The CCRC option: Move in now, stay for the duration

Continuing Care Retirement Communities (CCRCs) are a small but important segment of the retirement community industry. They're also one of the most complex and expensive eldercare options on the market — yet little is written about them.

There have been virtually no new CCRCs in our area for 20 years, but now there are at least three in the works and a few older ones are expanding. Their ads are creating a buzz. Their promises sound intriguing. It's time to put our "consumer protection" hat on and take a look.

The most common kind of retirement communities are what I call "month-to-month" — once you move in, you live there until they can no longer care for you. Some let you stay longer by offering additional assistance. Ultimately, however, you must move as your needs become more complex.

With a CCRC, once you move in, you can stay until you die. You begin in your own independent apartment or cottage, then, as your needs change, you might have home care or move to assisted living or to the nursing home on the same campus. Some CCRCs offer adult day services and dementia units. If no space is available in alternate care when you need it, you may have to move elsewhere temporarily (be sure to check your contract).

CCRCs have two fees. One is monthly to cover your apartment and the amenities the campus offers, such as housekeeping, meals, activities, and van service. A second is a one-time entrance fee, ranging anywhere from, say, $40,000 to $800,000, depending on size and luxury (plus a smaller fee for a second person). Usually, no ownership is attached to this entrance fee; when you die or move, the community keeps it. Some CCRCs offer partially refundable entrance fees based on how long you stay, but with higher monthly fees. There are four basic types of CCRC contracts:

Type A offers "lifecare." You pay the same monthly price, no matter where you live on campus. This means, as you need more care, your fees remain the same. Outsiders are not allowed to move into the nursing home or assisted-living section, nor is Medicaid accepted when residents run out of money. Most have foundations to cover the costs of those who outlive their assets.

Type B, the most common CCRC, offers the range of services from independent living to nursing home care, but the fees rise as your needs increase. Medicaid may be accepted, and discounts are provided for a certain number of days in the alternate-care units (such as for rehab after a broken hip). In addition, people from the outside can receive care in the assisted living area and in the nursing home.

Type C has two payment choices: one, no entrance fee and a higher monthly rental, or, two, an entrance fee and a smaller monthly fee. There are no discounted days in alternate care. Outsiders are admitted to alternate care, and Medicaid may be accepted.

Type D may have no entrance fee, and the various services aren't necessarily all on the same campus. Outsiders are admitted to alternate care, and Medicaid may be accepted.

When making comparisons, here are some things to consider:

Start exploring your CCRC options early. "Don't wait until you're ready to move," says Marta Willson, Marketing Director for Emerald Heights, a CCRC in Redmond, "because most CCRCs have long waiting lists." Just how long depends on how ready the person is to move and what sort of unit they require. A studio can be had within a few months while a two-bedroom unit with a view can take years.

Visit as many different choices as possible and bring a friend. When you're looking at something this complicated, it's good to have additional ears and eyes looking out for your interests. Have a meal in the dining room, talk to the residents. There are many industry variations in what's offered, so ask about meals, seating arrangements in the dining room, the activity calendar.

In your first visits, ask for copies of the resident contracts so you can compare the fine print, then have an attorney review them.

This is a long-term relationship, so you want to make sure the underlying company, whether it's a nonprofit or a for-profit, will endure. Ask for a copy of the latest financial audit to ensure the company has sufficient reserves. What is their ongoing quality-assurance process? Are they accredited? Do residents have a voice in what happens?

Inspect the areas that provide care, such as the assisted living area and the nursing home. Ask for the latest state survey report. Is this a place you'd be willing to live?

What will get a resident kicked out? What happens if you run out of money?

A key element is marketing. Is it handled internally, with employees who'll be there for the long-term (and who can be held accountable) or externally, by contractors who'll be gone by the time residents move in?

There are several negatives about CCRCs: Some people don't qualify, they can't afford the entrance fee or they're not healthy enough for admission. You also need to like the people who live there and like being around them because CCRCs attract socially active people. Consider what would happen if your adult children moved away. Would you be willing to give up the substantial entrance fee to move near them?

Still the positives are substantial. The most important in my book is being able to age among friends, and, as your needs change, to remain nearby. Your friends are there when a spouse becomes ill or dies. Another, which may surprise you: A portion of your entrance and monthly fees are tax-deductible as pre-paid medical expenses.

This concludes my series on how to choose good-quality eldercare.

Liz Taylor's column runs Mondays in the Northwest Life section. A specialist in aging and long-term care for 30 years, she consults with families and their elders. E-mail her at growingolder@seattletimes.com or write to P.O. Box 11601, Bainbridge Island, WA 98110. You can see all of her columns at www.seattletimes.com/growingolder/.