Continuing Care Retirement Community Entrance Fee

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RudyS
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Re: Continuing Care Retirement Community Entrance Fee

Post by RudyS »

David Jay wrote: Wed Sep 02, 2020 2:17 pm
RudyS wrote: Mon Aug 31, 2020 12:21 pm What if, heaven forbid, you don't make it till DW is 17? Say you both go under the bus in few years? The kids (if any) get nothing under the nonrefundable option.
Actually they get some $600,000 under the non-refundable option as follows (substitute, say, 16 for the power):
wanderer wrote: Mon Aug 31, 2020 9:54 am$433,400 left to invest for 18 years. $433,400 (1.02)^18 - $619,000.
Valid assessment, but I was referring to the black swan "in a few years." So it's not nothing for the kids but not very much. [I had forgotten wanderer's calculation when I posted.]
Topic Author
Prudence
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Re: Continuing Care Retirement Community Entrance Fee

Post by Prudence »

fandango wrote: Wed Sep 02, 2020 1:59 pm We have a large CCRC about 30 miles from us.

We currently live in a 55+ community, and we were impressed 4 or 5 years ago when the CEO of the CCRC came to visit us and made a presentation.

A few years later some of his staff members came and did another presentation. The focused mainly on $$$ and rules. Rules and more rules.

We decided that we weren't ready for that level of institutionalization. The rule thing really turned us off. The focus did not seem to on residents but on the rules of the institution.

My caution would be to check our CCRC several times and try to get down to the people who run it day by day. Anyone can put together a glossy brochure.
Agree. The CCRCs we are considering have had zoom meetings where current independent living residents rave about how great it is. The enthusiasm is a little frightening. They don't invite anybody who isn't thrilled. I would love to hear from residents that have transitioned to assisted living or comprehensive care, but, that would not be appropriate. Some residents admit that they are not happy under the Covid restrictions, but, they have expressed no regrets about having paid high entrance fees and monthly fees, and then all the common rooms were shut down (appropriately) for an indefinite period.
RudyS
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Re: Continuing Care Retirement Community Entrance Fee

Post by RudyS »

Since you are quite a few years ago from wanting/needing to make a move, and are on waiting lists as a contingency, I'd wait till things open up after Covid and visit places that let you check out the assisted living areas and talk to residents there. Our facility makes an effort to integrate the assisted living folks into general activities like programs and occasional dining room visits (pre-Covid!).
InMyDreams
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Re: Continuing Care Retirement Community Entrance Fee

Post by InMyDreams »

If there is a nursing facility, check the CMS rating - not a guarantee in and of itself. And as with a fund's performance, past performance does not guarantee future performance. Still, I don't know if the contract specifies how well they will comply with CMS guidelines?

My uncle is in a CCRC near an Ivy league university. He and his (now late) wife moved in thinking that if the CCRC failed to live up to its contractual obligations, there would be plenty of retired law professors and their family members to litigate the problem.

It is a type "A" facility - no refund, take care of you thru your remaining lifetime. He (they) has had no regrets about their decision.

My uncle is still independent, but I think overall he's been satisfied with the COVID restrictions that have been placed - he doesn't have to worry about going to the store, and he feels relatively safe in his environment. Even when the restrictions were tightest, he could get in his car and go for a drive.
RudyS
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Re: Continuing Care Retirement Community Entrance Fee

Post by RudyS »

Just want to point out, all plans vary. Type A is not necessarily non-refundable. Depends on the facility. I've seen options of 50% refundable too.
Gnirk
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Re: Continuing Care Retirement Community Entrance Fee

Post by Gnirk »

I, too, have been looking into CCC's, and all of them have definite increases in monthly payments depending upon the level of care. For example, a non-refundable buy-in of $250,000 would get us a lovely 2-bedroom independent living apartment for $5,100 per month. If one of us needs assisted living, memory care or skilled nursing care, the price goes up. And you aren't guaranteed that level of care, only that you have priority if you are already a resident.
Assisted Living- 1 Bedroom is $6,205 per month, plus additional $375-$2,970 per month, per person, for assistance with ADLs.
Memory Care- 1 bedroom is $4,890-$7,800 per month.
Skilled nursing, room and bath is $11,000 - $17,400 per month.

In contrast, my mom was diagnosed with Alzheimer's and 3 years after her diagnosis she needed more help than I could provide, so we moved her to a private care home 15 minutes from me, which specialized in memory care. It was licensed for three residents. My mom received truly excellent almost one-on-one care, wa served from-scratch meals, and lived there for 8 years with the last year of her life on Hospice. The total cost for those 8 years was $432,000. All private-pay. Thank you mom for being so frugal and making sure you had the financial resources to pay for excellent care.
Topic Author
Prudence
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Re: Continuing Care Retirement Community Entrance Fee

Post by Prudence »

Gnirk wrote: Thu Sep 03, 2020 12:49 pm I, too, have been looking into CCC's, and all of them have definite increases in monthly payments depending upon the level of care. For example, a non-refundable buy-in of $250,000 would get us a lovely 2-bedroom independent living apartment for $5,100 per month. If one of us needs assisted living, memory care or skilled nursing care, the price goes up. And you aren't guaranteed that level of care, only that you have priority if you are already a resident.
Assisted Living- 1 Bedroom is $6,205 per month, plus additional $375-$2,970 per month, per person, for assistance with ADLs.
Memory Care- 1 bedroom is $4,890-$7,800 per month.
Skilled nursing, room and bath is $11,000 - $17,400 per month.

In contrast, my mom was diagnosed with Alzheimer's and 3 years after her diagnosis she needed more help than I could provide, so we moved her to a private care home 15 minutes from me, which specialized in memory care. It was licensed for three residents. My mom received truly excellent almost one-on-one care, wa served from-scratch meals, and lived there for 8 years with the last year of her life on Hospice. The total cost for those 8 years was $432,000. All private-pay. Thank you mom for being so frugal and making sure you had the financial resources to pay for excellent care.
Thanks for the private care home suggestion if I can find one as good as yours nearby. There was a horror story about one of these homes in our area several years ago. But, I think it could work if there is a family member in close proximity who can drop by the home for unannounced visits, randomly and frequently.
sarahjane
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Re: Continuing Care Retirement Community Entrance Fee

Post by sarahjane »

CCRCs are Ponzi schemes. New entry fees go to support existing residents. There is seldom any leeway if occupancy levels fall because of something like this virus. We are on list for well respected ccrc but even before the pandemic its largest asset was goodwill which has no $$value. So you are at the mercy of the market whether this will all work out.
RudyS
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Re: Continuing Care Retirement Community Entrance Fee

Post by RudyS »

sarahjane wrote: Thu Sep 03, 2020 10:18 pm CCRCs are Ponzi schemes. New entry fees go to support existing residents. There is seldom any leeway if occupancy levels fall because of something like this virus. We are on list for well respected ccrc but even before the pandemic its largest asset was goodwill which has no $$value. So you are at the mercy of the market whether this will all work out.
Rather strong words. Our CCRC does not include "goodwill" as an asset. We received a multipage financial statement (audited) and other info before signing up. Monthly fees go towards supporting existing residents. While no guarantee, in my opinion CCRCs run by a non-profit have less risk than those operated for profit.
smitcat
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Re: Continuing Care Retirement Community Entrance Fee

Post by smitcat »

sarahjane wrote: Thu Sep 03, 2020 10:18 pm CCRCs are Ponzi schemes. New entry fees go to support existing residents. There is seldom any leeway if occupancy levels fall because of something like this virus. We are on list for well respected ccrc but even before the pandemic its largest asset was goodwill which has no $$value. So you are at the mercy of the market whether this will all work out.
Would you please post some data and the link to the source(s) that supports the % of goodwill and the observation that CCRC's are ponzi schemes.
Thank you
sailaway
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Re: Continuing Care Retirement Community Entrance Fee

Post by sailaway »

sarahjane wrote: Thu Sep 03, 2020 10:18 pm CCRCs are Ponzi schemes. New entry fees go to support existing residents. There is seldom any leeway if occupancy levels fall because of something like this virus. We are on list for well respected ccrc but even before the pandemic its largest asset was goodwill which has no $$value. So you are at the mercy of the market whether this will all work out.
Unlike all those other businesses that thrive on reduced customers...
Topic Author
Prudence
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Re: Continuing Care Retirement Community Entrance Fee

Post by Prudence »

smitcat wrote: Fri Sep 04, 2020 9:18 am
sarahjane wrote: Thu Sep 03, 2020 10:18 pm CCRCs are Ponzi schemes. New entry fees go to support existing residents. There is seldom any leeway if occupancy levels fall because of something like this virus. We are on list for well respected ccrc but even before the pandemic its largest asset was goodwill which has no $$value. So you are at the mercy of the market whether this will all work out.
Would you please post some data and the link to the source(s) that supports the % of goodwill and the observation that CCRC's are ponzi schemes.
Thank you
They are not Ponzi schemes. But, as you probably know, the entrance fee is not refunded until a new resident pays his or her entrance fee and takes occupancy of the vacated unit. So, if there was a significant decrease in occupancy, the fee may not be refunded for several months, years, or ever if a bankruptcy ensues under certain conditions. Also, some CCRCs have rules that will reduce the amount of a refundable entrance fee if, for example, their entrance fees have dropped after a resident signed his or her residency agreement. Experts recommend that a lawyer review the residency agreement before signing (and make sure the deposit is fully refundable).
ChrisC
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Re: Continuing Care Retirement Community Entrance Fee

Post by ChrisC »

Prudence wrote: Fri Sep 04, 2020 9:34 am
smitcat wrote: Fri Sep 04, 2020 9:18 am
sarahjane wrote: Thu Sep 03, 2020 10:18 pm CCRCs are Ponzi schemes. New entry fees go to support existing residents. There is seldom any leeway if occupancy levels fall because of something like this virus. We are on list for well respected ccrc but even before the pandemic its largest asset was goodwill which has no $$value. So you are at the mercy of the market whether this will all work out.
Would you please post some data and the link to the source(s) that supports the % of goodwill and the observation that CCRC's are ponzi schemes.
Thank you
They are not Ponzi schemes. But, as you probably know, the entrance fee is not refunded until a new resident pays his or her entrance fee and takes occupancy of the vacated unit. So, if there was a significant decrease in occupancy, the fee may not be refunded for several months, years, or ever if a bankruptcy ensues under certain conditions. Also, some CCRCs have rules that will reduce the amount of a refundable entrance fee if, for example, their entrance fees have dropped after a resident signed his or her residency agreement. Experts recommend that a lawyer review the residency agreement before signing (and make sure the deposit is fully refundable).
CCRCs have different business models, though I would hardly say any resemble a Ponzi scheme, which suggests a fraudalent pyramid of investors in a service, product or real estate venture where entrants in the scheme are primarily "profiting" from new entrants coming on the scene. Besides, CCRCs appear to be regulated by the States as a real estate, insurance and health center product or service with specific disclosure rules -- at least that's how they appear regulated in North Carolina by its State Department of Insurance.

We're waitlisted on a CCRC that has an equity ownership business model for CCRC residents, with a non-profit membership entity that owns common amenities at the CCRC, including the Health Center (all controlled by the CCRC residents). Residents purchase cottages (single family homes) or villas (condominium apartments), which can range from $365K to $1.3 million. Included in the purchase price is a non-refundable 10% membership fee, which provides payment for your membership into the non-profit entity that essentially oversees the CCRC along with the original developer who maintains an oversight interest in the CCRC project that it developed. The CCRC does not consider the 10% membership fee an entrance fee -- and from an accounting and medical expense standpoint, it probably isn't a tax deductible medical expense.

So, for this CCRC, you actually own your residence -- if you leave the campus, your unit becomes available to another prospective resident and the prior owner or the owner's estate gets the benefit of any real estate appreciation resulting from the sale, which has been significant in this CCRC since its inception in 1999. The CCRC/developer benefits by charging a management/operational fee and skims a 6% real estate commission on unit sales. Currently, there is a 4 year deep waitlist on applications into this CCRC. Of course, there are monthly fees but they cover a lot of home maintenance, social activities and health wellness. We've been on the waitlist for the last 16 months, but we expect not to be ready to move for at least another 4-6 years,if at all. You stay on the waitlist for 4 years, then have to re-apply again to renew your waitlist spot after 4 years -- we're currently 66 and 69. Most CCRCs in our area have waitlist programs which allow waitlisted people to participate in some events at the CCRC -- for instance, at our CCRC we're entitled to lunch at the dinning facility every month (with 2 additional guests). This provided us with the opportunity to meet residents at the CCRC, get an appeciation of the food and dining service, and see how some of the activities are displayed there. We used this lunch pass on a number of occasions, until Covid 19, and we were generally favorably impressed by the food/dining services and amenities offered by the CCRC.
fourwheelcycle
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Re: Continuing Care Retirement Community Entrance Fee

Post by fourwheelcycle »

I have never seen a news article about a CCRC that was discovered to be a Ponzi scheme. Maybe there have been some and I have missed them. However, state regulations for CCRCs vary widely, from very stringent to very limited. The best practice for anyone considering a $300-650K non-refundable entrance fee, or even up to a $1M+ refundable entrance fee, is to carefully review the audited financial reports and the formal residency contract (also called a residency agreement) of the CCRC they are most seriously considering. With so large an investment at stake, it would even be reasonable to find a fee-only financial advisor who is familiar with CCRC residency agreements and audited financials to assist in your evaluation.

Then ask the CCRC's CFO about any issues or questions you have after your review. If the CCRC will only let you and/or your financial advisor talk to their admissions director, but not to their CFO, that is a big red light.

The gold standards for CCRC financial evaluation are (1) a Fitch bond rating of BBB+ or better, or an equivalent rating from S&P (I am not familiar with S&P's current ratings levels) and (2) an actuarial funded status study. CCRC's without currently rated bond issuances will not have bond credit ratings, but any reputable CCRC should be doing periodic actuarial funded status studies and should be willing to share their most recent study with current and prospective residents. If a CCRC has never done an actuarial funded status study with an independent actuarial consultant that should also be considered as a red light. A funded service obligation (FSO) study is a less comprehensive alternative to an actuarial funded status study.
sarahjane
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Re: Continuing Care Retirement Community Entrance Fee

Post by sarahjane »

OP here. The ccrc I referred to recorded a sizable goodwill item as an asset on its balance sheet in connection with its affiliation with a large ccrc complex. It represents the excess of the carrying value of its assets over their estimated real value at the time of affiliation. In other words, this "asset" has no actual liquidation value and if eliminated, liabilities exceed assets which means the ccrc is essentially bankrupt. This "goodwill treatment is consistent with generally accepted accounting principles and would come into play in a liquidation situation if unable to meet its current obligations.
ChrisC
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Re: Continuing Care Retirement Community Entrance Fee

Post by ChrisC »

sarahjane wrote: Sat Sep 05, 2020 11:21 am OP here. The ccrc I referred to recorded a sizable goodwill item as an asset on its balance sheet in connection with its affiliation with a large ccrc complex. It represents the excess of the carrying value of its assets over their estimated real value at the time of affiliation. In other words, this "asset" has no actual liquidation value and if eliminated, liabilities exceed assets which means the ccrc is essentially bankrupt. This "goodwill treatment is consistent with generally accepted accounting principles and would come into play in a liquidation situation if unable to meet its current obligations.
Well, I’d be very careful with a CCRC that has to book goodwill to essentially show balance sheet solvency. I’d be looking at this CCRC’s debt structure, its cash flow statements, its overall occupancy levels, its expansion plans, if any, replacement reserve funding accounts, if any, and its independent subsidiary status if within a CCRC network like a large faith-based organization or a corporate entity such as Erickson, which I believe is the largest corporate CCRC, which came out of bankruptcy a decade ago.

I’m very comfortable with the audited financial statements I’ve seen for the CCRC we’ve waitlisted. And the CCRC appears we’ll managed. But things can always change. For one thing, while it has no current debt, it does have very limited plans to expand the number of beds in its skilled nursing care facility consistent with future residential needs.
Topic Author
Prudence
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Re: Continuing Care Retirement Community Entrance Fee

Post by Prudence »

ChrisC wrote: Fri Sep 04, 2020 6:12 pm
Prudence wrote: Fri Sep 04, 2020 9:34 am
smitcat wrote: Fri Sep 04, 2020 9:18 am
sarahjane wrote: Thu Sep 03, 2020 10:18 pm CCRCs are Ponzi schemes. New entry fees go to support existing residents. There is seldom any leeway if occupancy levels fall because of something like this virus. We are on list for well respected ccrc but even before the pandemic its largest asset was goodwill which has no $$value. So you are at the mercy of the market whether this will all work out.
Would you please post some data and the link to the source(s) that supports the % of goodwill and the observation that CCRC's are ponzi schemes.
Thank you
They are not Ponzi schemes. But, as you probably know, the entrance fee is not refunded until a new resident pays his or her entrance fee and takes occupancy of the vacated unit. So, if there was a significant decrease in occupancy, the fee may not be refunded for several months, years, or ever if a bankruptcy ensues under certain conditions. Also, some CCRCs have rules that will reduce the amount of a refundable entrance fee if, for example, their entrance fees have dropped after a resident signed his or her residency agreement. Experts recommend that a lawyer review the residency agreement before signing (and make sure the deposit is fully refundable).
CCRCs have different business models, though I would hardly say any resemble a Ponzi scheme, which suggests a fraudalent pyramid of investors in a service, product or real estate venture where entrants in the scheme are primarily "profiting" from new entrants coming on the scene. Besides, CCRCs appear to be regulated by the States as a real estate, insurance and health center product or service with specific disclosure rules -- at least that's how they appear regulated in North Carolina by its State Department of Insurance.

We're waitlisted on a CCRC that has an equity ownership business model for CCRC residents, with a non-profit membership entity that owns common amenities at the CCRC, including the Health Center (all controlled by the CCRC residents). Residents purchase cottages (single family homes) or villas (condominium apartments), which can range from $365K to $1.3 million. Included in the purchase price is a non-refundable 10% membership fee, which provides payment for your membership into the non-profit entity that essentially oversees the CCRC along with the original developer who maintains an oversight interest in the CCRC project that it developed. The CCRC does not consider the 10% membership fee an entrance fee -- and from an accounting and medical expense standpoint, it probably isn't a tax deductible medical expense.

So, for this CCRC, you actually own your residence -- if you leave the campus, your unit becomes available to another prospective resident and the prior owner or the owner's estate gets the benefit of any real estate appreciation resulting from the sale, which has been significant in this CCRC since its inception in 1999. The CCRC/developer benefits by charging a management/operational fee and skims a 6% real estate commission on unit sales. Currently, there is a 4 year deep waitlist on applications into this CCRC. Of course, there are monthly fees but they cover a lot of home maintenance, social activities and health wellness. We've been on the waitlist for the last 16 months, but we expect not to be ready to move for at least another 4-6 years,if at all. You stay on the waitlist for 4 years, then have to re-apply again to renew your waitlist spot after 4 years -- we're currently 66 and 69. Most CCRCs in our area have waitlist programs which allow waitlisted people to participate in some events at the CCRC -- for instance, at our CCRC we're entitled to lunch at the dinning facility every month (with 2 additional guests). This provided us with the opportunity to meet residents at the CCRC, get an appeciation of the food and dining service, and see how some of the activities are displayed there. We used this lunch pass on a number of occasions, until Covid 19, and we were generally favorably impressed by the food/dining services and amenities offered by the CCRC.
I like your CCRC. I live in Maryland and so are the two CCRCs where I am on waiting lists. Please share any details you have about a tax deduction on the entrance fee. Is it available on federal and state? After the recent tax law changes, we file jointly and take the standard deduction.
ChrisC
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Re: Continuing Care Retirement Community Entrance Fee

Post by ChrisC »

Prudence wrote: Sat Sep 05, 2020 2:41 pm
I like your CCRC. I live in Maryland and so are the two CCRCs where I am on waiting lists. Please share any details you have about a tax deduction on the entrance fee. Is it available on federal and state? After the recent tax law changes, we file jointly and take the standard deduction.
There have been several threads that tangentially touch upon the tax deductibility of a portion of the entrance fee for CCRC as a prepaid medical expense. Here's one of them: viewtopic.php?f=2&t=305697

I recall one poster here who posted in another thread that he was getting some tax advice from his CCRC that a significant portion of his entrance fee would be considered a prepaid medical expense.
RudyS
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Re: Continuing Care Retirement Community Entrance Fee

Post by RudyS »

Part of the entrance fee and part of the monthly fees, are deductible as a pre-paid medical expense on Federal. If states allow deduction of medical expenses, there is a benefit there too. The CCRC provides a letter each year, early in the year, describing what the percentages were for the previous calendar year. Late in 2019 my CCRC told me what the percentage had been in the prior year so I could make an estimate of my taxes. This subject had been discussed in the forum previously.
viewtopic.php?f=2&t=305697&p=5062397&hi ... c#p5062397
FactualFran
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Re: Continuing Care Retirement Community Entrance Fee

Post by FactualFran »

Gnirk wrote: Thu Sep 03, 2020 12:49 pm I, too, have been looking into CCC's, and all of them have definite increases in monthly payments depending upon the level of care. For example, a non-refundable buy-in of $250,000 would get us a lovely 2-bedroom independent living apartment for $5,100 per month. If one of us needs assisted living, memory care or skilled nursing care, the price goes up. And you aren't guaranteed that level of care, only that you have priority if you are already a resident.
Assisted Living- 1 Bedroom is $6,205 per month, plus additional $375-$2,970 per month, per person, for assistance with ADLs.
Memory Care- 1 bedroom is $4,890-$7,800 per month.
Skilled nursing, room and bath is $11,000 - $17,400 per month.
Two types of contracts usually offered by CCRCs are called Life Care Contracts (Type A) and Modified Contracts (Type B). With a Type A contract, the monthly fee does not change as additional levels of health care are provided. The monthly fee changes as normal operating costs of the CCRC changes.

With a Type B contract, the monthly fee changes as additional levels of health care are provided (and due to changes in normal operating costs). However, the contract usually includes a limited number of days for which an additional level of care is provided before the monthly fee is changed.

There are other types of contracts, such a fee-for-service. Each CCRC determines what type or types of contract it offers.
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willthrill81
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Re: Continuing Care Retirement Community Entrance Fee

Post by willthrill81 »

FactualFran wrote: Sat Sep 05, 2020 5:32 pm
Gnirk wrote: Thu Sep 03, 2020 12:49 pm I, too, have been looking into CCC's, and all of them have definite increases in monthly payments depending upon the level of care. For example, a non-refundable buy-in of $250,000 would get us a lovely 2-bedroom independent living apartment for $5,100 per month. If one of us needs assisted living, memory care or skilled nursing care, the price goes up. And you aren't guaranteed that level of care, only that you have priority if you are already a resident.
Assisted Living- 1 Bedroom is $6,205 per month, plus additional $375-$2,970 per month, per person, for assistance with ADLs.
Memory Care- 1 bedroom is $4,890-$7,800 per month.
Skilled nursing, room and bath is $11,000 - $17,400 per month.
Two types of contracts usually offered by CCRCs are called Life Care Contracts (Type A) and Modified Contracts (Type B). With a Type A contract, the monthly fee does not change as additional levels of health care are provided. The monthly fee changes as normal operating costs of the CCRC changes.

With a Type B contract, the monthly fee changes as additional levels of health care are provided (and due to changes in normal operating costs). However, the contract usually includes a limited number of days for which an additional level of care is provided before the monthly fee is changed.

There are other types of contracts, such a fee-for-service. Each CCRC determines what type or types of contract it offers.
My very possibly flawed understanding is that type A contracts generally also state that if the resident becomes financially destitute and unable to pay the monthly fee that they will still receive lifetime care, though I believe that the CCRCs require would-be residents to first demonstrate that they have enough assets to reasonably avoid this situation in the first place.
“It's a dangerous business, Frodo, going out your door. You step onto the road, and if you don't keep your feet, there's no knowing where you might be swept off to.” J.R.R. Tolkien,The Lord of the Rings
Gnirk
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Re: Continuing Care Retirement Community Entrance Fee

Post by Gnirk »

FactualFran wrote: Sat Sep 05, 2020 5:32 pm
Gnirk wrote: Thu Sep 03, 2020 12:49 pm I, too, have been looking into CCC's, and all of them have definite increases in monthly payments depending upon the level of care. For example, a non-refundable buy-in of $250,000 would get us a lovely 2-bedroom independent living apartment for $5,100 per month. If one of us needs assisted living, memory care or skilled nursing care, the price goes up. And you aren't guaranteed that level of care, only that you have priority if you are already a resident.
Assisted Living- 1 Bedroom is $6,205 per month, plus additional $375-$2,970 per month, per person, for assistance with ADLs.
Memory Care- 1 bedroom is $4,890-$7,800 per month.
Skilled nursing, room and bath is $11,000 - $17,400 per month.
Two types of contracts usually offered by CCRCs are called Life Care Contracts (Type A) and Modified Contracts (Type B). With a Type A contract, the monthly fee does not change as additional levels of health care are provided. The monthly fee changes as normal operating costs of the CCRC changes.

With a Type B contract, the monthly fee changes as additional levels of health care are provided (and due to changes in normal operating costs). However, the contract usually includes a limited number of days for which an additional level of care is provided before the monthly fee is changed.

There are other types of contracts, such a fee-for-service. Each CCRC determines what type or types of contract it offers.
My biggest concern is that if one of us should need the next level of care, that we are not guaranteed that level of care, we would just have "priority" if an opening comes up. My good friend's mom lived in our local CCRC, and when she needed skilled nursing care, it wasn't available! The CCRC made no accomodations elswhere for her. Her daughter had to move her out of the CCRC and to a LTC facility close to her, 1200 miles away. And this is a very popular CCRC with a long waiting list to get into independent living.
ChrisC
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Re: Continuing Care Retirement Community Entrance Fee

Post by ChrisC »

willthrill81 wrote: Sat Sep 05, 2020 5:50 pm
FactualFran wrote: Sat Sep 05, 2020 5:32 pm
Gnirk wrote: Thu Sep 03, 2020 12:49 pm I, too, have been looking into CCC's, and all of them have definite increases in monthly payments depending upon the level of care. For example, a non-refundable buy-in of $250,000 would get us a lovely 2-bedroom independent living apartment for $5,100 per month. If one of us needs assisted living, memory care or skilled nursing care, the price goes up. And you aren't guaranteed that level of care, only that you have priority if you are already a resident.
Assisted Living- 1 Bedroom is $6,205 per month, plus additional $375-$2,970 per month, per person, for assistance with ADLs.
Memory Care- 1 bedroom is $4,890-$7,800 per month.
Skilled nursing, room and bath is $11,000 - $17,400 per month.
Two types of contracts usually offered by CCRCs are called Life Care Contracts (Type A) and Modified Contracts (Type B). With a Type A contract, the monthly fee does not change as additional levels of health care are provided. The monthly fee changes as normal operating costs of the CCRC changes.

With a Type B contract, the monthly fee changes as additional levels of health care are provided (and due to changes in normal operating costs). However, the contract usually includes a limited number of days for which an additional level of care is provided before the monthly fee is changed.

There are other types of contracts, such a fee-for-service. Each CCRC determines what type or types of contract it offers.
My very possibly flawed understanding is that type A contracts generally also state that if the resident becomes financially destitute and unable to pay the monthly fee that they will still receive lifetime care, though I believe that the CCRCs require would-be residents to first demonstrate that they have enough assets to reasonably avoid this situation in the first place.
I think it is generally not wise to generalize too much about these contract types as each CCRC probably has its own specific features. I've only looked at Type B (discounted per diem pay-as-you go for residence in the assisted living or skilled nursing arm of the CCRC) or Type C (retail rates for pay-as-go residence in the ALF or SNF arm). But in each of these Type CCRCs that I've reviewed in my area, they all provide for "hardship" coverage of residents who can't meet their monthly fees, whether in Independent Living. Assisted Living or Skilling Nursing. In fact, one of these CCRCs, which has its founding derived from faith-based churches in the area, has a dedicated charitable fund for this purpose -- and it's a CCRC that's highly rated with very high entry barriers!

For the CCRC I'm waitlisted, which is a hybrid Type B, once you leave the Independent Living part of the campus to go into another part of the campus, you no longer pay monthly fees for Independent Living, but pay the discounted per diem rates for Assisted Living or Skilled Nursing care.
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Re: Continuing Care Retirement Community Entrance Fee

Post by ChrisC »

Gnirk wrote: Sat Sep 05, 2020 6:18 pm My biggest concern is that if one of us should need the next level of care, that we are not guaranteed that level of care, we would just have "priority" if an opening comes up. My good friend's mom lived in our local CCRC, and when she needed skilled nursing care, it wasn't available! The CCRC made no accomodations elswhere for her. Her daughter had to move her out of the CCRC and to a LTC facility close to her, 1200 miles away. And this is a very popular CCRC with a long waiting list to get into independent living.
Unfortunately, there is no way any CCRC could provide an iron-clad gurarantee that it will have a space available for you in the skilled nursing care unit when you need it! The CCRC I'm waitlisted, as other well managed CCRCs, appears to make reasonable assumptions and plans for assisted living and skilled nursing care need and capacity. It is now expanding bed capacity for the assisted living and skilled nursing wings. It also has commited in writing in its disclosure documents and membership agreement, that if an assisted living and skilled nursing bed is not avaiable it will take necessary steps to place you in comparable facility nearby.

You have to check the paperwork on this issue!
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Re: Continuing Care Retirement Community Entrance Fee

Post by visualguy »

Gnirk wrote: Sat Sep 05, 2020 6:18 pm My biggest concern is that if one of us should need the next level of care, that we are not guaranteed that level of care, we would just have "priority" if an opening comes up. My good friend's mom lived in our local CCRC, and when she needed skilled nursing care, it wasn't available! The CCRC made no accomodations elswhere for her. Her daughter had to move her out of the CCRC and to a LTC facility close to her, 1200 miles away. And this is a very popular CCRC with a long waiting list to get into independent living.
The whole concept of a CCRC is confusing to me... If they can't guarantee the next level of care, why even bother with them? Why not approach it as three stages that require solutions in potentially different locations: independent living (not sure why one would want to be in a facility for that), assisted living, and nursing care? Is it really that hard to get into a "good" nursing home, and being in a CCRC before you need nursing care increases your chances significantly?
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ResearchMed
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Re: Continuing Care Retirement Community Entrance Fee

Post by ResearchMed »

visualguy wrote: Sun Sep 06, 2020 2:48 pm
Gnirk wrote: Sat Sep 05, 2020 6:18 pm My biggest concern is that if one of us should need the next level of care, that we are not guaranteed that level of care, we would just have "priority" if an opening comes up. My good friend's mom lived in our local CCRC, and when she needed skilled nursing care, it wasn't available! The CCRC made no accomodations elswhere for her. Her daughter had to move her out of the CCRC and to a LTC facility close to her, 1200 miles away. And this is a very popular CCRC with a long waiting list to get into independent living.
The whole concept of a CCRC is confusing to me... If they can't guarantee the next level of care, why even bother with them? Why not approach it as three stages that require solutions in potentially different locations: independent living (not sure why one would want to be in a facility for that), assisted living, and nursing care? Is it really that hard to get into a "good" nursing home, and being in a CCRC before you need nursing care increases your chances significantly?
This could be a problem, obviously.

I think the larger the overall facility, there more ability there is to adjust.

For example, at what will probably be our future/final home (and we got to know it up close and personal for several years when MIL was there), the Rehab and Skilled Nursing sections are very similar. The Rehab tends to have shorter stay, and will take "outsiders" if there is room. In the Skilled Nursing, the Rehab therapists do their same type of work as prescribed, but the resident doesn't need to leave the section (unless that is part of the Rehab/exercise).
In the Assisted Living section, lots of extra care can be provided, so that it can come close to the next stage (Rehab or SN) unless there is something like oxygen needed full time, etc., more of a real hospital room. (SN is licensed as a hospital.)
Given that there are quite a few apartments/rooms available in each section, that should help with juggling around, especially with the use of the Rehab rooms, given the frequent turnover or even empty rooms between patients.
The palliative care physician and other specialists can go anywhere if needed. The mobile x-ray can go anywhere, and obviously more mundane medical care as well.

For those in Independent Living, there isn't usually an emergency to get into an ALF apartment, but I'm not sure how they would handle it if that were absolutely necessary... and with extra help in the apartment, which is a separate section but on the same interconnected campus, an awful lot of the same "Assistance" could be arranged prior to a physical move.

But these are all important issues, and we have more items on our "list to discuss" when we next meet with them (after the pandemic, assuming no emergency here).

I will say that watching "from the inside" was very helpful, seeing how transfers to a local hospital was arranged if needed, back to Rehab, then back to ALF apartment. Or extra hours of care arranged as needed, etc. Or transitions from one section to another. We really would not have been able to learn nearly as much, in detail, if we were "just visiting for a look and talk", etc.

This view/knowledge will make it much easier to pay that hefty entry fee.
We'll have a choice of 90% or 50% returned, although we'd prefer to pay even less and have much less or even nothing returned. We haven't yet explored if there is any flexibility.

Has anyone experienced any flexibility like this in the entry deposit arrangements for any CCRC type facilities?

RM
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TN_Boy
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Re: Continuing Care Retirement Community Entrance Fee

Post by TN_Boy »

visualguy wrote: Sun Sep 06, 2020 2:48 pm
Gnirk wrote: Sat Sep 05, 2020 6:18 pm My biggest concern is that if one of us should need the next level of care, that we are not guaranteed that level of care, we would just have "priority" if an opening comes up. My good friend's mom lived in our local CCRC, and when she needed skilled nursing care, it wasn't available! The CCRC made no accomodations elswhere for her. Her daughter had to move her out of the CCRC and to a LTC facility close to her, 1200 miles away. And this is a very popular CCRC with a long waiting list to get into independent living.
The whole concept of a CCRC is confusing to me... If they can't guarantee the next level of care, why even bother with them? Why not approach it as three stages that require solutions in potentially different locations: independent living (not sure why one would want to be in a facility for that), assisted living, and nursing care? Is it really that hard to get into a "good" nursing home, and being in a CCRC before you need nursing care increases your chances significantly?
I'm not a huge fan of CCRCs, but one attraction is that if you start independent, and then need more help, you might be able to stay in the same campus/community (nearby friends, various activities, staff you get to know, etc) without having to move from one facility to another.

As I think about, this could be a huge benefit to the *spouse* of the person needing more help. They can still access all the amenities of the community, while getting extra help for the spouse. And being physically close to the spouse.

I'd agree that it's not possible for the CCRC to *guarantee* you a bed if you need to move to the next level of care. It's not practical to keep huge number of beds available in case there is a mini-wave of people declining at about the same time. Another wrinkle though is that at least one CCRC I looked at (not for me) was spread across two or three small campuses in the same city. Skilled nursing was only available at one site, and I don't think memory care was available at all the sites either. So you might have to move to a different campus, which would mostly be like moving to a stand-alone care facility.

I can answer one question you asked: many people move to "independent living" facilities that can provide modest help -- not at assisted living facility levels, but there are staff around that can check on you, they might have onsite home health for ala carte services, etc. The living quarters themselves are tailored to folks whose days of bounding up stairs are over. And they'll have a dining room, plus various activities obviously tailored to the older crowd. It's not a bad choice for some people.

Getting in a "good facility" at the level you need is a combination of luck and maybe putting money down to be on a wait-list.
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Re: Continuing Care Retirement Community Entrance Fee

Post by RudyS »

TN_Boy wrote: Sun Sep 06, 2020 3:48 pm

I can answer one question you asked: many people move to "independent living" facilities that can provide modest help -- not at assisted living facility levels, but there are staff around that can check on you, they might have onsite home health for ala carte services, etc. The living quarters themselves are tailored to folks whose days of bounding up stairs are over. And they'll have a dining room, plus various activities obviously tailored to the older crowd. It's not a bad choice for some people.

Getting in a "good facility" at the level you need is a combination of luck and maybe putting money down to be on a wait-list.
My thoughts/experiences on "getting in":

DW and I visited several candidate facilities. Put deposits for waiting list on 3. One was refundable, 2 were not. We went with the place that wasn't. When we got to within 6 months of moving in, we submitted a financial statement and a medical summary. The CCRC contacted our doctors. The next step was an in-person assessment of physical issues. Mostly they relied on my doctor's summaries, but we did do the cognitive test. All was OK and we then were approved and soon moved in. The two big questions were whether our finances would support our stay at the CCRC, and were we healthy enough to join. The financial part was important because if we run out of money through no fault of our own, the CCRC will subsidize us. The health issue arises from the CCRC's perspective since there is no increase in cost if/when we need a higher level of service. Therefore, don't wait too long. As someone has said, better 5 years too soon than 5 minutes too late. We moved at ages 78 and 82. Still doing well!
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Re: Continuing Care Retirement Community Entrance Fee

Post by ChrisC »

visualguy wrote: Sun Sep 06, 2020 2:48 pm [quote=Gnirk post_id=5479128 time=<a href="tel:1599347886">1599347886</a> user_id=39799]
My biggest concern is that if one of us should need the next level of care, that we are not guaranteed that level of care, we would just have "priority" if an opening comes up. My good friend's mom lived in our local CCRC, and when she needed skilled nursing care, it wasn't available! The CCRC made no accomodations elswhere for her. Her daughter had to move her out of the CCRC and to a LTC facility close to her, 1200 miles away. And this is a very popular CCRC with a long waiting list to get into independent living.
The whole concept of a CCRC is confusing to me... If they can't guarantee the next level of care, why even bother with them? Why not approach it as three stages that require solutions in potentially different locations: independent living (not sure why one would want to be in a facility for that), assisted living, and nursing care? Is it really that hard to get into a "good" nursing home, and being in a CCRC before you need nursing care increases your chances significantly?
[/quote]

Perhaps it’s confusing because there’s a misapprehension of some of the benefits of CCRCs especially for couples. For many, high end CCRCs are like resorts or country clubs for those who initially can take advantage of their amenities. So, the independent living aspect of a CCRC is no different than living at a high end, age restricted community with all home maintenance and most food preparation needs taken care of by the CCRC. Moreover, many CCRCs monitor your safety and wellness and home heath care is typically available for those in need of rehabilitation or assisted living.

One of the key features of a CCRC is that if your health care deteriorates and you need LTC there is a special wing available for those for assisted living or skilled nursing care — in many cases, this is a small, but significant population of a CCRC — a concern raised by those who wonder whether a bed in this wing will be available if they need it. For instance, one CCRC in our area is now revamping its campus to replace its skilled nursing facility to accommodate burgeoning future demands. My waitlisted CCRC has a residential population of 440 but only 60 beds in the assisted living or skilled nursing facility are used. It plans on expanding occupancy capacity for this wing of the campus.

There are incalculable benefits to having all long term care and services available on one campus. For a couple, if one winds up in the assisted or skilled nursing care wing, visits by the healthy person can take place daily, avoiding the need to drive distances. This would be very important to me, especially if driving becomes a problem for either of us. I like the idea of having good transportation services, which many CCRCs have on campus, whether for medical appointments, shopping or airport trips. We know how difficult this can be for driving people around which we’ve had to do in the past and continue to do so for someone who we manage all medical appointments.
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Re: Continuing Care Retirement Community Entrance Fee

Post by visualguy »

ChrisC wrote: Sun Sep 06, 2020 4:21 pm For a couple, if one winds up in the assisted or skilled nursing care wing, visits by the healthy person can take place daily, avoiding the need to drive distances. This would be very important to me, especially if driving becomes a problem for either of us. I like the idea of having good transportation services, which many CCRCs have on campus, whether for medical appointments, shopping or airport trips. We know how difficult this can be for driving people around which we’ve had to do in the past and continue to do so for someone who we manage all medical appointments.
Thanks. I realized the benefit for couples in the past, but forgot about that one until a few mentioned it here.

I'm still quite ambivalent about CCRCs, but I understand the benefits a bit better. The aging trajectory really varies a lot from person to person, and it's pretty unpredictable, so I think committing to something like this is hard. It may or may not be a good fit depending on how things evolve over the years for the particular occupants, as well as the CCRC itself.

At least in my family (parents and grandparents), I've experienced the need for a nursing home for some of them, but not so much independent living or assisted-living facilities. A lot of it had to to do with the particular circumstances, health conditions, and personalities which could have been different. It just that you don't really know in advance, which is when you need to make the decision on a CCRC.
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Re: Continuing Care Retirement Community Entrance Fee

Post by ChrisC »

visualguy wrote: Sun Sep 06, 2020 5:35 pm
ChrisC wrote: Sun Sep 06, 2020 4:21 pm For a couple, if one winds up in the assisted or skilled nursing care wing, visits by the healthy person can take place daily, avoiding the need to drive distances. This would be very important to me, especially if driving becomes a problem for either of us. I like the idea of having good transportation services, which many CCRCs have on campus, whether for medical appointments, shopping or airport trips. We know how difficult this can be for driving people around which we’ve had to do in the past and continue to do so for someone who we manage all medical appointments.
Thanks. I realized the benefit for couples in the past, but forgot about that one until a few mentioned it here.

I'm still quite ambivalent about CCRCs, but I understand the benefits a bit better. The aging trajectory really varies a lot from person to person, and it's pretty unpredictable, so I think committing to something like this is hard. It may or may not be a good fit depending on how things evolve over the years for the particular occupants, as well as the CCRC itself.

At least in my family (parents and grandparents), I've experienced the need for a nursing home for some of them, but not so much independent living or assisted-living facilities. A lot of it had to to do with the particular circumstances, health conditions, and personalities which could have been different. It just that you don't really know in advance, which is when you need to make the decision on a CCRC.
I'm not totally committed to a CCRC; I'm waitlisted on one to keep my options open. For now, it's our Plan B; our Plan A is to stay put, and have home health care come to us. We have a great home to age-in-place and even suitable quarters for live-in help, and can easily leverage some of our LTCi benefits for home health care. I really like our current place and neigborhood and we're only 20 minutes away from our oldest child and her family. But I'm really getting tired of home maintenance (even though most of the home maintenance is hired help with the lawn, painting, appliance repairs, etc), and every day when I have to get something fixed, it moves me closer to a CCRC platform. And I have the history of my mother and mother-in-law in skilled nursing care and things there for one of them didn't work out well.
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Re: Continuing Care Retirement Community Entrance Fee

Post by chw »

Present value aside, I would be more concerned about the CCRC’s ability to refund the fee when the time comes. Review the contract closely to determine if the fee could be wiped out/reduced in a bankruptcy.
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Re: Continuing Care Retirement Community Entrance Fee

Post by GmanJeff »

visualguy wrote: Sun Sep 06, 2020 2:48 pm
The whole concept of a CCRC is confusing to me... If they can't guarantee the next level of care, why even bother with them? Why not approach it as three stages that require solutions in potentially different locations: independent living (not sure why one would want to be in a facility for that), assisted living, and nursing care? Is it really that hard to get into a "good" nursing home, and being in a CCRC before you need nursing care increases your chances significantly?
CCRCs attempt to predict demand for Assisted Living/Rehab/Memory Care, but perfect precision in such predictions is not possible. As others have said, one reason to have all levels of care on a single campus is the benefit of being near a spouse who remains in Independent Living, but another reason is that Independent Living residents usually have priority for spaces in the CCRC's higher levels of care over outside applicants when demand exceeds supply. In such cases, many Independent Living residents use in-home aides as an interim support measure while awaiting a vacancy, knowing they will receive priority in a facility on a campus with which they are already familiar, where friends as well as family in Independent Living may easily visit them. Additionally, residents transitioning to higher levels of care are usually already known to the campus medical staff who often provide campus-wide services across all residence types.
visualguy
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Re: Continuing Care Retirement Community Entrance Fee

Post by visualguy »

GmanJeff wrote: Sun Sep 06, 2020 7:19 pm
visualguy wrote: Sun Sep 06, 2020 2:48 pm
The whole concept of a CCRC is confusing to me... If they can't guarantee the next level of care, why even bother with them? Why not approach it as three stages that require solutions in potentially different locations: independent living (not sure why one would want to be in a facility for that), assisted living, and nursing care? Is it really that hard to get into a "good" nursing home, and being in a CCRC before you need nursing care increases your chances significantly?
CCRCs attempt to predict demand for Assisted Living/Rehab/Memory Care, but perfect precision in such predictions is not possible. As others have said, one reason to have all levels of care on a single campus is the benefit of being near a spouse who remains in Independent Living, but another reason is that Independent Living residents usually have priority for spaces in the CCRC's higher levels of care over outside applicants when demand exceeds supply. In such cases, many Independent Living residents use in-home aides as an interim support measure while awaiting a vacancy, knowing they will receive priority in a facility on a campus with which they are already familiar, where friends as well as family in Independent Living may easily visit them. Additionally, residents transitioning to higher levels of care are usually already known to the campus medical staff who often provide campus-wide services across all residence types.
Thanks, there are definitely some good points there. On the other hand, I personally have this aversion to "putting a healthy head in a sick bed". I feel like (at least for me) there would be a psychological impact to being in that environment, and being surrounded by old people with various degrees of medical issues (even those in independent living or ALF), so my inclination would be to avoid it until necessary. Even if, for example, I had to be there (in nursing care), not sure I would want my wife to be in the CCRC if she didn't also need it. I may change my mind as I get older, though :|
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Re: Continuing Care Retirement Community Entrance Fee

Post by thursdaysd »

so my inclination would be to avoid it until necessary
If you want admittance to a good CCRC, you can't wait to apply until you are ready to move. I am waitlisted for a local non-profit CCRC. The wait for a two bedroom unit is ten years, and four years for a one-bedroom. They are in the initial stages of an expansion which should help (I am now looking at a 2023 move in date for the expansion), but we are only at the beginning of the baby boomers deciding to move.
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Re: Continuing Care Retirement Community Entrance Fee

Post by Nowizard »

What do you receive for that fee? Are there ever any additional charges, regardless of whether in independent living, assisted care, dementia or nursing units? Are meals and all other care included? The fee sounds exorbitant compared to our area. The primary issue may be the initial and continuing charges if both refundable and non-refundable are overcharging.

Tim
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Re: Continuing Care Retirement Community Entrance Fee

Post by RudyS »

Nowizard wrote: Mon Sep 07, 2020 11:15 am What do you receive for that fee? Are there ever any additional charges, regardless of whether in independent living, assisted care, dementia or nursing units? Are meals and all other care included? The fee sounds exorbitant compared to our area. The primary issue may be the initial and continuing charges if both refundable and non-refundable are overcharging.

Tim
The answer varies with the CCRC, and with the level of care. All those we investigated had different fee structures. But in general it is safe to say at least one meal per day is included and some level of housekeeping. Even parking arrangements/costs vary. Essential to check with the specific CCRCs of interest to you. Here's an example - we can bring wine to the dinner table, they will hold onto started bottles in the dining room. One place we checked said we couldn't do that, they had a liquor license, we could buy wine at $6 a glass. That was, of course, a for profit place.
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Re: Continuing Care Retirement Community Entrance Fee

Post by Saving$ »

NotWhoYouThink wrote: Mon Aug 31, 2020 11:52 am We noticed that they seemed exceptionally eager to move her into Assisted Living, and realized that if they move someone there it frees up an apartment in Independent Living that they can charge the entry fee for.
This. And the opposite. Some friends bought into a CCRC, and when one of them had a stroke, the healthy spouse kept requesting either some help or move the spouse with the stroke to the nursing wing. They advised it was not bad enough to enter the nursing wing, and they did not provide help outside of the nursing wing. My friends hired private caregivers at their own expense. They also had a neighbor in independent living with no family, and this lady clearly needed more supervision. My friend and everyone on the floor kept reporting it, and the CCRC just used the lady's money to hire outside help.

Then as soon as a former independent living resident in the memory care wing passed away, they decided this neighbor needed to move. Coincidence? 2 months later, when a gentleman from 2 floors down who had been in the nursing area passed away, they suddenly decided my friend with the stroke could move to the nursing wing. It's all about revenue management and what is available, not about what the residents need.
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Re: Continuing Care Retirement Community Entrance Fee

Post by Saving$ »

willthrill81 wrote: Tue Sep 01, 2020 11:58 am
ScubaHogg wrote: Tue Sep 01, 2020 12:10 am
willthrill81 wrote: Mon Aug 31, 2020 11:20 am Our visit was well before COVID19, so it may be very different now. It has certainly shown that many elderly people living in very close proximity to each other carries its own risks.
Conversely, in many places, the only “company” many older citizens are getting these days are the co-residents of facilities like this, since for obvious reasons they have limited interaction with the public at large, so to speak.

Viewed in that light not living in close proximity with some other elderly people carries its own risks. Risks of social isolation in this case.
Yes, there aren't easy answers to the problem. Being separated from their family members is undoubtedly a strain on many elderly people, but the camaraderie of fellow residents must be a huge help during times as these.
But even that may be unavailable. A family member in a retirement community (not a CCRC) says the rules of the community are very strict due to Covid. They cannot socialize with anyone else there, they cannot leave without quarantining for 2 weeks upon return, meals are delivered to the apartments, visitors outside only on separate benches 10' apart that have been installed for Covid era visits, etc. Apparently her floor got together and everyone sat in their doorway socially distance 20+ feet and played a card game. They were discouraged from repeating this apparent transgression...she noted that quarantine would not be much different so has mused about going out for a ride to see a family member, socially distanced...
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Re: Continuing Care Retirement Community Entrance Fee

Post by ChrisC »

Nowizard wrote: Mon Sep 07, 2020 11:15 am What do you receive for that fee? Are there ever any additional charges, regardless of whether in independent living, assisted care, dementia or nursing units? Are meals and all other care included? The fee sounds exorbitant compared to our area. The primary issue may be the initial and continuing charges if both refundable and non-refundable are overcharging.

Tim
Entrance fees vary from CCRC to CCRC depending on the business model, so it would be difficult to generalize exactly what you get with that fee. I can tell you that the CCRCs I've investigated all encouraged you to do a side-by-side comparison of their monthly fees and the expenses the fees cover at the CCRC versus payment for your current household expenses (such as utilties, food, home maintenance services, etc). I did that comparison for the CCRC I was most interested. We calculated a 10% difference, with the CCRC monthly fee higher than what we pay for our current expenses. All CCRCs appear to disclose that you can expect their monthly fees to increase annually and they generally show the historical increases.

CCRC monthly fees cover meals and dining but the plans vary from CCRC to CCRC like meal plans would vary from institutional dining services at other places like colleges. For instance, one CCRC in our area provides a monthly stipend for meal services of $450 per month, per person on a use-it-or-lose-it basis. We actually dined at this CCRC and did not like the services there -- it was extremely crowded, with wait-times for seating, and with no opportunity for take-out services (though Covid likely changed that). The food was meh! In the CCRC we're most interested, each person gets 30 monthly meals (no carryover to the next month) for either lunch or dinner; breakfast is free, continental/buffet style; and meals can be ordered and delivered to your unit. We've dined there several times (part of our waitlist benefit); the food was surprisingly good, and menus varied weekly.

But it's difficult to make precise comparisons as some of the CCRC amenities/services included in the monthly fee are items that many would not incur outside of the CCRC -- for instance, a CCRC might have outstanding fitness and pool facilities, which might not mean anything to those who don't currently pay for such facilities. The monthly fees are generally all inclusive for services provided by the CCRC, except that home health care is generally billed separated, in many cases on a per diem basis. For a couple, you generally pay higher monthly fees than single residents. The rules vary for how the CCRC charge a couple when one of them enters the assisted living, dementia or skilled nursing wing of a campus, and it would also depend on the Type of CCRC involved, whether Type A, B, or C. Further, a portion of the monthly fee should be deductible as a pre-paid medical expense for LTC, even if you're in independent living.
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Re: Continuing Care Retirement Community Entrance Fee

Post by crefwatch »

It is not reasonable to expect a nursing home bed to be open and available on the day you need it. My mother (94) lay in a NYC emergency room for over 24 hours with a broken hip before an inpatient bed was found for her. "A health care system with no queuing is a system with excess capacity." You (the consumer) have to pay for excess capacity. Example: Britain and Canada have waiting lists for elective surgery, as well as having vastly lower healthcare costs than we have in the USA.

Many free-standing nursing homes effectively (if not acknowledging it) admit Private Pay patients more readily than they admit Medicaid patients. Get used to it.
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Re: Continuing Care Retirement Community Entrance Fee

Post by willthrill81 »

Saving$ wrote: Mon Sep 07, 2020 1:29 pm
willthrill81 wrote: Tue Sep 01, 2020 11:58 am
ScubaHogg wrote: Tue Sep 01, 2020 12:10 am
willthrill81 wrote: Mon Aug 31, 2020 11:20 am Our visit was well before COVID19, so it may be very different now. It has certainly shown that many elderly people living in very close proximity to each other carries its own risks.
Conversely, in many places, the only “company” many older citizens are getting these days are the co-residents of facilities like this, since for obvious reasons they have limited interaction with the public at large, so to speak.

Viewed in that light not living in close proximity with some other elderly people carries its own risks. Risks of social isolation in this case.
Yes, there aren't easy answers to the problem. Being separated from their family members is undoubtedly a strain on many elderly people, but the camaraderie of fellow residents must be a huge help during times as these.
But even that may be unavailable. A family member in a retirement community (not a CCRC) says the rules of the community are very strict due to Covid. They cannot socialize with anyone else there, they cannot leave without quarantining for 2 weeks upon return, meals are delivered to the apartments, visitors outside only on separate benches 10' apart that have been installed for Covid era visits, etc. Apparently her floor got together and everyone sat in their doorway socially distance 20+ feet and played a card game. They were discouraged from repeating this apparent transgression...she noted that quarantine would not be much different so has mused about going out for a ride to see a family member, socially distanced...
That's quite sad. Again, there aren't easy answers.
“It's a dangerous business, Frodo, going out your door. You step onto the road, and if you don't keep your feet, there's no knowing where you might be swept off to.” J.R.R. Tolkien,The Lord of the Rings
TN_Boy
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Re: Continuing Care Retirement Community Entrance Fee

Post by TN_Boy »

willthrill81 wrote: Mon Sep 07, 2020 3:11 pm
Saving$ wrote: Mon Sep 07, 2020 1:29 pm
willthrill81 wrote: Tue Sep 01, 2020 11:58 am
ScubaHogg wrote: Tue Sep 01, 2020 12:10 am
willthrill81 wrote: Mon Aug 31, 2020 11:20 am Our visit was well before COVID19, so it may be very different now. It has certainly shown that many elderly people living in very close proximity to each other carries its own risks.
Conversely, in many places, the only “company” many older citizens are getting these days are the co-residents of facilities like this, since for obvious reasons they have limited interaction with the public at large, so to speak.

Viewed in that light not living in close proximity with some other elderly people carries its own risks. Risks of social isolation in this case.
Yes, there aren't easy answers to the problem. Being separated from their family members is undoubtedly a strain on many elderly people, but the camaraderie of fellow residents must be a huge help during times as these.
But even that may be unavailable. A family member in a retirement community (not a CCRC) says the rules of the community are very strict due to Covid. They cannot socialize with anyone else there, they cannot leave without quarantining for 2 weeks upon return, meals are delivered to the apartments, visitors outside only on separate benches 10' apart that have been installed for Covid era visits, etc. Apparently her floor got together and everyone sat in their doorway socially distance 20+ feet and played a card game. They were discouraged from repeating this apparent transgression...she noted that quarantine would not be much different so has mused about going out for a ride to see a family member, socially distanced...
That's quite sad. Again, there aren't easy answers.
Yep, as I said before, the covid protocols in place at care facilities have been a disaster for both the residents and family of residents.

Note: I'm NOT saying these restrictions are wrong or unneeded; I'm only commenting on the effect these restrictions have on people.

Where the restrictions are really awful is when you have a person in declining/changing health. And the family ..... literally can't visit that person physically to see how they are doing (sorry, facetime calls and window visits don't solve the problem). You can get in if they start actually dying, but short of that, sorry no visits, no exceptions.

My state has only recently allowed *outside socially distanced visits*. You had no way to see your family member in the facility. And all visits, whether in-person outside or facetime, etc, have to be scheduled. No dropping by to see the resident.

And yes the quarantine requirements ... hospital visit? Yep, two weeks in quarantine after return. This is true of any trip outside the facility.

This problem is certainly not one I was worried about 8 months ago.
Saving$
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Re: Continuing Care Retirement Community Entrance Fee

Post by Saving$ »

Another issue to consider with the CCRC's is nursing care and Medicare compatibility.
I managed the affairs of an elderly relative who was moved from the hospital to a nursing home after a stroke. The relative's Medicare policy was linked to an HMO. The HMO had a list of nursing facilities they worked with, where they had rounding doctors, nurses and social workers. The relative wanted to move to a nicer nursing facility; there happened to be a 2 year old CCRC with very nice facilities that was taking outside private pay patients to fill up empty beds in the CCRC's nursing wing. It was in the right area of town to facilities visits from family and friends and would have been perfect, except..... the Medicare HMO did not have a contract with this facility, so routine medical care would all be out of network. The other option would have been to change this persons Medicare plan to one that included the CCRC's nursing facility. Due to the number of medical complication and the excellent and well coordinated care the relative was receiving from the HMO team, nobody in the family was willing to take on identifying, transferring and arranging for an entire new medical team, that without the HMO's managed care model, would probably not be as good. Thus we did not move the relative to the CCRC's nursing facility.

But what if you moved to a CCRC, and have a team of medical providers through your Medicare plan. Then 10 years down the road, when you need to move to the CCRC's skilled nursing wing you find out the CCRC's nursing wing no longer participates in the medical network of your Medicare plan? Now you either have to change medical teams (which can be very daunting if you are ill enough to need skilled nursing) or pay your medical expenses out of network?
TN_Boy
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Re: Continuing Care Retirement Community Entrance Fee

Post by TN_Boy »

Saving$ wrote: Wed Sep 09, 2020 7:59 pm Another issue to consider with the CCRC's is nursing care and Medicare compatibility.
I managed the affairs of an elderly relative who was moved from the hospital to a nursing home after a stroke. The relative's Medicare policy was linked to an HMO. The HMO had a list of nursing facilities they worked with, where they had rounding doctors, nurses and social workers. The relative wanted to move to a nicer nursing facility; there happened to be a 2 year old CCRC with very nice facilities that was taking outside private pay patients to fill up empty beds in the CCRC's nursing wing. It was in the right area of town to facilities visits from family and friends and would have been perfect, except..... the Medicare HMO did not have a contract with this facility, so routine medical care would all be out of network. The other option would have been to change this persons Medicare plan to one that included the CCRC's nursing facility. Due to the number of medical complication and the excellent and well coordinated care the relative was receiving from the HMO team, nobody in the family was willing to take on identifying, transferring and arranging for an entire new medical team, that without the HMO's managed care model, would probably not be as good. Thus we did not move the relative to the CCRC's nursing facility.

But what if you moved to a CCRC, and have a team of medical providers through your Medicare plan. Then 10 years down the road, when you need to move to the CCRC's skilled nursing wing you find out the CCRC's nursing wing no longer participates in the medical network of your Medicare plan? Now you either have to change medical teams (which can be very daunting if you are ill enough to need skilled nursing) or pay your medical expenses out of network?
How common is it that a person's "Medicare policy was linked to an HMO?" If someone had (what I think is) a more typical arrangement of Medicare plus perhaps supplemental insurance, would there have been any issues with the CCRC?

Also, of course, in your example, someone might move to a skilled nursing facility, and after the move the facility might stop participating in the "medical network of your Medicare plan."

I guess I'm mostly asking about the precondition here -- that medicare is linked to an HMO, a setup I'm unfamilar with.

My experience is mostly (for someone else) with Medicare and a good supplemental plan, and those two are paying for hospital bills across multiple hospitals, for rehab facilities, for various non-hospital doctors .... I've been shocked at how little out of pocket expense there have been.

To be clear, I'm not doubting your post, I'm looking for a better understanding of this particular type of Medicare plan.
stan1
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Re: Continuing Care Retirement Community Entrance Fee

Post by stan1 »

TN_Boy wrote: Sun Sep 06, 2020 3:48 pm Getting in a "good facility" at the level you need is a combination of luck and maybe putting money down to be on a wait-list.
In our experience family members who had the means to pay for private pay care got into very good facilities. Source of funds could be a pension, LTCI, home equity, rental real estate, or investments. Once wealth was disclosed the Red Sea parted and relatives were welcomed in with open arms.

I can only speak to our experiences not that of others, but we've seen it in four different states with six different patients where it is the case. Whether for profit or run by charity these places prefer residents who can pay their bills for the rest of their lives over patients who can't.

In our experience waiting lists disappear once the facility realizes the incoming resident has $1M plus in assets. One facility paid to relocate a recent widow out of a 2 bedroom apartment to create a vacancy for inlaws who wanted 2 bedrooms. We were told there was a very long waiting list for 2 bedroom units at all the facilities in their city. Once we got to the point where asset levels were disclosed and a decision was eminent due to declining health a so called scarce two bedroom unit for immediate move in was suddenly found at three different facilities. In another facility ground floor two bedroom units "never came open"; once a move in date was set by some miracle there were two to choose from and both had been recently renovated. These were all well managed and comfortable facilities not luxury accomodations. Scarcity is part of sales and marketing. In one which supposedly had only one unit come open a month upon moving in we realized they had 5-10 units open almost all the time.

Also, for those who are looking at Riderwood in Maryland and/or Falcon's Landing in No VA and maybe 1 or 2 others in DC metro area they may be close to a unicorn and not representative even of CCRCs in other places. There is a huge community of retired government employees and military in the DC metro area who can afford to live there in large part due to six figure inflation indexed pensions and highly escalated property values.
fourwheelcycle
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Re: Continuing Care Retirement Community Entrance Fee

Post by fourwheelcycle »

Saving$ wrote: Wed Sep 09, 2020 7:59 pm .....what if you moved to a CCRC, and have a team of medical providers through your Medicare plan. Then 10 years down the road, when you need to move to the CCRC's skilled nursing wing you find out the CCRC's nursing wing no longer participates in the medical network of your Medicare plan? Now you either have to change medical teams (which can be very daunting if you are ill enough to need skilled nursing) or pay your medical expenses out of network?
I can only speak for the local Type A contract CCRC in our community, where my wife and I are on there waiting list. The admission agreement (residency agreement) requires you to pay your (big) one-time entrance fee and also pay a monthly fee (which rises a few percentage points each year as the CCRC's operating costs increase). You also have to let them review your finances to show you can afford to pay your monthly fee at least for your actuarial lifetime, and you have to maintain a Medicare supplemental insurance plan (like Plan G, not an HMO Advantage plan) for your lifetime. The CCRC pays for your Plan D insurance (it's not free; they build it Into their monthly fees).

Having paid the fees and agreed to maintain Medicare supplemental insurance, the CCRC pledges to take care of 100% of your health care for the rest of your life - primary care, specialty care, surgical care, cancer care, dementia care, assisted living, nursing home care, and skilled rehab care after a stroke or a total hip or total knee operation. You never see another health care bill, ever. The bills come to the CCRC and the CRC pays any balances owed. If your spouse continues to live in your independent living apartment while you move to memory care, assisted living, nursing, or skilled nursing/rehab care, your monthly fee does not increase. If you move to memory care and six months later your spouse moves to assisted living or the nursing care unit, your monthly fee still does not go up. You and your spouse continue to pay the same monthly fee you began to pay when you first moved in, with small annual percentage increases, for the rest of you life, no matter what level of care you each require.

You will never have to worry about in-network or out-of-network billing issues again - ever.
Whakamole
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Re: Continuing Care Retirement Community Entrance Fee

Post by Whakamole »

TN_Boy wrote: Mon Sep 07, 2020 6:29 pm
Yep, as I said before, the covid protocols in place at care facilities have been a disaster for both the residents and family of residents.

Note: I'm NOT saying these restrictions are wrong or unneeded; I'm only commenting on the effect these restrictions have on people.

Where the restrictions are really awful is when you have a person in declining/changing health. And the family ..... literally can't visit that person physically to see how they are doing (sorry, facetime calls and window visits don't solve the problem). You can get in if they start actually dying, but short of that, sorry no visits, no exceptions.

My state has only recently allowed *outside socially distanced visits*. You had no way to see your family member in the facility. And all visits, whether in-person outside or facetime, etc, have to be scheduled. No dropping by to see the resident.

And yes the quarantine requirements ... hospital visit? Yep, two weeks in quarantine after return. This is true of any trip outside the facility.

This problem is certainly not one I was worried about 8 months ago.
Something similar happened to a relative of mine. Everything was great before; now they have been socially isolated; and while that may be good to prevent COVID transmission, it's been terrible for their mental health and (from what it sounds) their cognitive health as well.

My parent, who was thinking about a CCRC, is no longer as enthusiastic, and I do not blame her.
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thursdaysd
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Re: Continuing Care Retirement Community Entrance Fee

Post by thursdaysd »

I am over 70 and immuno-compromised and live alone. I am being very careful and only "meeting" people by phone/internet. You think "socially isolated" only happens in CCRCs? I think I would be better off if I had already moved to one.
Thursday's child has far to go
GmanJeff
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Re: Continuing Care Retirement Community Entrance Fee

Post by GmanJeff »

thursdaysd wrote: Thu Sep 10, 2020 9:37 am I am over 70 and immuno-compromised and live alone. I am being very careful and only "meeting" people by phone/internet. You think "socially isolated" only happens in CCRCs? I think I would be better off if I had already moved to one.
This is a rational response. CCRCs which locked down their campuses are protecting their residents as much as is practically possible. Isolation is undesirable, but infection is even more so.
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