Understanding Senior Living Community Housing Contracts. Learn how to choose the right CCRC or other contract and avoid common pitfalls

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1 Understanding Senior Living Community Housing Contracts Learn how to choose the right CCRC or other contract and avoid common pitfalls

2 UNDERSTANDING SENIOR LIVING You want to move to a senior living community, but that s just the first of many decisions you ll need to make. From resort-style communities on the beach to independent apartments, location preference is only the tip of the iceberg when it comes to choosing your ideal senior lifestyle. Whether you re looking to dive into senior living for the long haul or test the waters with a rental, banking on continued good health or want to ensure care as you age, you ll have to sign a contract that stipulates the services you ll receive and what you ll pay now and down the road. This guide can help you navigate the different contracts you may encounter as you embark on your search for a new home. CCRC CONTRACTS Continuing care retirement communities offer multiple levels of care all on one campus. This setting is generally attractive to seniors who like to plan ahead. CCRCs are most useful for seniors who can come in at the independent living level and move through higher levels of care as needed over time. The CCRC is a promise of future care, inclusive of the various levels, says Marc Herrera, vice president of skilled nursing administration and risk management at be.group. All other types of senior living are month-tomonth arrangements. Most CCRCs are nonprofit organizations with business models surrounding a mission of senior care and service, says Daniel S. Ogus, executive vice 2

3 CCRC CONTRACTS ARE MORE COMPLEX THAN OTHER TYPES OF SENIOR LIVING AGREEMENTS BECAUSE THEY OFFER MORE SERVICES. UNDERSTANDING SENIOR LIVING president and chief operating officer at be.group. All levels of care in a CCRC are usually provided by the same management. Otherwise, if you move into a community that offers only one level of care (such as assisted living) and then need a higher level of care (like skilled nursing), you will likely need to move to a different community managed by a separate corporation with a whole new set of requirements and costs. CCRC contracts are more complex than other types of senior living agreements because they offer more services. There are three common types of CCRC agreements that typically secure long-term living accommodations, services and health care for residents. 1. Type A (Life Care Agreements) According to the Commission on Accreditation of Rehabilitation Facilities, Type A contracts include overall housing, residential services (amenities) and unlimited health-related services. Type A contracts provide a sense of stability, as future costs are much more predictable regardless of any changes in needed services or care. Residents pay a much larger entrance fee compared to other contract types, but the monthly fee is flat through all levels of care. You pay an entrance fee, then should you eventually need assisted living, your monthly fee will stay the same, says Herrera. However, while the level of security provided by this contract can be an advantage, the CARF cautions that there is a possibility that healthy residents could end up paying in advance for services they may never use. 3

4 2. Type B (Modified Agreements) As with Type A, Type B contracts include housing and residential services. Unlike Type A, Type B does not cover all future health care needs but does offer discounted or waived rates for those services. For example, if you fall and break your hip, you d get 30 days free in the health center, says Herrera. But after that, you ll start paying a fee for each service as you would at the doctor s office. While Type B contracts have a lower entrance fee than Type A, the CARF cautions that, should an increase in care become necessary, it would be the resident s responsibility to cover costs. UNDERSTANDING SENIOR LIVING 3. Type C (Fee-For-Service Agreements) Like both A and B, Type C contracts cover housing, residential services and health care. Basically, it s pay as you go, says Herrera. Residents pay a smaller entrance fee in the beginning. Then, if you don t need to use higher levels of care, there is no additional cost to you beyond your monthly service fee for using amenities like transportation or activities. While Type C contracts will save you on up-front costs, the resident risks the potential for large costs down the road if there is a sudden need for care. The CARF states that Type C contracts are ideal for healthy seniors who do not foresee any need for 24-hour skilled nursing care. CONTRACTS BEYOND CCRCS If you are considering a move to a senior living community that offers only one or a couple of levels of care but is not a full CCRC, or if you are considering a move to a CCRC but aren t sure about the long-term commitment, there are other contract options. The following are the five most common. 1. Rental agreements A rental agreement is a month-to-month residential and service contract and is not considered a continuing care contract. If someone isn t sure about moving into a CCRC and he or she wants some flexibility, a rental agreement allows them to try it out for a few months, says Herrera. Rental agreements require residents to pay a higher monthly cost and fee-forservice rates on any health care needs. Since rental agreements provide much 4

5 UNDERSTANDING SENIOR LIVING more freedom, residents are able to convert to a CCRC contract or cancel the agreement at any time. But with freedom comes risk, as unlike Types A, B and C, there is no promise of future care within a rental agreement. 2. Age-restricted communities Also known as active adult communities, this option is restricted to residents who are at least 55 years old, and does not provide health-related support or increased care. Age-restricted communities offer for-sale, single-family homes in the form of condos, mobile homes and townhouses. Typically, rental properties are not an option, and many communities include recreation amenities such as golf courses and gyms. Keep in mind that these additional perks are often included in a monthly homeowners association fee. They do not, however, include meal service, cleaning or other amenities generally included in independent living communities. 3. Independent living Independent living contracts cover housing in an independent living community. Typically, residents pay a rental rate or monthly fee, and the community may not provide any supportive services. According to the Assisted Living Federation of America, this option is best for active seniors who do not need assistance and is often the most affordable. That said, it s ideal for independent living contracts to include some link to services (such as assistance with transportation or medication management) otherwise the community will not be able to accommodate a senior who wants to remain in one place as care needs arise, warns Herrera. If they cannot provide future care for someone who becomes frail, Herrera says it s important that the community set strict rules about residency when a senior can no longer be truly independent because it can become unsafe for the resident to remain there without help. In these settings, the person who 5

6 REGARDLESS OF THE ENVIRONMENT YOU CHOOSE, MOVING TO A SENIOR LIVING COMMUNITY IS A BIG DECISION THAT REQUIRES A LOT OF THOUGHT AND EVEN MORE RESEARCH. needs services is often left with no assistance in accessing local long-term care supportive services like home care and home health, says Herrera. UNDERSTANDING SENIOR LIVING 4. Assisted living Assisted living communities provide housing, support, amenities and assistance with activities of daily living (such as dressing, bathing or managing medication). Such communities do not generally charge an entrance fee, but often charge a community fee of about one month s rent. Assistance is typically covered by a monthly fee. Medicare does not cover assisted living services, and most facilities charge market rates. However, a little research will help you find some options that participate in Medicaid waiver programs. The issue with care-related communities (assisted living and skilled nursing) is always about quality and staffing, says Herrera. Staff longevity is important, so that staff gets to know you or your loved one, and can provide care accordingly. 5. Skilled nursing Skilled nursing communities (often called nursing homes) provide 24-hour care for people with chronic conditions or those who have short-term rehabilitation needs. Fees cover all services, from custodial care like helping a resident bathe, eat and getting in and out of bed to laundry, medical care and community maintenance. Medicare does not generally cover long-term nursing home stays, but some insurance companies will allow you to use your life insurance to cover long-term care. Nursing home contracts vary state by state, but all communities must adhere to the federal Nursing Home Patient s Bill of Rights, which protects residents. Always do site visits, look for management stability and consistent good survey outcomes, says Herrera. Hospital case management and social workers can help with this. STEPS BEFORE YOU SIGN Regardless of the environment you choose, moving to a senior living community is a big decision that requires a lot of thought and even more research. Here are some important steps to take before signing a contract. 6

7 1. Consult a financial adviser. Joining a senior living community is a serious investment. Spend time with your trusted financial adviser. Your biggest pitfall is not understanding how health care, especially Medicare, works in our country, says Ogus. How much money do you have and how much will you need? Understand what benefits you re getting from Medicare as well as your retirement packages. UNDERSTANDING SENIOR LIVING 2. Research the organization and management. The financial stability of the community as well as the continuity of management are two essential factors to vet thoroughly. Is the management able to make improvements regularly? Will you be working with the same staff regularly, or is there a high turnover rate? If you re going to live somewhere for 30 years, you need to know its history, Herrera says. Ogus suggests reading online reviews and visiting communities to talk directly to residents. Additionally, every community that receives Medicare subsidies is visited and reviewed once a year unannounced, and those results are public knowledge on the federal website. Don t just look at one year of bad results, look at them year over year, says Ogus. See if there have been legal issues. Check their background like anyone you would do business with. 3. Understand which services are covered. Asking about guaranteed services will alleviate many of those what if questions: What if you get dementia? What if you become debilitated? Ask management specific questions about what s covered in your contract beyond care services. What types of wellness and preventive care services are available in the community? Understand how they charge for specialized programming and activities. 4. Find out how refunds work. Signing a CCRC contract is a big decision so what if you change your mind? Understand how the refund works by asking questions prior to signing the agreement, Herrera says. 5. Ask about a benevolence program. Many nonprofit CCRCs offer benevolence programs if a resident exhausts his or her financial resources. Say someone has lived in the community for years and now she cannot afford to pay at that higher level this program subsidizes her as she continues to live at the same level, says Herrera. 7

8 UNDERSTANDING SENIOR LIVING 6. Make sure your voice will be heard in the future. Some communities have their own associations, and residents have the right to be represented on boards. It s collaborative management, says Herrera. Many communities are managed with a lot of advice from residents. 7. Determine what role your family will play. We can t share information with children if the resident doesn t give us permission to do so, says Ogus. If a resident has a condition change, we hope he or she will allow us to share with one of their adult children. Make sure your family understands the financial commitment and how your contract works so they know what will happen in the event of an emergency. 8. Explore, visit, ask questions, repeat. We want [potential residents] to make the right decision, says Ogus. We want them to choose us, but we d rather them not choose us if it s not the right decision for them. An unhappy resident can spoil it for the rest of the community. It should be a lifestyle decision, not a sentence. This guide is brought to you by be.group. As one of California s largest nonprofit providers of senior living communities, be.group is dedicated to helping residents and clients discover new ways to embrace life s possibilities and new options for exploring their potential. Our vision begins and ends with the people we serve. We re here to help older adults be who they want to be: themselves. Learn more about be.group communities at thebegroup.org. Contact us at (818)

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