Lately there is a lot of discussion about allowing seniors to “age in place,” receiving whatever care they may need in their homes. This movement in favor of aging in place has brought about many positive changes, including increased support services for those who want to stay in their home and the expansion of public benefit programs that will provide some level of home care for those who qualify. However, home is sometimes a lonely and isolating place for seniors. For seniors who want to stay active and engaged while they age, a continuing care retirement community (CCRC) may be the answer. These communities are places where seniors can live independently in apartments, townhouses, or stand-alone residences. They typically provide a host of activities for residents, as well as transportation to shopping, doctor’s appointments, and cultural activities. If a resident requires care or assistance, the community typically has an assisted living facility and a nursing home on site where care can be provided. This allows the resident who needs care to stay in close proximity to a spouse or friends who may require different levels of care or none at all.
Here are five things to think about if you are considering a move to a CCRC:
- Size and Location are Important
CCRCs vary in the number of residents and the physical size of the campus. If you have no mobility issues, you may love a sprawling campus or living units that are at a distance from the common areas and activity rooms. If you move more slowly, you may prefer a smaller community with a more compact layout. You should also consider carefully the location of your particular unit within the facility, as well as such things as the distance from your unit to the elevator or the trash chute. Consider how close the community is to your family, your doctors’ offices, your place of worship, or other places to which you frequently travel. Some communities provide transportation for their residents on scheduled shopping trips or individual excursions. If you will be relying on community transportation, make sure it will take you where you need to go and understand any costs involved.
- Consider the Costs
Take the time to carefully consider the cost of buying into a CCRC as well as the monthly fees. Make sure you understand what these fees cover and what they do not. Facilities with higher buy-in costs and monthly fees may cover the cost of some or all of the care you may need in the future. Other facilities are more affordable to enter initially but require you to pay-as-you-go for the care you need. Depending on which model you feel is best for you, make sure you are able to comfortably afford the cost, both now and in the future, especially if your care needs increase. Make sure you ask about the CCRC’s history of fee increases. If there comes a time when you are no longer able to afford to live in the community, find out if the community has a benevolent fund or other means to assist residents who have spent their assets but wish to remain there. Take the time to understand how the CCRC you are considering is owned and managed, how decisions are made about when and if fees are increased, and to what extent the residents have input over how the facility is run, what activities are offered, etc.
- What are Your Present and Future Health Care Needs?
Are you healthy and mobile with no health issues in sight or do you have an illness that is likely to require care in the future? If you anticipate the need for future care, consider whether the CCRC is able to deliver the type of care you will need, and whether you will be able to receive that care in your unit or if you will have to relocate to one of the other on-site facilities. How is the decision made if and when you will need to relocate, and is your input or your family’s input meaningfully considered? Does the community have a separate assisted living facility? If you need a limited amount of assistance each day, can care be delivered to you in your independent living unit? When choosing a unit, consider whether there are physical features that will make it difficult for you to continue to live there as you age.
- What Types of Activities Do you Enjoy?
One of the best things about CCRCs are the variety of activities they offer to their residents and how easily accessible those activities are. Consider what activities you enjoy, and make sure the community provides them. Do you like to garden? If so, does the community have garden plots available to residents, or a greenhouse where you can garden in the winter months? Do you like to sing, dance or play an instrument? If so, is there a community chorus, regular social events where dancing is involved, or a piano available for residents to use? Do you want a lifelong learning community that has a schedule of lectures for residents to attend, or book or discussion groups that meet on a regular basis? Are you someone who likes to stay physically active? If so, look for a community with walking paths, a fitness center and/or a swimming pool, and consider how accessible these facilities are from the unit you are considering.
- Read the Fine Print
Like any other legal or financial transaction, making the decision to become a resident of a CCRC is an important decision that should not be made without careful consideration and advice from your financial and legal advisors. Take the time to visit, have a meal with current residents. How is the food? Do the residents like living there? What don’t they like about it? Read the agreements you must sign carefully and consult an attorney to be sure you understand what those documents say in terms of the costs you will have to pay, the services that are covered by your monthly fee, any additional fees, what type of care you can receive and in what location, etc. Make sure you examine the financial strength of the facility and its parent company, as the CCRC’s ability to continue to operate is crucial to your future. If the CCRC refunds a portion of the buy-in cost to your heirs following your death, the financial strength of the company will dictate whether your heirs receive those funds down the road.
Keep in mind that CCRCs, unlike nursing homes, are not regulated by the Commonwealth of Massachusetts. Some CCRCs choose to become accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF), an independent organization. More information is available at www.carf.org. The Commonwealth’s Executive Office of Elder Affairs also has a wealth of information on CCRCs available on-line at http://www.mass.gov/elders/housing/ccrc/.
September 2014
Attorney Maria Baler is an estate planning and elder law attorney and a partner with the Dedham law firm of Samuel, Sayward & Baler LLC. She is also a director of the Massachusetts Chapter of the National Academy of Elder Law Attorneys (MassNAELA). For more information, visit www.ssbllc.com or call (781) 461-1020. This article is not intended to provide legal advice or create or imply an attorney-client relationship. No information contained herein is a substitute for a personal consultation with an attorney.