Continuing care retirement communities, also known as CCRCs or life plan communities, are a long-term care option for older people who want to stay in the same place through different phases of the aging process. Thus you can enter one when able to live fully independently (no assistance needed) and stay in the same community as one progresses through the need for increasing level of care, from moderate assisted living all the way through memory care and/or full-time nursing care — people with Alzheimer’s and/or those who need assistance getting dressed and bathing. For a couple who need different levels of care CCRCs can be an important way of remaining near one another.
Some people attempt to planfor eventualities by purchasing Long Term Care insurance policies. Those typically kick in to cover a variety of expenses, but only after a waiting period where one needs to be able to cover other expenses for periods of up to the first 60 days, Depending upon the contract, these may have time or dollar limits on the amount of coverage, and for some people it can be hard to continue paying premiums when one’s income is limited to Social Security and pensions and whatever one can draw from other funds,.
There are over 2,000 CCRCs in the US. Perhaps 4 in 5 are in some way non-profit, although there are non-profit facilities which are not very appealing and there are some run by for-profit organizations that are effective and pleasant places to be.
There is a national certification program in which some CCRCs participate, run by the Center for Accreditation of Rehabilitation Facilities (CARF International) and there is a list of CCRCs certfied by them which you can explore here (but many excellent CCRCs choose not to go through the certification process — we started our search using that list).
You can also get assistance in your search through things like A Place for Mom, which does not charge YOU for their services, and is exceedingly helpful if one is searching for a place for immediate assisted living — NOTE most CCRCs require you to be capable of independent living upon entry to the community.
Okay, I have given an overview. I will turn 76 in May, Leaves tured 65 in January, IT was shortoy after her birthday she made clear this was the direction she wanted to go. That is in part because her mother developed cognitive problem and lacked resources and the family had to scramble to care for her. By contrast her father never needed additional levels of care once he entered an excellent CCRC founded originally as a non-profit by faculty from Haverford and other nearby colleges, but which has since been taken over by Sunrise as one of their Monogram Communities (and this is one we have explored).
We considered three areas — Charlottesville VA, because we both have connections in the area, it is close to the Blue Ridge Mountains which my wife loves, there is excellent medical care through UVa, we both would have access to communities for our religious needs (me Quaker her Orthodox Christian), and there is a vibrant intellectual live; the Philadephia area, with many excellent hopsitals and is a center for research for her blood cancer, the religious needs met, both of us having lived in the area, and being near 3 of her 4 siblings (1 in DE and 2 in NJ) and almost all nieces and nephews; and right here around DC, where we have lived since 1982, where she could continue in her current parish where we were married in 1985, she might be able to continue with her medical providers or at least her oncologist, we would be no further away from family than we are now, and perhaps we could move and one or both of us continue to work part or full time for a while (more about this anon).
We have explored more than a dozen possibilities so far, and have already visited 6 and have deposits (largely or completely refundable) at 3 and may visit up to 3 more.
One also needs to know that there are different types of contracts — Type A often called LifeCare, Type B often called Modified LifeCare, and Type C or fee for service. You can read about those here.
Then there are two things to consider. First is Entrance Fee — how much do you have to pay upfront to enter the community, Second is the monthly fee. Sometimes the entrance fee can be the same regardless of type of contract, sometimes it varies. If you are coming in on a Type A, there may be a deduction if you come in with Long Term Care( LTC) insurance. usually only if both of you have such insurance. There also may be similar reductions for LTC on monthly fees.
If you are getting the sense that the nomber of possibilities makes it difficult to compare places, I have not yet even offered all of the possibilities. For example, on entrance fees — there are levels of refundability possible (if you die or leave the community) — this is too complicated to easily summarize. Some sites offer variants of this (which can also be complicated to explain).
Then there is what happens if you need a greater level of care — how much if at all does it add to monthly costs?
What is covered in monthly fees — important for comparisons on cost. Are at least basic cable and internet included or is even that separate? IS there at least an internal to community phone system? How about residence cleaning — every week or every other week? What about bed linens?
Then there are meals. Most places are one meal daily for independent living, but some give a monetary amount to be used per person per month, some let you carry over balances (most do not), some will raise charge for meals for nursing care where it is all your meals.
Most when you move into your residence will consider upgrading things, repainting, etc, at no cost to the new resident, some will charge more for some customization (additional shelving, etc).
Then about deposits — we have seen from $500 to $2500 with perhaps allof that refundable if you do not join the community. This is usually to get on a priority (waiting) list. Many of the more deisrable places have waiting lists for almost all size residences. One we have not yet visited has a 6-8 year waiting list for the size residence we want which given my age is not feasible. Mos have at least a 1 year wait.
Some will let you be on the list for various size residences, others do not specify size, others require a specific type/ Some may let you move into say a smaller residence while waiting for your more desirable one, paying only the entrance fee and monthly fees for that then upgrading when your desired place becomes available. Others will only let you temporarily occupy a place if (a) they cannot prepare your desired residence within 3-=30 days of when you agree to accept, and/or you are having trouble selling your previous residence (although normally in that case they will point you in a direction of a bridge loan against that residence to help cover entrance fees).
Then there are issues of taxes — on income and other items. One place we are considering is in NJ, and there is a separate monthly charge for one’s share of real estate taxes. States handle state income taxes differently. For example, both VA and MDhave progressive tax rates that cap at 5.75% (in VBA at over 17Kof taxable income for a couple) and also tax Social Security income as does the Federal Government. PA and NJ don/t tax Social Security. PA has a flat tax rate of 3.05% or thereabouts. NJ has a variable tax rate, but allows an exclusion of a fair amount of pension income from state taxes. I hope that is helping you understand how complicated this can be.
Depending upon the type of contract, a chunk of both the entry fee and of monthly fees may b e considered deductible as prepaid medical expense. That can make a difference on what one can afford, especially on entrance fee.
Then one has to qualify — both medically and financially. In most cases a simple examination of all relevant medical information is sufficient on the medical We know of one place that may require a medical examination, depending upon the medical history. As far as financial, will one have the resources to cover your entrance fee and still have other resources. Will your income AFTER TAXES cover not only the monthly fees but also all other anticipated monthly expenses? In qualifying you, how much weight will a place give to assets left over after entrance fees to help cover monthly expenses.
Do you keep paying for LTC insurance if on a Type A contract, what does that give you as additional coverage versus the additional cost of doing so? I have been told by some places that 40% or less of their community members who enter independent living ever move to a higher level of care. How does that help you balance the risk of going to a Type C contract for the lower entrance fee and monthly cost but having more assets (including from savings on monthly costs) versus the risk exposure should higher level of care be required later? More about this anon as well.
We are NOT at this point visiting any places with only Type C contracts, even though there is a small possibility that we might go that route (which I will explain), because there are places that are as or more convenient that will offer us a choice of types of contract.
Costs are to a large degree tied to the square footage of residences. with some modifications for things like number of bathrooms and types of rooms/porches and whether or not the space includes garage space. We do not need a garage. We do need either 2 bedrooms or 1 bedroom + den, want at least 1 1/5 baths, and probably need at least 900 sq feet. Depending upon location and age of place and whether or not it is non-profit, we have seen entrance fees on Type A contracts from 217,000 to around 400,000, and monthly fees from 6900 to almost 9,000. And that is without getting into all the other issues that can factor into things cited above.
What we do know is this — I am committed to full-time teaching through next school year, because my wife will not be eligible for full Social Security until July 2023. I am already drawing both Social Security and a pension. The longefr she waits to retire the more my wife would have on pension and Social Security, and the more she will put pre-tax into her Federal Thrift Savings account. Meanwhile, while I continue to work full-time I am able to accumulteat least 1,500/mo more in savings. Given my age, the latest I want to do this is January 2025
We know there would be some marginal tax benefits were we to do this at the beginning of a year — any money we would have to withdraw from Federal Thrift savings would be at a somewhat lower federal rate (we think 2% lower), but that would mean that I would have no income beyond Social Security and Pension for several moths (i receive paychecks for each school year thorugh the end of August).
One more issue for us is that we have three cats. Many places have a 2 pet limit, although so far all but one of the places we are considering would allow us to keep all 3 but not replace one should it pass. The three cats is not negotiable for us, and we will not consider a place where we cannot keep our entire family.
A further complication- — Leaves has been paying for years into a cadillac-level LTC insurance plan, that has no lifetime limit on time or money, and provides a substantial amount of monthly benefits already. Because of my health history I cannot obtain LTC insurance. I just had my annual checkup with my cardiologist (remember — I had a stroke in 2029, followed by surgery to clear out a blocked carotid artery and I have a stent to control an aortic aneurysm) and I am not considered at any greater health risk than a normal 75 year old, in fact I may be in better shape. Her inclination is both to keep her LTC insurance and go to a place with a Type-A contract. We have gotten on the list for a place in Charlottesville where we could have a 2- bed, 2 bath with a den with a big patio or balcony and almost 1100 sq feet which we could well afford without using all the resources other than the Thrift Savings. The issue is that it is 2 hours further from her family than where we currently live. She has agreed that were we to wind up there she would head north to DE and/or NJ to see family at least monthly. But she worries that were I to predecease her and she no longer feels she can drive that she would not see them. That is an issue.
One place in PA that is gorgeous, that we both like, that is near enough to family, will not currently qualify us for a large enough apartment. It is the most expensive of the places at which we have looked. We were by chance given a tour by a long-term resident with whom some 40+ years ago I played on a club soccer team consisting of alumni of Haverford College. We are for now keeping our place on the priority list.
Another in PA in theory has a hard 2-pet limit, although we are waiting to see if they are willing to give us a waiver. That would be acceptable to both of us were the cats able to come with us. We are on the priority list there as well.
Thursday I visited a place in Maryland that would be half an hour closer to her family than where we live now, where I was given a tour and the inside scoop by the widow of someone I knew from Haverford, her husband having had the same blood cancer as does Leaves on the Current. One positive is that it is about 20 minutes from the school at which I teach, I have gotten clearance that if I wanted the year after next I could cut back to 3 or 4 classes (rather than the 5 or six I might teach next school year), Jurretta could easily get to her current church, she might be able to keep working full-time for an extra year, and she might even be able to keep her oncologist. The woman I saw also connected me with someone older than me who is a distinguished journalist who covered the Supreme Court with whom 12 years ago I was in a seminar who is very high on that place. While founded by Episcopalians, it is associated with the Kendal group which is run on Quaker principles ( the too expensive place in PA is also Quaker, as is one in NJ about which i will write now).
The place in NJ is Quaker, only a few miles from where one sister lives, has wonderful grounds and about half of the complex — which includes 2 separate communities — is a nature preserve. It is about a 12 minute walk from the church my wife attends when visiting that sister, one where she is a parg of the community, and whose choir director is someone I have known fro more than 40 years (and with whom I briefly overlapped in graduate school in the mid-70s). We have not yet set a visit but I have had an extensive phone conversation with them, I have indirect connections with the larger community around it (briefly taught at a nearby Quaker school where the top two board members attended, although not when I was there). We are waiting for clarification on the cat issue.
We have come to some agreement. Since my spouse is the one most motivated in this direction, and since well more than half the funds between us are hers rather than mine or point, she gets the final decision on which place, while I have the bulk of the decision on when, given that am more than ten years older.
We are fortunate. We both had decent incomes. We have assets from living for more than 30 years in a house that has greatly appreciated. My wife and her siblings inherited from grandparents.
Neither of us has Medicare Part B, because as a federal employee she has very good family health insurance, more than half of which is paid for by the government and will be even after she retires. In short, we are able to consider options like this.
Alsl, we both having worked for governments have defined benefit pensions, something not available to many younger than us.
In short, we have many options for a comfortable retirement not available to most Americans. That is a subject for some consideration. Part of the reason for that is the severe economic inequity that if anything has gotten worse in recent years, something clearly visible in the obscene increase in the wealth of certain infamous billionaires.
One reason I have not been posting here is the amount of time I have spent exploring this subject. That has included identifying possible sites, setting up visits, visiting, making connections with people who can tell us more details, doing the calculations of what our assets and income would be at various possible points of making the move. I thought sharing some of what I have been learning might be of use to others here. Hence this post.
And at least by posting I remind those who read this that I have not disappeared.