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two Continuing care retirement communities and the need for technology training

The CCRC model

As baby boomers have come of retirement age, adequate senior housing has become important as an industry to meet the needs of an increasingly larger aging population. As illustrated in the demographic data in Chapter 1, the number of Americans aged 65 and older has dramatically increased and will continue to increase so that by the year 2050, the number of Americans aged 65 and older will comprise more than 20% of the US population, and many of them will prefer or require some level of a CCRC.

As baby boomers reach the age of those considered the oldest old (aged 85 and over), the necessity of long-term care will become even more essential. Chronic conditions or disease can necessitate greater levels of caregiving and limit an older adult's ability to remain in his or her own home. Significant out-of-pocket healthcare expenditures hinder access to care and quality of life and leave insufficient resources for other necessities. As a result, in the past few years, there has been a shift away from skilled nursing facilities toward a private market-based system, such as a CCRC.

A CCRC is a tiered senior housing model for older adults who can no longer maintain a private residence, need assistance with activities of daily living (ADLs), or require skilled nursing care. They offer older adults the opportunity to live at one location for the remainder of their lives, with options to receive greater assistance with care as their needs increase. CCRCs offer levels of care beginning with garden homes or apartment/ condominiums where healthy older adults can live independently, but have access to services if needed. When assistance with everyday activities becomes necessary, they can move into assisted living or skilled nursing care facilities without leaving their retirement community. Memory care units are fast becoming a standard feature for CCRCs. The tiered levels are often referenced as a "continuum of care." This allows residents to age in place, thereby taking the stress of further relocation off of them and their potential caregivers, such as children or close relatives.

However, peace of mind for the future can be very expensive; the cost of moving into a CCRC is greater than other options for long-term care because residents are paying for the potential of future services as well as present services. Monthly charges can range up to $5000 per month, based on factors such as location and amenities, services provided by the CCRC, level of assistance, and choice of housing. However, the initial fee that guarantees access to care for the remainder of life can vary quite dramatically, ranging from over $100,000 up to $1,000,000. Due to consumer demand, many CCRCs are now offering older adults greater financing options with refunds available if certain conditions are met.

According to the AARP (2015), there are three types of contracts for residents:

  • 1. Life care contract. This is the costliest option but guarantees unlimited care for life in the assisted living or skilled nursing options if needed.
  • 2. Modified contract. This option offers needed services at a fixed rate over a set period of time. At the end of this time, the services are still available but at a higher rate.
  • 3. Fee-for-service contract. This option may lower the initial entrance fee but assisted living and skilled nursing charges are assessed at the current rate.

CCRCs may vary in scope, size, and amenities, but three basic aspects are present in virtually every CCRC in the United States:

  • • All levels of care from independent living through skilled nursing are offered, with access available for life.
  • • Programs and amenities are available that contribute to healthier living with an emphasis on wellness. These can include state-of-the- art facilities, exercise programs, educational opportunities, travel opportunities, and appealing dining choices.
  • • Options for rest-of-life care in one place are available, based on the type of contract entered into.

The CCRC has continued its evolution with the "CCRC without walls." The concept of a CCRC without walls takes the types of services provided at a CCRC and makes them applicable to an in-home setting. As with a traditional CCRC, an entrance fee is required, as well as regular monthly fees and fees that apply to whatever services are offered in the package by the individual CCRC. This modern version of the CCRC is attractive to older

adults because of its lower entrance fee for those who lack the financial resources to move into a traditional CCRC, allowing them to benefit from the services offered and the prospect of future care. However, the conditions for admission include stricter guidelines in terms of health, age, and number and type of chronic conditions. Another criterion is the necessity of a Medicare supplement insurance policy. Overall, initial admission into the CCRC is typically granted to healthy, independent older adults.

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