Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Non-investing personal finance issues including insurance, credit, real estate, taxes, employment and legal issues such as trusts and wills.
User avatar
Topic Author
Sandtrap
Posts: 19591
Joined: Sat Nov 26, 2016 5:32 pm
Location: Hawaii No Ka Oi - white sandy beaches, N. Arizona 1 mile high.

Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by Sandtrap »

Excellent introductory article on the Pros, Cons, and Expenses of Aging in Place in a Continuing Care Retirement Community (CCRC).

https://www.aplaceformom.com/planning-a ... ommunities

Another at AARP on CCRC's.

https://www.aarp.org/caregiving/basics/ ... ities.html
What CCRCs Are
Part independent living, part assisted living and part skilled nursing home, CCRCs offer a tiered approach to the aging process, accommodating residents’ changing needs. Upon entering, healthy adults can reside independently in single-family homes, apartments or condominiums. When assistance with everyday activities becomes necessary, they can move into assisted living or nursing care facilities. These communities give older adults the option to live in one location for the duration of their life, with much of their future care already figured out. This can provide a great level of comfort to both your parents and you and take much of the stress out of the caregiving relationship.
Types of Contracts
There are three basic types of contracts for CCRCs:

Life Care or Extended Contract: This is the most expensive option, but offers unlimited assisted living, medical treatment and skilled nursing care without additional charges.
Modified Contract: This contract offers a set of services provided for a set length of time. When that time is expired, other services can be obtained, but for higher monthly fees.
Fee-for-Service Contract: The initial enrollment fee may be lower, but assisted living and skilled nursing will be paid for at their market rates.

What CCRCs Cost
The most expensive of all long-term-care options, CCRCs require a hefty entrance fee as well as monthly charges. Entrance fees can range from $100,000 to $1 million — an upfront sum to prepay for care as well as to provide the facility money to operate. Monthly charges can range from $3,000 to $5,000, but may increase as needs change. These fees are dependent on a variety of factors including the health of your loved one(s), the type of housing they choose, whether they rent or buy, the number of residents living in the facility and the type of service contract. Additional fees may be incurred for other options including housekeeping, meal service, transportation and social activities.
Questions:
1 Are there other types of financial arrangements not brought out in the articles that "Boglers" may be aware of through personal experience? Explain.

2 Potential financial pitfalls, pros/cons that "Boglers" have experience with?

3 Much like "Boglers" might keep SPIA's on the table as an option in retirement. Are there any here that might considder CCRC's for self or family? Why?

My MIL is elderly (90+) with dementia so this is a timely topic.
mahalo,
j :D
Wiki Bogleheads Wiki: Everything You Need to Know
User avatar
ResearchMed
Posts: 16795
Joined: Fri Dec 26, 2008 10:25 pm

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by ResearchMed »

Sandtrap wrote: Sun Mar 25, 2018 9:23 pm
<snip>

My MIL is elderly (90+) with dementia so this is a timely topic.
mahalo,
j :D
True CCRC's in our area (there aren't many that fit that category) require that one be reasonably healthy upon initial entry.
You might want to look into whether there are similar requirements of CCRC's near you/your MIL.
If so, then there are other types of Assisted Living/Memory Care/Skilled Nursing continuum facilities available.

RM
This signature is a placebo. You are in the control group.
User avatar
plannerman
Posts: 855
Joined: Wed Feb 21, 2007 9:42 pm
Location: NC Mountains

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by plannerman »

The initial buy-in price at our CCRC was based on the choice of dwelling--cottage, villa or, different sizes of apartment. In addition, our CCRC had multiple buy-in options. For example, these are made up numbers, $500k with no return, $750k for a 50% return, or $1M for a 90% return of the buy-in. The latter two options appeal to those who want to insure they leave some legacy.

Our experience was every CCRC we looked at had different menus of services and fees. One needs to decide what they are looking for the CCRC to provide and shop around.

plannerman
fourwheelcycle
Posts: 1968
Joined: Sun May 25, 2014 5:55 pm

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by fourwheelcycle »

My wife and I are about age 70. We have been on the waiting list for an excellent local Type 1 contract (non-refundable) CCRC for ten years and we are now at the top of the waiting list, in a "hold" position. We have also looked at several other top level CCRC's in our region. Some have 90% refund policies, others do not. Obviously, the add-on for a refundable contract should be priced similar to an annuity - shop carefully and compare apples to apples prices.

If you consider any CCRC other than a Type 1 full lifecare contract (no change in monthly fee if one or both spouses move to memory care, assisted living, or long term care) you need to shop carefully to understand the price increase if one spouse moves to a health care unit and the other stays in the original apartment or cottage, or if both spouses move to health care units.

We are concerned about three issues:

When to move? When our local CCRC opened 18 years ago everyone who moved in was about 68 - 72 (young!). They all said it was like going off to college again. Now the first generation has aged to their late 80's and the current generation is moving in at 78 to 82 (not too far from walkers). My wife wants to wait until we are 78, but I face a risk of dementia beginning at about that age and becoming debilitating at age 80 - 82. I will not be eligible for a life care contract if we wait until I have well-established dementia. Some CCRC's will not let you sign a life care contract if you have any Dx of dementia, but our local CCRC's criteria is that the affected spouse must be able to live safely and independently in their apartment if the "healthy" spouse happens to die soon after they move in.

How good is the food? We are used to our own choice of very good food and menus at home. I love to cook! Some CCRCs offer food we could not tolerate. Others, including our local one, offer very good food based on contracted food services (which are priced and graded high, medium, and low, so shop carefully). The best food seems to be at (higher cost) CCRCs that have their own chefs, not contracted food services. The benefit of a good chef is probably better meal preparation, but also locally rather than corporately budgeted and selected food and meal plans).

What is the current financial strength, and future financial risk, of the CCRC? Our local CCRC is financially very strong. However, the management seems set on expanding "to improve scale costs and benefits", and the not-for-profit Board seems ready to go along. If they spend a ton of money for construction and marketing, and hire more overhead staff, for a project that flops, they could end up with financial problems - which will be supported by captive residents who have invested $400 - 500K or more (mostly non-refundable) and are therefor not in a position to move to another CCRC.
Last edited by fourwheelcycle on Mon Mar 26, 2018 11:12 am, edited 2 times in total.
fposte
Posts: 2327
Joined: Mon Sep 02, 2013 1:32 pm

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by fposte »

My father was in a CCRC for close to 20 years, and I'm strongly likely to do the same.

I'm single with no kids, so the idea of having the support services defaulting to on is really appealing; it also makes it much easier to avoid becoming isolated as you grow less mobile, especially since so many of my friends now are work-related. I have several health problems and don't want to play the LTCI gamble, and I'm familiar with the CCRC in town that's my likely choice. For me it's about control--I'd rather choose a path I know I can follow than hope for the best and have things go downhill fast if I get unlucky.

Cons are that the one I'm looking at isn't as delightful as the one where my dad was (none of those are close enough to me to make sense, since I want to stay in town); I also need to investigate the assisted middle phase some more, because it doesn't seem as clear cut as I'd like.

A friend and I will be touring it later this spring to learn more.
Lexi
Posts: 130
Joined: Sat Jan 30, 2016 9:28 am

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by Lexi »

My mother moved from another state into a CCRC near us at just about her 80th birthday. She lived in an independent apartment and then skilled nursing for ~6 years in all. She was very happy with the situation.

The financial options included base initial payment with the amount returned disappearing at a fixed rate per month down to zero, 1.5 x initial payment with 90% returned at death or departure, and an in-between option. Setting up a spreadsheet model to see which has the best financial result is easy with the key variables being life expectancy and rate of return on the difference in initial payment that was presumably invested. In her case the 90% return option seemed best. For someone younger with a longer life expectancy the no return option might be better, especially if the rate of return on investment is expected to be high.

An advantage of the 90% return option was that you could move elsewhere if you did not like the place because you still had most of the money. With the disappearing initial payment option your payment would be greatly depleted by the time you decided you did not want to stay there. For us this turned out to be only a psychological advantage but I do think it was important.

For the poster with a 90 year old needing memory or skilled nursing care CCRCs could be an option but their basic model is to move in while healthy enough to be independent and move through the care levels as needed. They do sometimes take people directly into skilled nursing at a higher charge, but that just makes them another nursing home option, one that I would expect to be higher than average quality. I would suggest looking for new CCRCs that are likely to have a younger age group of residents with less need for skilled nursing care. If the facility has empty beds they will be willing to take patients directly. Older CCRCs with an older age population probably will need their skilled nursing beds for their existing residents.
Fallible
Posts: 8798
Joined: Fri Nov 27, 2009 3:44 pm

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by Fallible »

Sandtrap wrote: Sun Mar 25, 2018 9:23 pm Excellent introductory article on the Pros, Cons, and Expenses of Aging in Place in a Continuing Care Retirement Community (CCRC).
https://www.aplaceformom.com/planning-a ... ommunities

Another at AARP on CCRC's.
https://www.aarp.org/caregiving/basics/ ... ities.html ...
The AARP caregiving basics are very helpful and important to know, but it appears the "A Place for Mom" is limited to having its "senior advisors" send surveys to clients, then recommend potential places for them to visit, after which the seniors continue researching a community and decide for themselves which is best. The "Mom" group says it does not charge seniors for its advice because it is paid by the senior community when a senior actually moves in. So it seems to be mainly a starting point in the search for the right community, although that could be of some help simply by narrowing choices. But I would want to know more about the relationship between "Mom" and the communities it recommends.

Also, In her excellent retirement book, How to Make Your Money Last, Jane Bryant Quinn has a chapter on retirement communities that includes the different kinds, their expenses, and how to check out their financial health.
"Yes, investing is simple. But it is not easy, for it requires discipline, patience, steadfastness, and that most uncommon of all gifts, common sense." ~Jack Bogle
User avatar
JoeRetire
Posts: 15381
Joined: Tue Jan 16, 2018 1:44 pm

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by JoeRetire »

Sandtrap wrote: Sun Mar 25, 2018 9:23 pm My MIL is elderly (90+) with dementia so this is a timely topic.
Sorry to say, but many (most?) CCRCs wouldn't accept your MIL.
see: http://www.mylifesite.net/blog/post/fit ... quirement/

You probably need to consider a Memory Care Unit instead.
This isn't just my wallet. It's an organizer, a memory and an old friend.
User avatar
CULater
Posts: 2832
Joined: Sun Nov 13, 2016 9:59 am
Location: Hic sunt dracones

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by CULater »

CCRCs can vary widely in terms of the physical setup. One that I'm aware of has independent living, assisted living, and nursing care all in the same or adjoining buildings. When you move through the levels you are basically moving to different "wings" of the same facility. This seems desirable because your physical surroundings don't change that much, and you can remain in the same area as friends and acquaintances you may have made. For example, if a move is required because of one spouse, the other higher-functioning spouse can remain in touch with friends and familiar settings.

Other large CCRCs are spread out geographically. One I'm aware of, requires you to move some distance away from the independent living facilities to an assisted living facility, where you would basically have to start up again as a newcomer leaving friends and acquaintances behind. It also maintains a waiting list of residents who are eligible for the move; apartments are not available "on demand." And it accepts outside applicants as well, who have lower priority on the waiting list. Same applies to the nursing care unit. So, I'm really not sure what the advantages of this CCRC are compared to just moving to different facilities based level of care requirements; except perhaps that the transitions are a bit simpler and you have the inside edge on waiting lists.
On the internet, nobody knows you're a dog.
User avatar
Topic Author
Sandtrap
Posts: 19591
Joined: Sat Nov 26, 2016 5:32 pm
Location: Hawaii No Ka Oi - white sandy beaches, N. Arizona 1 mile high.

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by Sandtrap »

JoeRetire wrote: Mon Mar 26, 2018 5:55 pm
Sandtrap wrote: Sun Mar 25, 2018 9:23 pm My MIL is elderly (90+) with dementia so this is a timely topic.
Sorry to say, but many (most?) CCRCs wouldn't accept your MIL.
see: http://www.mylifesite.net/blog/post/fit ... quirement/

You probably need to consider a Memory Care Unit instead.
Thanks for the info and link.
I'm saving all of the info on this thread as an option for DW and I if it should come to that someday.
However, for MIL, we are looking into all options.
Mahalo,
j :D
Wiki Bogleheads Wiki: Everything You Need to Know
delamer
Posts: 17453
Joined: Tue Feb 08, 2011 5:13 pm

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by delamer »

OP, your mother-in-law is likely not going to be eligible to enter a CCRC on the Life Care model due to her dementia. She may be eligible to move into a Memory Care Unit at a good CCRC at the “off the street” rate. My admittedly limited experience is that the good ones will have waiting lists. So now is the time to investigate her options.

My mother lived an independent apartment in a CRCC for 15 years and then spent about 6 months in its skilled nursing facility at the end of her life. She entered via a nonrefundable deposit Life Care contract, and her monthly fee did not increase when she moved into the nursing facility. If she had not had the Life Care contract, the nursing home would have cost $12,000 per month. My back-of-the envelope calculation indicates that, financially, her estate came out about even with the deposit model.

Overall, it was a good experience for her. My mother had never lived in a group situation before, and her complaints reminded me of my feelings about my college dorm — sometimes disliked the food, weird dorm mates, and the cost.

But she made good friends (outliving them all, for better or worse), enjoyed excursions in the local area, liked activities in the facility, etc. Transportation was available for doctors’ appointments and shopping at no added cost.

The staff in the apartment building — including social workers and nurses — kept a close eye on the residents and were the ones who alerted me that my mother might have dementia (I lived out of state and only saw her a few times a year) and arranged for her to be tested. There was a clinic open weekdays where residents could go to have health complaints checked out.

Obviously, the financial stability of the facility is hugely important. My mother’s ended up renting some of the apartments to seniors during and in the aftermath of the Great Recession. Houses weren’t selling so people could not afford the deposits to enter Life Care. I actually thought the rentals were a good solution to a temporary problem. Better to have some income rather than having the units sit empty.

My mother’s building was nice and well maintained. But the major and minor dining rooms, a card room, and a movie room were the only public use areas. No pool, no tennis courts, no gym. But that also meant lower costs.

My husband and I will definitely consider a CRCC in later retirement. My in-laws are hoping to move into one soon (if they can get their house sold).
One thing that humbles me deeply is to see that human genius has its limits while human stupidity does not. - Alexandre Dumas, fils
GCD
Posts: 1195
Joined: Tue Sep 26, 2017 7:11 pm

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by GCD »

fourwheelcycle wrote: Mon Mar 26, 2018 9:06 am How good is the food? We are used to our own choice of very good food and menus at home. I love to cook! Some CCRCs offer food we could not tolerate. Others, including our local one, offer very good food based on contracted food services (which are priced and graded high, medium, and low, so shop carefully). The best food seems to be at (higher cost) CCRCs that have their own chefs, not contracted food services. The benefit of a good chef is probably better meal preparation, but also locally rather than corporately budgeted and selected food and meal plans).

What is the current financial strength, and future financial risk, of the CCRC? Our local CCRC is financially very strong. However, the management seems set on expanding "to improve scale costs and benefits", and the not-for-profit Board seems ready to go along. If they spend a ton of money for construction and marketing, and hire more overhead staff, for a project that flops, they could end up with financial problems - which will be supported by captive residents who have invested $400 - 500K or more (mostly non-refundable) and are therefor not in a position to move to another CCRC.
You can research the financial strength of a facility, but the food is hard to predict over the long run. My mom was in a CCRC that had a change of management and they changed up the food. Boy was she ticked off. That aspect seems to be a real gamble. Any number of restaurants go downhill when the chef leaves. The same thing is possible in a CCRC.
shell921
Posts: 623
Joined: Fri Jul 06, 2018 5:13 pm

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by shell921 »

Can you "try before you buy"? Do these CCRCs have guest apartments where seniors can pay to stay for a few days to a week to see if they might enjoy LIVING there?
sarahjane
Posts: 233
Joined: Tue Jan 21, 2014 4:18 pm

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by sarahjane »

May require you to go on their wait list which involves a fee which may be mostly refundable before using guest rooms which are probably free for short stay.
Carl53
Posts: 2693
Joined: Sun Mar 07, 2010 7:26 pm

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by Carl53 »

shell921 wrote: Mon Apr 08, 2019 2:45 pm Can you "try before you buy"? Do these CCRCs have guest apartments where seniors can pay to stay for a few days to a week to see if they might enjoy LIVING there?
When we investigated one for my inlaws a few years ago, we were offered a few complimentary nights. We found it very nice and the food was wonderful. The inlaws ultimately chose to stay in their home, FIL ended up living there nearly 80 years, but initially were somewhat excited to go as a result of our reports and the fact that they had perhaps ten friends living there already. SIL later admitted to torpedoing the idea when we were not around. At this point MIL very well might not qualify due to a little dementia and spouse and SIL are trying to keep MIL afloat in rural home, but are exhausted.
HIinvestor
Posts: 1881
Joined: Tue Apr 08, 2014 3:23 am

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by HIinvestor »

We have seen both. We have had several loved ones living in CCRCs and seen some “age in place.” There are definitely pros and cons of each, especially as the patients become increasingly frail and need more and more care and resources.

CCRCs vary greatly as to cost and quality, whether you pay a significant upfront cost or just monthly rental+ rates, whether any amount is returned if the patient(s) leave/die, what is included/excluded, activities, amenities, transportation, what are grounds for being kicked out and more.

Definitely visit several and ask a lot of questions. Talk with people who live there—what do they like? Dislike? Miss? If you can find folks who left the place, try to interview them as well.

Visit the varying levels of care as well—independent, assisted, skilled, rehab, nursing home. Find out also about how to get extra help hired to remain in independent living.

Most folks want to stay in their own homes as long as possible. They may resist hiring help due to pride or frugality and then find it difficult to adjust to having help around.

It can be exhausting for lives ones to fill in the gaps at CCRCs and also when elders are living in their own homes, especially when many are still working and may be caring for children/grandchildren/dependents.

When it becomes impossible to meet the needs of elders in their own homes, it can create a crisis move, which can add to the trauma of the situation. Also, when folks move when they’re older and have fewer social skills, it’s harder for them to adapt to their new community.

There can be a divide among the CCRC of the OLD/feeble/frail/fragile and the younger/active/fitter.

There are also smaller homes in communities sometimes called board and care. Costs and quality and staffing ratios can vary considerably.
User avatar
RickBoglehead
Posts: 7877
Joined: Wed Feb 14, 2018 8:10 am
Location: In a house

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by RickBoglehead »

Carl53 wrote: Tue Apr 09, 2019 3:40 am
shell921 wrote: Mon Apr 08, 2019 2:45 pm Can you "try before you buy"? Do these CCRCs have guest apartments where seniors can pay to stay for a few days to a week to see if they might enjoy LIVING there?
When we investigated one for my inlaws a few years ago, we were offered a few complimentary nights. We found it very nice and the food was wonderful. The inlaws ultimately chose to stay in their home, FIL ended up living there nearly 80 years, but initially were somewhat excited to go as a result of our reports and the fact that they had perhaps ten friends living there already. SIL later admitted to torpedoing the idea when we were not around. At this point MIL very well might not qualify due to a little dementia and spouse and SIL are trying to keep MIL afloat in rural home, but are exhausted.
Since she torpedoed the idea, she's now reaping her reward.
Avid user of forums on variety of interests-financial, home brewing, F-150, EV, home repair, etc. Enjoy learning & passing on knowledge. It's PRINCIPAL, not PRINCIPLE. I ADVISE you to seek ADVICE.
Carl53
Posts: 2693
Joined: Sun Mar 07, 2010 7:26 pm

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by Carl53 »

RickBoglehead wrote: Tue Apr 09, 2019 5:04 am
Carl53 wrote: Tue Apr 09, 2019 3:40 am
shell921 wrote: Mon Apr 08, 2019 2:45 pm Can you "try before you buy"? Do these CCRCs have guest apartments where seniors can pay to stay for a few days to a week to see if they might enjoy LIVING there?
When we investigated one for my inlaws a few years ago, we were offered a few complimentary nights. We found it very nice and the food was wonderful. The inlaws ultimately chose to stay in their home, FIL ended up living there nearly 80 years, but initially were somewhat excited to go as a result of our reports and the fact that they had perhaps ten friends living there already. SIL later admitted to torpedoing the idea when we were not around. At this point MIL very well might not qualify due to a little dementia and spouse and SIL are trying to keep MIL afloat in rural home, but are exhausted.
Since she torpedoed the idea, she's now reaping her reward.
Except the spouse is my spouse.
User avatar
RickBoglehead
Posts: 7877
Joined: Wed Feb 14, 2018 8:10 am
Location: In a house

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by RickBoglehead »

Carl53 wrote: Tue Apr 09, 2019 6:21 am
RickBoglehead wrote: Tue Apr 09, 2019 5:04 am
Carl53 wrote: Tue Apr 09, 2019 3:40 am
shell921 wrote: Mon Apr 08, 2019 2:45 pm Can you "try before you buy"? Do these CCRCs have guest apartments where seniors can pay to stay for a few days to a week to see if they might enjoy LIVING there?
When we investigated one for my inlaws a few years ago, we were offered a few complimentary nights. We found it very nice and the food was wonderful. The inlaws ultimately chose to stay in their home, FIL ended up living there nearly 80 years, but initially were somewhat excited to go as a result of our reports and the fact that they had perhaps ten friends living there already. SIL later admitted to torpedoing the idea when we were not around. At this point MIL very well might not qualify due to a little dementia and spouse and SIL are trying to keep MIL afloat in rural home, but are exhausted.
Since she torpedoed the idea, she's now reaping her reward.
Except the spouse is my spouse.
Totally understand.
Avid user of forums on variety of interests-financial, home brewing, F-150, EV, home repair, etc. Enjoy learning & passing on knowledge. It's PRINCIPAL, not PRINCIPLE. I ADVISE you to seek ADVICE.
fourwheelcycle
Posts: 1968
Joined: Sun May 25, 2014 5:55 pm

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by fourwheelcycle »

Sandtrap wrote: Sun Mar 25, 2018 9:23 pm
1 Are there other types of financial arrangements not brought out in the articles that "Boglers" may be aware of through personal experience? Explain.

2 Potential financial pitfalls, pros/cons that "Boglers" have experience with?

3 Much like "Boglers" might keep SPIA's on the table as an option in retirement. Are there any here that might considder CCRC's for self or family? Why?

My MIL is elderly (90+) with dementia so this is a timely topic.
1. I didn't notice any reference to return of a portion of the entrance fee in the article. Some CCRCs price their entrance fees based on no return at death, 50% return, or even 90-100% return. If you ever consider such pricing, check the fee w/ and w/o the return provision, and see how much your heirs would have at your actuarial death if you invested the return premium along with the rest of your portfolio. Sometimes these return premiums are priced at a bargain rate, but often they are priced at a rate you could beat if you simply invested the difference.

2. People considering CCRCs must be very careful to understand Type A, B, and C life care contracts (full, modified, and a la carte). CCRC entrance and monthly fees can vary widely. People may choose a lower priced CCRC and then realize they have to pay more if they ever need assisted living, memory care, or long term nursing care. Also, be sure to understand each CCRC's buyer's remorse or early death policy. Will they return your entrance fee if you don't like the community after a few months or a year? Or if you unexpectedly die soon after you move in?

3. My wife and I are on the waiting list for a Type A contract CCRC. We have both been heavily involved in arranging care for our parents and we do not want to impose this burden, or the need to clean out and sell our house, on our children. Also, I have a family risk of Alzheimer's around age 80 and I do not want to impose this possible burden of care on my wife. Finally, we are very familiar with the CCRC and its residents. We think we will be very happy to live there, with no grass to mow, after age 76 or so.

If your MIL has established dementia it is unlikely she would be accepted for a life care contract at a CCRC, although she might be accepted for an a la carte "per diem" contract. Most CCRC's require that each person, or each member of a couple, be well enough to live alone in their independent living unit at the time they move to the community. Some CCRC's will not even accept people if they have any diagnosis of cancer, stroke, Alzheimer's, etc., even if it has not progressed to the point of compromising ADL functions.
User avatar
RickBoglehead
Posts: 7877
Joined: Wed Feb 14, 2018 8:10 am
Location: In a house

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by RickBoglehead »

As others have posted, unfortunately for the OP, MIL is past a CCRC by a long shot.

I've posted this before, but figured it might help here. Planning without the involvement of family doesn't work. Aging in place without a plan doesn't work. CCRC doesn't work if it's too late from a dementia / care standpoint.

My in-laws made no plans. My FIL's father lived to 99. Their plan was to age in place, helped by "the girl down the street". Of course it wasn't any specific girl, nor would she have any specific training. Part of this was that my in-law's were CHEAP, part was they were stubborn, and part was that my MIL had mental issues that weren't just from old age. They wouldn't discuss any of it.

My MIL was the one always with ailments, most of them imagined. She wouldn't even bring her spouse into the exam room, nor did he care to be involved. Therefore, what her doctor told her was left to the imagination. Eventually, we called a family meeting at her doctor's office - basically an intervention. In-laws, my wife and I (she was an only child), and doctor. He explained they were at tremendous risk, and strongly recommended in home help. They agreed. Later declined. Then agreed. In-home help lasted two weeks, 3 times per week for 4 hours, before MIL fired them. Them attempted suicide by pills because she was distraught that she could no longer care for the home properly. Or, she was just acting out due to her mental issues. Counseling lasted less than a year before she gave that up too.

Fast forward a few years of continued living on the edge. MIL falls and breaks arm because she's a) not using her walker, b) not using the nightlights, and c) too stubborn to ask for help. Overall, several months away from home, cost of close to $50,000 billed. Their out of pocket cost under $200, so why take any precautions (thanks Medicare). Nightlights replaced with automatic sensor nightlights and they were told if we found them unplugged during visit we'd never come again. Aged agency brought in (free) to survey home and recommend changes (removal of throw rugs, thresholds, addition of safety bars, railings...) FIL initially refused to do most changes, we told him we'd go to court to put her in a facility if he didn't make changes. He made most of them.

A few more years, FIL gets ill (first ever). Due to inability for her to care for him, they request our help to go to assisted living NOW. Yes, NOW. Good luck with that. FIL ends up in hospital, then rehab. Then MIL in hospital while he's in rehab, then joins him in rehab. He goes to assisted living, while she's in rehab by herself she bites a nurse, so assisted living won't take her. Independent living only solution, lasts 4 months with twice per week 911 calls for imagined illnesses (staff is required by law to call 911 after gently redirection of MIL's request not accepted). Next step was locked assisted living by declaring MIL incompetent. They lived apart, with monthly visits, for several years, then because he now needs assisted living he joins her, but in separate building to avoid them working together to cause issues. That goes on until her death 6 months later, and he lasts another year.

We did consider a CCRC when FIL too ill but they wouldn't have been admitted. Other big issue would have been that the clientele in this facility were too white collar. Retired college professors, world travelers. My in-laws ate at Arby's and Big Boys, and dragged their house trailer to Missouri and Alaska. Would have been ugly.

Nothing works without a plan, with family members included. Even with a plan, plans need to be altered. Family needs to be ready to step in and make tough decisions. These decisions rip at your guts, cause sleepless nights, and you jump every time the phone rings - what happened now?

For those that haven't gone through it with a family member, it's worse than you can imagine.

For those that are planning for their own care, plan thoroughly. Include your loved ones in your decisions. Try to do what's right for everyone.
Avid user of forums on variety of interests-financial, home brewing, F-150, EV, home repair, etc. Enjoy learning & passing on knowledge. It's PRINCIPAL, not PRINCIPLE. I ADVISE you to seek ADVICE.
User avatar
CULater
Posts: 2832
Joined: Sun Nov 13, 2016 9:59 am
Location: Hic sunt dracones

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by CULater »

RickBoglehead wrote: Tue Apr 09, 2019 7:18 am As others have posted, unfortunately for the OP, MIL is past a CCRC by a long shot.

I've posted this before, but figured it might help here. Planning without the involvement of family doesn't work. Aging in place without a plan doesn't work. CCRC doesn't work if it's too late from a dementia / care standpoint.

My in-laws made no plans. My FIL's father lived to 99. Their plan was to age in place, helped by "the girl down the street". Of course it wasn't any specific girl, nor would she have any specific training. Part of this was that my in-law's were CHEAP, part was they were stubborn, and part was that my MIL had mental issues that weren't just from old age. They wouldn't discuss any of it.

My MIL was the one always with ailments, most of them imagined. She wouldn't even bring her spouse into the exam room, nor did he care to be involved. Therefore, what her doctor told her was left to the imagination. Eventually, we called a family meeting at her doctor's office - basically an intervention. In-laws, my wife and I (she was an only child), and doctor. He explained they were at tremendous risk, and strongly recommended in home help. They agreed. Later declined. Then agreed. In-home help lasted two weeks, 3 times per week for 4 hours, before MIL fired them. Them attempted suicide by pills because she was distraught that she could no longer care for the home properly. Or, she was just acting out due to her mental issues. Counseling lasted less than a year before she gave that up too.

Fast forward a few years of continued living on the edge. MIL falls and breaks arm because she's a) not using her walker, b) not using the nightlights, and c) too stubborn to ask for help. Overall, several months away from home, cost of close to $50,000 billed. Their out of pocket cost under $200, so why take any precautions (thanks Medicare). Nightlights replaced with automatic sensor nightlights and they were told if we found them unplugged during visit we'd never come again. Aged agency brought in (free) to survey home and recommend changes (removal of throw rugs, thresholds, addition of safety bars, railings...) FIL initially refused to do most changes, we told him we'd go to court to put her in a facility if he didn't make changes. He made most of them.

A few more years, FIL gets ill (first ever). Due to inability for her to care for him, they request our help to go to assisted living NOW. Yes, NOW. Good luck with that. FIL ends up in hospital, then rehab. Then MIL in hospital while he's in rehab, then joins him in rehab. He goes to assisted living, while she's in rehab by herself she bites a nurse, so assisted living won't take her. Independent living only solution, lasts 4 months with twice per week 911 calls for imagined illnesses (staff is required by law to call 911 after gently redirection of MIL's request not accepted). Next step was locked assisted living by declaring MIL incompetent. They lived apart, with monthly visits, for several years, then because he now needs assisted living he joins her, but in separate building to avoid them working together to cause issues. That goes on until her death 6 months later, and he lasts another year.

We did consider a CCRC when FIL too ill but they wouldn't have been admitted. Other big issue would have been that the clientele in this facility were too white collar. Retired college professors, world travelers. My in-laws ate at Arby's and Big Boys, and dragged their house trailer to Missouri and Alaska. Would have been ugly.

Nothing works without a plan, with family members included. Even with a plan, plans need to be altered. Family needs to be ready to step in and make tough decisions. These decisions rip at your guts, cause sleepless nights, and you jump every time the phone rings - what happened now?

For those that haven't gone through it with a family member, it's worse than you can imagine.

For those that are planning for their own care, plan thoroughly. Include your loved ones in your decisions. Try to do what's right for everyone.
I know how hard this has been, because my situation has some similarities. Mother now 102 and we've been in and out of several living facilities starting when she developed paranoid dementia in her 80s. She just broke her leg in a fall and is in a nursing facility for the first time for rehab and then LTC, but starting with the paranoia again. Most recently, she claims the staff was trying to kill her. She's actually recovering from the broken leg and might outlive the rest of us because she's killing us.
On the internet, nobody knows you're a dog.
User avatar
RickBoglehead
Posts: 7877
Joined: Wed Feb 14, 2018 8:10 am
Location: In a house

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by RickBoglehead »

CULater wrote: Tue Apr 09, 2019 8:40 am I know how hard this has been, because my situation has some similarities. Mother now 102 and we've been in and out of several living facilities starting when she developed paranoid dementia in her 80s. She just broke her leg in a fall and is in a nursing facility for the first time for rehab and then LTC, but starting with the paranoia again. Most recently, she claims the staff was trying to kill her. She's actually recovering from the broken leg and might outlive the rest of us because she's killing us.
I empathize with situation. Many things sound familiar. My MIL had issues for decades that were never dealt with or resolved. When the burden fell to us, the experts basically said - "Nothing can be fixed at this stage. Therapy is impossible due to dementia, nothing is remembered. We can make her as comfortable as possible, but cannot control her outbursts (both verbal and physical) except with medication." At times they had to resort to an injection that resulted in a day of sleep.

We were "lucky" as my wife was the only child, she had POA, and she relied on me to do the "dirty work". I was despised by my MIL, but so what. My FIL could see what was going on, and made a comment here and there over the years. My response was - your daughter is dealing with this because you didn't deal with it over the past decades. At times it tore my wife up, but you deal with the cards you are dealt. When my MIL passed, some of the weight lifted off our shoulders. When my FIL passed, the remainder did. Not jumping when the phone rings is a luxury now.

Best wishes.
Last edited by RickBoglehead on Tue Apr 09, 2019 2:35 pm, edited 1 time in total.
Avid user of forums on variety of interests-financial, home brewing, F-150, EV, home repair, etc. Enjoy learning & passing on knowledge. It's PRINCIPAL, not PRINCIPLE. I ADVISE you to seek ADVICE.
Ybsybs
Posts: 549
Joined: Thu Aug 28, 2014 4:28 pm

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by Ybsybs »

RickBoglehead wrote: Tue Apr 09, 2019 9:23 am
CULater wrote: Tue Apr 09, 2019 8:40 am I know how hard this has been, because my situation has some similarities. Mother now 102 and we've been in and out of several living facilities starting when she developed paranoid dementia in her 80s. She just broke her leg in a fall and is in a nursing facility for the first time for rehab and then LTC, but starting with the paranoia again. Most recently, she claims the staff was trying to kill her. She's actually recovering from the broken leg and might outlive the rest of us because she's killing us.
I empathize with situation. Many things sound familiar. My MIL had issues for decades that were never dealt with or resolved. When the burden fell to us, the experts basically said - "Nothing can be fixed at this stage. Therapy is impossible due to dementia, nothing is remembered. We can make her as comfortable as possible, but cannot control her outbursts (both verbal and physical) except with medication." At times they had to resort to an injection that resulted in a day of sleep.

We were "lucky" as my wife was the only child, she had POA, and she relied on me to due the "dirty work". I was despised by my MIL, but so what. My FIL could see what was going on, and made a comment here and there over the years. My response was - your daughter is dealing with this because you didn't deal with it over the past decades. At times it tore my wife up, but you deal with the cards you are dealt. When my MIL passed, some of the weight lifted off our shoulders. When my FIL passed, the remainder did. Not jumping when the phone rings is a luxury now.

Best wishes.
Our experience thus far has been in line with how eldercare has gone CULater and RickBoglehead.

None of the advice in books on eldercare seem to match the reality spouse and I live with. I don't know if we are tremendously unlucky or if all the how to books writers are hopeless naive.
User avatar
changingtimes
Posts: 483
Joined: Mon Jul 24, 2017 9:28 am

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by changingtimes »

Ybsybs wrote: Tue Apr 09, 2019 1:13 pm
Our experience thus far has been in line with how eldercare has gone CULater and RickBoglehead.

None of the advice in books on eldercare seem to match the reality spouse and I live with. I don't know if we are tremendously unlucky or if all the how to books writers are hopeless naive.
A very close friend is in a very similar situation with her dementia-suffering mother, now 92 and still living at home with a sainted aid who's there daily. They tried to put her in an assisted living facility, but she was smart enough to take the bus to the bank and close her existing checking account because her daughter "was stealing from her." (No she wasn't, but it was that account that the SS check and all autopayments for utilities, etc., came from, so it turned into a lovely mess.) Then the facility threw her out, and adult protective services said that if she was smart enough to take the bus and close the account, they couldn't force her into care.

And, to up the complexity factor of it all, throw "no savings" into the mix, which means dealing with Medicaid as part of it all.
shell921
Posts: 623
Joined: Fri Jul 06, 2018 5:13 pm

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by shell921 »

I think everyone is different and some older people THRIVE and become more ALIVE once the burden of running a home is lifted from them. Especially if they no longer drive and have been isolated in their homes - if they get to a retirement facility they are able to have activities and socialize and eat with people --without driving - instead of sitting alone in their lonely house.

Staying in your own home after you are 85 is fine if you are mentally and physically able to and you want to and are still able to drive. BUT, it can be a recipe for isolation if you can not drive or you become unable to maintain your home and the many tasks of daily living. Living in your own home is overrated if all your friends die or move away.
My 70 year old sister in law works 7 days a week for a woman named mrs o who just turned 94. My sis in law has been helping her for over 2 years now. mrs o fell and broke her wrist and that's how she got started with my sis in law. mrs o's son read my sis in law's ad in the local paper - she was advertising herself as as "assistant". she went to meet mrs o and her son and then she started walking mrs o's dog for her and driving her to the store and to medical appts. her mind is fine but in these last 2 years she has been in the hospital 3 times with some sort of intestinal "leakage"!! more and more was done for her by my sis in law. each time she got out of the hospital she was weaker and able to do less. it is sad to see but she is slowing fading away. now she is very dependent on my sis in law. it's worked out fine because my sis in law likes this older lady and they live close to each other. mrs o got up to use the toilet in the middle of the night one time and fell down. she cut herself and was bleeding. who did she call at 3 a.m.? my sis in law ! sis in law went right over there and cleaned her up and bandaged her up and got her back into bed. so if you live long enough you will at some point need help to remain in your own home.

It's not my fondest desire to go into a retirement place one day but it's something i will consider. i don't want to be isolated in my home, depending on whom ? my friends will all be old too. I made a younger friend a few years ago-- but would I want to burden HER-? no way. she has her own life/problems to deal with.

I think it's good to have a plan - but it's only plan "A" .
if your only plan is to stay in your place and age in place, wonderful if you can do it. but you also need to have a plan"B". a fallback plan in case something happens and you can't stay in your place or in case you live to be over age 90.

How many 90+ year olds do you know who are able to live in their own place without anyone helping them? when people get old they become weaker and more frail. it's just a sad fact of life.


While we would all wish to dance at our 100th birthday parties and die in our sleep soon thereafter, that's seldom how life works.
Most people have NO PLAN for living life if they live past age 85. Most seniors over age 85
usually need some kind of help to stay in their homes. Not all but most.
Here is a list of things I read on-line that you need to think about if you plan to live in your
home when you are old:

People already know how to live at home and they know if they like it – but, in fact, it is the most bewildering choice of all.
What happens when your doctor, plumber, housekeeper all move away?
What happens if your friends all move away?
What happens if you lose your license? What happens to your social life when your friends stop driving at night (They will and you will )?

How age friendly is your home – could you live there in a wheel chair or walker?

Will you be able to find a reliable person to help with activities of daily living?
If one of you had to move to assisted living or nursing, could you still afford the house? How safe is your neighborhood?
Carefreeap
Posts: 3899
Joined: Tue Jan 13, 2015 6:36 pm
Location: SF Bay Area

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by Carefreeap »

One issue I haven't seen addressed directly is consideration of choosing a CCRC which is near the child(ren) most likely to be supervising a parent's care. My friend grew up in Sacramento. After her mom was widowed, eldest daughter moved her to a CCRC near Sacramento. Four of the five kids live in the SF Bay Area. Eldest son who was physically the closest would call but not visit. Daughters got tired of making the drive and wound up selling the "apartment" and moving Mom to assisted living closest to them. Cost of getting out of the CCRC wasn't cheap but fortunately Mom had plenty of assets plus spousal pension and SS. Draw against assets was minimal even in VHCOLA Bay Area. The five kids split a pretty decent inheritance.

It's a caution I give my other friends who want to move out of So. Cal for a more tax friendly state. Are your kids going to want to visit you? These are people who have plenty of money, who live in a single-level home in a mild climate. Most people would envy their lifestyle but the husband is fixated on not paying CA taxes after living in CA for over 25 years. :oops:
Every day I can hike is a good day.
Gill
Posts: 8221
Joined: Sun Mar 04, 2007 7:38 pm
Location: Florida

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by Gill »

Reviving this older thread, as I now continue on in years, I like the idea of a CCRC but it seems to me it makes less financial sense as one ages. This is with particular reference to the initial endowment or upfront payment. Most CCRC's accept residents at age 60 and if such a person lives to be 85 the initial cost is amortized over 25 years. On the other hand, a new resident at 85 might live five more years and therefore the endowment is amortized over five years, substantially increasing the total cost for this person. Is there any adjustment offered for this factor?
Gill
Cost basis is redundant. One has a basis in an investment | One advises and gives advice | One should follow the principle of investing one's principal
UpperNwGuy
Posts: 9479
Joined: Sun Oct 08, 2017 7:16 pm

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by UpperNwGuy »

Make sure you obtain the most current information about any CCRC that interests you. Many CCRCs lost money during the pandemic because of an increased vacancy rate. Many CCRCs are now having serious staffing problems. I would be worried about making a down payment to any but the most healthy CCRC.
User avatar
ResearchMed
Posts: 16795
Joined: Fri Dec 26, 2008 10:25 pm

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by ResearchMed »

Gill wrote: Fri Jan 28, 2022 9:57 am Reviving this older thread, as I now continue on in years, I like the idea of a CCRC but it seems to me it makes less financial sense as one ages. This is with particular reference to the initial endowment or upfront payment. Most CCRC's accept residents at age 60 and if such a person lives to be 85 the initial cost is amortized over 25 years. On the other hand, a new resident at 85 might live five more years and therefore the endowment is amortized over five years, substantially increasing the total cost for this person. Is there any adjustment offered for this factor?
Gill
You'd need to discuss this with any/each facility, as they probably have their own "rules" - and they may each make various customized arrangements, or not.

But keep in mind that the longer one waits/the older one gets, the more likely it is that one might end up with some disqualifying medical condition.
As they say, it's better to plan to move into such a facilty 5 years too early than 5 minutes too late...

There are other similar facilities that are more pay as you go, and in that case, they don't have such high entry fees, but they do bill for all services.
Some, including some good ones, will do financial vetting at entry and then agree not to kick you out if you run out of money (assuming you haven't squandered it). This is where MIL was, and where we plan to go. It's very nice, and very expensive...

But we have no major bequest desires, other than for "whatever ends up being left".

RM
This signature is a placebo. You are in the control group.
delamer
Posts: 17453
Joined: Tue Feb 08, 2011 5:13 pm

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by delamer »

Gill wrote: Fri Jan 28, 2022 9:57 am Reviving this older thread, as I now continue on in years, I like the idea of a CCRC but it seems to me it makes less financial sense as one ages. This is with particular reference to the initial endowment or upfront payment. Most CCRC's accept residents at age 60 and if such a person lives to be 85 the initial cost is amortized over 25 years. On the other hand, a new resident at 85 might live five more years and therefore the endowment is amortized over five years, substantially increasing the total cost for this person. Is there any adjustment offered for this factor?
Gill
I’ve not heard of any CCRC offering an adjustment, although I believe some offer a refund if you die very soon after moving in (maybe within a year). Presumably, their business plan rests in part on some residents dying before using many services.

My mother spent 15 years in a CCRC, all but the last several months in an independent apartment. And then she was in skilled nursing until she died. The initial deposit would have covered about 18 months of skilled care, which ended up being about one year more than she needed. But her status as a member of the community let her jump the line for a room in the nursing home. Otherwise, we would have had to pay for pricey private nursing care in her apartment for an unknown period.

My mother’s place was nice and well-maintained, but didn’t offer the facilities that some high end places do. No pool, all apartments, a smaller campus, etc.
One thing that humbles me deeply is to see that human genius has its limits while human stupidity does not. - Alexandre Dumas, fils
curmudgeon
Posts: 2630
Joined: Thu Jun 20, 2013 11:00 pm

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by curmudgeon »

Gill wrote: Fri Jan 28, 2022 9:57 am Reviving this older thread, as I now continue on in years, I like the idea of a CCRC but it seems to me it makes less financial sense as one ages. This is with particular reference to the initial endowment or upfront payment. Most CCRC's accept residents at age 60 and if such a person lives to be 85 the initial cost is amortized over 25 years. On the other hand, a new resident at 85 might live five more years and therefore the endowment is amortized over five years, substantially increasing the total cost for this person. Is there any adjustment offered for this factor?
Gill
I haven't been deep into CCRCs for ourselves yet, but having been somewhat involved with family members using them, I would say that the "age at entry" has been rising significantly over the past several decades. Many folks are choosing to stay in their own houses longer before moving to a CCRC. I think that may lead to higher turnover in units, but also need for a higher proportion of "memory care" or other assisted space. Many CCRCs offer a variety of options for the initial payment, some of them with potential for partial refund under various circumstances.

It is well to understand the underlying management and operation controls before committing to a CCRC. I'm aware of one large and generally well-regarded place where there is a "management company" separate from the actual local facility operations. While both are nominally "non-profit" organizations, there is very little accountability for the management company and yet it's contract with the local facility gives it pretty much complete control over personnel and operations. Our relatives who lived there for 20 years were very happy with the community and facility, but I noticed that they and other residents are very bitter about the control issues.
InMyDreams
Posts: 1886
Joined: Tue Feb 28, 2017 10:35 am

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by InMyDreams »

curmudgeon wrote: Fri Jan 28, 2022 10:19 am..., but I noticed that they and other residents are very bitter about the control issues.
which were highlighted in the pandemic with masks, communal dining and activities.

The other problem I have my eye on - you join a CCRC, hopefully knowing what their assisted & memory care facilities are like, but what will they be like when you need them.

Also, quality of meals is more important than might first be appreciated. Initially, a community member may be primarily eating food they prepare themselves, but over time that will probably change. If the institution's quality has also declined, what to do?

But I've also seen seniors who chose to age in their homes isolated there - few visitors, minimal mobility. Tough decisions.
User avatar
mrmass
Posts: 1523
Joined: Thu Jul 26, 2018 6:35 pm
Location: MA

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by mrmass »

My step father is aging in place. Hes 89 My mom (his wife of 46yrs) passed in August. A big issue is no first floor bathroom.
Another, He barely can cook. Luckly I found a prepared food delivery for him. He gets a delivery every Wed of about 8 dinners.

He's stubborn guy, and he won't likely move out. My wife and I are basically all he has. We're the only ones that visit. We bring food, water, cook for him hang and watch tv.

When I call, he says "nobody's around"

These cold days must be long and boring. Terrible end of life in my opinion. We won't go to any type of assisted living. I can't even bring it up.
Ependytis
Posts: 617
Joined: Mon Oct 17, 2016 11:10 am

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by Ependytis »

It sounds like with CCRCs you’re paying in advance for a cheaper rate long-term. In other words, you’re buying longevity insurance. I have to assume CCRCs are in business to make a profit. Therefore, the average person is paying more than the goods and services they’re receiving unless they live an extra long life. If that is true, wouldn’t it be simpler to delay Social Security and get the increased benefits to pay the potential costs of living longer?
delamer
Posts: 17453
Joined: Tue Feb 08, 2011 5:13 pm

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by delamer »

Ependytis wrote: Fri Jan 28, 2022 2:22 pm It sounds like with CCRCs you’re paying in advance for a cheaper rate long-term. In other words, you’re buying longevity insurance. I have to assume CCRCs are in business to make a profit. Therefore, the average person is paying more than the goods and services they’re receiving unless they live an extra long life. If that is true, wouldn’t it be simpler to delay Social Security and get the increased benefits to pay the potential costs of living longer?
It’s not longevity insurance. It is insurance to cover the (very high) cost of assisted living and/or skilled nursing care, if needed. Those are more commonly needed for the “old old,” but only about half of 65 year-olds will end up needing those services before they die.
One thing that humbles me deeply is to see that human genius has its limits while human stupidity does not. - Alexandre Dumas, fils
ChrisC
Posts: 1475
Joined: Tue Jun 19, 2012 9:10 am
Location: North Carolina

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by ChrisC »

Gill wrote: Fri Jan 28, 2022 9:57 am Reviving this older thread, as I now continue on in years, I like the idea of a CCRC but it seems to me it makes less financial sense as one ages. This is with particular reference to the initial endowment or upfront payment. Most CCRC's accept residents at age 60 and if such a person lives to be 85 the initial cost is amortized over 25 years. On the other hand, a new resident at 85 might live five more years and therefore the endowment is amortized over five years, substantially increasing the total cost for this person. Is there any adjustment offered for this factor?
Gill
Your concern is premised on CCRCs that have an "endowment" or entrance fee (whether fully or partially refundable) business model, There are CCRCs that have an equity business model (where the CCRC resident actually owns the residential unit and thus could capture real estate appreciation in the unit when the resident later exits the campus). Here's an example of the equity business model: https://thecypressofcharlotte.com/

At the other extreme, there are CCRCs that have a rental business model, with no up-front entrance fee. Here's a recent entrant in the crowded and growing CCRC field in my area: https://www.barclayatsouthpark.com/

There are so many CCRC variations that it's probably more helpful to visit as many as you can, especially since this seems to be a growing industry, adapting to many emerging healthcare and business issues.
RudyS
Posts: 2821
Joined: Tue Oct 27, 2015 10:11 am

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by RudyS »

Yes, there are numerous business models for CCRCs. DW and I, 80/85, have lived in a modified Type 1 CCRC for almost 3 years. Large buy-in price, 90% refundable (to give us a way out if we didn't like that lifestyle or specific CCRC. But we are very happy. There were extensive (lock-in) restrictions during early phase of Covid-19, but we were all happy with the feeling of safety. This entity was operated by a large faith-based non-profit in our area. We were vetted for medical and financial fitness. Then, if we run out of money due to no fault of our own, we can stay anyway.
The "modified" aspect is that there is a rather small additional charge if/when we move to assisted living, or skilled nursing.
We moved here to be closer to our kids. Just 45 min. drive instead of 800 miles. We wanted to down-size from a large house anyway, and chose this route rather than move to a condo back home, and then eventually move a second time.
Due to the distance from our former home, we limited the number of places to check out when we visited the area. This one seemed like "we could live here happily the rest of our lives."
To answer OP's question about pitfalls, there were useful points already mentioned, but I would say, be sure to read the contract carefully, and when visiting, try to gauge how friendly the residents and staff are. And as said before, better 5 years too soon than 5 minutes too late.
Morgenstern
Posts: 15
Joined: Fri Dec 31, 2021 12:23 am

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by Morgenstern »

delamer wrote: Fri Jan 28, 2022 3:14 pm
Ependytis wrote: Fri Jan 28, 2022 2:22 pm It sounds like with CCRCs you’re paying in advance for a cheaper rate long-term. In other words, you’re buying longevity insurance. I have to assume CCRCs are in business to make a profit. Therefore, the average person is paying more than the goods and services they’re receiving unless they live an extra long life. If that is true, wouldn’t it be simpler to delay Social Security and get the increased benefits to pay the potential costs of living longer?
It’s not longevity insurance. It is insurance to cover the (very high) cost of assisted living and/or skilled nursing care, if needed. Those are more commonly needed for the “old old,” but only about half of 65 year-olds will end up needing those services before they die.
I presume the up-front fee is in part to protect the CCRC from having new, reasonably healthy residents gift their their money to family members and then five or more years later sticking the CCRC's nursing home with low Medicaid reimbursements rather than private patient payments from the reserve fund that was paid up-front.
ChrisC
Posts: 1475
Joined: Tue Jun 19, 2012 9:10 am
Location: North Carolina

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by ChrisC »

Morgenstern wrote: Sat Jan 29, 2022 1:27 am
delamer wrote: Fri Jan 28, 2022 3:14 pm
Ependytis wrote: Fri Jan 28, 2022 2:22 pm It sounds like with CCRCs you’re paying in advance for a cheaper rate long-term. In other words, you’re buying longevity insurance. I have to assume CCRCs are in business to make a profit. Therefore, the average person is paying more than the goods and services they’re receiving unless they live an extra long life. If that is true, wouldn’t it be simpler to delay Social Security and get the increased benefits to pay the potential costs of living longer?
It’s not longevity insurance. It is insurance to cover the (very high) cost of assisted living and/or skilled nursing care, if needed. Those are more commonly needed for the “old old,” but only about half of 65 year-olds will end up needing those services before they die.
I presume the up-front fee is in part to protect the CCRC from having new, reasonably healthy residents gift their their money to family members and then five or more years later sticking the CCRC's nursing home with low Medicaid reimbursements rather than private patient payments from the reserve fund that was paid up-front.
I don't think that's one of the reasons for the up-front fee in those CCRCs with the high entrance fee as a core entry requirement. The fee might simply be prepayment (or an advance payment) for the potential cost of long term care in the assisted living or skilled nursing care wing of the CCRC. Besides, most CCRCs do not psarticipate in the Medicaid program and many aren't even Medicare facilities for rehabilitation services. I think if you do have a CCRC that accepts Medicaid residents it might suggest that this paricular CCRC is having financial difficulties and that its participation in Medicaid is an effort to shore up it financial postion by bolstering revenues and taking in non-residents of the CCRC.

CCRCs with up-front fees might use various ways of ensuring that residents continue to make monthy payments on their stay or any additional payments for skilled nursing stays. Firstly, they can have exacting financial reviews of income sources of applicants to a CCRC; they can impose restrictions on gifting if income sources for residents could be inadequate to meet increasing monthly maintenance or additional costs for assisted living or skilling nursing care. And if these measures fail, they generally have back-up, benevolent funds (which in many cases are funded by other residents) to take care of residents who fall short financially on their maintenance obligations.
delamer
Posts: 17453
Joined: Tue Feb 08, 2011 5:13 pm

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by delamer »

Morgenstern wrote: Sat Jan 29, 2022 1:27 am
delamer wrote: Fri Jan 28, 2022 3:14 pm
Ependytis wrote: Fri Jan 28, 2022 2:22 pm It sounds like with CCRCs you’re paying in advance for a cheaper rate long-term. In other words, you’re buying longevity insurance. I have to assume CCRCs are in business to make a profit. Therefore, the average person is paying more than the goods and services they’re receiving unless they live an extra long life. If that is true, wouldn’t it be simpler to delay Social Security and get the increased benefits to pay the potential costs of living longer?
It’s not longevity insurance. It is insurance to cover the (very high) cost of assisted living and/or skilled nursing care, if needed. Those are more commonly needed for the “old old,” but only about half of 65 year-olds will end up needing those services before they die.
I presume the up-front fee is in part to protect the CCRC from having new, reasonably healthy residents gift their their money to family members and then five or more years later sticking the CCRC's nursing home with low Medicaid reimbursements rather than private patient payments from the reserve fund that was paid up-front.
Many/most/all have restrictions in the initial contract on gifting, post-entrance. So if a resident gifts money to family, charity, etc., and later can’t pay their fees, then the agreement for the CCRC to continue to provide care is voided.

And I think my mother was required to maintain health insurance too.
One thing that humbles me deeply is to see that human genius has its limits while human stupidity does not. - Alexandre Dumas, fils
User avatar
Kagord
Posts: 1676
Joined: Fri Nov 23, 2018 12:28 pm
Location: Peaksville, Ohio

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by Kagord »

I kind of look at CCRC as having a LTC component. IE, should you need nursing care for an extended period, you'll pay the same monthly rate, which is usually significantly cheaper than the 8-10K a nursing home would charge.
delamer
Posts: 17453
Joined: Tue Feb 08, 2011 5:13 pm

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by delamer »

Kagord wrote: Sat Jan 29, 2022 10:10 am I kind of look at CCRC as having a LTC component. IE, should you need nursing care for an extended period, you'll pay the same monthly rate, which is usually significantly cheaper than the 8-10K a nursing home would charge.
That’s the model that my mother was under. Although not all contracts operate that way.
One thing that humbles me deeply is to see that human genius has its limits while human stupidity does not. - Alexandre Dumas, fils
User avatar
nss20
Posts: 57
Joined: Wed Jan 01, 2020 12:36 pm

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by nss20 »

Thanks for a very interesting thread.

As I try to research CCRCs, I keep running into the lack of financial information on the websites. It seems to be a norm that the cost is not posted on most of the websites and they all want you to fill out a form to obtain it.

Are there any independent places to go to get the cost information? Also, any suggestions on how to compare various CCRCs?
Morgenstern
Posts: 15
Joined: Fri Dec 31, 2021 12:23 am

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by Morgenstern »

ChrisC wrote: Sat Jan 29, 2022 9:08 am
Morgenstern wrote: Sat Jan 29, 2022 1:27 am
delamer wrote: Fri Jan 28, 2022 3:14 pm
Ependytis wrote: Fri Jan 28, 2022 2:22 pm It sounds like with CCRCs you’re paying in advance for a cheaper rate long-term. In other words, you’re buying longevity insurance. I have to assume CCRCs are in business to make a profit. Therefore, the average person is paying more than the goods and services they’re receiving unless they live an extra long life. If that is true, wouldn’t it be simpler to delay Social Security and get the increased benefits to pay the potential costs of living longer?
It’s not longevity insurance. It is insurance to cover the (very high) cost of assisted living and/or skilled nursing care, if needed. Those are more commonly needed for the “old old,” but only about half of 65 year-olds will end up needing those services before they die.
I presume the up-front fee is in part to protect the CCRC from having new, reasonably healthy residents gift their their money to family members and then five or more years later sticking the CCRC's nursing home with low Medicaid reimbursements rather than private patient payments from the reserve fund that was paid up-front.
I don't think that's one of the reasons for the up-front fee in those CCRCs with the high entrance fee as a core entry requirement. The fee might simply be prepayment (or an advance payment) for the potential cost of long term care in the assisted living or skilled nursing care wing of the CCRC. Besides, most CCRCs do not psarticipate in the Medicaid program and many aren't even Medicare facilities for rehabilitation services. I think if you do have a CCRC that accepts Medicaid residents it might suggest that this paricular CCRC is having financial difficulties and that its participation in Medicaid is an effort to shore up it financial postion by bolstering revenues and taking in non-residents of the CCRC.

CCRCs with up-front fees might use various ways of ensuring that residents continue to make monthy payments on their stay or any additional payments for skilled nursing stays. Firstly, they can have exacting financial reviews of income sources of applicants to a CCRC; they can impose restrictions on gifting if income sources for residents could be inadequate to meet increasing monthly maintenance or additional costs for assisted living or skilling nursing care. And if these measures fail, they generally have back-up, benevolent funds (which in many cases are funded by other residents) to take care of residents who fall short financially on their maintenance obligations.
Thanks for that very helpful information. I did not know that the nursing home component of many CCRCs run independently of Medicare and/or Medicaid. That’s probably a plus for the residents, as long as the CCRC is financially healthy enough to keep things running at a high level.
User avatar
nss20
Posts: 57
Joined: Wed Jan 01, 2020 12:36 pm

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by nss20 »

delamer wrote: Fri Jan 28, 2022 3:14 pm It’s not longevity insurance. It is insurance to cover the (very high) cost of assisted living and/or skilled nursing care, if needed. Those are more commonly needed for the “old old,” but only about half of 65 year-olds will end up needing those services before they die.
I didn't realize what a high percentage will need nursing care. I assume that if you are a couple, the first to die is likely to continue living "independently". I would be curious to know where to look up the statistics and the fraction of the elderly who are married but living in a nursing facility.
RudyS
Posts: 2821
Joined: Tue Oct 27, 2015 10:11 am

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by RudyS »

nss20 wrote: Sat Jan 29, 2022 1:57 pm Thanks for a very interesting thread.

As I try to research CCRCs, I keep running into the lack of financial information on the websites. It seems to be a norm that the cost is not posted on most of the websites and they all want you to fill out a form to obtain it.

Are there any independent places to go to get the cost information? Also, any suggestions on how to compare various CCRCs?
Costs vary by size of unit, number of people per unit, life care plan or not, etc. I don't think I filled out a form, but did make phone calls for a general discussion. Based on that, we chose those CCRC's that we felt were worth a visit.
User avatar
willthrill81
Posts: 32250
Joined: Thu Jan 26, 2017 2:17 pm
Location: USA
Contact:

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by willthrill81 »

While I'm very much on board with the idea of a CCRC and will likely be interested in going to one at some point, there's no way that I'm going to hand over hundreds of thousands of dollars for a lifetime or 'type A' contract for guaranteed care without knowing that the organization I'm giving my money to is financially sound.
The Sensible Steward
RudyS
Posts: 2821
Joined: Tue Oct 27, 2015 10:11 am

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by RudyS »

nss20 wrote: Sat Jan 29, 2022 2:33 pm
delamer wrote: Fri Jan 28, 2022 3:14 pm It’s not longevity insurance. It is insurance to cover the (very high) cost of assisted living and/or skilled nursing care, if needed. Those are more commonly needed for the “old old,” but only about half of 65 year-olds will end up needing those services before they die.
I didn't realize what a high percentage will need nursing care. I assume that if you are a couple, the first to die is likely to continue living "independently". I would be curious to know where to look up the statistics and the fraction of the elderly who are married but living in a nursing facility.
And of those who do need nursing care, most do not need it for a very lengthy time. There is a statistic on length of nursing home stays but I don't have it at hand. In the CCRC where we live, it is common that when one member of a couple needs to go to an advanced level of care, either both move to assisted living so they can be together, or if one needs skilled nursing care, the spouse will remain in independent living. In our case, the CCRC has approx 300 residents, there might be a half dozen married folks in skilled nursing who have a spouse back in independent living.
User avatar
willthrill81
Posts: 32250
Joined: Thu Jan 26, 2017 2:17 pm
Location: USA
Contact:

Re: Costs, Pros, & Cons of CCRC - Continuing Care Retirement Communities - Aging in Place. Pitfalls?

Post by willthrill81 »

RudyS wrote: Sat Jan 29, 2022 3:59 pm And of those who do need nursing care, most do not need it for a very lengthy time. There is a statistic on length of nursing home stays but I don't have it at hand.
About 75% of those who need nursing home care need it for fewer than three years.
The Sensible Steward
Post Reply