Continuing care retirement communities: one move, one contract, and what to read twice

What it is

A continuing care retirement community offers, under one contract, an independent apartment or cottage, meals and services, and access to more care as health changes: an adult home or assisted living level, and skilled nursing, either on site or at an affiliated nursing home. New York also licenses a fee-for-service version, where you pay for the higher levels of care as you use them.

Residents are generally 62 or older, must meet the community's health and financial standards, must be able to live independently on move-in day, and must be enrolled in Medicare Part A and Part B with a Medicare supplement policy.

How the money works, in general

There is an entrance fee and a monthly fee. The state's own page says entrance fees begin at roughly $115,000 for a single person and monthly fees begin at roughly $2,100, and both go up with the size of the unit and the contract type. Some contracts refund part of the entrance fee when the resident leaves or dies; some do not. This is a large financial decision, and an elder law attorney or a financial professional who has read the contract is the right person to ask. Cardinal does not give financial or legal advice.

Two kinds of contract

• Life care (Type A): the monthly fee does not go up because you need more care, only for ordinary cost increases. The community carries the risk of your future care.
• Modified (Type B): a set amount of higher-level care is included; after that you pay more. You carry more of the risk in exchange for lower fees.
• Fee-for-service communities charge market rates for assisted living and nursing care when you need them.

Who oversees them

The New York State Department of Health reviews the financial feasibility of a CCRC, and the Department of Financial Services reviews and approves the disclosure statement and residency agreement and does periodic financial reviews with Health. Ask for the most recent disclosure statement; the community is required to have one.

Questions to ask

• Which contract type is this, and exactly what care is included at each level without a change in the monthly fee?
• Is any of the entrance fee refundable, to whom, and when?
• Where is skilled nursing provided? On this campus or at another nursing home, and what are its state inspection results?
• What happens if a resident runs out of money? Many nonprofit CCRCs have a benevolence fund; ask how it works and what the conditions are.
• What is the history of monthly fee increases over the last five years?
• What happens if one spouse needs nursing care and the other does not?
• Who decides when a resident moves to a higher level of care, and can the family take part?
• May we see the audited financial statements and the disclosure statement?

In CarePair

CCRCs appear in Find care with their licensed levels listed. If you are comparing one against an enhanced assisted living residence, a Cardinal advisor can lay the two paths side by side.