When one or both parents begin needing more assistance at home, it may be time to begin asking whether some alternative arrangements might make sense.  Continuing care retirement communities may be one option.  CCRC’s accommodate a range of needs from mostly independent living to more hands on assistance in the form of nursing visits and meal deliveries.

Making such a move, however, is a big decision and one to be made carefully.  Part I of this excellent article, provided by A Place For Mom, a referral service for assisted living, Alzheimer’s facilities and more, is an excellent resource for things to think about when considering if a CCRC is right for your parent(s).

Driving through Rockwood Forest Estates, you wouldn’t think it was anything more than a slightly upscale suburb, says resident Elizabeth Hulteng. This neighborhood of roughly 150 homes, lush with landscaped gardens, pine forest, and protected wetlands, is part of Rockwood South, a Continuing Care Retirement Community (CCRC) in Spokane, Washington. Continuing care retirement communities are retirement communities with accommodations for independent living, assisted living, and nursing home care, offering residents a continuum of care. A person can spend the rest of his life in a CCRC, moving between levels of care as needed. People in the senior housing industry call this “aging in place,” although it does require leaving one’s original residence.
 
Hulteng and her husband chose a CCRC so their children would not have to worry about them. Since her husband had cancer in 1977, the couple also wanted his post-cancer health needs met within their community. In 1991, they moved into a Rockwood Forest Estates house. Until her husband died in 1996, his entire healthcare took place at home, with nurses visiting and meals delivered to their doorstep. “We were able to stay in the house and felt perfectly comfortable,” says Hulteng. She says her community is an easy place to be a widow, giving her access to activities and an active social group.
 
There are no reliable statistics about how many senior citizens are living in continuing care retirement communities. “[They] are not licensed or certified by one entity. They are defined differently in every state; some are called CCRCs, others are called Active Adult Community Homes [or Lifetime Communities],” says Sue Matthiesen, the managing director of Aging Services at the Commission on Accreditation of Rehabilitation Facilities (CARF), which has the nation’s only accrediting body for continuing care retirement communities (the Continuing Care Accreditation Commission, also known as CARF-CCAC). When choosing a CCRC, it is important to look at services offered by each community, the possible benefits and disadvantages, the costs, and the contractual obligations of the CCRC.

CCRC Basics

Some continuing care retirement communities are more than 100 years old. Religious and fraternal organizations began operating continuing care retirement communities as missions of service, both for members and neighbors who were becoming indigent, says Jaak Juhkentaal, COO of Rockwood South. A CCRC is not simply an active adult community; its defining characteristic is the continuum of care paradigm. To be defined as a CCRC, a community must offer independent living, assisted living, and nursing home care all in one campus. (Acute care takes place at nearby hospitals.) Older adults must move into a CCRC when they are healthy. Although settings vary, most have a common dining room, activity centers, gyms, outdoor recreation, and swimming pools. Social events happen on campus and often there are outings to events, such as a night at the symphony. Depending on the community, living spaces can include houses, cottages, clusters, townhouses, duplexes, and apartments.
 
Choosing to live in a CCRC is a costly endeavor, and individuals with low or even middle incomes and assets usually can’t afford this senior housing/healthcare option. Payment plans differ at each CCRC, but a large entrance fee is usually required. This fee can be as little as $10,000 and as much as $500,000. With most continuing care retirement communities, an individual isn’t buying the place she lives in. Residents must also pay a monthly maintenance fee, which can range from roughly $200 to more than $2,000. A contract between the resident and the CCRC spells out what the monthly maintenance fee covers, as well as health care coverage and costs (see CCRC Financial Facts, below).
 
The Benefits and Possible Disadvantages of Continuing Care Retirement Communities

Residing in a CCRC can lessen worry for both the resident and his loved ones. Juhkentaal’s parents both lived in a Seattle-area CCRC for the last ten years of their lives. “It was a good decision. It made moving through the continuum so much easier,” he says. “They had people they knew to help them make their own decisions.”

Continuing care retirement communities can be a beneficial place for widows. According to Juhkentaal, after a spouse dies, the widow or widower often starts to self-isolate while grieving. “The other residents don’t impose themselves when someone has lost a spouse, but it’s safe to talk to someone in the dining room and the neighbors,” he says. “In essence, it is a social network that keeps people functioning and motivated.”

The health and wellness centers lead senior living activities to help all seniors lead a more active life, which can be hard to coordinate in the regular community, says Matthiesen. This engaging, community-centered lifestyle can help keep residents healthy. Juhkentaal expects to go to the 107th birthday party of a resident in September. “He gets nominal assistance in assisted living. He has subtle supports from the staff, but he can also be independent and make his own choices,” says Juhkentaal. “I don’t know if that would have happened in his own home.”

Outside of a CCRC, elderly people often need someone to mow their lawns and take them to the grocery store. Perhaps they don’t always want to prepare their meals. At a CCRC, the following services may be offered, depending on the monthly maintenance contract:

•    Meals
•    Transportation
•    Lawn care
•    Gardening
•    Garbage and snow removal
•    Housekeeping
•    Social activities
•    Laundry
•    Some utilities
•    Health monitoring services
•    Emergency call monitoring
•    Security

Hulteng spends half of each year at Rockwood South and the rest of her time at a vacation home in Idaho. “I can just walk out the door and not worry about anything,” she says.

When Hulteng is in-residence, her CCRC checks daily on her well-being. If a Rockwood South resident doesn’t check-in by 10:30 am (by pressing a button in her home), the staff attempts to reach her by phone. If no one answers, the nursing staff physically checks on the resident.

This community awareness of a person also helps with health care needs. Juhkentaal says a housekeeper may be the first person to note a change in a resident. Perhaps a resident always kept her apartment as neat as a pin, but now it is noticeably messier. “The early evidence gets treatment,” he says. The staff also helps ease transition into other levels of care. Knowing most care (except hospitalization) is provided within the campus can be reassuring for residents.

However, continuing care retirement communities aren’t right for every individual. “Not every consumer wants to leave [his] home,” says Matthiesen. Besides leaving cherished space and familiar territory, a person is moving into a community almost entirely composed of senior citizens. Often someone likes his neighborhood because there is an intergenerational mix, with toddlers, young couples, and retirees, says Juhkentaal.
 
A person also needs to be comfortable with both the healthcare continuum and the monetary responsibility of living in a CCRC. Deciding healthcare options for the rest of ones life and committing to lifelong financial obligations is a big decision.

This article is reprinted with permission from A Place For Mom , a free referral service helping families find nursing homes, assisted living and Alzheimer's facilities, retirement communities and home care for aging loved ones.