometimes told there is no Medicaid slot available for them.

Many CCRCs don't take Medicaid or other subsidies, and some facilities that had taken Medicaid may switch to no-Medicaid policies. That leaves residents who have no assets with no place to live. Nationally, discharge-related complaints are the second-most-common complaint at nursing homes, behind the failure to respond to requests for assistance. And it's the third-most-common complaint at assisted-living facilities, behind problems with medication administration, and disappointment with the food.

When residents run out of funds to pay their monthly fees, complicated state rules can force them into nursing homes for at least a month so they can qualify for Medicaid, and then back out into another assisted living facility, Residents who thought they'd found their final homes now must look for new places to live.

We have a staff doctor available for residents

However,  the doctor will only be available on certain days and there is no doctor on the premises after normal working hours.

Many CCRC independent living facilities have an on-site medical clinic staffed with a physician or physician assistant who sees residents during normal office hours. If medical assistance is needed after hours, you are usually transported to outside medical facilities.

Assisted living facilities house frail, vulnerable residents, so one would assume they would have a doctor on the premises 24/7. However, they do not, and many facilities do not even have a registered nurse on the premises. There is not much health care in these facilities; they just help residents with daily living tasks. Regulations vary at the state level as to what type of personnel must be present and during what hours. A lack of medically trained staff means that, even if you need something as simple as treating a cut, you must wait for a nurse. It also leads to an overuse of emergency services and hospitalizations, which creates stress and extra costs for residents.

The population of assisted living facilities has grown older and sicker since this housing concept first appeared, and hospitals are discharging patients much sooner than in the past. In response to these trends, assisted living facilities are adding more on-site nursing services. You should always ask what the medical staffing levels are at the facilities you are considering.

Nursing homes generally have a doctor as the medical director who supervises the nurses on staff. While there may or may not always be a doctor on-site, there will always be one on call.

We provide you with each level of care you need

However, we determine when you need a higher level of care, not you.

If you are in one level of care, the director of the CCRC (with input from many sources, including your and your family) makes the final determination when you must move to the next level. For example, if you are in independent living, the director determines when you must move to assisted living. If you and your family disagree with the decision and refuse to move, you may be told to move out of the CCRC.

Each facility in a CCRC retains broad discretion over who can stay there. This includes asking residents to leave if their behavior is deemed too much of a problem. They usually state it as “We can no longer meet your needs.”

Facilities are licensed by the state to provide a certain level of care. If the resident’s needs exceed the facility’s capabilities, then the resident may have to move. For example, a facility may not be able to safely accommodate an Alzheimer’s patient who has become combative. A resident with increased needs may be allowed to stay in assisted living if he or she can afford to hire an around-the-clock health aide to stay with him or her.

Alarms, Alarms, Alarms

Safety comes at a price.

Every CCRC resident living unit comes with smoke detectors and may also have CO2 detectors. This is for resident safety and is usually required by law. If you did not notice the detectors when you moved in, they will soon make their presence known. When they are activated, they alarm (audibly and visually), and doors between common areas will automatically close.

Smoke detectors activate in the presence of smoke or dust particles in the air. Smoke can come from burned toast or an overcooked roast or cake in the oven. Dust can come from contractors remodeling a living unit.

CCRC residents are old and, as they get older, they tend to forget things, such as bread in the oven, which results in smoke and thus activates a smoke detector. CCRC residents usually live there for the rest of their lives. As they die or move into higher levels of care, their living units become available for new residents. Since this is a regular occurrence, living units are constantly being remodeled. Sometimes contractors are careless and make too much dust and this activates a smoke detector.

This means that alarms can occur quite frequently so be prepared.

Independent living

It's called independent living for a reason.

Independent living means INDEPENDENT living, you are not dependent on the CCRC to take care of you. Don’t expect the CRC to give medical aid when you fall or injure yourself. They may come to give you basic help and call 911, but you need to call 911 first. If you need assistance in living, you must pay for aides to assist you, or you pay more to enter assisted living, memory care, or skilled nursing care.

“Fringe” benefits

There are unspoken fringe benefits to living in a CCRC.

CCRC residents can have visitors in their living units and many do, and not to play cards. Many CCRC residents are sexually active and enjoy having plenty of sex. Pregnancy might not be an issue, but sexually transmitted diseases are. The Centers for Disease Control and Prevention reported a rise from 2007 to 2011 in chlamydia rates among those ages 55 and over. High levels of genital herpes have also been reported.

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