The distinguishing—even defining—feature of a continuing care retirement community (CCRC, or life plan community) is contractually-provided access to a “continuum of care,” which typically includes independent living, assisted living, memory care, and/or skilled nursing care; each of these services is usually offered on-site (although not always). I wrote a blog post about the “continuum of care” concept if you’d like to learn more.
Many CCRC contracts will state that residents of the CCRC have priority access to these various levels of care services if and when needed, which means they will be given preferential access over those who do not live within the community and/or who do not have a continuing care contract. Some CCRC contracts even go so far as to say that these services are “guaranteed” to be provided to residents if needed.
>> Related: A Primer on CCRC Residency Contracts
Care in one place: The appeal of a CCRC
A retirement community that allows residents to live independently for as long as possible, but also will meet its residents’ unique care needs into the future, is an attractive option for many seniors. Residents of CCRCs often speak about the value of the relationships they’ve developed with other residents, easy access to a variety of services and maintenance-free living, the various wellness aspects, and more. Of course, many who choose a CCRC say a big part of the decision is based on the fact that they don’t want to be a burden to their adult children if the future. Some may have experienced for themselves the stress and heartache of caring for an aging loved one and don’t want to put their own family through that. Still others simply like the sense of security that comes with knowing they will have readily available access to whatever care services they may need in the future.
But what happens if there isn’t space available in the CCRC’s healthcare center if and when a resident needs care services?
CCRC healthcare center policies
The CCRC’s healthcare center is the part of the CCRC that traditionally has been referred to as a “nursing home,” although many of these facilities are a far cry from the sterile and institution-like atmosphere of the nursing homes of old. The healthcare center is staffed 24/7 by an array of care providers, such as licensed practical nurses (LPNs), licensed vocational nurses (LVNs), and registered nurses (RNs).
It is a valid concern that I’ve heard from prospective CCRC residents that there won’t be room for them in the healthcare center if and when it is needed, especially if a health issue requiring skilled nursing care arises suddenly. But the reality is that, while this situation can and sometimes does occur, most CCRC providers do a really good job of projecting needs based on their resident population and history. For example, I recently spoke to a representative of Vista Grande Villa in Jackson, Michigan. They seek to maintain at least one female and one male open bed in their healthcare center for their residents. In other words, even though most CCRCs do accept outside residents directly into their healthcare center, especially at time where occupancy in the facility is low, these reserved beds are maintained specifically for CCRC residents. Certainly there may be times when both of these beds are occupied but many nursing home visits are short-term in nature so it is likely that a bed will open up again before too long.
Policies will vary from community to community, but typically in situations where there isn’t space in the healthcare center when needed by a resident, the CCRC should work with the resident and their family to determine if the care needed can safely and adequately be provided in the person’s independent living or assisted living residence until a space comes available within the healthcare center. At Vista Grande Villa, if both of the open beds reserved for residents are already utilized, they provide 24-hour home healthcare services within the patient’s residential unit at no cost until space becomes available in their healthcare center. In fact, this is what the resident typically prefers anyway, if possible.
As a last option, and if a temporary work-around solution for care is not feasible for the patient, most CCRCs will have an agreement in place with another skilled nursing care provider in the area whereby a resident can temporarily receive the needed services off-site until space becomes available, usually without paying any additional cost beyond what they would have paid for care within their own CCRC. Obviously, this is far from ideal since it runs counter to the whole “continuum of care” concept of a CCRC, but it is a stopgap solution when there simply is no other on-site solution.
It’s important to consider that free-standing skilled nursing centers—those that are not located within a CCRCs—often have to turn people away due to having no room available. By contrast, even in a situation where a CCRC does not have the space available, it is helpful to know that the staff is responsible for working out the most appropriate short-term solution; that the burden of this task doesn’t fall purely on the shoulders of the resident and the resident’s family.
Understand contractual guarantees around care
People who opt to move to a CCRC are usually planners who prefer taking a proactive approach in addressing their future housing and care needs. But choosing the CCRC that is right for you is a big decision—both psychologically and financially. One of the things you are paying for with your selected CCRC is the peace of mind of knowing that you will have access to the care services you need, no matter what health concerns might arise.
That’s why, when you are considering various CCRC choices, it is so important to ask questions about their guarantees and policies around access to the community’s healthcare center and what provisions they have in place if a resident requires nursing care but the community doesn’t have space within their own healthcare center. And be sure you understand the specific language on this topic in your CCRC contract before signing.