Continuing Care Retirement Community Entrance Fee

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bberris
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Re: Continuing Care Retirement Community Entrance Fee

Post by bberris »

chw wrote: Sun Sep 06, 2020 7:04 pm 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.
Of course it can. The CCRC gets the funds for the refund when they resell the unit. The buildings are probably mortgaged to the max. You can't get blood from a stone.
Whakamole
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Re: Continuing Care Retirement Community Entrance Fee

Post by Whakamole »

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.
For you, yes, it sounds ideal. My relative has a single bedroom that she can't leave (and I don't think anyone can enter, maybe critical maintenance?), all meals are contact-less. That system will protect against other infectious diseases as well.
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Prudence
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Re: Continuing Care Retirement Community Entrance Fee

Post by Prudence »

chw wrote: Sun Sep 06, 2020 7:04 pm 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.
Agree. Refundable entrance fees are refunded only when the unit is re-occupied by a new resident. Therefore, if a CCRC were to have a significant increase in vacated units for any reason, the residents would likely lose a significant percentage, if not all, of their refundable entrance fees. In the event of a bankruptcy, any available funds would be used to first pay off bondholders. Although we are currently on two CCRC waiting lists, the more I have learned about CCRCs, the more skeptical I have become. Regarding the refundable entrance fee, one must accept that those funds could be gone forever.
Dottie57
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Re: Continuing Care Retirement Community Entrance Fee

Post by Dottie57 »

TN_Boy wrote: Tue Sep 01, 2020 12:53 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.
Not so much. Many communal activities have been eliminated, at least in facilities in my state.

It's been a disaster in all ways for both residents and families of the residents.
+1 I know that in my state communal living became almost a prison where residents had to stay in their residence and meals and mail delivered to them. Not sure about independent living facilities.
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thursdaysd
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Re: Continuing Care Retirement Community Entrance Fee

Post by thursdaysd »

It's been a disaster in all ways for both residents and families of the residents.
For whom has it not been a disaster? As I posted, I am doubly at risk and live alone. I would be delighted if someone else was cooking and delivering my meals, etc. etc.
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Saving$
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Re: Continuing Care Retirement Community Entrance Fee

Post by Saving$ »

TN_Boy wrote: Wed Sep 09, 2020 9:15 pm
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.
Probably a poor choice of words on my part. I think it was a Medicare Advantage Plan associated with an HMO. The relative's entire care network of doctors and specialists was at that HMO. That HMO had a list of 20 or so nursing homes with whom they had agreements. Any other nursing home and the medical care would have been a) out of network and b) not nearly as well coordinated as it was with the HMO (I was actually shocked at how well they coordinated care among specialists without being prompted or badgered at all and how well that seemed to work, especially after dealing with another relative whose care was entirely uncoordinated).
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LilyFleur
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Re: Continuing Care Retirement Community Entrance Fee

Post by LilyFleur »

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).
We had an attorney review the contract. They suggested revising it to state that the refundable entrance fee be paid to the heirs within 6 months of our parent's death. The board of the institution had to approve this change, and they did.
fourwheelcycle
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Re: Continuing Care Retirement Community Entrance Fee

Post by fourwheelcycle »

fourwheelcycle wrote: Mon Aug 31, 2020 3:32 pm Our local CCRC has not had a single case of Covid (fingers crossed), but it has experienced a short term decline in new resident move-ins simply because people do not want to board a cruise ship during a pandemic. My wife and I are still four or more years from making a move, so we have time to watch and assess the finances of our local CCRC before we have to make a decision.
Although Covid is not over, and is actually heating up again just as vaccines are becoming available, I thought it would be interesting to provide an update on our local CCRC. To my surprise, although the CCRC had a few new resident entrance delays at the beginning of the Covid period last spring, as the summer and fall progressed it turned out many new residents chose to pay their entrance fees, at $500K plus, just to hold their units, even though they could not move in because the CCRC was on total lockdown except for essential staff. Overall, the CCRC has done OK on their annual operating budget, even though they have had increased expenses for special Covid equipment and supplies and they have set up and held-open two "Covid" rooms on the nursing unit. So far, they have had zero Covid cases among the residents.

In the local community, many older residents say they are glad they are not locked-down, or locked-up (!), in a retirement community, but most residents of the CCRC say they feel safer than if they were out in the general community. Until last fall my wife and I felt we had the advantage of being able to visit our children and grandchildren, with each family about two hours away. However, by Thanksgiving the risk of visiting over the holidays seemed too great, so we will probably not see each other again except by FaceTime until we (adults) are all vaccinated.
crefwatch
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Re: Continuing Care Retirement Community Entrance Fee

Post by crefwatch »

It was reported close above, that the facility to which the skilled-nursing patient moved to was trying to fill empty beds. I suppose that is possible, although it's more common to hear about bed shortages within a CCRC. AFAIK, most CCRCs will only accept new residents who are Independent. They don't normally accept skilled nursing patients as new residents. I could be wrong.
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ResearchMed
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Re: Continuing Care Retirement Community Entrance Fee

Post by ResearchMed »

Prudence wrote: Thu Sep 10, 2020 10:26 am
chw wrote: Sun Sep 06, 2020 7:04 pm 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.
Agree. Refundable entrance fees are refunded only when the unit is re-occupied by a new resident. Therefore, if a CCRC were to have a significant increase in vacated units for any reason, the residents would likely lose a significant percentage, if not all, of their refundable entrance fees. In the event of a bankruptcy, any available funds would be used to first pay off bondholders. Although we are currently on two CCRC waiting lists, the more I have learned about CCRCs, the more skeptical I have become. Regarding the refundable entrance fee, one must accept that those funds could be gone forever.
Whether the refund depends upon a new resident probably varies by facility. Or perhaps by whether there is a long waiting list (although this could vary over time, whereas the terms of the main contract likely don't change back and forth).

We've only got a $750 non-refundable "deposit" down for the waiting list where we expect to go, and we were quite surprised that was all they wanted to give us a place in the queue. (The queue position can be adjusted from choices like "asap" or "expected in 3-5 years", etc., as well as unit size (or "first available of X size".) We didn't mind the 'non-refundable' nature of this fee, given it was quite a low cost in the scheme of things here.

But this facility isn't a true CCRC, with all care "guaranteed" in the future.

MIL was there until she passed recently, so we had a good chance to get to know the place from the inside, and the more we saw, the more impressed we became (a nice surprise).

They do have a hefty entry free, and a sliding scale for the amount of entry fee and the associated percentage refund. So if you want a higher percentage refunded, you pay more up front. If you want to pay less up front, you get a smaller refund percentage. And the entry fee depends upon the size of the apartment or cottage, etc.
And there is still a relatively high monthly charge, although the extra for a second person in the apartment is low.
This is at the Independent Living phase.

If one enters at ALF (Assisted Living Facility) or Skilled Nursing (SN) stay, it's just a hefty monthly fee, but they do some serious financial vetting, as they have a policy of not kicking anyone out if they run out of money. The intensive vetting makes it almost like a "real" CCRC. It's a bit odd that only the Independent Living section has that hefty semi-non-refundable entry fee.

If we do enter at the Independent stage, and then transition to the ALF section, we'd use the refund to continue the (higher) monthly payments for the more significant level(s) of care.

We got to see how the "if you run out of money" works. MIL was within less than a year of running out of money, and she was already in Skilled Nursing. We had already started filling out the paperwork for Medicaid, but she passed about 5 weeks short of her 100th birthday.
If one is still in ALF as running out of money looms, they try to get them certified for Skilled Nursing, move them there, and then within the year, change them to Medicaid.
[We are really surprised that this facility will switch to Medicaid. It's one of the most expensive in the area, with a waiting list, sometimes very long. It's non-profit, but still... the money has to come from somewhere.]

She didn't have COVID, but the loneliness probably contributed to her demise at that point, since they were on a very strict lockdown. Previously, they had set up a tent (mostly open sides) for visits, and everyone (except the resident depending upon medical condition) had to wear a mask, 6+ feet separation at all a times, with a "chaperone" to enforce that.
DH was in very frequent contact with her and several staff/medical members, and it was clear she was going down hill, and starting to exhibit some "not-optomistic" signs.
He was allowed to visit in person, and she passed the next day. It was as if she had been waiting to see him first...

We'll obviously have the contract reviewed in far more detail when we get closer.
For now, we have postponed any plans to downsize, as this isn't the time to be visiting apartments or condos (with no stairs!), or to have anyone trooping through our house as part of selling.

And we can't really move to the Independent Living section anyway, until DH actually retires (or goes < half time), as the significant money is in a 403b, which is inaccessible until then.

As for COVID, they did have a few cases early on, and a few people did pass away.
For now, at least, there are no cases among residents, although a few staff members are quarantined at their homes. But that's not too much reassurance, given the possiblity of asymptomatic transmission.
We did get a few emails about Independent Living, offering some minimal "specials".
At least it's not a high rise, with the highest level being third floor. So many people could walk up and avoid elevators if they preferred.

It's a huge decisions, and COVID makes even more tricky.

At least, vaccinations begin there next week.

RM
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Kurmudjon
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Re: Continuing Care Retirement Community Entrance Fee

Post by Kurmudjon »

Wow just an excellent write up on things to consider. Thanks!
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Lexx
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Re: Continuing Care Retirement Community Entrance Fee

Post by Lexx »

I totally agree with this! My father had surgery that altered his life at age 70. The next 11 years was a slow and steady decline. Dementia was the worst part of it. The care facilities require you to go on their insurance plan. So if you're not healthy enough they won't take you anyway. We found that out right after my dad got home from his surgery. The good ones are VERY expensive. We found one that I kind of liked where the condos were over a million. However one has to really wonder about the stability of their finances. After my dad passed, my mom moved into an independent living senior care facility. It's very expensive at $5500/mo and she only gets a 1.5 room unit. To tell you the truth, I couldn't live that way. I've told my wife and kids that I want to die at home, not in some care facility where I slowly rot away.

And you're right about the need for lots of family involvement when it comes to finances, medical care, liasing with doctors, etc. It's a burdensome task and no care facility can do all that for you.
TN_Boy wrote: Tue Sep 01, 2020 12:49 pm
The notion that a CCRC substantially reduces the need for family help/monitoring of an aging person strikes me as (sorry but I have to say this) hopelessly naive.

This is based on helping two family members, one of them very extensively, and managing a total of four moves (as people decline). I cannot fathom how a CCRC would substantially change the help needed. And I know other people who have dealt with aging parents and such.

Who manages the finances -- pays the bills, etc. Does the CCRC take over management of bills and investments. Would you really want that??

Who decides what care level is needed -- independent, assisted living, etc. Do you really want a CCRC making those decisions?

Who coordinates medical care? Between GP, various specialists, hospital visits, etc. Do you really think a CCRC can/will do that? I'm not talking transportation to the doctors office. I'm talking understanding the medical problems and coordinating between providers.

Who monitors the care being received at a facility? The CCRC? Wait, the CCRC is PROVIDING the care ..... and it doesn't matter a bit whether we are talking a CCRC or the finest care facility in your state. You want the best care for somebody, you have to be involved. Staffing levels will *always* be an issue. Turnover of staff providing the hands-on care is *always* an issue.

I could go on. While picking the appropriate care facility and making a move happen is painful, it's generally not what takes the most time, since the move occurs over a relatively limited time-frame. What takes the time is completely managing the money, ensuring that whatever care is being provided is high quality, balancing health care decisions (there are many many health care decisions the CCRC cannot and should not be making). And the phone calls .... mom or dad fell ..... mom or is losing weight ...... they have condition X, is surgery the right choice ...... mom or dad was taken to the hospital, will you be meeting them at the ER .......

Where I see a CCRC as appealing is if you move in while independent, make a lot of friends, and as you need more care with physical issues, you can get that help -- possibly by moving to another location within the campus -- and still see your friends. For people who develop dementia, that could be valuable to the spouse -- they still have a support group of friends to lean on. In fact, I could see support of the spouse who doesn't need as much help as a big benefit of a CCRC.

But if, for example, your parents are in a CCRC, and one dies and then the other develops a lot of issues, the survivor needs (ideally) involved family to ensure the right things happen. At that point any notion the CCRC takes much burden off kids is sadly mistaken. Especially when a person develops dementia, well, somebody has to make the decisions for that person and there are a lot of decisions to be made.
RudyS
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Re: Continuing Care Retirement Community Entrance Fee

Post by RudyS »

TN_Boy wrote: Tue Sep 01, 2020 12:49 pm
I think you are right to worry about this "So, this may cancel out the main benefit of the CCRC that they will always take care of you."

I've seen these comments in this thread about CCRCs:

"they either have no children or do not want to impose any burden on their own children to arrange and supervise their care when they become older."

and

"Since we have no children, we are very likely to go directly from our work-life home to such a place. "

and

"Yes, I would prefer aging in place because our house is in an excellent location (since 1980). The issue is to avoid becoming a burden to family in the future."

And frankly, I don't understand what people are thinking when they make these comments. First, I'll be clear I have not worked with CCRCs housing relatives of mine (though I know people who have done this and nothing in their experience contradicts what I am about to say).

The notion that a CCRC substantially reduces the need for family help/monitoring of an aging person strikes me as (sorry but I have to say this) hopelessly naive.

This is based on helping two family members, one of them very extensively, and managing a total of four moves (as people decline). I cannot fathom how a CCRC would substantially change the help needed. And I know other people who have dealt with aging parents and such.

Who manages the finances -- pays the bills, etc. Does the CCRC take over management of bills and investments. Would you really want that??

Who decides what care level is needed -- independent, assisted living, etc. Do you really want a CCRC making those decisions?

Who coordinates medical care? Between GP, various specialists, hospital visits, etc. Do you really think a CCRC can/will do that? I'm not talking transportation to the doctors office. I'm talking understanding the medical problems and coordinating between providers.

Who monitors the care being received at a facility? The CCRC? Wait, the CCRC is PROVIDING the care ..... and it doesn't matter a bit whether we are talking a CCRC or the finest care facility in your state. You want the best care for somebody, you have to be involved. Staffing levels will *always* be an issue. Turnover of staff providing the hands-on care is *always* an issue.

I could go on. While picking the appropriate care facility and making a move happen is painful, it's generally not what takes the most time, since the move occurs over a relatively limited time-frame. What takes the time is completely managing the money, ensuring that whatever care is being provided is high quality, balancing health care decisions (there are many many health care decisions the CCRC cannot and should not be making). And the phone calls .... mom or dad fell ..... mom or is losing weight ...... they have condition X, is surgery the right choice ...... mom or dad was taken to the hospital, will you be meeting them at the ER .......

Where I see a CCRC as appealing is if you move in while independent, make a lot of friends, and as you need more care with physical issues, you can get that help -- possibly by moving to another location within the campus -- and still see your friends. For people who develop dementia, that could be valuable to the spouse -- they still have a support group of friends to lean on. In fact, I could see support of the spouse who doesn't need as much help as a big benefit of a CCRC.

But if, for example, your parents are in a CCRC, and one dies and then the other develops a lot of issues, the survivor needs (ideally) involved family to ensure the right things happen. At that point any notion the CCRC takes much burden off kids is sadly mistaken. Especially when a person develops dementia, well, somebody has to make the decisions for that person and there are a lot of decisions to be made.
Another aspect is geography. While our kids may/will have to get involved in our care at some point, we made the move from our former home in the Midwest to Massachusetts because it will be lots easier for them to be involved when they live 15-20 miles from our CCRC, than 800 miles. Of course we also get to see them more often since we moved here.
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