Combination Facilities
What is a continuing care retirement community CCRC?
A continuing care retirement community or CCRC is a facility that basically has this aging in place concept where you move in, and generally when people move in, they are in pretty good shape and don't require a lot of assistance, but the idea is that no matter how much assistance they may need, as life goes on and whatever medical conditions may develop and so on, that they can stay in that setting and so they have got an independent setting, and then they will have an assisted setting, and then usually they have got a nursing facility, all within the same campus. So, you can go up or down in levels of care, depending on what else is going on with you. If you break a hip, you go to the nursing centre for a while and then you can move back, if you are doing okay, and so on.
What range of services do combination facilities provide?
Usually, these CCRC's have a very wide range of services that can range from people who have essentially no needs at all, may be able to even still cook their own meals and drive their own car and so on, and then all the way through the whole scope of assisted living services. So that could be just meal assistance, but it could also be the whole gamut of bathing assistance, grooming assistance, and maybe even toileting assistance. And then the nursing home, of course, would even have medical services including the need for IV's, feeding tubes, wound care or things like that would typically require more care even than assisted.
Does a CCRC meet its claim of 'aging in place'?
In general, that whole concept of aging in place is fairly well met by the CCRC's that are out there now. Some of them have more ability to keep people in that setting than others, and clearly it's not a hospital, so most of them don't have the type of care that you could get in an acute care hospital. Nursing homes, skilled nursing facilities, give pretty high level care, so they can do IV antibiotics. They can do pretty significant respiratory care, and from one facility to the next as far as the CCRC's there may be a range as far as just how sick you can be and still stay there. But certainly if you're a person who doesn't want to be put in the acute care hospital, you can stay there in a hospice setting, and when your condition gets to the point where you need high levels of care.
Why have CCRCs become a popular long-term care option?
I think CCRCs are a natural concept that is just going to be something that people like because you move into a place. Especially because, let's say you move in there, you're 67 years old, you're still walking five miles a day and driving and going on vacations and so on. You're still sort of in the prime of life. But anyway, these are people that are fully independent, vibrant people They're saying, "We'll move into this place. I may be here for 30 years." It's a whole community. They get to know people. They get to know the staff and then it's a very attractive notion that you can stay there, live out your years there and not have to be bounced between a bunch of different kinds of care settings.
Is a CCRC the same as a 'stepped care community'?
I'd say the term "CCRC" and "stepped care" are pretty interchangeable. There may be specific states or areas where they have a different meaning or a slightly different range of services, but essentially it's the same thing. "Stepped care" can also be used to refer to just an assisted living that has different levels of care, going from practically independent to practically nursing home, so that would be another way that you could use that term.
What are the advantages of a CCRC?
I'd say the biggest advantage of a CCRC is that whole tag line about aging and place and essentially being able to stay in one basic campus and get all of your needs met. Now you're there with the same people, your neighbours, your friends that live in the same place, some of whom you know you can get to know very well over the course of the years that you're living there together. Even if you go from independent to assisted, assisted to nursing, those people are still there. There is only one person that you pay the bills to and so on, and you're just not getting bounced among a whole bunch of different places, so there is familiarity, and particularly with patients who have dementia or other kinds of memory problems and so on, having familiar faces, familiar surroundings, and just familiar stuff and pictures on the wall, your own personal stuff, that can be really reassuring.
What are the disadvantages of a CCRC?
The disadvantages of a CCRC are generally that if at some point you decide you don't like the place, you are already bought in. Typically, they have a fairly steep enrolment fee, like joining a country club or something like that. If you decide to move out, typically you would lose that enrolment fee or that initiation fee. That's one thing. Then clearly there are some places where perhaps what is offered or what they claim they are able to provide may not exactly be what they are able to provide. Perhaps some of the nursing centers don't have the level of skill that another skilled nursing facility in the area might have that you might require. You've already paid all this money and yet you might wind up having to move to a different setting, or stay there and get care that is perhaps below the level that you would need.