Mon, 1 June 2009
Continuing Care Retirement Communities (CCRCs), are communities that provide a full continuum of care for their residents. They have flexible accommodations designed to meet their resident’s health and housing needs as those needs change over time, offering independent living, assisted living and nursing home care, usually all in one location.
As a requirement for admission to most CCRCs, residents are required to pay an entrance fee or a lump sum “buy-in” which, in addition to other things, guarantees the resident’s right to live in the facility for the remainder of his/her lifetime. In addition to the entrance fee, residents pay a monthly service fee.
The entrance fee is often, but not always, reimbursable (at least partially) if the individual moves from the facility, passes away while a resident at the facility, or otherwise terminates the contract. Many contracts also contain a provision wherein an individual is able to use a portion of the entrance fee towards monthly resident charges if the resident exhausts his resources and becomes otherwise unable to pay.
The concept is a very appealing one. The resident knows that as he or she ages and needs increased care it will all be provided by the same organization, usually in the same location. There are certain risks, however, that make it unsuitable for many.
The CCRC is promising to provide care over a potentially long time frame without knowing exactly how much it will cost or when it will be needed. The concept is something akin to insurance. The company must make projections as to how many of its residents will need what level of care at any one time. But so many things can go awry. What happens if too many people need nursing home care at one time? What about the rising cost of long term care? What happens if residents run out of money? Or the CCRC runs out of funding? Certainly possible in today’s world, where not even big financial companies like Prudential or AIG are safe.
Because of all these contingencies the CCRC contracts have many so called “out” clauses. When you buy into the community there isn’t an iron clad guaranty that no matter what you’ll be able to stay. Under some scenarios you may run out of money and be asked to leave. This risk is especially present when husband and wife move to the community together. If one spouse needs nursing home care for an extended period the couple may spend down their assets towards that care, leaving the health spouse with not enough to cover his/her care. In some cases the entrance fee can be used for that care but then what? Is Medicaid a possibility? Maybe, but usually the resident must satisfy certain conditions imposed by the CCRC in addition to Medicaid eligibility rules. It depends on the terms of the contract.
It is, therefore, very important to review the contract (which can be 40 pages or more) with an elder law attorney before signing and go through these different scenarios. If you put all your financial eggs into the CCRC basket, what happens if that basket springs a leak? It is a good idea to have an emergency plan in place.
Category:Long term care planning -- posted at: 6:00am EST