Additional questions to help you decide if a CCRC is right for you. (Last in the series of 7 articles on CCRCs.)
In a previous article, I suggested questions to ask a CCRC finance team member about the community’s long-term financial viability to determine whether it’s the right place for you.
Chances are, by the time you sit down with the salesperson, you’ve already perused the marketing materials and taken a tour of the CCRC. Many of your questions have probably been answered, but here are some things you want to be sure to cover:
- Is the CCRC willing to do a preliminary assessment of my finances before or shortly after I place my name on the waiting list?
Imagine putting your name on the CCRC’s 5-year waiting list, only to find out 5 years from now that you don’t qualify financially. Believe it or not, some CCRCs don’t do a financial assessment until much later in the application process. You should ask! And if they aren’t willing to do this, find another community that will. Even if you don’t qualify for your desired type of residence, a good CCRC will advise you on what you would qualify for. Note that your final acceptance into the community depends on qualifying financially and health-wise when your unit becomes available. So, you should expect to have two financial assessments, one at either end of the process.
- What services are NOT included in the monthly service fee?
CCRC service fees are high partly because many of a resident’s daily expenses are included in the monthly fee. Be sure you know what’s included beforehand so you can budget effectively. Services typically folded into the fee include: household appliances, electricity and heat, light weekly or bi-weekly housekeeping, uncovered parking, snow removal, maintenance and repairs, gardening and landscaping, use of the pool and exercise equipment, group exercise classes, on-site entertainment, use of the activity and meeting rooms, shuttle service to surrounding towns, and at least one daily chef-prepared meal. Some communities will even include a limited amount of daily in-unit personal assistance while you are still living independently.
Extra services often include: TV/Phone/Internet charges, use of an on-site spa or salon, a personal trainer, additional chef-prepared meals (even with Type A contracts, some CCRCs charge extra for these when you move to assisted living or skilled nursing), off-site entertainment and classes, covered or garage parking, and transportation beyond a limited radius. You are also responsible for furnishing your own unit and for your medical care (although most of your medical expenses would be reimbursable by Medicare). You should also ask about additional charges for having guests over for dinner (in the dining halls), as this can add up over time. Finally, if you are purchasing anything other than a Type A contract, you will probably have to pay extra for some of your assisted living and skilled nursing services.
- How have the monthly service fees changed each year over the past five years?
Notice I didn’t ask for the average rate of increase. Averages can be deceiving, especially when they cover a lot of years. You want a year-by-year percentage increase over the recent past. A typical rate of increase in the CCRCs we’ve researched is 3% to 4% per year (approximately 1% to 2% adjusted for inflation), which, perhaps not coincidentally, is the average rate of increase in long-term care costs throughout the United States. If the rates have been higher or have fluctuated wildly, ask why. This may be an indication that the community is not managing its operations well.
- What happens if I exhaust my financial resources prematurely and have trouble paying the fees? Have you ever required a resident to leave for financial reasons?
CCRCs do not want residents to move out because of a lack of money. Besides being highly disruptive to the resident and his or her family, the optics of this would not be good from a public relations standpoint. CCRCs try to reduce those chances when they evaluate an applicant’s finances. Despite their best efforts, however, residents can run out of money. Many CCRCs allow residents to tap into the refundable portion of their entrance fee if necessary. Some communities also maintain benevolence funds residents can use to help with the monthly fees. You should inquire about these provisions and whether they appear in the contract. Remember, just because these financial aids are in the contract doesn’t mean you have the right to use them, only to apply to use them. The CCRC management has the right to say no if they think it would strain the community’s resources or if you were irresponsible with your own money. Still, it’s preferable to have these provisions included in the contract.
- What happens when one member of a couple needs a higher level of care? Can one spouse move to an assisted living or skilled nursing unit while the other spouse remains in their independent living residence, without incurring too much additional cost?
The answer may depend on the type of contract you purchase. The CCRC might charge more for the additional meals provided in the assisted living and skilled nursing wings. If you purchase a Type A contract, the fees shouldn’t increase significantly to occupy two units. If they do, you could encounter considerable financial risk. All contracts are a little different, so it’s important to read the fine print.
- What flexibility do I have if I want to move to a different residence within the CCRC once I’m living there? Do current residents have priority over new applicants? Would I incur another non-refundable portion of the entrance fee?
You should be clear about how flexible the CCRC is about this before moving in. If there isn’t much flexibility, or you would incur significant additional fees if you moved within the community, it’s especially important to choose your residence wisely the first time.
- What happens if I need care that’s unavailable at the community? What are the options? Who pays? If it’s a temporary move, will I be allowed back? How would this work?
There are a few cases in which a resident would need to leave the community for non-financial reasons. For example, if a community doesn’t have a “lock-down” unit (some don’t), a memory-impaired resident who becomes aggressive or prone to walking away from the campus might need to move to another type of facility off-campus. If this is a permanent move, how does the resident and/or the CCRC pay for it? If temporary, would the resident have to keep paying their monthly fee at the CCRC to hold their unit?
- What are the terms under which I or my estate would receive the refundable portion of the entrance fee if I left the community?
This question, of course, assumes the type of contract you purchase offers a reimbursable portion of the entrance fee. The terms vary from community to community. Some CCRCs withhold the reimbursable portion until they resell the unit. If that’s so, is there a maximum length of time before they pay the money back even if they are unable to resell the unit? And would you or your estate have to continue paying the monthly service fee until they either resell it or the maximum amount of time elapses? If so, this could put you or your estate at some financial risk.
- What is the process for deciding to move me to the next level of care? Who makes that decision?
There is undoubtedly a formal process for this. You (and your adult children or other trusted individuals) should know and be comfortable with it so there are no surprises if that time comes.
In addition to speaking with the sales staff, I strongly recommend that you interview some of the residents (preferably without a member of the sales team present). If you have a friend who lives there or knows someone who does, it might be wise to meet with them and ask a few questions. Here are some questions you might ask a resident:
- What do they like most and least about living there?
- How does the reality differ from their expectations before moving in?
- How responsive is the CCRC staff to their needs?
- How would they describe the resident culture there? Warm and inviting vs. isolated and aloof? Down-to-earth vs. high-brow? What are the community’s political and spiritual leanings, if any? The sales staff probably can’t answer some of these questions anyway. You’ll get better, more accurate answers from the residents.
- Have they made friends, and are they able to balance their sense of community with their need for privacy in the way they had hoped?
- Are they participating in interesting on and off-campus activities?
- Have there been any unexpected CCRC-related expenses that significantly impacted their personal finances since moving in?
- How’s the food? Are the menus changed often? Is the wait staff professional?
- Do they have timely access to on-site medical care if a minor health issue arises?
- How much influence do the residents have on CCRC policies and procedures, or on planning activities and events? Do their opinions count? Do any residents sit alongside staff on planning committees?
- Looking back on it, did the resident make the right decision to live there? Would they recommend this CCRC to a friend?
This is the last in a series of seven articles I’ve written about Continuing Care Retirement Communities. I will continue to research this field and interview new communities over time. CCRCs are just one type of senior living facility. In a future series of articles, I hope to include other types of senior living arrangements.