Continuing Care Retirement Communities (CCRCs): A Guide


CCRCs offer a seamless residential continuum, encompassing independent housing, assisted living, and round-the-clock nursing services, all conveniently housed under one roof. Residents make an entry fee payment and an adjustable monthly rent in exchange for the assurance of lifelong care. With a range of on-site medical and social services and facilities, CCRCs allow residents to transition smoothly from independent living to more intensive care as their needs evolve. Nursing care is often available within the CCRC or in close proximity. In addition to healthcare services, CCRCs typically provide meals, housekeeping, maintenance, transportation, social activities, and security.

The Diverse World of CCRCs:

CCRCs come in a variety of shapes and sizes, each with its own unique offerings and personality. From urban high-rises to garden apartments, cottages, cluster homes, or single-family homes, CCRCs cater to diverse preferences. Some CCRCs even provide specialized units designed for individuals with specific medical needs, such as Alzheimer’s disease.

The Lifelong Guarantee:

Unlike assisted living or skilled nursing facilities, CCRCs provide a lifelong place to live. While other care options may ask residents to leave if they cannot provide the required level of care, CCRCs offer the assurance of long-term residency. However, it’s important to note that most CCRCs do not guarantee entry into their skilled nursing facilities. If all nursing units are occupied, the CCRC may arrange for the resident to receive care in another nursing home within the community. This may come as a surprise to many elders who hold the opposite belief.

Considerations and Costs:

One downside of CCRCs is the associated cost, which may exceed the budgets of individuals with low or moderate income and assets. Prices vary based on the level of care provided, the type of contract, and the size and location of the unit. Entry fees can surpass $500,000, accompanied by monthly charges exceeding $3,000. Refund policies differ among CCRCs, with some offering refunds when a unit is sold and others not. It’s crucial to thoroughly review the CCRC’s annual disclosure statement before committing a substantial amount of money or signing any agreements. This ensures confidence in the CCRC’s ability to deliver the promised services for the specified contract duration.

Understanding CCRC Fee Arrangements:

While the entry and monthly fee arrangement is most common, CCRCs may also offer rental or equity arrangements. Rental arrangements involve paying a monthly fee that typically covers housing and designated services, including healthcare. Equity arrangements, on the other hand, involve purchasing a residence similar to a cooperative apartment or condominium. However, the resale of the unit is usually limited to individuals meeting the community’s eligibility criteria. Additional service and healthcare packages may be available for purchase by residents.

CCRC Entry Requirements:

Most CCRCs have specific entry requirements. They typically require residents to be in good health, capable of independent living upon admission, and within certain age limits. Facilities may also mandate Medicare Part A and Part B coverage, as well as potentially Medigap coverage. Some CCRCs even require long-term care coverage to manage fees effectively. Affiliation with a religious, ethnic, or fraternal order may be a requirement for certain CCRCs. Applicants must demonstrate their financial ability to meet the required fees, and waiting lists are common due to high demand.

Funding and Evaluation:

While many CCRC residents finance their care through personal funds, Medicare and sometimes Medicaid can be used to cover specific services. Most CCRCs accept either Medicare or Medicaid, although Medicare generally does not cover long-term nursing care. It’s essential to carefully evaluate CCRCs before making a decision, as this is a significant and lifelong choice. Some communities offer prospective residents the opportunity to experience life at the facility before committing. Reviewing the facility’s background and experience, financial statements, levels of care provided, fees, and services included in regular fees is crucial. Seeking legal or financial counsel before signing any agreements is highly advisable.

Key Questions for CCRC Evaluation:

When evaluating CCRCs, consider asking the following questions:

  1. What is the CCRC’s background and experience?
  2. Can you review the facility’s financial, actuarial, and operating statements?
  3. What levels of care are provided, and are they licensed or certified by the state?
  4. How much is the entrance fee, monthly fee, processing fee, and other fees?
  5. Is a refund available, either in full or in part?
  6. What is the monthly fee, and can it be increased?
  7. What happens if you cannot afford the monthly fees?
  8. Do the fees change based on your level of care needs?
  9. How does a change in marital status affect the fees?
  10. What if spouses require different levels of care?
  11. Which services are included in the regular fees?
  12. What assessments are done to determine your needs, and how is the care plan reviewed?
  13. Is on-site nursing care available, and who covers the cost?
  14. Are nursing services provided outside the nursing unit?
  15. Can you receive Medicare and Medicaid coverage in the facility?
  16. Who makes decisions regarding changes in the level of care?
  17. What are the staffing levels and qualifications of the staff?
  18. Does the facility have a resident council, and how are complaints and disputes handled?
  19. What are the grounds for eviction or contract termination?
  20. What are your rights under the law if you experience an injury, and does the contract release the facility from liability resulting from negligence?

By carefully considering these factors and obtaining complete information, you can make an informed decision when selecting a CCRC that best suits your needs and preferences.

To learn more about estate planning and elder law, visit Estate and Elder Planning by David Wingate at For an Initial Consultation, call (301) 663-9230. We can assist you with powers of attorneys, living wills, wills, trusts, Medicaid planning, and asset protection. With office locations in Frederick, Washington, and Montgomery Counties, Maryland, we are here to provide you with peace of mind.


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