A continuing care retirement community, or CCRC, offers something no other senior living option provides: a continuum of care on a single campus. Your parent can move in while active and independent, then seamlessly transition to assisted living, memory care, or skilled nursing as health needs change, without moving to a new community or finding new care providers.
This peace of mind comes at a price. CCRCs typically require substantial entrance fees, and the contracts are complex. Understanding how CCRCs work is essential before making this significant commitment.
What is a CCRC?
A CCRC is a residential community that provides housing and services across the full spectrum of senior care needs, all on one campus or within one organization.
Levels of Care Typically Offered
- Independent living: Apartments or cottages for active seniors
- Assisted living: Help with daily activities like bathing and medication
- Memory care: Specialized care for dementia and Alzheimer's
- Skilled nursing: 24-hour medical care for complex health needs
- Rehabilitation: Short-term therapy after surgery or illness
The CCRC Value Proposition
- Aging in place: Never need to move to a different community
- Predictable costs: Know what care will cost (depending on contract type)
- Priority access: Guaranteed bed in higher care levels
- Continuity: Same community, familiar staff, established friendships
- Couple flexibility: Spouses can be in different care levels on same campus
- Comprehensive services: Dining, activities, wellness, healthcare coordination
CCRCs Go By Many Names
CCRCs may also be called Life Plan Communities, Life Care Communities, or Continuing Care Communities. The concept is the same: multiple care levels in one place with contractual arrangements for future care.
Understanding Contract Types
CCRC contracts vary significantly in how they handle future care costs. Understanding these differences is crucial.
Type A: Life Care (Extensive Contract)
The most comprehensive and expensive option.
- Entrance fee: Highest ($200,000-$1M+)
- Monthly fee: Moderate ($3,000-6,000)
- Care costs: Little to no increase when moving to higher care levels
- Risk: Community bears risk of your future care costs
Best for: Those who want maximum cost predictability and can afford the large upfront investment.
Type B: Modified Contract
A middle-ground option.
- Entrance fee: Moderate ($150,000-500,000)
- Monthly fee: Moderate ($2,500-5,000)
- Care costs: Some care included (often a set number of days), then discounted rates
- Risk: Shared between you and community
Best for: Those seeking some cost protection but not willing to pay for full life care coverage.
Type C: Fee-for-Service Contract
Lowest upfront cost, highest ongoing risk.
- Entrance fee: Lowest ($50,000-200,000)
- Monthly fee: Lower for independent living ($2,000-4,000)
- Care costs: Full market rate for any care services needed
- Risk: You bear full risk of future care costs
Best for: Those with limited assets for entrance fees or who believe they won't need extensive future care.
Comparing Contract Types
| Feature | Type A | Type B | Type C |
|---|---|---|---|
| Entrance Fee | Highest | Moderate | Lowest |
| Monthly Fee (IL) | Moderate | Moderate | Lower |
| Future Care Costs | Predictable/Minimal increase | Some increase | Full market rate |
| Financial Risk | Community bears | Shared | Resident bears |
| If Healthy | May "overpay" | Moderate value | Good value |
| If Need Care | Excellent value | Good value | Expensive |
Understanding CCRC Costs
CCRC costs have two main components: entrance fees and monthly fees.
Entrance Fees
The upfront payment to join the community.
- Range: $100,000 to $1,000,000+
- Factors: Location, unit size, contract type, amenities
- Refund options: Various policies available
Entrance Fee Refund Options
Non-refundable (Standard):
- Lowest entrance fee option
- No refund upon death or departure
- May have small refund window (90 days)
Declining Refund:
- Refund decreases over time (typically 2% per month for 50 months)
- After set period, no refund
- Moderate entrance fee premium
Partially Refundable:
- Fixed percentage returned (50%, 75%, 90%)
- Refund goes to estate upon death
- Higher entrance fee premium
Fully Refundable:
- Full entrance fee returned (minus any care used)
- Highest entrance fee
- Essentially a loan to the community
Monthly Fees
Ongoing charges covering housing, services, and amenities.
- Independent living: $2,500-6,000/month
- Assisted living: $4,500-8,000/month
- Memory care: $6,000-10,000/month
- Skilled nursing: $8,000-15,000/month
Typically includes:
- Housing and utilities
- Dining plan (often 1-3 meals daily)
- Housekeeping and maintenance
- Activities and programs
- Transportation
- Some healthcare services
Monthly Fees Increase Annually
Plan for annual increases of 3-5%. Over a 15-20 year stay, monthly fees can more than double. Review the community's history of fee increases and factor growth into long-term financial planning.
Benefits and Risks
Benefits of CCRCs
- Comprehensive planning: One decision covers all future care needs
- Guaranteed access: Priority for higher care levels
- Predictable costs: Especially with Type A contracts
- No future moving: Spouses can stay together even with different needs
- Community: Long-term relationships with residents and staff
- Quality: CCRCs often have higher standards than standalone facilities
- Health emphasis: Wellness programs, preventive care
- Family peace of mind: Care needs are handled
Risks and Considerations
- Large upfront investment: Significant financial commitment
- Potential loss: If you leave or community fails, entrance fee may be lost
- Community financial health: CCRCs can go bankrupt
- Lock-in: Harder to move if unhappy
- May not need care: Could pay for insurance never used
- Rising monthly fees: Can outpace income/savings
- Complex contracts: Easy to misunderstand terms
- Asset spend-down: Using home equity for entrance fee
Evaluating a CCRC
Given the financial stakes, thorough evaluation is essential.
Financial Health
- Request audited financial statements
- Check occupancy rates (should be 90%+)
- Review history of fee increases
- Understand their reserves and debt
- Check for any state regulatory actions
- Ask about their accreditation (CARF-CCAC)
Quality of Care
- Tour all care levels, not just independent living
- Check state inspection reports for skilled nursing
- Ask about staff turnover and training
- Talk to residents at each care level
- Understand the transition process between levels
- Ask what happens if your parent disagrees with care level recommendation
Contract Review
- Have an elder law attorney review before signing
- Understand exactly what triggers a move to higher care
- Know the refund policy inside and out
- Clarify what happens if you run out of money
- Understand circumstances for contract termination
- Review the resident agreement and bill of rights
Questions to Ask
- What is your current occupancy rate at each care level?
- How are monthly fee increases determined?
- What's your average fee increase over the past 5 years?
- What happens if I can no longer afford the monthly fees?
- How is the decision made to move someone to a higher level of care?
- Can I bring my own furniture? What about pets?
- What's included in the monthly fee vs. extra charges?
- Are there waitlists for any care levels?
Who is a CCRC Right For?
Good Candidates
- Significant assets (typically $300,000+ plus home equity)
- Want certainty about future care arrangements
- Planning ahead while still healthy
- Value community and social engagement
- No children or children live far away
- Want to reduce burden on family for future care decisions
- Prefer one comprehensive solution
May Not Be Right For
- Limited assets for entrance fee
- Prefer to stay in current home as long as possible
- Close family support network nearby
- Already have significant care needs (may not qualify)
- Uncomfortable with long-term contractual commitments
- Want to preserve estate for heirs
Alternatives to Consider
CCRCs aren't the only option for planning future care.
Age in Place + Long-Term Care Insurance
- Stay home, use insurance if care is needed
- More flexibility, no entrance fee
- Risk: insurance may not cover all needs
Rental Independent Living + Plan for Future
- Move to independent living community without entrance fee
- Preserve assets for future care needs
- May need to move again if care needs increase
Sequential Moves as Needed
- Stay home, move to assisted living when needed, etc.
- No large upfront commitment
- More uncertainty and multiple transitions
Frequently Asked Questions
A CCRC is a senior living community that offers multiple levels of care on one campus: independent living, assisted living, memory care, and skilled nursing. Residents can transition between care levels as needs change without moving to a new community. CCRCs typically require an entrance fee plus monthly fees.
CCRCs typically require an entrance fee ranging from $100,000 to over $1 million, plus monthly fees of $3,000-7,000 for independent living. Costs vary dramatically based on location, contract type, and unit size. Some entrance fees are partially refundable.
Three main types: Type A (Life Care) has highest entrance fee but covers future care at little additional cost. Type B (Modified) has moderate fees with some care included. Type C (Fee-for-Service) has lowest entrance fee but you pay full market rate for any care needed. Each has different risk/reward profiles.
Refund policies vary by community and contract. Options include: non-refundable (lower fee), declining refund (decreases over time), and partially refundable (50-90% returned to estate). Fully refundable contracts have highest entrance fees. Read contracts carefully and consult an attorney.
Final Thoughts
CCRCs represent a significant decision, both financially and personally. For the right family, they offer peace of mind that's hard to replicate: the knowledge that your parent's care needs are covered no matter what happens.
But this security comes at a substantial price, and the contracts are complex. Before committing, ensure your parent truly understands what they're agreeing to, can comfortably afford both the entrance fee and ongoing monthly costs (accounting for increases), and has thoroughly evaluated the community's financial health and quality.
Working with an elder law attorney and financial advisor experienced with CCRCs is strongly recommended. This is not a decision to make quickly or without professional guidance.