CCRCs - problems with the transition process to higher care levels?

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CULater
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CCRCs - problems with the transition process to higher care levels?

Post by CULater » Sat Feb 16, 2019 11:33 am

I'm beginning to educate myself on Continuing Care Retirement Communities (CCRCs), and I think this might be a journey rather than a destination. I think a great deal of due diligence is merited before selecting this option. I'd like to tap into the experiences of the Boglehead community regarding CCRCs. There are lots of questions, but one in particular is on my mind:

The major benefit of being in a CCRC is that you'll be able to transition seamlessly and easily to higher levels of care as you might need to do that. However, I'm wondering if there might be unanticipated bumps in the road. For example, how do you know you'll be able to transition to higher care levels in a timely manner if that is needed? I'm particularly concerned about needing to move to the highest care levels to 24/7 skilled-nursing or memory care; particularly as a result of an unexpected and sudden change in health status (e.g., hip fracture, stroke, heart attack, etc.)

Will an assisted-living or skilled-nursing bed be available when you need it? CCRCs are often built in phases, starting with independent-living units for the healthy new residents. In some cases, residents need skilled-nursing facilities that aren't even built yet. In other cases, CCRCs will admit people from outside the community to the nursing facility. What happens if an appropriate placement is not available in your CCRC? Can care be provided to you temporarily where you currently reside? Would you have to move temporarily to another facility? How would any extra costs be covered in this event?

I'd be interested in hearing about people's experiences in CCRCs in the above regard, either themselves or friends or family. What should CCRC shoppers be looking for and what information should they be getting and how should they be getting it to avoid future problems?
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Re: CCRCs - problems with the transition process to higher care levels?

Post by RickBoglehead » Sat Feb 16, 2019 11:34 am

Very good questions. I have seen posts of people saying when it was time to move there were no beds. Or they were refused.

Good to be very cautious, big financial and lifestyle decision.
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Re: CCRCs - problems with the transition process to higher care levels?

Post by Shallowpockets » Sat Feb 16, 2019 11:52 am

I think medicare might have a say in this. Not your call to request skilled nursing unless you pay out of pocket. Whether or not a bed is available in the facility you reside is probably based upon availability. No way are they going to keep a bed empty on the off chance someone may need it. I doubt if all of these transitions you desire would be seamless.
If you break a hip, have a stroke you will be in a hopital and discharge planners will plan your next step when it is time for you to go.

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Re: CCRCs - problems with the transition process to higher care levels?

Post by InMyDreams » Sat Feb 16, 2019 11:59 am

I have concerns in the opposite direction: the new CCRC near me (which refers to itself as a lifeplan community, I think?) is a different type, where you receive 90% back of the cost of moving in to your apartment to use as your nursing costs - in their facility (not yet developed) or one of your choice.

I would need to read very carefully about how the decision to move permanently to a care facility is made. It seems to me that it is an opportunity to churn the apartments. It seems like there would be no financial downside to the CCRC (get to keep the 10% while bringing someone else at a new, higher price) while they get to plug a hole in their nursing facility (if you stay).

Medicare pays for Skilled Nursing Facilities only after a minimum 3 day hospital stay, only for a set period of time. Long term care is self funded, or funded thru LTCI - or Medicaid.

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Re: CCRCs - problems with the transition process to higher care levels?

Post by GmanJeff » Sat Feb 16, 2019 12:24 pm

Typically, residents in CCRCs receive priority placement in higher levels of care from Independent Living when needed, including to Assisted Living, Rehab (meant to be temporary), and Memory Care. Often, the transition from one level to another is planned as a resident's needs become more apparent, so there is time for the staff to work with the resident to plan and execute the transition.

In the case the OP describes of an unexpectedly acute need, residents will be moved as space becomes available. That may require a transitional period outside the community in a different facility while awaiting space or perhaps a period in the Independent Living unit with a aide or visiting nurse while awaiting a move. CCRCs are unable to maintain a large inventory of unoccupied units in their higher levels of care on a "just in case needed" basis; that would not be an economically viable practice.

In practical terms, it may be the case that the more expensive facilities are better positioned to more rapidly transition their residents, because demand is tempered by the cost. Furthermore, turnover at the higher levels of care may be relatively high, leading to moderate wait times for space. It may be possible to obtain information from a specific established CCRC you're considering about typical wait times for residents who need to move on from Independent Living, since that's likely to vary from community to community based on many factors - the average age of the population in Independent Living (newer communities have younger residents who won't, as a group, require advanced care for a while), the ratio of higher-level care units to Independent Living units, and so forth.

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Re: CCRCs - problems with the transition process to higher care levels?

Post by delamer » Sat Feb 16, 2019 12:37 pm

GmanJeff wrote:
Sat Feb 16, 2019 12:24 pm
Typically, residents in CCRCs receive priority placement in higher levels of care from Independent Living when needed, including to Assisted Living, Rehab (meant to be temporary), and Memory Care. Often, the transition from one level to another is planned as a resident's needs become more apparent, so there is time for the staff to work with the resident to plan and execute the transition.

In the case the OP describes of an unexpectedly acute need, residents will be moved as space becomes available. That may require a transitional period outside the community in a different facility while awaiting space or perhaps a period in the Independent Living unit with a aide or visiting nurse while awaiting a move. CCRCs are unable to maintain a large inventory of unoccupied units in their higher levels of care on a "just in case needed" basis; that would not be an economically viable practice.

In practical terms, it may be the case that the more expensive facilities are better positioned to more rapidly transition their residents, because demand is tempered by the cost. Furthermore, turnover at the higher levels of care may be relatively high, leading to moderate wait times for space. It may be possible to obtain information from a specific established CCRC you're considering about typical wait times for residents who need to move on from Independent Living, since that's likely to vary from community to community based on many factors - the average age of the population in Independent Living (newer communities have younger residents who won't, as a group, require advanced care for a while), the ratio of higher-level care units to Independent Living units, and so forth.
This is consistent with my personal experience for my mother.

When it was determined that she needed to move from her independent apartment to memory care, there was not a memory care apartment available. Because she was a LifeCare resident, though, she went to the top of the waiting list.

She ended up not going to memory care (because of unrelated health reasons) and had to go to the skilled nursing center. I engaged a private nursing agency to provide help for several weeks before she went to skilled nursing.

The staff at her CCRC was overall really helpful, but transitions can be difficult in terms of timing, cost, etc.

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Re: CCRCs - problems with the transition process to higher care levels?

Post by CULater » Sat Feb 16, 2019 12:49 pm

This is consistent with my personal experience for my mother.

When it was determined that she needed to move from her independent apartment to memory care, there was not a memory care apartment available. Because she was a LifeCare resident, though, she went to the top of the waiting list.

She ended up not going to memory care (because of unrelated health reasons) and had to go to the skilled nursing center. I engaged a private nursing agency to provide help for several weeks before she went to skilled nursing.

The staff at her CCRC was overall really helpful, but transitions can be difficult in terms of timing, cost, etc.
Thanks for this information. You describe the scenario that I envisioned; likely to be a wait time for a transition to a higher care level, and that could result in the need for temporary care in place or a temporary move to an outside facility. I'm assuming you had to pay out of pocket for 24/7 care for your mother in her independent living apartment until there was an opening in skilled nursing? That can be quite costly and I'm guessing would not be covered by the contract in the CCRC.
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Re: CCRCs - problems with the transition process to higher care levels?

Post by delamer » Sat Feb 16, 2019 12:56 pm

CULater wrote:
Sat Feb 16, 2019 12:49 pm
This is consistent with my personal experience for my mother.

When it was determined that she needed to move from her independent apartment to memory care, there was not a memory care apartment available. Because she was a LifeCare resident, though, she went to the top of the waiting list.

She ended up not going to memory care (because of unrelated health reasons) and had to go to the skilled nursing center. I engaged a private nursing agency to provide help for several weeks before she went to skilled nursing.

The staff at her CCRC was overall really helpful, but transitions can be difficult in terms of timing, cost, etc.
Thanks for this information. You describe the scenario that I envisioned; likely to be a wait time for a transition to a higher care level, and that could result in the need for temporary care in place or a temporary move to an outside facility. I'm assuming you had to pay out of pocket for 24/7 care for your mother in her independent living apartment until there was an opening in skilled nursing? That can be quite costly and I'm guessing would not be covered by the contract in the CCRC.
Yes, the costs were out of pocket. Fortunately, it only was for about 6 weeks.

The unfortunate truth, as you have perceived, is that there aren’t always good options — at least in the short term.

But don’t underestimate the help you’ll get from doctors, nurses, social workers, etc. on the staff to help you sort through the situation.

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Re: CCRCs - problems with the transition process to higher care levels?

Post by ncbill » Sat Feb 16, 2019 2:50 pm

A bed at that particular facility is not guaranteed.

E.g. at my grandmother's CCRC they tore down their existing nursing building (semi-private rooms) and replaced it with a new one with smaller rooms (only private), cutting the number of skilled nursing beds roughly in half.

They'd still find a bed for a resident who needed one, just maybe not at the CCRC's nursing facility.

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Re: CCRCs - problems with the transition process to higher care levels?

Post by CULater » Sat Feb 16, 2019 3:40 pm

ncbill wrote:
Sat Feb 16, 2019 2:50 pm
A bed at that particular facility is not guaranteed.

E.g. at my grandmother's CCRC they tore down their existing nursing building (semi-private rooms) and replaced it with a new one with smaller rooms (only private), cutting the number of skilled nursing beds roughly in half.

They'd still find a bed for a resident who needed one, just maybe not at the CCRC's nursing facility.
I wonder how they'd do that, other than just call around to find an available bed just like I'd have to do. The problem is that beds are not readily available at the "good" skilled nursing facilities and you have to settle for one at a lower-rated one. If I were in a CCRC, I'd be expecting something better than this. Doesn't help if the CCRCs nursing facility is a "good" one if you can't get into it when you need to.
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Re: CCRCs - problems with the transition process to higher care levels?

Post by visualguy » Sat Feb 16, 2019 4:18 pm

CULater wrote:
Sat Feb 16, 2019 3:40 pm
ncbill wrote:
Sat Feb 16, 2019 2:50 pm
A bed at that particular facility is not guaranteed.

E.g. at my grandmother's CCRC they tore down their existing nursing building (semi-private rooms) and replaced it with a new one with smaller rooms (only private), cutting the number of skilled nursing beds roughly in half.

They'd still find a bed for a resident who needed one, just maybe not at the CCRC's nursing facility.
I wonder how they'd do that, other than just call around to find an available bed just like I'd have to do. The problem is that beds are not readily available at the "good" skilled nursing facilities and you have to settle for one at a lower-rated one. If I were in a CCRC, I'd be expecting something better than this. Doesn't help if the CCRCs nursing facility is a "good" one if you can't get into it when you need to.
Right, and without such a guarantee, the value of a CCRC is questionable... Why would you go into one? Is it all about increasing your chances of getting into a better nursing home even though it's not guaranteed? Doesn't seem good-enough unless the risk of being sent somewhere else for a nursing home is extremely low.

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Re: CCRCs - problems with the transition process to higher care levels?

Post by fposte » Sat Feb 16, 2019 4:34 pm

visualguy wrote:
Sat Feb 16, 2019 4:18 pm

Right, and without such a guarantee, the value of a CCRC is questionable... Why would you go into one? Is it all about increasing your chances of getting into a better nursing home even though it's not guaranteed? Doesn't seem good-enough unless the risk of being sent somewhere else for a nursing home is extremely low.
In my experience with my father's CCRC and a different one that's my main focus in town, the risk has been extremely low. I don't think there's any way to get a guarantee that you'll be 100% sure they will honor when, hopefully years down the line, you need a SNF.

It's obviously an important question to ask of any CCRC, and I'm glad it got raised to remind me to drill down farther when I'm closer to actually making the move. But the lack of a guarantee won't keep me from making the move.

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Re: CCRCs - problems with the transition process to higher care levels?

Post by RudyS » Sat Feb 16, 2019 6:22 pm

GmanJeff wrote:
Sat Feb 16, 2019 12:24 pm
Typically, residents in CCRCs receive priority placement in higher levels of care from Independent Living when needed, including to Assisted Living, Rehab (meant to be temporary), and Memory Care. Often, the transition from one level to another is planned as a resident's needs become more apparent, so there is time for the staff to work with the resident to plan and execute the transition.

In the case the OP describes of an unexpectedly acute need, residents will be moved as space becomes available. That may require a transitional period outside the community in a different facility while awaiting space or perhaps a period in the Independent Living unit with a aide or visiting nurse while awaiting a move. CCRCs are unable to maintain a large inventory of unoccupied units in their higher levels of care on a "just in case needed" basis; that would not be an economically viable practice.

In practical terms, it may be the case that the more expensive facilities are better positioned to more rapidly transition their residents, because demand is tempered by the cost. Furthermore, turnover at the higher levels of care may be relatively high, leading to moderate wait times for space. It may be possible to obtain information from a specific established CCRC you're considering about typical wait times for residents who need to move on from Independent Living, since that's likely to vary from community to community based on many factors - the average age of the population in Independent Living (newer communities have younger residents who won't, as a group, require advanced care for a while), the ratio of higher-level care units to Independent Living units, and so forth.
Good summary. We considered numerous CCRC's, and have actually visited several before selecting one. Not only are there several types, with different approaches to lifecare , each with a different financial approach, there is the issue of availability of higher levels of care, and so forth. I would almost say that no two plans are the same. It is important to carefully evaluate all the details. And remember it is not just the details of enhanced living/nursing care, but the many years you will be in independent living at that CCRC before you "graduate".

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Re: CCRCs - problems with the transition process to higher care levels?

Post by ChrisC » Sun Feb 17, 2019 9:40 am

GmanJeff wrote:
Sat Feb 16, 2019 12:24 pm
CCRCs are unable to maintain a large inventory of unoccupied units in their higher levels of care on a "just in case needed" basis; that would not be an economically viable practice.

In practical terms, it may be the case that the more expensive facilities are better positioned to more rapidly transition their residents, because demand is tempered by the cost. Furthermore, turnover at the higher levels of care may be relatively high, leading to moderate wait times for space. It may be possible to obtain information from a specific established CCRC you're considering about typical wait times for residents who need to move on from Independent Living, since that's likely to vary from community to community based on many factors - the average age of the population in Independent Living (newer communities have younger residents who won't, as a group, require advanced care for a while), the ratio of higher-level care units to Independent Living units, and so forth.
This has not been my impression at the more expensive facilities we've toured. Demand is not really tempered by cost in these facilities, with wait lists extending 4 years and 100% occupancy levels at all life stages. It appears to be a real quandry for those thinking far ahead with the idea that a suitable skilled nursing space on the CCRC campus will be available for them at their time of need.

As you state in your first sentence, supply is often constrained by optimizing profit and efficiency.

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Re: CCRCs - problems with the transition process to higher care levels?

Post by CULater » Sun Feb 17, 2019 10:59 am

So, based on some of the posts from people who have first-hand knowledge about this, it looks like my concern is valid: in fact maybe I underestimated the problem. I was concerned that you or your loved one could end up being exported to another skilled-nursing facility (of unknown or dubious quality) for a relatively short period of time until a bed was available back at the (presumably higher quality) CCRC facility. That was bad enough.

But I'm now learning that placement could perhaps be for a much longer period of time; perhaps the entire time you end up needing skilled nursing. In my mind, this voids the whole premise of joining a CCRC. Perhaps many of these places are not much more than expensive up-scale senior independent living places with the added hook that you'll receive high-quality care as you age and require higher levels of care. Now I learn that maybe you might not receive any better care than someone who didn't join a CCRC - they might wind up in the same place you do anyway.

This seems like a MAJOR drawback of CCRCs to me. I'm not sure what you can do to avoid getting into this kind of bait-and-switch situation when you select a CCRC and become locked into that facility for life. All you are really getting for your money is being able to get on a shorter waiting list for a bed than people who applying from outside the CCRC. Perhaps "life care" is a "life sentence"? Very worried.
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Re: CCRCs - problems with the transition process to higher care levels?

Post by fposte » Sun Feb 17, 2019 11:12 am

CULater wrote:
Sun Feb 17, 2019 10:59 am
So, based on some of the posts from people who have first-hand knowledge about this, it looks like my concern is valid: in fact maybe I underestimated the problem. I was concerned that you or your loved one could end up being exported to another skilled-nursing facility (of unknown or dubious quality) for a relatively short period of time until a bed was available back at the (presumably higher quality) CCRC facility. That was bad enough.
I don't think that's an accurate read of the responses--I'm seeing only one post from somebody with personal experience of a delay, and that delay was covered by a few weeks of onsite care in the apartment. People otherwise are talking about the potential of a problem, not the first-hand experience of a problem. And if you want to be fair, might be good to elicit responses from people with personal experience of a smooth transition into skilled nursing at a CCRC, which was the experience of my father and all of his friends.

I'm not saying it's guaranteed, but I think you're being alarmist about the likelihood.

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Re: CCRCs - problems with the transition process to higher care levels?

Post by CULater » Sun Feb 17, 2019 11:32 am

fposte wrote:
Sun Feb 17, 2019 11:12 am
CULater wrote:
Sun Feb 17, 2019 10:59 am
So, based on some of the posts from people who have first-hand knowledge about this, it looks like my concern is valid: in fact maybe I underestimated the problem. I was concerned that you or your loved one could end up being exported to another skilled-nursing facility (of unknown or dubious quality) for a relatively short period of time until a bed was available back at the (presumably higher quality) CCRC facility. That was bad enough.
I don't think that's an accurate read of the responses--I'm seeing only one post from somebody with personal experience of a delay, and that delay was covered by a few weeks of onsite care in the apartment. People otherwise are talking about the potential of a problem, not the first-hand experience of a problem. And if you want to be fair, might be good to elicit responses from people with personal experience of a smooth transition into skilled nursing at a CCRC, which was the experience of my father and all of his friends.

I'm not saying it's guaranteed, but I think you're being alarmist about the likelihood.
I anxiously await more first-hand accounts. That's what I was hoping for when starting this thread. Perhaps I'm being alarmist, but that's an important counterbalance to all the sanguine posts I've read on the board about CCRCs. Much needed I think. Caveat Emptor. The problem is that the people with the most valuable information are probably in the worst position to share it because of age and infirmity. Where do you get valid and credible information about this issue? Pretty sure it won't be coming from CCRCs.
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Re: CCRCs - problems with the transition process to higher care levels?

Post by PalmQueen » Sun Feb 17, 2019 11:49 am

Another potential scenario, which happens more than you might imagine, is that administrators push residents into higher levels of care against their wishes in order to free up desirable independent living units for new customers.

Check out this article -
https://www.sandiegouniontribune.com/li ... story.html

Take-away from the article:

Elder law attorneys say the fact that so many CCRC contracts give administrators authority over when residents are placed into higher levels of care presents a significant conflict of interest.

San Diego lawyer Anthony Thompson said he regularly defends clients who have been transferred to higher-cost arrangements against their wishes so administrators can market the entry-level residence to a new customer.

“The contracts are pretty ironclad, however,” he said. “They have a good legal team… When you have the administration and staff of a facility making the determinations of level of care, and they are clearly incentivized to increase that level, you can see how things could go wrong.”


I've seen this happen first-hand and it's traumatic for everyone involved.
Edited to add: Except the CCRC administration who use this method to enhance their profits from both residents involved.
Last edited by PalmQueen on Sun Feb 17, 2019 12:04 pm, edited 1 time in total.

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Re: CCRCs - problems with the transition process to higher care levels?

Post by ChrisC » Sun Feb 17, 2019 11:52 am

CULater wrote:
Sun Feb 17, 2019 11:32 am
fposte wrote:
Sun Feb 17, 2019 11:12 am
CULater wrote:
Sun Feb 17, 2019 10:59 am
So, based on some of the posts from people who have first-hand knowledge about this, it looks like my concern is valid: in fact maybe I underestimated the problem. I was concerned that you or your loved one could end up being exported to another skilled-nursing facility (of unknown or dubious quality) for a relatively short period of time until a bed was available back at the (presumably higher quality) CCRC facility. That was bad enough.
I don't think that's an accurate read of the responses--I'm seeing only one post from somebody with personal experience of a delay, and that delay was covered by a few weeks of onsite care in the apartment. People otherwise are talking about the potential of a problem, not the first-hand experience of a problem. And if you want to be fair, might be good to elicit responses from people with personal experience of a smooth transition into skilled nursing at a CCRC, which was the experience of my father and all of his friends.

I'm not saying it's guaranteed, but I think you're being alarmist about the likelihood.
I anxiously await more first-hand accounts. That's what I was hoping for when starting this thread. Perhaps I'm being alarmist, but that's an important counterbalance to all the sanguine posts I've read on the board about CCRCs. Much needed I think. Caveat Emptor. The problem is that the people with the most valuable information are probably in the worst position to share it because of age and infirmity. Where do you get valid and credible information about this issue? Pretty sure it won't be coming from CCRCs.
Hmmmm, first hand accounts from whom? Not likely that a resident of a CCRC in skilled nursing care would be here. I thought you heard from some children or relatives of those who navigated the process for loved ones. Some states have guides, which display occupancy rates, expansion plans and number of spaces at each life stage. Here's NC's :https://www.ncdoi.com/SE/Documents/CCRC ... e_2017.pdf.

I think you have to carefully read the information in the covenants and conditions of the CCRC, review occupancy, campus footprint and expansion plans, and interview residents and CCRC staff -- not sure there is anything else you can do.

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Re: CCRCs - problems with the transition process to higher care levels?

Post by quantAndHold » Sun Feb 17, 2019 12:20 pm

Have you asked the places you’re looking at the question of what percentage of people who go into skilled nursing have to be placed offsite for nursing care, and what’s the median time they were placed offsite?

My story...

Dad was in a Type D (pay as you go rental) CCRC, that was sold to a new management company after he had been living there for five years. When he moved in, he was promised that they would take care of him, in his apartment, at whatever level he needed, unless he needed memory care, which they had in a separate wing. It worked fine while he was independent, and when he needed some assistance. When he needed rehab, he was moved to another facility the company owned for the rehab, which actually was still fine, since it was nicer than his place, and he got excellent care. When he needed full nursing care, however, things broke down. The new company didn’t have the ability to provide the care he needed, which we found out after he hadn’t gotten his meds for a week, and I had to yank him out of there on a weekend. I filed a complaint with the state, which found that they were negligent, and gave the company a slap on the wrist. Some people got fired. It wasn’t enough for how they treated dad, but there you are.

The company he originally rented from was one of the better respected companies in the field, and I suspect he wouldn’t have had a problem if the place hadn’t been sold. The company that bought the place was the bottom of the barrel, with the lowest pay and worst staffing ratios in the industry. I wanted to move him, but by the time the sale happened, his health was starting to turn, and moving would have been difficult.

How to protect yourself from that? No idea at all.

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Re: CCRCs - problems with the transition process to higher care levels?

Post by CULater » Sun Feb 17, 2019 12:32 pm

CCRCs remind me of the pros and cons of buying a life annuity. You have the promise of securing things in advance, but at the cost of being locked into an irrevocable decision once you've made it.

The alternative to a CCRC would be to try to handle things ala carte. You start at the independent living level with a range of choices including senior independent-living residences/apartments. Your next stop would be to an assisted-living facility or hiring homecare to remain in your independent living arrangement. Finally, you might need to move to a SNF or nursing home. The difficulty with this approach is that you might need to make several moves to different facilities and it could be difficult if you have deteriorated physically and mentally to do this successfully. If you have trusted family, friends, or legal/financial counsel with power of attorney, those transitions could be entrusted to them.

The presumed benefit of a CCRC is that these transitions are pre-arranged and managed/facilitated by CCRC administrators. Another presumed benefit is that the higher-care levels in a good CCRC are of high quality, so you would have fewer concerns about winding up in crummy assisted-living or SNC. Is that about it? It seems to me that with proper oversight and management of one's affairs, you could essentially achieve the same objectives, assuming you have the same financial resources that you'd need to get into a CCRC. With appropriate management of wait listing by your advocates, you could likely get into "good" assisted living and SNF facilities, perhaps the very same ones that CCRC residents are in since many accept non-resident applicants.

What do you see as the pivotal advantages of becoming a resident of a CCRC, as opposed to relying on advocates to assist or manage transitions to higher care levels?
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Re: CCRCs - problems with the transition process to higher care levels?

Post by RudyS » Sun Feb 17, 2019 3:33 pm

PalmQueen wrote:
Sun Feb 17, 2019 11:49 am
Another potential scenario, which happens more than you might imagine, is that administrators push residents into higher levels of care against their wishes in order to free up desirable independent living units for new customers.

Check out this article -
https://www.sandiegouniontribune.com/li ... story.html

Take-away from the article:

Elder law attorneys say the fact that so many CCRC contracts give administrators authority over when residents are placed into higher levels of care presents a significant conflict of interest.

San Diego lawyer Anthony Thompson said he regularly defends clients who have been transferred to higher-cost arrangements against their wishes so administrators can market the entry-level residence to a new customer.

“The contracts are pretty ironclad, however,” he said. “They have a good legal team… When you have the administration and staff of a facility making the determinations of level of care, and they are clearly incentivized to increase that level, you can see how things could go wrong.”


I've seen this happen first-hand and it's traumatic for everyone involved.
Edited to add: Except the CCRC administration who use this method to enhance their profits from both residents involved.
In general, a valid concern. But specific instances can, and do, differ. Not all CCRCs use this cost model. The one we are moving into is operated as part of a non-profit organization. It is a Type A, which means in most cases there is no increase in my cost, or their revenue, at higher levels of care. The exception is that if a pre-existing condition is identified in the pre-acceptance process and written into the contract, and transfer to a higher level facility becomes necessary due to such condition, then we are responsible for the first year of additional cost (approx. $10k). And also, there is a 90% refund of the buy-in price if we chose to leave, or if we die, it goes to our heirs. So not completely locked in.

I am thinking that a major benefit of this thread is the message to very carefully understand just what is involved at any specific CCRC.

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Re: CCRCs - problems with the transition process to higher care levels?

Post by GmanJeff » Sun Feb 17, 2019 6:55 pm

CULater wrote:
Sun Feb 17, 2019 11:32 am
fposte wrote:
Sun Feb 17, 2019 11:12 am
CULater wrote:
Sun Feb 17, 2019 10:59 am
So, based on some of the posts from people who have first-hand knowledge about this, it looks like my concern is valid: in fact maybe I underestimated the problem. I was concerned that you or your loved one could end up being exported to another skilled-nursing facility (of unknown or dubious quality) for a relatively short period of time until a bed was available back at the (presumably higher quality) CCRC facility. That was bad enough.
I don't think that's an accurate read of the responses--I'm seeing only one post from somebody with personal experience of a delay, and that delay was covered by a few weeks of onsite care in the apartment. People otherwise are talking about the potential of a problem, not the first-hand experience of a problem. And if you want to be fair, might be good to elicit responses from people with personal experience of a smooth transition into skilled nursing at a CCRC, which was the experience of my father and all of his friends.

I'm not saying it's guaranteed, but I think you're being alarmist about the likelihood.
I anxiously await more first-hand accounts. That's what I was hoping for when starting this thread. Perhaps I'm being alarmist, but that's an important counterbalance to all the sanguine posts I've read on the board about CCRCs. Much needed I think. Caveat Emptor. The problem is that the people with the most valuable information are probably in the worst position to share it because of age and infirmity. Where do you get valid and credible information about this issue? Pretty sure it won't be coming from CCRCs.
Well, the advantages of a CCRC usually extend far beyond the availability of transitional levels of care, and can in some cases encompass things like on-site security and emergency medical response, restaurants, on-site routine medical care and other facilities such as gyms, pools, libraries, hairdressers, banking facilities, community transportation services, entertainment, organized clubs and activities, and so on. Many residents never need the higher levels of care, so for them the other features of the community are what end up having been most important. And, for those who do eventually need higher levels of care, some will be able to transition immediately, some after a brief delay, and some probably after long delays, depending on the community and demand at the specific time in question.

In the case where a resident is unable to be immediately placed in an on-site higher level of care, the resident can go anywhere they like and are able to pay for which has a vacancy and are not compelled to use a facility designated by the CCRC. As I noted in a previous post, it's just not realistic to expect to have an unlimited number of units in higher tiers of care on "stand-by". Instead, the CCRCs attempt to predict demand and to provide an appropriate supply. This being impossible to predict with unerring accuracy, there will always be times when higher tiers are full, and times when there are vacancies. Additionally, at least in some CCRCs, a good-faith effort is made to triage among those waiting for higher levels of care, so that those who can manage by staying in their Independent Living unit a little longer, perhaps with a aide or a visiting nurse, will be given a lower priority than someone who presently requires more assistance than could be provided that way. So, if your need is more pressing, you'd be afforded consideration in that regard.

All that said, to your point about wanting first-hand accounts, I doubt they'd be much use to you because different facilities are exactly that - different. They vary in the average age of their population, which affects how likely residents are to need higher levels of care sooner rather than later, they vary in the ratio of higher-level units to Independent Living units they have, they vary in the amount, variety, and quality of off-site options which may exist near them, and so on.

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Re: CCRCs - problems with the transition process to higher care levels?

Post by visualguy » Sun Feb 17, 2019 7:39 pm

They can change with time too due to ownership changes and other factors. The longer the time period, the higher the probability of changes.

Not sure I buy into the benefits of CCRCs, but I can't say I researched it much or thought about it much. Seems better to live independently until help is needed, and then get home care for as long as that is possible. Once that isn't sufficient, go to the best nursing home you can get with your level of assets. Waiting lists are definitely a problem, so not sure how to get around that. Maybe you get on waiting lists while you're still at the home care stage.

Anyway, I think it's a mess either way.

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Re: CCRCs - problems with the transition process to higher care levels?

Post by delamer » Sun Feb 17, 2019 8:24 pm

PalmQueen wrote:
Sun Feb 17, 2019 11:49 am
Another potential scenario, which happens more than you might imagine, is that administrators push residents into higher levels of care against their wishes in order to free up desirable independent living units for new customers.

Check out this article -
https://www.sandiegouniontribune.com/li ... story.html

Take-away from the article:

Elder law attorneys say the fact that so many CCRC contracts give administrators authority over when residents are placed into higher levels of care presents a significant conflict of interest.

San Diego lawyer Anthony Thompson said he regularly defends clients who have been transferred to higher-cost arrangements against their wishes so administrators can market the entry-level residence to a new customer.

“The contracts are pretty ironclad, however,” he said. “They have a good legal team… When you have the administration and staff of a facility making the determinations of level of care, and they are clearly incentivized to increase that level, you can see how things could go wrong.”


I've seen this happen first-hand and it's traumatic for everyone involved.
Edited to add: Except the CCRC administration who use this method to enhance their profits from both residents involved.
The point of a LifeCare arrangement is that the clients cost do not increase as s/he moves into a higher level of care.

So it depends on the type pf payment model purchased.

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Re: CCRCs - problems with the transition process to higher care levels?

Post by stan1 » Sun Feb 17, 2019 8:33 pm

CULater wrote:
Sun Feb 17, 2019 12:32 pm

What do you see as the pivotal advantages of becoming a resident of a CCRC, as opposed to relying on advocates to assist or manage transitions to higher care levels?
Even with a CCRC you still are best served by having an advocate, although that task may be easier at a CCRC.

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Re: CCRCs - problems with the transition process to higher care levels?

Post by ResearchMed » Sun Feb 17, 2019 8:37 pm

PalmQueen wrote:
Sun Feb 17, 2019 11:49 am
Another potential scenario, which happens more than you might imagine, is that administrators push residents into higher levels of care against their wishes in order to free up desirable independent living units for new customers.

Check out this article -
https://www.sandiegouniontribune.com/li ... story.html

Take-away from the article:

Elder law attorneys say the fact that so many CCRC contracts give administrators authority over when residents are placed into higher levels of care presents a significant conflict of interest.

San Diego lawyer Anthony Thompson said he regularly defends clients who have been transferred to higher-cost arrangements against their wishes so administrators can market the entry-level residence to a new customer.

“The contracts are pretty ironclad, however,” he said. “They have a good legal team… When you have the administration and staff of a facility making the determinations of level of care, and they are clearly incentivized to increase that level, you can see how things could go wrong.”


I've seen this happen first-hand and it's traumatic for everyone involved.
Edited to add: Except the CCRC administration who use this method to enhance their profits from both residents involved.
This doesn't make sense if there is not a long-term financial incentive to the CCRC/facility.

Where MIL is, usually, there is a hefty deposit as one arrives. It can be higher, with more back to the estate, or less with less back, etc. (In some cases, there isn't any, with proof of adequate resources for expected life, etc.)

However, IF someone actually runs out of money, it typically would be at a rather advanced age, such that skilled care would be deemed appropriate. At that point, either the person is already in skilled care, or is still in assisted living, perhaps with extra help.

In any event, the person would remain in skilled nursing or be moved there, and then be continued onward, at Medicaid rates.
The facility certainly is not making big profits once someone is on Medicaid; quite the opposite.

This is a non-profit, associated with the major university and teaching hospital complex where we (DH and I) have been for decades.
We now have our eye on this for ourselves, having had a very good inside look since MIL arrived there, and as her planning continues.
We will probably go to independent living sooner rather than later, just to "get in".
Once in, current residents are always at the top of any lists for moving (be it to a different level of care, or a different size/type of unit).
The waiting list for Skilled Nursing for "outsiders" is many years long.
It's very difficult to get in "later" than at the independent living stage.
And that "stage" is quite appealing... free standing cottages, to townhouses, to condo-like apartments in the main complex.
But it is not inexpensive :shock:

RM
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Re: CCRCs - problems with the transition process to higher care levels?

Post by PalmQueen » Sun Feb 17, 2019 11:45 pm

ResearchMed wrote:
Sun Feb 17, 2019 8:37 pm
PalmQueen wrote:
Sun Feb 17, 2019 11:49 am
Another potential scenario, which happens more than you might imagine, is that administrators push residents into higher levels of care against their wishes in order to free up desirable independent living units for new customers.

Check out this article -
https://www.sandiegouniontribune.com/li ... story.html

Take-away from the article:

Elder law attorneys say the fact that so many CCRC contracts give administrators authority over when residents are placed into higher levels of care presents a significant conflict of interest.

San Diego lawyer Anthony Thompson said he regularly defends clients who have been transferred to higher-cost arrangements against their wishes so administrators can market the entry-level residence to a new customer.

“The contracts are pretty ironclad, however,” he said. “They have a good legal team… When you have the administration and staff of a facility making the determinations of level of care, and they are clearly incentivized to increase that level, you can see how things could go wrong.”


I've seen this happen first-hand and it's traumatic for everyone involved.
Edited to add: Except the CCRC administration who use this method to enhance their profits from both residents involved.
This doesn't make sense if there is not a long-term financial incentive to the CCRC/facility.

Where MIL is, usually, there is a hefty deposit as one arrives. It can be higher, with more back to the estate, or less with less back, etc. (In some cases, there isn't any, with proof of adequate resources for expected life, etc.)

However, IF someone actually runs out of money, it typically would be at a rather advanced age, such that skilled care would be deemed appropriate. At that point, either the person is already in skilled care, or is still in assisted living, perhaps with extra help.

In any event, the person would remain in skilled nursing or be moved there, and then be continued onward, at Medicaid rates.
The facility certainly is not making big profits once someone is on Medicaid; quite the opposite.

This is a non-profit, associated with the major university and teaching hospital complex where we (DH and I) have been for decades.
We now have our eye on this for ourselves, having had a very good inside look since MIL arrived there, and as her planning continues.
We will probably go to independent living sooner rather than later, just to "get in".
Once in, current residents are always at the top of any lists for moving (be it to a different level of care, or a different size/type of unit).
The waiting list for Skilled Nursing for "outsiders" is many years long.
It's very difficult to get in "later" than at the independent living stage.
And that "stage" is quite appealing... free standing cottages, to townhouses, to condo-like apartments in the main complex.
But it is not inexpensive :shock:

RM
The issue pointed out in the article is that administrators of some CCRCs create spaces for new residents in independent living sections by forcing current independent living residents into higher levels of care before they need or want it.

It has nothing to do with running out of money or trying to enter a community at a higher care level. In fact, victims of the practice are likely to have entered the community earlier (so have been there longer) and have substantial resources (so can afford the more desirable units).

I'm not saying this is the case in every CCRC, just raising awareness that it does happen sometimes. Before signing, it's important to read every word of the agreement and perhaps have an attorney review it with you to understand your rights.

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Re: CCRCs - problems with the transition process to higher care levels?

Post by visualguy » Sun Feb 17, 2019 11:58 pm

PalmQueen wrote:
Sun Feb 17, 2019 11:45 pm
The issue pointed out in the article is that administrators of some CCRCs create spaces for new residents in independent living sections by forcing current independent living residents into higher levels of care before they need or want it.

It has nothing to do with running out of money or trying to enter a community at a higher care level. In fact, victims of the practice are likely to have entered the community earlier (so have been there longer) and have substantial resources (so can afford the more desirable units).

I'm not saying this is the case in every CCRC, just raising awareness that it does happen sometimes. Before signing, it's important to read every word of the agreement and perhaps have an attorney review it with you to understand your rights.
Right, but what do you do if the agreement has a clause that says that the CCRC is allowed to determine the level of care? Try to find another CCRC that doesn't have such a clause?

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Re: CCRCs - problems with the transition process to higher care levels?

Post by PalmQueen » Mon Feb 18, 2019 12:15 am

visualguy wrote:
Sun Feb 17, 2019 11:58 pm
Right, but what do you do if the agreement has a clause that says that the CCRC is allowed to determine the level of care? Try to find another CCRC that doesn't have such a clause?
Pretty sure they'll all have a clause to that effect. Some may be more inclined to abuse that power than others.

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Re: CCRCs - problems with the transition process to higher care levels?

Post by ChrisC » Mon Feb 18, 2019 9:13 am

GmanJeff wrote:
Sun Feb 17, 2019 6:55 pm
Well, the advantages of a CCRC usually extend far beyond the availability of transitional levels of care, and can in some cases encompass things like on-site security and emergency medical response, restaurants, on-site routine medical care and other facilities such as gyms, pools, libraries, hairdressers, banking facilities, community transportation services, entertainment, organized clubs and activities, and so on. Many residents never need the higher levels of care, so for them the other features of the community are what end up having been most important. And, for those who do eventually need higher levels of care, some will be able to transition immediately, some after a brief delay, and some probably after long delays, depending on the community and demand at the specific time in question.
For my wife and I, this is the primary driver for us to pursue the CCRC we've been considering. Additionally, one gets tired of home maintenance and yard up-keep. But I do like the idea of having skilled nursing care on campus if we ever need it.

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Re: CCRCs - problems with the transition process to higher care levels?

Post by newstreetnj » Mon Feb 18, 2019 9:28 pm

My sister was at a lovely CCRC but as her dementia progressed, the nursing facility was unable/ unwilling to handle her and we were encouraged to find a memory care facility for her. So, it's important to make sure that the nursing care facility is competent and structured for memory care.

I do want to add that a CCRC that is owned and run by those living in it is better than a for-profit.

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Re: CCRCs - problems with the transition process to higher care levels?

Post by Saving$ » Mon Feb 18, 2019 10:26 pm

I can give you first/secondhand experience of the opposite: One of the couple is 15 years older than the other. When the older of the couple needed more care due to a doctor saying the older one could not stay alone unsupervised, and needed more assistance with bathing and dressing than the spouse could provide, the CCRC stated that since the younger had no medical issues yet, they would not allow them to move to the next level of care.

The CCRC required that they stay living in the independent living area, and hire in home care. The kicker was that the CCRC would not allow just any in home care provider - had to be hired through a company the CCRC contracts with, had to be paid direct by the couple, and the CCRC got a cut of the payments. This was not disclosed anywhere in the contract or mentioned by anyone they spoke with when they initially applied. However the contract was vague enough about decisions "at the sole discretion of" the CCRC that there was nothing they could do but comply. Since this CCRC knows their entire asset situation, they are convinced the CCRC is intent on milking them for as much as possible...and keeping them in the lowest cost (to the CCRC) independent living as long as possible. When they applied the CCRC had empty spaces in the assisted living wing; now they don't, so they think the CCRC changes policy to adjust to that.

Also, they are not the only ones to whom this is happening. There are several quite confused single older women residents wandering around independent living who really need more supervision. But the assisted and memory care units are all full, so when it gets too bad, the CCRC hires someone for the resident to get in home care (in the independent living wing) at added expense to the resident....

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Re: CCRCs - problems with the transition process to higher care levels?

Post by ChrisC » Mon Feb 18, 2019 10:59 pm

Saving$ wrote:
Mon Feb 18, 2019 10:26 pm
I can give you first/secondhand experience of the opposite: One of the couple is 15 years older than the other. When the older of the couple needed more care due to a doctor saying the older one could not stay alone unsupervised, and needed more assistance with bathing and dressing than the spouse could provide, the CCRC stated that since the younger had no medical issues yet, they would not allow them to move to the next level of care.

The CCRC required that they stay living in the independent living area, and hire in home care. The kicker was that the CCRC would not allow just any in home care provider - had to be hired through a company the CCRC contracts with, had to be paid direct by the couple, and the CCRC got a cut of the payments. This was not disclosed anywhere in the contract or mentioned by anyone they spoke with when they initially applied. However the contract was vague enough about decisions "at the sole discretion of" the CCRC that there was nothing they could do but comply. Since this CCRC knows their entire asset situation, they are convinced the CCRC is intent on milking them for as much as possible...and keeping them in the lowest cost (to the CCRC) independent living as long as possible. When they applied the CCRC had empty spaces in the assisted living wing; now they don't, so they think the CCRC changes policy to adjust to that.
This seems a bit odd to me from your description. It suggests that the couple, one spouse able and one spouse medically impaired, were both as a team trying to enter assisted living wings of the CCRC, where only the medically impaired spouse might have been eligible to enter. If my spouse and I were faced with a similar situation, I would rather have the home care with both my wife and I remaining in the same home. Do you know if this was a Type A or Type B or C business model for the CCRC?
Saving$ wrote:
Mon Feb 18, 2019 10:26 pm
Also, they are not the only ones to whom this is happening. There are several quite confused single older women residents wandering around independent living who really need more supervision. But the assisted and memory care units are all full, so when it gets too bad, the CCRC hires someone for the resident to get in home care (in the independent living wing) at added expense to the resident....

This does not seem all that unreasaonable to me, if home care is a better fit rather than confinement to assisted living or memory care units; as we all age, we do get confused -- I'm having difficulty myself with remembering roads I've travelled before and my wife and I both have lapses in short term memories -- but I rather have home care help rather than being assigned to depressing assisted living or memory care wings of a CCRC -- I'd rather not be institutionalized if I can avoid it.

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Re: CCRCs - problems with the transition process to higher care levels?

Post by PalmQueen » Tue Feb 19, 2019 12:09 am

newstreetnj wrote:
Mon Feb 18, 2019 9:28 pm
I do want to add that a CCRC that is owned and run by those living in it is better than a for-profit.
This has been my observation as well. And if not owned by the residents, then associated with/overseen by religious or other not-for-profit organizations.

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Re: CCRCs - problems with the transition process to higher care levels?

Post by PQ12$ » Tue Feb 19, 2019 8:25 am

CULater wrote:
Sun Feb 17, 2019 12:32 pm
CCRCs remind me of the pros and cons of buying a life annuity. You have the promise of securing things in advance, but at the cost of being locked into an irrevocable decision once you've made it.

The alternative to a CCRC would be to try to handle things ala carte. You start at the independent living level with a range of choices including senior independent-living residences/apartments. Your next stop would be to an assisted-living facility or hiring homecare to remain in your independent living arrangement. Finally, you might need to move to a SNF or nursing home. The difficulty with this approach is that you might need to make several moves to different facilities and it could be difficult if you have deteriorated physically and mentally to do this successfully. If you have trusted family, friends, or legal/financial counsel with power of attorney, those transitions could be entrusted to them.
The presumed benefit of a CCRC is that these transitions are pre-arranged and managed/facilitated by CCRC administrators. Another presumed benefit is that the higher-care levels in a good CCRC are of high quality, so you would have fewer concerns about winding up in crummy assisted-living or SNC. Is that about it? It seems to me that with proper oversight and management of one's affairs, you could essentially achieve the same objectives, assuming you have the same financial resources that you'd need to get into a CCRC. With appropriate management of wait listing by your advocates, you could likely get into "good" assisted living and SNF facilities, perhaps the very same ones that CCRC residents are in since many accept non-resident applicants.
What do you see as the pivotal advantages of becoming a resident of a CCRC, as opposed to relying on advocates to assist or manage transitions to higher care levels?
+1
This resonates with me. A CCRC is a strategic crap shoot, and probably a sound decision for people without good/trusted advocates to navigate these transitions for you. I think if you have a good network of advocates (kids, etc.) and have the money the a la carte method described here probably gives you the same results.

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Re: CCRCs - problems with the transition process to higher care levels?

Post by CULater » Tue Feb 19, 2019 9:32 am

This resonates with me. A CCRC is a strategic crap shoot, and probably a sound decision for people without good/trusted advocates to navigate these transitions for you. I think if you have a good network of advocates (kids, etc.) and have the money the a la carte method described here probably gives you the same results.
What I'm wondering here is whether such a person (me, for example) would be better off arranging with an elder law attorney or other qualified person to act as DPOA and advocate and make these decisions and arrangements -- i.e. to act as your "life care manager and advocate." You want someone who can act in your best interests as a health care fiduciary rather than CCRC administrators who may have conflict of interest regarding your placement. Even if you are in a CCRC, it might be a good idea to have a DPOA advocate to deal with the CCRC. Why assume that a CCRC is going to act benevolently -- it's a business and you're a customer.
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Re: CCRCs - problems with the transition process to higher care levels?

Post by ChrisC » Tue Feb 19, 2019 5:01 pm

PQ12$ wrote:
Tue Feb 19, 2019 8:25 am
This resonates with me. A CCRC is a strategic crap shoot, and probably a sound decision for people without good/trusted advocates to navigate these transitions for you. I think if you have a good network of advocates (kids, etc.) and have the money the a la carte method described here probably gives you the same results.
Seriously, all care is a strategic crap shoot. Even with the best planned home care, independent or assisted living or skilled nursing care, irrespective of the home or facility one is residing, it's still susceptible to things going awry. One needs a patient, understanding caregiving envionment, surrounded and observed by loving friends and family members or those with an exceptional interest in your health and well-being to make transitions work well.

You need this even if you're fortunate to have all your care in your home -- your cargiving spouse can become overwhelmed in caring for a medically impaired spouse at home and both can be dragged down; the caregiving attendant for homecare might rob you blind and treat you like a dog; the skilled nursing CNAs might stop turning you over in bed and you develop bedsores; the assisted living facility might start feeding you slop or stop bathing you periodically. The checks on this are constant visits and observations by family, friends or interested observers. If one thinks CCRCs are the panacea for transitioning through different stages of life, I believe this is a delusion -- it's helpful but you still need a keen pair of observers, as in the case of any other arrangement.

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Re: CCRCs - problems with the transition process to higher care levels?

Post by Saving$ » Tue Feb 19, 2019 8:35 pm

ChrisC wrote:
Mon Feb 18, 2019 10:59 pm
Saving$ wrote:
Mon Feb 18, 2019 10:26 pm
I can give you first/secondhand experience of the opposite: One of the couple is 15 years older than the other. When the older of the couple needed more care due to a doctor saying the older one could not stay alone unsupervised, and needed more assistance with bathing and dressing than the spouse could provide, the CCRC stated that since the younger had no medical issues yet, they would not allow them to move to the next level of care.

The CCRC required that they stay living in the independent living area, and hire in home care. The kicker was that the CCRC would not allow just any in home care provider - had to be hired through a company the CCRC contracts with, had to be paid direct by the couple, and the CCRC got a cut of the payments. This was not disclosed anywhere in the contract or mentioned by anyone they spoke with when they initially applied. However the contract was vague enough about decisions "at the sole discretion of" the CCRC that there was nothing they could do but comply. Since this CCRC knows their entire asset situation, they are convinced the CCRC is intent on milking them for as much as possible...and keeping them in the lowest cost (to the CCRC) independent living as long as possible. When they applied the CCRC had empty spaces in the assisted living wing; now they don't, so they think the CCRC changes policy to adjust to that.
This seems a bit odd to me from your description. It suggests that the couple, one spouse able and one spouse medically impaired, were both as a team trying to enter assisted living wings of the CCRC, where only the medically impaired spouse might have been eligible to enter. If my spouse and I were faced with a similar situation, I would rather have the home care with both my wife and I remaining in the same home. Do you know if this was a Type A or Type B or C business model for the CCRC?
They were trying to have the older one in the memory care area during the day, and the younger one stays in independent. They were told that would be no problem when they signed up, and they believed the contract confirmed that, but that turned out not to be true. I have no idea what type of CCRC, other than it is a for profit.
ChrisC wrote:
Mon Feb 18, 2019 10:59 pm
Saving$ wrote:
Mon Feb 18, 2019 10:26 pm
Also, they are not the only ones to whom this is happening. There are several quite confused single older women residents wandering around independent living who really need more supervision. But the assisted and memory care units are all full, so when it gets too bad, the CCRC hires someone for the resident to get in home care (in the independent living wing) at added expense to the resident....

This does not seem all that unreasaonable to me, if home care is a better fit rather than confinement to assisted living or memory care units; as we all age, we do get confused -- I'm having difficulty myself with remembering roads I've travelled before and my wife and I both have lapses in short term memories -- but I rather have home care help rather than being assigned to depressing assisted living or memory care wings of a CCRC -- I'd rather not be institutionalized if I can avoid it.
Apparently some of these folks are so far gone they cannot make that decision, and their family really wants them in the memory wing for more safety, as well as freedom to wander around a safe place without always being followed; some are required to fund 24/7 care. The scuttlebutt is that as soon as the residents money starts to get low, the CCRC suddenly says a space opened up in memory care...

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Re: CCRCs - problems with the transition process to higher care levels?

Post by InMyDreams » Fri Feb 22, 2019 1:04 pm

PalmQueen wrote:
Tue Feb 19, 2019 12:09 am
newstreetnj wrote:
Mon Feb 18, 2019 9:28 pm
I do want to add that a CCRC that is owned and run by those living in it is better than a for-profit.
This has been my observation as well. And if not owned by the residents, then associated with/overseen by religious or other not-for-profit organizations.
Is there a list or website of these CCRC's?

My uncle is in a Kendal facility. It has worked well for him and my late aunt.

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