Example of life in a CCRC
(Arbor Acres in Winston-Salem, NC)
It's a live-in resort for those of a certain age. You get to enjoy the rest of your life and let them take care of the rest.
Continuing care
Continuing care is defined by the NORTH CAROLINA General Statute § 58-64-1 as "...the furnishing to an individual other than an individual related by blood, marriage, or adoption to the person furnishing the care, of lodging together with nursing services, medical services, or other health-related services, under a contract approved by the Department in accordance with this Article effective for the life of the individual or for a period longer than one year. "Continuing care" may also include home care services provided or arranged by a provider of lodging at a facility to an individual who has entered into a continuing care contract with the provider but is not yet receiving lodging..."
A continuing care retirement community (CCRC) is defined by the American Association of Homes and Services for the Aging (AAHSA) as "an organization that offers a full range of housing, residential services, and health care to serve its older residents as their needs change over time."
Continuing Care Retirement Community
A Continuing Care Retirement Community (CCRC) or Life Plan Community is a type of retirement community that provides housing and a resort-like living style for independent living residents, usually with a minimum age of 62, with the added benefit of providing residents a continuum of round-the-clock care as needed for the rest of their lives. These levels of care include onsite medical clinics, home care, rehabilitation care, assisted living care, skilled nursing care, and memory care. Each CCRC is different, even if it is part of a corporate system of CCRCs.
A CCRC is a network of caring and support between residents and their families and the CCRC management, employees, volunteers, and service providers where they all work together to provide a rich, challenging, comfortable, interesting, healthy, safe, and secure environment for the residents for the rest of their lives.
Living in a CCRC means your housing and medical care for the rest of your life has been predetermined by you. Having your future care taken care of relieves you and your loved ones from having to deal with these decisions in the future under stressful conditions. It’s like buying life insurance or long-term care insurance. With a CCRC, you know you will be cared for and that you will not be a burden on loved ones as you age and decline in health.
Being able to live independently is a major benefit of living in a CCRC but you must prove the ability to live independently when the contract is signed.
Only three qualifications to live in a CCRC
To live in a CCRC you don't need references or a resume. There is no interview. They don't care about your religion, race, nationality, gender, or sexual preference. There are only three qualifications needed to live in a CCRC:
- Age. Be at or over a certain age (usually 60 but can be greater).
- Health. Be able to live independently at acceptance.
- Wealth. Have the financial means to live there for the rest of your life.
Same thing, new name
In recent years, leaders in the retirement community industry began to think that the name “Continuing Care Retirement Community” no longer presented the best perception among today’s older adults. They thought that many middle-age and older adults considered the phrase “continuing care” to mean a place where old people go to be cared for until they die, such as an “old age home” or a “rest home,” rather than to mean a place where it is exciting and fun to live and fosters personal growth and new experiences.
In response to this, LeadingAge, an association of not-for-profit aging services providers, in association with other groups, including CCRC owners, started a search to find a new name. In 2015, the new name the group recommended was “Life Plan Community.” They also recommended that the name should not be abbreviated to LPC.
The group feels Life Plan Community does a better job conveying what tomorrow’s mature adults want in a senior living residence. The name change is more to represent the appeal shift and not the services offered by CCRCs. The group said the new name is “expansive and inspirational” and allows “planning” and “living” to merge rather than being oppositional.
The term Life Plan Community was chosen because of what the words mean:
- Life. This indicates that the communities are much more than being about care. They are also about living your life to the fullest.
- Plan. This indicates the “safety net” benefits that CCRCS offer, including care and advanced wellness services, are planned for by you before you need them.
- Community. This indicates it is a group of people who, while they may have individual characteristics, personalities, or interests, they are living together in harmony within a larger society.
An effort is underway, explained at LifePlanCommunity.org, to encourage the use of the new name and to change industry marketing strategies to stress more of the independent living aspects of the communities to lower the age at which most baby boomers move into retirement communities.
The term “Continuing Care Retirement Community” is self-explanatory. You immediately know it has something to do with living in a retirement community that provides continuing care, with the assumption that this means all types of care, throughout the rest of your life. Whereas, with the term “Life Plan Community” you have no idea what it means without some explanation. Therefore, I don’t think a complete changeover will occur for decades. So, for now, this guide will continue to use the term Continuing Care Retirement Community (CCRC).
CCRC concept is not new
CCRCs are not a new phenomenon, some were founded more than 100 years ago, to meet the needs of widows and orphans resulting from the casualties of the Civil War. The needs of the elderly were heightened during the Depression and “old age homes” sponsored by faith-based, not-for-profit organizations emerged as a response to the problem.
Now, as the population is aging, especially the affluent baby boomer generation, there has been a greater demand for CCRCs, and more are being built every year. Most CCRCs in operation today were originally built expressly for the primary purpose of offering continuing care; independent living was a secondary benefit. Newly built CCRCs now stress the independent living benefits of living in a CCRC more than they do the continuing care aspects.
Some facts about CCRCs:
- Over 90% of CCRCs are not-for-profit.
- About 50% of CCRCs are faith-based while others are sponsored by universities, health systems, military groups, or fraternal organizations.
- Of the faith based CCRCs, about 21% are Lutheran, about 18% are Methodist, about 14% are Presbyterian, and about 13% are Roman Catholic. Other faiths are represented, such as Baptist, Moravian, Quaker, Presbyterian, Lutheran, and more.
- A CCRC may be a single-campus organization, such as Salemtowne in Winston-Salem, NC, or part of a corporate system of CCRCs, such as Erickson Living.
- A typical CCRC has fewer than 300 total housing units. About 33% have more than 300 units and only 8% have more than 500 units.
- Over 80% of CCRCs are self-managed.
- CCRCs are in a range of geographical areas from urban to suburban. Most tend to be near shopping areas, medical centers, and recreation areas.
- Today, there are over 2,000 CCRCs in the United States, located in 48 states. The District of Columbia. Pennsylvania, Ohio, California, Illinois, Florida, Texas, Kansas, Indiana, Iowa, and North Carolina boast the greatest number (ranked in that order).
- Some CCRCs are in or near major recreation areas, such as beaches, mountains, lakes, golfing, or skiing.
- The average age of a resident in recent years is about 78.
- About 77% of the residents are women.
- There is about a 12% turnover rate among residents.
According to a 2018 analysis of 1,955 CCRCs across the United States conducted by Chicago-based specialty investment bank Ziegler:
- Most CCRCs in the United States continue to be not-for-profit, and for-profit CCRCs are more likely to be part of a multi-site organization.
- Most CCRCs (78%) are sponsored by a not-for-profit organization and, of these, 64% are entry-fee communities and 25% are rental.
- Among for-profit CCRCs, only 26% are entry-fee communities and 64% are rental.
- About 80% of for-profit CCRCs are part of a multi-site organization. The number of CCRCs in total that are part of a bigger system is almost 65%. This percentage has been increasing due in part to recent industry consolidation trends.
- The median number of independent living units in CCRCs nationwide is 120, the median number of assisted living units is 43, and the median number of skilled nursing units is 72.
- Pennsylvania has the most CCRCs of any U.S. state, with just under 200. The next most densely populated states for CCRCs are Ohio, California, Florida, and Illinois. Wyoming is the only state in the U.S. that does not have any CCRCs.
Amenities offered by CCRCs
CCRCs are self-contained, usually gated, have tight security, and offer practically everything a resident may need at one monthly cost. CCRCs range in size from about 100 to 500 living units and may have from a few hundred to over a thousand residents.
CCRCs offer many amenities, much like a resort or fine hotel. They provide services to make life easier, such as housekeeping, prepared meals, property and grounds maintenance, meal delivery, medical transportation, etc. They also provide services to make life enjoyable.
Depending on the CCRC, the following services may be offered:
- Moving services.
- Local or regional cultural or recreational trips.
- Education programs and auditing of classes at a local university.
- Medically related transportation and weekly shopping trips.
- All home maintenance, including housekeeping, appliance maintenance, linen cleaning, laundry, trash, snow removal, landscaping, security, and some or all utilities.
- Concierge services.
- Exercise classes.
- Community-wide Wi-Fi.
- A method of daily morning check-ins to ensure the resident is okay. If the resident does check-in by the appointed time, the staff will visit the resident to ensure he or she is not having a problem.
- Craft and woodworking activities.
- Community garden.
- Organized social and recreational activities.
- Dog park.
- Walking trails.
- Walking/running tracks.
- Fishing.
- Chapel.
- Golf and indoor miniature golf.
- Tennis.
- Library.
- Bocce courts.
- Shuffleboard courts.
- Gym, pool, spa, and fitness equipment.
- Guest rooms.
- On-site medical clinic with doctors and/or nurses.
- Processing of Medicare and insurance reimbursement forms.
- Banking services
- Hairdressers and barbers.
- Convenience store,.
- Thrift shop.
- Computer room.
- Pool tables.
- Business center
- Game rooms.
- Bars.
Cost to live in CCRC
Most CCRCs have entrance fee plans (partial refunds may be offered), some have rental plans, and some have both. Rental plans may not have an entrance fee, but they have sustainably higher monthly fees. The information in this guide deals mostly with CCRCs with entrance fees; however, most of the information also pertains to CCRCs with rental plans.
All CCRCs have monthly fees, which WILL increase each year. The fees cover one or meals a day, lodging, and all the amenities. Some CCRCs have lower monthly fees but charge fees for such things as cleaning, parking, etc. Fees are discussed in more detail later in the guide.
CCRCs come in all sizes
Most CCRCs have less than 500 residents but there are some large ones. The nation’s largest single-site, not-for-profit CCRC is Erickson Living’s Charlestown campus in Catonsville, MD, with over 2,400 residents.
A CCRC is a BIG commitment
Moving into a CCRC is arguably the single biggest lifestyle change decision you will ever make. All other decisions in your life were just steps along the path toward the end of your life. This is essentially the last lifestyle decision you will make before you die, so you do not want to make any mistakes, especially since the decision requires a significant financial commitment and the economic penalties for breaking a contract and moving out are very high. Once you move to a CCRC, you will probably live there until you die.
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