Costs Of Combination Facilities
How much does a CCRC cost?
CCRC's are pretty expensive. Generally there's a buy in amount and that can be half a million dollars or more. And different facilities are structured differently, but generally they require that you have a pretty decent amount of assets, that you can then have rent taken against or other charges, other billings, maybe if you use their pharmacy and things like that, and depending on the level of care that you're requiring. Now some facilities are structured in a way that your heirs, after you die, can get part of the money back, and so those are things that you should discuss with your financial planner, attorney and so on.
Will the cost of a CCRC change based on the level of care I need?
Some of the facilities have a setup where the amount that you get billed or the amount that gets taken against you. The amount that they may have in an account with your name, it can vary depending on the level of care that you have. Other facilities I believe just have essentially a set fee, and once you have bought into the place, essentially you can live out your days there and it doesn't exactly matter what level of care you have. They've just agreed to take care of you no matter what, particularly some of the non profit facilities and some of the religious outfits are able to do that so that if you plop down $600,000 dollars for you and your wife to move into a place that means that even when that's all been essentially spent you can still stay there.
Do you rent or buy units in a CCRC?
As far as whether you rent or buy, I think there's a very ability in the structure, the corporate structure of the buildings and however they're chartered. Typically there's no real ownership interest in most of the facilities that I'm familiar with. There are some facilities that are moving toward that now, so that there's a value to what you have and so you may get back, or when you die your heirs may get back, maybe half of what you put in. So that's certainly a more attractive option on that basis.
Is it wise to sign an all-inclusive contract at a CCRC?
I think whether or not you decide to have an all inclusive services included in your contract at one of these places, depends on your personal finances, and on exactly what the deal is. So it would ultimately vary from one situation to the next and what a person's personal philosophy is, what their level of assets is and how they want to be providing for their heirs and a whole bunch of estate planning things that probably should be best discussed with an estate planning expert.
What is a 'Life Care Contract' at a CCRC?
The term "Life Care Contract" is basically that whole concept that you'll never have to move out of that place, and that their essentially agreeing to care for you no matter how high your care or needs, even to the point where you become essentially totally dependant. You could be a late stage dementia patient who can no longer speak, can't feed themselves, or can't even turn themselves in bed. And the facility is saying that even though you're driving a car and cooking your own meals right, now we're going to take care of you no matter what. In most cases that can be done. Of course if you have some kind of acute surgical problem or something that requires that you go into the hospital, they can't provide for those needs, but short of an acute hospitalization, they can pretty much agree to take care for you no matter what until the end of your life.
What is a fee-for-service contract at a CCRC?
A fee-for-service contract at a CCRC means that you will be charged, essentially on a card basis whatever it is, the services that you need for a given month are done on that basis, essentially, the specific things you are using, or the specific services that you are utilizing, You are getting charge for those as oppose to just an all inclusive.
Who decides when a patient needs to be moved from one level of care to the next in a CCRC?
In a CCRC, the decision as to what level of care a resident needs to be at is made by the facility staff, and there is typically a case manager or care manager that would be a big decision maker. It's not always set in stone, and certainly the residence's personal wishes and those of the family would be taken into account, but particularly in places where you're paying, depending on the level of care that you have, where it's basically fee for service, you're going to obviously want mom to stay in a lower level of care. For them, they would rather have you on a higher level of care because they get more per month from there, so there is a little bit of give and take, but ultimately I don't know of any facilities that allow the resident in their family to be the decision makers as far as the level of care.
Does Medicaid help pay for a continuing care retirement community?
In general, Medicaid doesn't cover any of the care that's provided in a CCRC. One exception to that is a situation where a person has been brought into a building and they have basically exhausted their assets, and in those situations if the person is in a skilled nursing facility or the nursing facility portion of the facility, then Medicaid will pick up the tab for that, assuming they are, there's no other assets.
