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Continuing Care for Seniors 

As you age, you may find it difficult to continue living on your own but may not need skilled nursing care. You may be able to take care of your daily needs, but find yard work, house work, and preparing three meals every day is becoming too much. 

This is when the concept of continuing care may be worth considering. 

Continuing care retirement communities provide different levels of assistance from on-site cottages where residents live independently but get meals in a dining area, to assisted living quarters, to skilled nursing care.

Here are some questions to ask if you are thinking about continuing care:

What types of living options are offered, and can I (and my partner) stay here as we need more intensive care?
Continuing Care Retirement Communities (CCRCs) cover a vast array of housing arrangements from low-cost efficiency apartments to luxury condominiums and single family houses. There are a couple of “age at home” communities in Pennsylvania, but most communities include housing owned by the Continuing Care Provider on centralized grounds referred to as a campus.

Often, the community has a minimum age requirement, such as 55 or 60 years old. These communities may allow a younger member to enter as a part of a couple as long as one partner meets the community’s age requirement. Specific entrance policies are set by each provider; however they must disclose information that would impact a potential resident’s decision.   

Continuing care communities frequently are part of a skilled nursing facility, an assisted living facility, or personal care home. Usually these facilities give priority admittance to the CCRC residents when more intensive care is required.  However, CCRCs are not always associated with facilities which provide advanced medical care. In some communities, continuing care may be limited to housing, meals, housekeeping and maintenance, security, and a variety of other services.

Prospective residents must consider a number of factors in choosing among communities including the type of living arrangements available and the specific services that a prospective resident would require or expect. 

What are the upfront fees?  Must I sign over my assets to live here?
A resident is not required to sign over his/her assets and should not sign over his/her assets.

Continuing Care Retirement Communities require a set one-time entrance fee as well as monthly or periodic fees. The entrance fees can range from several thousand dollars to one million dollars.  The amount of the entrance fee is indicative of the type of living facility and services provided.    

Those facilities that charge a lower entrance fee of a few thousand dollars are likely to be a small room located within a skilled nursing facility or personal care home.  A resident may be the only CCRC resident in such communities. These communities offer convenient transition to higher level care.

Those facilities that charge a higher entrance fee are likely to focus significant resources on the continuing care community. These communities generally include a variety of living arrangements such cottages, luxury condominiums, or apartment suites. These are generally larger communities which may include up to several hundred continuing care residents. These communities also may include higher end services including access to pools and fitness centers.  These CCRCs offer seniors a true community of similarly-aged individuals with similar interests.  The services provided generally remove many of the responsibilities associated with home ownership, such as meal preparation, housekeeping and maintenance, utility and tax expenses.

The one-time entrance fee charged to a resident cannot be increased. The amount of the fees may vary depending on certain refund plans and the type of unit selected. The entrance fee must be at least equal to, or more than, one year of monthly fees. Usually the entrance fee is earned by the provider over a number of years (typically five years). The unearned portion of the entrance fee is refunded to a resident who dies or leaves the community.  

What are the monthly costs, and what do these costs cover?
In addition to a one-time entrance fee, CCRCs charge a monthly fee, often referred to as a monthly maintenance fee. These fees can range from a few hundred dollars to several thousand dollars. This fee can be increased from time to time, but the provider must disclose a schedule of previous increases over the last five years.

The monthly fee goes to pay for such things as meals, housekeeping, grounds maintenance, security and a variety of other services which are detailed in the disclosure statement.

Will any insurance, health or long-term care, cover all or part of these costs?
It could. If your health now allows you to make a claim on your long term care policy, these payments will provide you the additional cash to pay your monthly maintenance fee.  

There are quite a number of factors that a person must consider in selecting a continuing care community, such as size and nature of the community, its proximity to friends and family, the cost, as well as a number of other highly personal factors. Much of the information needed to select a community can be found in the annual disclosure statement and by visiting a facility. While the disclosure statement covers the community in general, the resident agreement is a specific contract between each resident and the provider. It is extremely important that each resident understand the terms of the resident agreement and their rights and responsibilities under the agreement.

Show me the money statement!  Every continuing care retirement community in Pennsylvania must give a disclosure statement to current and prospective residents providing information about the financial status of the facility. Read this carefully, and if you have a trusted family member, friend, or financial adviser, get them to read it too. Also ask for the resident’s agreement and read it carefully. This spells out what the facility will provide and what your rights and responsibilities are.

For more information, read our Continuing Care RetirementCommunity Guide or find a community in your area.