Courtesy of Susan Hindman

Active adults wanting to live in one retirement community that will take care of them into their frail years are turning to continuing care retirement communities (CCRCs), which provide a continuum of care that includes housing, services, and health care, in one setting.

Whether it’s all in one building or spread over several buildings on one large campus, a CCRC offers separate housing for independent living, an assisted living facility, and nursing homes for those needing skilled care—which seniors move into as their health dictates. When a different level of care is needed, transitioning to a new residence is easy, and people won’t be far from friends. CCRCs are sometimes called life care communities.

The independent housing may be small or large apartments, cottages, cluster homes, single-family homes, and even three-bedroom “villas” with decks and gardens. Assisted living units may be small studio or one-bedroom apartments with small kitchens. Nursing home accommodations are usually furnished one-room units with an attached bathroom and house at least two.

“CCRCs offer a great sense of community, and residents often speak of themselves as being part of an extended family,” according to RetirementLiving.com. “Although nobody is obliged to participate in the community’s programs, there is often an array of social activities and facilities. They often have exercise equipment, and programs and classes in which to use them. Woodworking shops, hobby shops, greenhouses, and craft shops can be found in many CCRCs. Some are near country clubs with golf and tennis facilities. All have buses to take residents to whatever activities interest them, such as concerts, sporting events, and shopping.”

According to the New York Times, there are about 1,900 CCRCs, more than 80% of them nonprofit operations, which are home to more than half a million older adults. The organizations sponsoring the CCRCs may set up communities that cater to affinity groups, such as religious organizations, fraternal orders, and ethnic groups.

Money, however, is a big factor. CCRC costs include an entrance fee, the cost of purchasing a unit, and a monthly fee, making them “the most expensive long-term-care solution available to seniors,” according to Helpguide.org. Buy-in, or entrance, fees can range from $60,000 to more than $120,000, according to the MetLife Mature Market Institute’s 2009 market survey. Monthly fees—which can include meal plans, utilities, housekeeping, maintenance, transportation, and activities—can range from $400 to more than $2,500.

The fees vary according to whether you own or rent the living space, the size and location of the residence, the amenities chosen, whether the living space is for one or two people, the type of service contract chosen (there are three to choose from), and the current care needs (seniors in good health at the time they sign up pay less). Many contracts guarantee a lifetime of housing and care, and detail those obligations.

You’ll have to do your homework to compare costs, which “vary enormously,” according to the Times. “Unlike assisted living facilities or nursing homes, CCRCs around the country . . . offer fundamentally different products.” Some communities are more upscale than others, and regional differences can have an effect. The Times advises you “visit several communities, amass a lot of information, and then sit down with an accountant and a lawyer.”

For some examples of facilities and pricing, visit the Times’ site. CarePathways offers a lengthy list of questions to ask before deciding on a CCRC, and the Commission on Accreditation of Rehabilitation Facilities has more information about CCRC contracts. (See links below.)

Another continuing care model is called CCRC without walls, or continuing care at home (CCAH). The same continuum of care is provided, only it’s done in the member’s current home. You pay a one-time enrollment fee and monthly fees, based on the plan selected, and receive a range of services—such as care coordination, transportation, meals, and nursing services—at home. This type of program is less expensive than moving into a CCRC.

In order to qualify, new members must meet age requirements, be in good health, and not need services at the time of signup. A 2008 report found five states offering CCAH programs: New Jersey, Pennsylvania, Ohio, Tennessee, and Maryland. Since then, programs have begun in Connecticut, Illinois, and Washington, D.C.