HELP: Mom's CCRC is changing the contract!!

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bh3fpinv
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HELP: Mom's CCRC is changing the contract!!

Post by bh3fpinv »

Hello,

I'm hoping some of the intelligent, experienced people can provide some guidance regarding a situation my elderly Mother if facing.

Approximately 6 years ago my Mother bought into a CCRC in Indiana with independent & assisted living as well as a skilled nursing facility. Fortunately, she has continued to reside in the independent living portion of the facility. A few days ago the facility informed the residents that due to the pandemic, difficult staffing issues, and costs/inflation that the skilled nursing facility is going to be closed. Residents in the skilled nursing facility are going to be placed elsewhere and the CCRC is going to contract with another similar type facility in the area to provide nursing home care for residents if needed in the future.

In a few days they facility leadership is meeting one on one with residents to sign an amended contract. Unfortunately, I cannot be at the meeting as I just learned of this and I am out of the country. I've asked my Mother not to sign anything until we can review it together.

I think that this maybe a breach of contract, however, as would be expected the contract contains a clause stating that the contract can be changed and scope of care can be reduced with "reasonable cause."

I am not looking for legal advise as we will most likely be contacting an attorney before signing any agreements, however, what I am looking for is some help deciding what questions to ask. The only questions that immediately comes to mind are "Will her monthly fee be reduced?" or "Will the percentage of her guaranteed refund be increase since services are being reduced?" and "What is the likelihood that other services are going to be reduced?"

What other issues should we be considering? Thanks for your time and input!

BH3
BarbBrooklyn
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Re: HELP: Mom's CCRC is changing the contract!!

Post by BarbBrooklyn »

You should certainly have the new contract reviwed by an attorney.

Do you hold power of attorney for mom?

In your shoes, I would call the facility and ask them not to present mom with any paperwork until it has been reviewed by both you and the attorney.
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Topic Author
bh3fpinv
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Re: HELP: Mom's CCRC is changing the contract!!

Post by bh3fpinv »

Thanks BarbBrooklyn, Yes, I do have a general power of attorney for her.

BH3
andypanda
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Re: HELP: Mom's CCRC is changing the contract!!

Post by andypanda »

I would email the written request as well as overnight the written request. Or call a local lawyer to hand deliver the request.
Topic Author
bh3fpinv
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Re: HELP: Mom's CCRC is changing the contract!!

Post by bh3fpinv »

Thanks! Much appreciation for the suggestions!

BH3
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celia
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Re: HELP: Mom's CCRC is changing the contract!!

Post by celia »

bh3fpinv wrote: Mon Aug 15, 2022 6:09 am I am not looking for legal advise as we will most likely be contacting an attorney before signing any agreements, however, what I am looking for is some help deciding what questions to ask.
OK, I’ll focus on the questions to ask…
The only questions that immediately comes to mind are "Will her monthly fee be reduced?" or "Will the percentage of her guaranteed refund be increase since services are being reduced?" and "What is the likelihood that other services are going to be reduced?"
Didn’t you notice the reason for the upcoming changes? It sounds to me that inflation and lack of qualified staffing are the reasons some changes need to be made. Good for them for addressing this head-on instead of lowering expected services they won’t be able to provide. And why would you expect her fees to be reduced during these difficult times? But asking about services is reasonable, just like you likely did before she moved in.
Residents in the skilled nursing facility are going to be placed elsewhere and the CCRC is going to contract with another similar type facility in the area to provide nursing home care for residents if needed in the future.
Q1: Will the residents who need nursing care continue to pay this CCRC or will their contract be transferred to the nursing home who will honour it the same as if the residents had initially contracted there?

Q2: What are the difference in cost and services between the existing nursing care and the proposed place? Are both places periodically evaluated by a state inspector (or similar) and what are their current ratings? [Here you probably need to know about state licensing rules and might be able to look up the results yourself. Or social services might have complaints they investigated online.]

Q3: What happens if a resident needs care that either the new or proposed nursing home can’t provide?

Q4: How many times have these contracts been updated in the last 20 years and what were the reasons, other than inflation? [This should have been asked before she moved in. Obviously, no business can continue to provide the same services without raising prices occasionally.]

Q5: Have the services changed at all since your mom moved there? [There most likely have been covid-related services that she never had to pay for, such as staff taking meals to individual rooms when quarantines were going on. With food droppings around the whole facility, rooms were likely fumigated/sprayed frequently to prevent insects/rodents while the residents temporarily lived in a different section. Many places around here also wouldn’t let anyone in or out of the grounds unless they were going to a doctor appointment and resident activities were suspended.]

I had 4 relatives in various types of assisted living over the last 4 years and every facility where we had someone was conscious of doing the best they could for the residents. Some staff and residents came down with covid and then things immediately changed as needed. So please keep this in mind as working in these facilities was harder than before the pandemic started. And the staff is usually not paid what they are worth.

Also double check that your mom is fully vaccinated (per the facility records.)
crefwatch
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Re: HELP: Mom's CCRC is changing the contract!!

Post by crefwatch »

You're right to consult an attorney. I'd note that some "Eldercare Attorneys" specialize in a single area, like (for example) Medicaid Trusts. So consult someone who works regularly with CCRC's, representing only clients, not facilities. It may be relevant to consider whether the CCRC is part of a state-regulated Not for Profit, or if it is part of some huge chain of for-profit facilities.

In my town, the largest employer is a large NFP facility with Assisted Living and Skilled Nursing, but also many other "products", including juvenile mental health and so on. They recently started to acquire (!) Independent Living facilities in other towns because .... (opinion) "that's where the money is" right now. Usage is non-denominational, but it is a faith-based organization.
niagara_guy
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Re: HELP: Mom's CCRC is changing the contract!!

Post by niagara_guy »

I am not an attorney. Your mom already has a contract, so no need on her part to sign a new contract, right? I would read the current contract she has and the proposed contract from the CCRC, then I would probably discuss with an attorney.

Don't forget you can always try to negotiate a better deal with the CCRC for signing a new contract, and you can walk away (keep your current contract) if you don't like the deal.
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galawdawg
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Re: HELP: Mom's CCRC is changing the contract!!

Post by galawdawg »

bh3fpinv wrote: Mon Aug 15, 2022 6:09 am I think that this maybe a breach of contract, however, as would be expected the contract contains a clause stating that the contract can be changed and scope of care can be reduced with "reasonable cause."
Have you actually read the contract? If not, that should be your first step. If you have read it but are uncertain whether the announced actions by the CCRC constitute a breach, then a consultation with an attorney should be the next step.

You and/or your mother should fully understand the rights and obligations of each party as set forth in the contract before any meeting or communication with the CCRC about the announced changes.
ScubaHogg
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Re: HELP: Mom's CCRC is changing the contract!!

Post by ScubaHogg »

celia wrote: Mon Aug 15, 2022 9:52 pm
And why would you expect her fees to be reduced during these difficult times?
Because the monthly fee in a CCRC often covers all levels of care. At a min the fee ensures all levels of care are provided in one location. By unilaterally eliminating one of the major levels of care the CCRC is lowering the services provided.
“Conventional Treasury rates are risk free only in the sense that they guarantee nominal principal. But their real rate of return is uncertain until after the fact.” -Risk Less and Prosper
earlyout
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Re: HELP: Mom's CCRC is changing the contract!!

Post by earlyout »

Are you assuming the CCRC will not pay the fees for the residents that are transferred to the off-site SNF? If instead, the CCRC pays for the SNF, there is no reason the CCRC should reduce their monthly fees with this change.
ScubaHogg
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Re: HELP: Mom's CCRC is changing the contract!!

Post by ScubaHogg »

earlyout wrote: Tue Aug 16, 2022 9:56 am Are you assuming the CCRC will not pay the fees for the residents that are transferred to the off-site SNF? If instead, the CCRC pays for the SNF, there is no reason the CCRC should reduce their monthly fees with this change.
I disagree strongly. For an elderly person, perhaps having dementia, having to move physical locations is not just a small inconvenience. It’s disorienting. They will no longer have access to any friends they have or spaces they are familiar and comfortable with. On top of that, generally SNFs in CCRCs are a full step above what can even be found outside of a CCRC.

This is not a small change. I’m with the OP that this is a major change in the “product” the CCRC is providing.
“Conventional Treasury rates are risk free only in the sense that they guarantee nominal principal. But their real rate of return is uncertain until after the fact.” -Risk Less and Prosper
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Watty
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Re: HELP: Mom's CCRC is changing the contract!!

Post by Watty »

It would also be good to have someone review the finances of the CCRC.

Changing the details of the care is one thing which is good to be concerned about but I would be more concerned that they may be in financial trouble and may need to declare bankruptcy which would be an order of magnitude worse.

I don't know much about CCRC but if she has an entrance fee that is partially refundable then the new agreement could also change that.
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celia
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Re: HELP: Mom's CCRC is changing the contract!!

Post by celia »

ScubaHogg wrote: Tue Aug 16, 2022 9:35 am
celia wrote: Mon Aug 15, 2022 9:52 pm And why would you expect her fees to be reduced during these difficult times?
Because the monthly fee in a CCRC often covers all levels of care. At a min the fee ensures all levels of care are provided in one location. By unilaterally eliminating one of the major levels of care the CCRC is lowering the services provided.
I’m saying some services had to change due to covid as mandated by the state/county. More health-centric services were added, while some activities were reduced. Things like doing crafts, singing, or playing bingo indoors has likely been suspended. The OP needs to find out how the services changed, then apply an inflation factor to the costs.

The CCRC didn’t have a choice in most of the changes. Now that things are easing up covid-wise, they need to bring their contracts up to date.

I knew of some independent Adult Day Care programs before covid and they had to be shut down during covid. None of the ones I knew about have re-opened. Likely reasons are that they were held in small facilities where social distancing cannot be accommodated. It also can’t be enforced on the small vans that picked up the disabled or elderly at their homes.

Expecting that nothing should have changed is not realistic.

OP, Did you attempt to visit your mom during covid so you could see first-hand what was changing? Or do you live too far away?


There is also a difference in “basic services” that applies to everyone like landscaping, security, transportation, as opposed to the additional “level of care” services each individual requires/ chooses (like housing unit). We don’t know if everything was spelled out in one contract or if there were separate contracts for the levels of care.
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Re: HELP: Mom's CCRC is changing the contract!!

Post by ScubaHogg »

celia wrote: Tue Aug 16, 2022 10:45 am
ScubaHogg wrote: Tue Aug 16, 2022 9:35 am
celia wrote: Mon Aug 15, 2022 9:52 pm And why would you expect her fees to be reduced during these difficult times?
Because the monthly fee in a CCRC often covers all levels of care. At a min the fee ensures all levels of care are provided in one location. By unilaterally eliminating one of the major levels of care the CCRC is lowering the services provided.
I’m saying some services had to change due to covid as mandated by the state/county. More health-centric services were added, while some activities were reduced. Things like doing crafts, singing, or playing bingo indoors has likely been suspended. The OP needs to find out how the services changed, then apply an inflation factor to the costs.

The CCRC didn’t have a choice in most of the changes. Now that things are easing up covid-wise, they need to bring their contracts up to date.
I don’t know how you could possible know that but it’s besides the point that moving an elderly person from me location to another location isn’t a small, trivial change.

I seriously doubt though the local state/county told the CCRC they couldn’t provide SNF services anymore though
“Conventional Treasury rates are risk free only in the sense that they guarantee nominal principal. But their real rate of return is uncertain until after the fact.” -Risk Less and Prosper
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bh3fpinv
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Re: HELP: Mom's CCRC is changing the contract!!

Post by bh3fpinv »

I really appreciate this group and all the helpful information that it has provided to my spouse and I over the years! When I first heard of this change one of my first thoughts was to post about it here....and I'm glad that I did. You all have gave me much to think about! Rather than respond to the many helpful posts I will just say THANK YOU and let you know that I very much appreciate your thoughtful input!! :happy :happy :happy
OP, Did you attempt to visit your mom during covid so you could see first-hand what was changing? Or do you live too far away?
I do live far away, but I visited her frequently over the last year due to an ongoing health problem that is now resolved. The CCRC "seemed" unchanged to me. There were some differences such as the dining room was closed for a long period. My Mom picked up her meals in the dining room and I suppose some were delivered to those who my have difficulty picking things up. Otherwise, I didn't see any changes. I didn't hear much from Mom either about negative changes. My cousin, who lives close by and sees her frequently didn't seem to notice any significant changes in level of care either.

Anyway, You all have give me some helpful guidance and I really appreciate your assistance!

BH3
WillRetire
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Re: HELP: Mom's CCRC is changing the contract!!

Post by WillRetire »

ScubaHogg wrote: Tue Aug 16, 2022 9:35 am
celia wrote: Mon Aug 15, 2022 9:52 pm
And why would you expect her fees to be reduced during these difficult times?
Because the monthly fee in a CCRC often covers all levels of care. At a min the fee ensures all levels of care are provided in one location. By unilaterally eliminating one of the major levels of care the CCRC is lowering the services provided.
It depends on the contract. There might be different plans. Some plans/contracts don't increase the monthly fee when resident moves to higher level of care; others do.

Also, most contracts I've seen have a clause that states something to the effect that the resident may be moved to a different site if the current site cannot accommodate their needs.

OP needs to read the original contract, and follow advice to prevent mother from signing anything new until it can be reviewed.
Katietsu
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Re: HELP: Mom's CCRC is changing the contract!!

Post by Katietsu »

I would feel much more comfortable if you could choose your own SNF and the CCRC would still be required to contribute to costs. In other words, if the CCRC arranges for its residents to be cared for at The Orchards SNF for $150 a day, I would want to receive $150 a day should I instead decide to live at The Meadows SNF. This seems like one possible compromise if you have any negotiating power.
Mr. Rumples
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Re: HELP: Mom's CCRC is changing the contract!!

Post by Mr. Rumples »

Check to see if the state has an ombudsman; this might fall under social services/adult protective services also. Here is an example:

https://theconsumervoice.org/uploads/fi ... -sheet.pdf

https://www.dss.virginia.gov/files/divi ... n_plan.pdf
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Re: HELP: Mom's CCRC is changing the contract!!

Post by ChrisC »

bh3fpinv wrote: Mon Aug 15, 2022 6:09 am

A few days ago the facility informed the residents that due to the pandemic, difficult staffing issues, and costs/inflation that the skilled nursing facility is going to be closed. Residents in the skilled nursing facility are going to be placed elsewhere and the CCRC is going to contract with another similar type facility in the area to provide nursing home care for residents if needed in the future.

BH3
This sounds ominous and it may foreshadow fuure draconian moves by the CCRC. I would be inclined to start casting my net to other CCRCs, especially if capable of moving there.

Even if residents envisioned staying on one campus for skilled nursing care, there's probably an escape clause in the contracts with the CCRC for the CCRC to do what they're now doing in eliminating on the on-campus skilled nursing facility and transferring current residents there to other facilities. There also might be a licensure or regulatory reason for them to do what they are doing: essentially closing all operations there. Staffing is a major problem wth almost all care facilities and those struggling might be on a downward financial spiral.

If a CCRC does not have enough staff to handle its skilled nursing facility, especially if it's a Medicare or Medicaid approved facility, then closure might be the only option. I have no idea what the contracts with this CCRC say about removing skilled nursing care on campus as a benefit to residents who bought into this CCRC. For the OP, 6 years at this CCRC might be the best you will ever get at this place in independent living. I'd seriously consider getting out now!
Californiastate
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Re: HELP: Mom's CCRC is changing the contract!!

Post by Californiastate »

The pandemic has forced closure of many businesses over the last few years. Without reviewing the contract, this doesn't sound unreasonable. The original document would need to paper around potential future issues like a pandemic. Their business would need some relief unless bankruptcy is their only option. Hire an appropriate attorney to review the new document and define the way forward.
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