Return to the Brecht Associates Site Retirement Communities: Understanding Your Options by Nicole Muller Nicole Muller is a consultant with Brecht Associates, Philadelphia, a consulting firm specializing in market feasibility and planning for retirement housing. Philadelphia is home to some of the first retirement communities in the nation, dating back to the mid-1800's. Many were formed by local churches to care for their infirmed and indigent members and resembled small nursing homes or boarding homes. For example, Presbyterian Homes and Services opened its first retirement community in 1872 in southwest Philadelphia and was the first community in the world of its kind within the Presbyterian Church. Then named the Presbyterian Home for Widows and Single Women, this community cared for the needs of primarily elderly women who became widows as a result of the Civil War. Over the years, this community and many others like it underwent significant changes to care for the needs of the elderly. Today, Presbyterian Homes and Services provides services to 2,500 seniors in the greater Philadelphia area including a fully integrated retirement community at this location with affordable housing and a new state-of-the-art health care center on its campus. The early communities, developed more than 100 years ago, paved the way for the wide variety of retirement communities found today. The Philadelphia region now offers hundreds of senior housing options for those with diverse needs and varied incomes. In addition to traditional nursing homes, today,s seniors are able to choose among numerous independent living, continuing care, and assisted living communities which are sponsored by both for-profit and non-profit organizations. Making the decision to move to one of these retirement communities is often a difficult one. Some retirees plan their move early so that they can be free from the worries of security, chores, maintenance and future health care needs while others wait for some type of crisis before realizing the need to move. For those searching for the right solution, the number of choices available today can often become overwhelming. Many do not even know where to begin. The following questions seek to answer some of the most common areas of confusion regarding the search for the right community: What is the difference between continuing care, independent living and assisted living communities? Continuing Care Retirement Communities (CCRCs): Also known as life-care communities, CCRCs offer independent living, assisted living and a nursing center all on one campus. Residents move into independent living within a CCRC when they are healthy and active and enjoy all of the benefits of an independent living community including 24-hour security, emergency response, maintenance-free living and the social activities and amenities within the community. Services typically include meals, housekeeping and transportation. In addition, they have the security of knowing that if and when their health care needs change, assisted living and skilled nursing care are readily available. Independent Living: These communities provide socialization, security and maintenance free living to seniors who are capable of daily living without assistance. Residents live in private apartments, ranging mostly from studios to two-bedrooms, and have access to the community,s common areas and amenities (described in detail later). In addition, independent living communities typically provide 24-hour security with emergency response, numerous social activities, and home and lawn maintenance. Services such as meals, housekeeping and transportation are often available as needed. Independent living can be found in a freestanding community (with no other levels of care), within a CCRC, or along with assisted living or a skilled nursing center. Assisted Living: Assisted living, also known as personal care in Pennsylvania, provides supportive services for older adults who need personal assistance but do not need nursing care on a daily basis. Services typically include three meals daily, housekeeping, transportation, medication reminders and assistance with activities of daily living such as bathing and dressing. These communities are designed to maintain a resident's independence and dignity for as long as possible within their own apartment. Assisted living may coexist with an independent living community and/or a nursing center, can be part of a CCRC or it can be a freestanding or standalone community. For those with Alzheimer,s Disease and related dementia, many assisted living communities provide a specific wing designed to care for these individuals and some communities are exclusively designated for dementia care. CCRC QUESTIONS Do all CCRCs have the same financial plans and health care contracts? No. While by definition, CCRCs provide a full continuum of care from independent living to skilled nursing, there are a variety of financial contracts available in the Philadelphia area. These contracts differ depending on the amount of health care included. Generally there are three types of CCRC contracts: All-inclusive: This type of CCRC provides an unlimited amount of health care services as needed by the resident; there is no limit on the number of days in assisted living or in the health center. Because the all-inclusive contract serves as a form of insurance guaranteeing a resident,s future health care needs, these communities charge a large up-front sum of money known as an entrance fee. In addition, a monthly fee is charged to cover the costs of services in the community such as utilities, meals, housekeeping, security, transportation and maintenance. Monthly fees increase within a community according to the size of the independent living apartment. However, the monthly fee remains the same (except for slight inflation increases) if a move to assisted living or nursing care is eventually needed. Modified: CCRCs with modified contracts provide the same lifetime guarantee and amenities as the all-inclusive CCRC but limit the amount of nursing care provided or health care days included. Once this specified amount of care is received, the resident pays for the health services rendered, usually at a reduced rate. As with the all-inclusive contract, an entrance fee is charged along with a monthly service fee. Fee-for-Service: This type of contract allows residents to pay for only the services they require. The monthly fee is therefore increased according to the level of care required. A fee-for-service CCRC, which charges an entrance fee, will guarantee that a space will be made available in the health center when needed. A CCRC, which does not charge an entrance fee, is known as a rental community. Although every effort is made to meet the health care needs of residents, rental CCRCs cannot guarantee that a health care bed will be available when needed. Both types of fee-for-service communities charge a monthly fee appropriate for the level of health care being received. Which CCRC contract is the most affordable? Each community offers a unique package of services and amenities and therefore comparing prices becomes a challenging task. Monthly fees can vary drastically due to the number of meals provided, frequency of housekeeping and the amount of health care included. Entrance fees can be either completely or partially refundable or non-refundable which makes the comparison even more confusing. In addition, communities with lower entrance fees may have higher monthly fees and vice versa. When considering the various types of contracts, the all-inclusive communities will typically have the highest entrance fees because they are ensuring future health care coverage. However, the all-inclusive contracts also provide unlimited health care at no additional charge. So eventually, this type of community may be the most affordable if a long health care stay becomes necessary. The modified and fee-for-service contracts will generally have lower fees for those in independent living but both types of communities would become much more expensive if long-term health care were required. What amenities are typically found in CCRCs? Some compare CCRCs to living in a resort or in a fine hotel. They offer fine dining rooms with elegantly prepared meals and common spaces to suit just about any interest. Many have wellness and exercise rooms, arts and crafts room, computer labs, greenhouses and outdoor gardening areas, woodworking shops, auditoriums, private dining rooms for special occasions and some even offer swimming pools, movie theaters and bowling alleys. These amenities allow residents to explore new interests as well as maintain existing hobbies. In addition, CCRCs usually have full time activities directors who plan social calendars with a wide variety of outings including everything from local theater trips to international tours. Activities may also include dancing, concerts, lecture series, exercise programs, crafts and festive seasonal events. What is the value of an accredited community? CCRCs may be accredited by the Continuing Care Accreditation Commission, a division of the American Association of Homes and Services for the Aging (AAHSA), which requires that a community meet or exceed specific standards of excellence in the areas of governance and administration, resident life, finance and health care. The accreditation process involves an intensive year-long self study involving management, residents, staff and board members and culminates in a three day investigative study by the commission. CCRCs may also be accredited by the Joint Commission for Accreditation of Health Care Organizations (JCAHO), which evaluates the nursing centers within CCRCs. Both the CCAC and JCAHO accreditations are voluntary but are regarded as a mark of quality. "People are really looking for these stamps of approval which go far beyond the required annual State inspections," noted Elaine Kaiser, director of marketing and admissions at Dunwoody Village, a CCAC and JCAHO accredited community. Do I need a long-term care insurance policy? All-inclusive CCRC contracts replace the need for long-term care insurance because the community assumes the responsibility for future health care. Some policies may work together with CCRCs which offer the fee-for-service or modified health care contracts. If you have an existing policy or are thinking of purchasing one, this is an important question to ask of both the insurance company and the CCRC you are considering. When should I start looking for the right community? CCRCs admit residents when they are in good health and are able to live independently. Many have waiting lists of several years, particularly if a specific apartment is desired. For these reasons, it is best to begin to research the various retirement housing options available long before they are actually needed or desired. "As soon as someone retires, they should develop a retirement plan and determine whether a CCRC is the right choice for them. It is important not to wait until the last minute because at that time a CCRC may no longer be an option," explained Barbara Terinoni, retirement counselor at Wood River Village. After narrowing down your choices, it is wise to get to know the communities personally by visiting often and attending special events. The next step is to place your name on the waiting list so that when the time does come to move, an apartment will be available. ASSISTED LIVING QUESTIONS Do all assisted living communities provide the same amount of personal care services?No. Assisted living communities charge a monthly fee which covers services either on an unlimited or fee-for-service basis. All-inclusive: An all-inclusive monthly fee is the same for all residents regardless of the amount of personal care they specifically need. These monthly fees may appear higher than those within a fee-for-service community because all services are provided as needed with no additional charges. In the long-run as the need for personal care services increases, this type of community may be more affordable because the costs are spread among all residents. In addition, the resident is aware of the set monthly fee without worrying about additional costs for each service. Fee-for-Service: The fee-for-service communities have monthly fees which may appear lower because they charge residents only for the services they need. However, as the need for assistance increases, the costs significantly increase. Fee-for-service or "unbundled pricing" is provided in various ways. Some communities use pricing tiers and categorize residents into appropriate levels of care with set fees. Others charge incrementally for personal care services based on the amount of assistance or time given to a resident. It is important to understand exactly what services are included in the monthly and any additional costs for services which may be incurred. Before comparing the monthly fees of various assisted living communities, be sure to be comparing apples to apples. What services and amenities are provided in an assisted living community? Three meals daily, housekeeping and laundry services, activities, and transportation are typically provided and included in the monthly service fees. Personal care services available include assistance with activities of daily living such as bathing, grooming, dressing, eating, medication monitoring, and cueing or reminder services. Depending on the type of contract, the personal care services may be included in the monthly fee or may be offered for an additional cost. Amenities usually include an attractive dining room, activity spaces, lounges, convenience stores, beauty parlors and wellness clinics. How do the costs of an assisted living community compare to a CCRC?The biggest financial difference is that assisted living communities do not charge an entrance fee. This is possible because assisted living communities are not guaranteeing future nursing care, as is found in the CCRCs. Some assisted living communities charge an application fee or a community fee which may or may not be refundable. These fees generally do not exceed one month,s rent. Price differences between assisted living communities are most often caused by the amount of personal care included in the monthly fee. In addition, some communities charge extra for personal laundry, transportation costs, telephone and cable television. What is respite care? Many assisted living communities offer what is known as respite care. Respite care is designed to care for a senior on a temporary basis by inviting them into the community and caring for their personal care needs. Often, seniors who are discharged from a hospital stay benefit from respite care until they are stable enough to return home. Families who are going on vacation or who simply need a break from the demands of caregiving may also seek respite care for an older family member. Respite care gives families peace of mind in knowing that their loved ones are safe and that their needs are being met. In some cases, it is also a good way to determine whether a particular community and assisted living in general are the best alternative for care. Do I need a long-term care insurance policy? A long-term care policy is not required to move into an assisted living community. However, most policies will cover the costs of assisted living to some extent. Be sure to check your policy and ask the assisted living community in order to understand the amount of services and the length of a stay covered. When should I start looking for the right community? Unlike CCRCs, assisted living communities have significantly shorter waiting lists and therefore are able to accept residents usually within a few weeks or months. Because assisted living communities provide care to those who need supportive services, residents are usually prompted by some type of health care crisis before moving. "If you begin to notice changes in your parents appearance like not being able to groom or dress themselves anymore or find that they can no longer make meals or remember to take their medicines, it is a good idea to look at assisted living," explained Mary Ellen Jones, director of community relations for the Quadrangle, a Marriott CCRC in Haverford, Pennsylvania. If families are familiar with the assisted living concept and the communities nearby, they will be comforted in knowing that they have made the best selection for their loved one if and when the need arises. Whether it is an independent living or assisted living community or a continuing care retirement community, there are a wide variety of housing options to suit the needs of today,s older adults. Accessing your needs and understanding your options are the keys to choosing the right community for yourself or a family member. With the proper research and planning, you will have the time to make the right decision before a crisis occurs and the move to a retirement community will provide happiness and peace of mind for you and your family. Return to the Brecht Associates Site