Moving to a Continuing Care Retirement Community

The Calligraphy CCRC in Napa, CA

"If you wait until you are sick, it will be too late." These were the words one of my daughters said as she stood behind me in the office of the Continuing Care Retirement Community I was visiting near her home.  She and her sisters had been of tremendous help while their father, my husband, was dying the year before, and they were afraid that eventually they would be in charge of taking care of me at the end of my life.  I know how difficult it was for them and I wanted to save them from having to go through that experience again.  

At the same time, my husband and I had been married for over 50 years before he died, and I had never made a major decision without being able to discuss it with him.  I worried that I might be making a bad financial decision, or doing something I would regret.  However, my daughters pointed out that I had been looking at a variety of CCRCs for years, even while my husband was alive.  I had simply never made the commitment to move into one.  As I wrote the check for the deposit, I realized I had finally made the decision.

If you are considering moving into a CCRC, either by yourself or as a couple, here are some things you should consider.

What is a CCRC?

A Continuing Care Retirement Community, or CCRC, is designed to give senior citizens confidence that they will have a home where they will be cared for until the end of their life, whether they become frail, or develop dementia, cancer or any other serious health condition.  Meals and housekeeping are generally provided, as well as a variety of age appropriate activities.  They usually have staff on hand to assist you if you fall or need to be taken to a hospital.  It is NOT the same as a skilled nursing home.  While living in a CCRC, you may go into a nursing home to rehabilitate from a serious health situation, such as heart surgery. However, once you are able, you can return to your own apartment in your CCRC where they will provide follow-up care, such as bringing meals to your apartment and checking to make sure you are OK.

Preparing to Move into a CCRC

How do you get ready to move into a CCRC? First, as my daughter pointed out, you want to make the decision while you are still healthy enough to handle the stress and experience of going through a move.  As my daughter said, if you wait until you are very sick, it will be too hard for you to do everything necessary.

The first thing you will need to do is to downsize the number of possessions you plan to take with you.  In most cases, you will be moving into an apartment or cottage that is much smaller than your current home.  

I did this by giving away and selling most of my furniture, which was too large for my new apartment.  I kept my nightstands and bedroom dresser, but not my king size bed.  I gave my formal dining furniture to a daughter.  I also gave away my large sofa and matching love seat.  In addition, I donated or gave to adult grandchildren nearly all my kitchen supplies.

What did I keep?  I kept the things which meant the most to me.  I kept my clothing, bathroom supplies, books, photo albums, favorite artwork, my digital Aura frame, family photos, and a few favorite antiques and items of furniture that would help me put a personal stamp on my new home.  In addition, I purchased a queen size bed and a couple of lift recliners, which would be helpful after the knee surgery I expect to get in the near future. 

Moving into Your CCRC

Despite the dozens of items, and hundreds of pounds of belongings which I gave away, I was overwhelmed by the number of boxes I had when I moved into my new apartment.  Even though I thought I had given away everything which I did not need, I quickly discovered that I still had more than I needed. At the suggestion of the move-in assistant at my new community, I hired a woman who helped me unpack and find a place for most of my possessions. This kept me from becoming depressed at all I needed to do.

I also made a number of trips to the dumpster after I moved into my new retirement community.  It would have been better to downsize even more before my move.

If I have one recommendation, it is to be brutal about getting rid of things before you move.  You will not need very much in your new home.  For example, I love yoga and brought along three yoga mats. However, I discovered that the community has plenty of nice yoga mats which I could use.  I gave away two, and still kept one of my yoga mats, but certainly did not need to keep all of them.

Adjusting to Life in a CCRC

After I got my possessions unpacked, I realized there would be an adjustment period.  I missed my old friends in the community where I had lived before.  I had trouble remembering the names of the other 150+ residents in my new community.  I was unsure what to do, where to sit at dinner, and which activities to join. In general, I felt insecure, like a new kid at school. This is normal, but still a very uncomfortable feeling.

Fortunately, I soon met another new woman, and we began to eat dinner together and invite other people to join us.  This made it easier to get to know the other residents.  However, we had to initiate meeting other people, although everyone was friendly and kind when we approached them. We decided that the two of us would sit down in the evenings at a table set for six, and then ask other people to sit with us.

I have also found it is helpful to participate in as many activities as possible.  In just the first few weeks of living here, I have gone to art and exercise classes, made a wreath for my door, played Bingo, listened to live music in the main lobby, and joined a trivia game. I also plan to go on some of the excursions which are being organized by the community and will probably join the book club.

Be Patient After You Move

It is important to be patient after you move into a Continuing Care Retirement Community.  It may feel quiet and a little lonely, at first, until you get into the swing of things.  It will take time to meet other people and decide which activities you enjoy. You will be rebuilding your life in a new community, with new people, and it will take time to adjust.  

I have to admit I have had my moments of panic, when I wanted to reverse course and move back to the community where I lived before moving here.  However, I know how much that would hurt and worry my daughters.

Do Not Wait Until You are Frail

Some people wait until they are already frail before they move to a CCRC.  They may be on chemotherapy after a cancer diagnosis, or they could have advanced Parkinson's disease, suffering from Alzheimer's, or experiencing other severe medical problems. 

If you wait until that point, it will be difficult for you to participate in planning your move and deciding what you want to bring with you. It will also be more difficult for you to make friends and become active in the new community. You could end up going directly into a skilled nursing home, rather than choosing a comfortable CCRC.  It is better to move into a CCRC while you feel somewhat healthy and you are able to make new friends and participate in the activities which are offered.

If you follow these suggestions, you are likely to have a very pleasant experience and enjoy your new home.  Remember, you can still stay in touch with your old friends and, if you choose a CCRC near your family, you will be able to see them, too. The loneliness and awkwardness will eventually go away.

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Retirement Housing for Aging Alone - Are You Prepared for the Future?

Millions of Americans are aging alone, often because they are divorced or widowed.  Others may never have married.  Large numbers of them may not have children, or their children may have their own physical, mental or addiction problems which make them unlikely to be of much help.  Although most of us believe we will be able to take care of ourselves for the rest of our lives, this is not always realistic.  What happens if you are diagnosed with a serious illness or dementia?  Everyone needs to understand their options for aging alone, so they are prepared when the time comes and they need extra help.

Reach Out to Others for Help

The first thing you need to realize is that few people really need to be totally alone, unless they are unwilling to reach out for help.  Organizations such as your church or place of worship, the local senior center, and Meals on Wheels have resources to help you, whether you need permanent or temporary assistance, such as after a surgery. 

If you wish to remain in your own home as long as possible, contact the organizations mentioned above, as well as your nearest state Social Services department, and follow their suggestions.  You may qualify for financial assistance, discounts on your utilities, special telephones for the hearing impaired, free or discounted transportation, Meals on Wheels delivered to your home, and handicapped accessible equipment to make it easier for you to live alone.  For many people, these services make it possible for them to remain in their own home much longer than would otherwise have been possible.

It is likely that there are also businesses in your community which will make it easier to stay in your own home as you age.  Find out if you can get your groceries delivered, your cleaning picked-up, and a maid service to clean for you.  Does your local transportation authority have buses or ride share services which will take you to shopping centers or doctors' appointments?  Are you taking advantage of online banking?  All of these conveniences make it easier to live alone, even when you have trouble getting around on your own.

In addition, set up your own circle of friends and relatives who may be in the same situation.  Create a phone circle so you regularly make phone calls and receive calls from others.  In this way, you can help check on them and they can check on you.  This can bring peace of mind in the event you fall or are injured, knowing someone will check on you and, if you do not respond, they will call a neighbor, relative or the police to do a wellness check.

A friend of mine has a 90 year-old neighbor whom she worries about.  Together they came up with a plan that the 90 year-old would open the blinds in her kitchen window by 10:00 every morning.  When my friend sees the blinds have been opened, she knows her neighbor is OK.  A simple plan such as this one can make it easier to live alone, while knowing that your neighbors are looking out for you.

You can also use technology, such as a Great Call device or similar wearable alarm system, so you can easily reach someone in an emergency.  You simply need to push a call button and the agent who answers can call a neighbor, friend, police or ambulance service for you, depending on the situation. You can even do something as simple as taking the time to make sure you always carry your cell phone around in your pocket.

Finally, pull together a few social circles.  These can be people who get together on a regular basis such as book clubs, quilting clubs, lunch pals, or dinner groups.  Join a bridge group or take a class at a senior center or community college.  Send cards or emails to friends and relatives so you stay in touch.  All these social contacts can enrich your life and help you feel less alone, which is important for both your mental and physical health.

Housing for Those Needing More Care

Once you have exhausted all the programs which have enabled you to live on your own, what should you do when you eventually need more care than is possible for you to get in your own home?  This is when you or a person you trust should plan ahead for the best type of housing for you.  You need to consider the types of care you may need, the activities which interest you, the amount of socialization you think you would enjoy, and how close you want to be to your current community support such as your church, old friends and relatives.

You can start by using a reputable agency to hire a personal caregiver.  This may help you stay in your own home even longer.  However, it is important that a friend or relative checks on the caregiver regularly, to make sure they are giving you appropriate care and not taking advantage of you.

You may also consider moving into an over-55 community where you can live in a separate home of your own and participate in community activities, but have an added layer of security as well as the company of neighbors who are also aging in their own homes. 

Several of my friends have moved into a wide variety of special senior living facilities and wondered why they waited so long.  Modern assisted living communities have parties, cocktail hours, special events, classes, trips, pools, art studios, gyms and more, while providing meals, housekeeping and other types of care.  Once they have gotten settled, most of my friends have loved their new homes!

Personally, I am currently living in an over-55 independent living active adult community.  I have plans to move in the next couple of years into senior apartments which include dinner, lunch and housekeeping, but no nursing care.  In the event this is not enough care, I also have long-term care insurance so I can move into assisted living or a memory care facility when I get really old!  However, I'm not in a hurry for that to happen and, perhaps, it never will. 

There are a number of senior housing choices available:

Independent Living Apartments:  These are ideal for people who want the security and simplicity of living in a senior community, but do not need any assistance with daily living needs.  In some of these communities, you prepare your own meals and do your own grocery shopping.  In others, your meals are provided.  Some locations have a hybrid system in which dinner and, perhaps, lunch are provided, but you are on your own for breakfast.  You should check out a variety of communities until you find one which seems right for you.  If you are financially limited, many cities provide senior apartments which can be rented on a sliding scale, depending on your income.  You may need to go on a waiting list, so sign up as soon as you begin to think this is something you would like to do. 

Assisted Living Residences:  These are ideal for people who do not need medical care but who might need assistance with the normal activities of daily living, such as bathing, eating, dressing, using the bathroom, walking or transitioning back and forth from a bed to wheelchair.  They usually provide meals, housekeeping, transportation, medication management, and fun, interesting activities.  The cost can range from about $4,000 to $10,000 a month, depending on the amount of help you need, the size of your room or apartment, and the area where you live.  Long-term care insurance may help with the expense.

Continuing Care Retirement Communities or a CCRC:  These are sometimes called life care communities and it is something you may want to investigate years before you expect to need one.  In this way, you will have a say in where you may end up living.  A CCRC is composed of senior apartments and cottages which have a tiered approach.  You start out living in an independent living unit.  Then, as the need arises, you may be moved to a skilled nursing or memory care facility in the same community, so you can get the assistance you need while still maintaining your connections.  Most of these communities require that you are able to function on your own in an independent living unit when you first move in, so it is important you plan ahead.

A few CCRCs are rentals and some allow you to use your long-term care policy to cover the cost, which can vary depending on the amount of care you will need.

However, most CCRCs require you to buy into the community and they will not accept a long-term care policy.  The "buy-in" can range from $100,000 to $1 million, with the money often coming from the sale of your home.  In addition, the monthly fees can range from $3,000 to $5,000 per person.  There are different types of contracts available including unlimited life care, modified life care with limits, and fee for service, with the responsibility for expensive long-term care lying with the resident, not the facility.  Before you choose a CCRC, you will want to visit all the ones in the area where you plan to live and compare whether they are rentals or the type where you pay an entrance fee, the monthly cost, potential extra fees, as well as what type of contract you will have.  It can be complicated to compare them, so you want to investigate your choices thoroughly while you are still in good health and of sound mind.  The benefit of a CCRC is that you can settle comfortably into one and, if you have planned well, you will never have to move again.  They will take care of you for the remainder of your life.  This brings a great deal of peace-of-mind to many people.

Board and Care Homes:  If you are looking for a comfortable, homey setting which is less expensive than most assisted living residences and CCRCs, then you may want to investigate your choices in board and care homes.  They are private homes which have been converted to small senior living facilities with professional staff.  They do not feel as institutional as other facilities and they can feel safer and more supportive than trying to remain alone in your own home.  You will be living with a small group of other people and have a staff to make your life more comfortable. 

Nursing Homes:  Also known as skilled nursing facilities, they will care for you and provide around-the-clock medical care.  Some of them are also rehabilitation facilities and you may stay in one temporarily while you recuperate from surgery, such as a hip replacement.  They have a higher level of care than an assisted living facility or a Board and Care home.  If you pay for a nursing home out-of-pocket, it can average $82,000 a year or more to stay in a semi-private room, according to a 2016 National Nursing Home Survey.  However, your costs may be covered by a long-term care policy or, in some cases, Medicaid.  You should investigate your financial options as soon as you move into one, before any Medicare or health insurance benefits expire.

Plan Ahead for Late In Life Care

If you expect to age alone, it is smart to start early to investigate your various options for receiving appropriate medical care should you have surgery or become seriously ill.  If you are fortunate, you may discover you never need to use the most expensive, comprehensive care, such as a nursing home.  However, if you do have a need for this advanced care, even temporarily, it is smart to know your options and consider how you will pay for it.  Put your choices in writing and give the information to one or two trusted family members or friends, so you are sure your wishes will be honored, should you not be able to speak for yourself.

Whether you age in your own home or move into some type of senior housing, you should make sure you have a will and trust, your finances are in order, and everything is as organized as possible.  Make certain you have a trustee who can handle everything for you, should you become unable to handle things yourself.

While you are at it, you may also want to consider discussing your healthcare wishes with your doctor and putting them in writing, too.  A Living Will or Healthcare Directive is another way to make sure your wishes will be honored during the last few years of your life.

In you are interested in learning more about aging, common medical problems, where to retire, financial planning, Social Security, Medicare and more, use the tabs or pull-down menu at the top of the page to find links to hundreds of additional articles.

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Choosing a Continuing Care Retirement Community

One retirement option that is appealing to more and more retirees as they age is the concept of moving into a Continuing Care Retirement Community.   These are a great choice for people who wish to move only once after they retire and stay in the same place for the rest of their life, without the stress of worrying about ever having to move again.

There are approximately 1,900 CCRC's in the United States.  The most popular states for them are Pennsylvania, Ohio, California, Illinois, Florida, Texas, Kansas, Indiana, Iowa and North Carolina.

Cost of Moving to a CCRC

Although they appeal to a large number of retirees, moving to a Continuing Care Retirement Community is not cheap.  Most of them require the residents to make a large upfront deposit that ranges from about $80,000 to $750,000 ... with a average of about $250,000.  In some cases, a portion of the deposit may be refunded to your heirs when you die, depending on how long you lived in the community.  While this may seem like an impossible amount of money for the average person, the majority of residents used the equity they received when they sold their home ... since they had no intention of moving back into a single family residence, again.


In addition, you will be expected to pay a monthly fee that covers your housing, meals and other amenities.  This can range from $1000 to $2700.  Again, while this may seem like a lot of money for some people, remember that it covers your rent, utilities, meals and transportation for the rest of your life.  This expense is affordable for many people who are planning to live off of their Social Security and/or pensions.  Therefore, while expensive, these communities are not as unaffordable as many people may first believe, although some people may need to supplement their Social Security or pensions with money from their retirement savings or other sources.

Types of CCRC's

Your community may be all-inclusive, taking care of nearly all your needs for the rest of your life; or they may be partially inclusive, where certain things are included and others are covered by private insurance; or they may be set up with a fee-for-service structure, where you only pay for what you use.

Continuing Care Retirement Communities vary in how they charge you for medical expenses and nursing care.  Some CCRC's include health-care costs.  In other cases, residents can use their private insurance, Medicare, and long-term care insurance to cover their medical needs and skilled nursing care. It is important to discuss this with management in advance, so you have a clear idea of how this will be handled.


Before you move in, expect the CCRC to evaluate your ability to cover your future anticipated expenses.

What to Expect in a CCRC

These communities are appealing residential communities, not old-fashioned nursing homes.  Residents live in private apartments or cottages.  Depending on the community a resident chooses, they may either have one meal a day or all of their meals served to them restaurant style.

Like other over-55 communities, the typical CCRC will have clubs, activities, entertainment, transportation, classes, swimming pools, shops, hair salons, and fitness facilities.  In addition, many of them have access to caregivers or skilled nursing care, often provided by outside contractors for an additional fee, for those who need it.  These residences also have modern amenities like cable television and Wi-Fi.

While the average age to move into a CCRC is about 80, some people do decide to move in while they are in their 60's and 70's, especially if they have have a chronic condition that makes it more difficult for them to prepare their own meals, drive their own cars, etc.  It is an ideal living situation for many senior citizens who are single, have had a heart attack or stroke, who are losing their eyesight, developing Parkinson's Disease, or have similar infirmities.  Younger adults are frequently delighted that they made this decision when they realize that they are still young enough to fully enjoy the amenities.  Older residents often say they wish they had moved in years before.

How to Find a Continuing Care Retirement Community

One way to search for a CCRC in the area where you want to live is to go to CARF.org.  This is the website of the Commission on Accreditation of Rehabilitation Facilities ... which evaluates and accredits both rehab facilities and retirement communities.

On the CARF.org website, go to Home - Find a Provider.  Click on Advanced Search. Then enter the State and under Program scroll down until you find Continuing Care Retirement Communities.  When I entered this information for my home state of California, I found 24 CCRCs in my state that were accredited by CARF.  By clicking on the ones in the towns that interested me, I was able to learn more specific information about them.

Once you have a list of CCRCs that interest you, I highly recommend that you look at their individual websites and then go out and pay them a personal visit ... possibly more than once.

In addition to the CARF website, you may also find information on the CCRCs in your state by going on the website for the Department of Social Services in your state.  Their site should explain state regulations for these communities and answer some of your questions.  For example, in California, I learned a lot at http://www.calccrc.ca.gov, including finding a list of both non-profit and for-profit providers.  The state list was much longer and more comprehensive than the list on the website for CARF.org, which indicated to me that there are many CCRCs that are not affiliated with CARF.

Moving into a Continuing Care Retirement Community is an appealing choice for many people and one that should be explored by anyone who wants the security of knowing that they have a permanent home for the rest of their life, regardless of changes in their health.


Resources:

http://www.calccrc.ca.gov/ (from the California Department of Social Services)

"Understanding CCRCs," Where to Retire Magazine, January/February 2014.

CARF.org (website for the Commission on Accreditation of Rehabilitation Facilities)

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