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Continuing Care Retirement Communities (CCRCs)

Continuing Care Retirement Communities (CCRCs)

CCRCs offer the entire residential continuum-from independent housing to assisted living to round-the-clock nursing services-under one "roof". Residents pay an entry fee and an adjustable monthly rent in return for the guarantee of care for the rest of their life. Because CCRCs maintain an assortment of on-site medical and social services and facilities, residents can enter the community while still relatively healthy and then move on to more intensive care as it becomes necessary. Nursing care is often located within the CCRC or at a related facility nearby. In addition to health care services, CCRCs also typically provide meals, housekeeping, maintenance, transportation, social activities, and security.
CCRCs are diverse in their offerings and personality. The CCRCs run the gamut from urban high-rises to garden apartments, cottages cluster homes, or single-family homes. Some CCRCs provide units that are designed for people with special medical needs, such as Alzheimer's disease.
Most importantly, CCRCs guarantee a life-long place to live. Assisted living and even skilled nursing facilities make no such guarantees, and in fact they may ask you to leave if they believe they cannot provide the care you require. However, bear in mind that virtually no CCRC will guarantee an individual entry into the skilled nursing facility that is a part of the CCRC. If all the nursing units are filled (by either other residents or non-residents), the CCRC may place the ailing resident in another nursing home in the community. This can come as a rude shock to most elders, who believe precisely the opposite.
The downside of CCRCs is the cost, which can be more than those with low or moderate income and assets can afford. Prices depend on the amount of care provided, the type of contract, and the unit's size and geographic location. Entry fees can be more than $500,000, with monthly charges in excess of $3,000.
Generally a refund will no longer be available after a specified period of residency. Some refundable fees revert to your estate when your unit is sold, while others do not. Therefore, before you expend a large some of money immediately and commit future monies, you need an assurance that the CCRC will be able to provide the promised services for the period of time stated in the contract. Consequently, review the annual CCRC disclosure statement.
CCRC fee arrangements
Although the entry and monthly fee arrangement is the most common, some CCRCs offer rental or equity arrangements. Under a rental arrangement, residents pay only a monthly fee, which typically covers housing and designated services (sometimes including health care services). Under equity arrangements, residents purchase their residence in the same way they would a cooperative apartment or condominium, although the resale of the unit is usually limited to those who meet the community's eligibility criteria. Residents then may purchase service and health care packages for an additional fee.
CCRCs often allow you to choose from three different fee schedules:
* Extensive contracts, which include unlimited long-term nursing care at little or no increase in the monthly fee. This arrangement requires residents to pay a higher fee initially;
* Modified contracts, which include a specified duration of long-term nursing care, beyond which fees rise as care increases; and
* Fee-for-service contracts, in which residents pay a reduced monthly fee but pay full daily rates for long-term nursing care.
The Maryland Department of Aging ("MDA") issues certificates to CCRC's. However, this certification is not an endorsement or guarantee of the community. Also, the MDA maintains financial and other records on all CCRC,s, which are accessible to the public. Consumer packets may be obtained by calling 1-800-AGELINE.
CCRC entry requirements
Most CCRCs require that a resident be in good health, be able to live independently when entering the facility, and be within minimum and maximum age limits. As a prerequisite to admission, facilities may also require both Medicare Part A and Part B, and perhaps Medigap coverage as well. A few are now even requiring long-term care coverage as a way of keeping fees down. Some CCRCs are affiliated with a specific religious, ethnic or fraternal order and membership in these groups may be a requirement. Of course, applicants will have to demonstrate that they have the means to meet the required fees. Also, you may be placed on a waiting list, since CCRCs are often sought after.
Many CCRC residents usually fund their care out of their own pockets. However, Medicare, and at times Medicaid, can be used to pay for certain services, and most CCRCs accept either Medicare or Medicaid. Although Medicare does not generally cover long-term nursing care, it often covers specific services that a CCRC resident might receive, such as physician services and hospitalization. Because the financial requirements for residence are fairly strict and the costs are relatively high, very few CCRC residents are eligible for Medicaid.
How to evaluate a facility and contract
Deciding on a CCRC is a once-in-a-lifetime choice, and it is a decision that should be made carefully. Many communities allow prospective residents to experience life at the facility. Each community has an agreement or contract that lays out the services provided. You should make sure you understand the contract before signing, and you would be well advised to seek legal or financial counsel before entering into any agreement.
Twenty Questions for a Continuing Care Residential Facility
1. What is the CCRC's background and experience?
2. Review the facility's financial, actuarial, and operating statements. Does it have sufficient financial resources?
3. What levels of care are provided? Licensed or certified by the State of Maryland?
4. How much is the entrance fee, monthly fee, processing fee, and other fees?
5. Can you get a refund of all or part of it?
6. What is the monthly fee?
7. Can the monthly be increased?
8. What happens if you cannot afford the monthly fees?
9. Do the fees change when your level-of-care needs change?
10. What happens if your marital status changes? Will your payments change, or will you be asked to move?
10. What if spouses require different levels of care?
11. What services are included in my regular fees?
* Meal services?
* Special diets/tray service?
* Utilities?
* Cable television?
* Furnishings?
* Unit maintenance?
* Linens/personal laundry?
* Housekeeping?
* Recreational/cultural activities?
* Transportation?
12. What kind of assessment is done to determine your needs? Is a plan prepared for meeting those needs? How is it reviewed?
* Physician services?
* Medications?
* On site nursing care facility services: Are they on-site? Who pays?
* Nursing services outside a nursing unit?
* Private duty nursing?
* Dental and eye care?
* Personal care services?
* Homemaker/companion services?
* Drugs, medication and medical equipment/supplies?
* Emergency call system?
13. What happens if a nursing bed is not available when you need it?
14. Can the facility ask you to move if you become too sick or impaired to be cared for by the facility?
15. Can you receive Medicare and Medicaid coverage in the facility? Do you need to buy private insurance or participate in a special group insurance program?
16. Who is involved in making the change of level of care decisions?
17. What are the staffing levels and professional qualifications of the staff?
18. Is there a resident council? How are complaints and disputes handled?
19. What are the grounds for eviction? What happens if you break a rule? What conditions can the CRCC terminate the contract?
20. What happens if you are injured? Does the contract release the facility from liability for injury resulting from negligence? What are you rights under the law?

The contributing author, David Wingate is an attorney in the Frederick and Hagerstown areas.

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