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It’s been seven years since my dad’s Father’s Day confession – when he told me privately he wanted to move to Cincinnati to be closer to his kids and grandkids but didn’t know how to convince Mom.  I took our conversation to heart and decided I would begin a personal campaign to help them to move closer to us and the rest of our family.

Over the last seven years they’ve experienced health issues, a scam, two robberies and changes in their neighborhood that made the case for moving even stronger.  The three of us have had very open and honest conversations about why it makes sense to move, and why they can’t bring themselves to give up their accumulated belongings, routines, and the familiarity of a home they’ve lived in for nearly 40 years.  We came very close to buying a home for them about five minutes away from ours, following the advice from my own blog, but that fell through when an inspection revealed some issues with the house that caused my mother to snap out of her ‘I think we can make this work’ mindset that almost carried us over the finish line.

At a recent family picnic, I watched my 85-year-old dad sit quietly while his family talked around him.  These periods of mentally ‘checking out’ are happening more often, and I saw my mother’s concerned look along with her quick scan of the room to see if anyone else had noticed.  Having them closer would make it much easier to help and protect them, but after seven years of trying, I have come to accept they will likely follow the same path so many people do – they will make a change only when circumstances force them.

So, I’ve shifted my thinking another direction.  What do we do when a critical illness or death forces them to make a change?  Based on my research and observations of our client experiences over the last 30+ years, an eventual move to a continuing care retirement community (CCRC) seems to be the best solution.

A CCRC allows residents to live independently as long as possible, then as their health status changes they can shift to higher levels of care and assistance within the same living area, reducing the stress of another move to an unfamiliar place.  There are a variety of different CCRCs, from all-inclusive plans that require a significant entry fee with on-going mortgage-sized monthly fees, to those that require small up-front payments and monthly fees depending on the level of care you require – sometimes referred to as rental plans.  The all-inclusive CCRCs are fundamentally an insurance product, as their contracts provide housing and nursing needs for the rest of your life once you’ve been accepted into the community and met their initial financial requirements.

There are many factors to consider when choosing a CCRC, but the most important is the financial strength of the organization behind the community, since you are relying on them to keep their promise of lifelong care after you become a resident.  Most all-inclusive communities are non-profits that were originally created and funded by religious organizations, and some still have foundations in place to help support them and subsidize the cost of residents who can no longer pay their full monthly fees.  In the greater Cincinnati area these communities include Llanfair, Twin Lakes and Twin Towers, Otterbein, and the Marjorie P. Lee Community.

Once you’re comfortable with the financial strength of the communities you’re considering, there are other questions to answer before helping someone choose the right community for them:

  • Who lives in the community, and does it fit you? My parents are very active and seem younger than their years, so a community primarily made up of physically-challenged residents might make them uncomfortable.  Many CCRCs have a variety of activities and events that will allow them to participate in the community and stay connected, and this is something that would be very important to them as well.
  • What is the occupancy rate of the community? Along with the initial review of financial strength, it’s important to gauge the on-going health of the CCRC.  An occupancy rate of 85% or higher is important to sustain the community’s ability to provide promised services.
  • How much is the entrance fee and is it refundable? About half of the CCRCs have a refundable entrance fee that goes to the resident if they move or to their estate if they die, but only if they were still paying the full monthly assessment.  Some reduce the refund based on the number of years of occupancy.  Be sure you understand the conditions.
  • How much are the monthly fees and what do they cover? Some CCRCs cover only housing and healthcare, while others include meals and all other ancillary services.  Ask about the history of rate increases and what increases are expected in the future.
  • Is your spouse or partner guaranteed the ability to stay within the CCRC if they require another level of care? Most CCRCs allow spouses to live separately within the community if one can live independently and the other needs nursing care, for example.  Of course, the total monthly fees will be higher with separate living arrangements, but at least they will still be close to one another.
  • How is the nursing home within the community rated by Medicare? If the CCRC looks like a place you would want your loved one to live, make sure the nursing home they may need to transfer to is also highly rated and able to provide excellent care if that becomes their need.  You can search for nursing home ratings by location or name on the gov website.    

Plan B is just getting started.  Hopefully I’ll have my parents closer to the rest of their family before the 10th anniversary of my Father’s Day conversation, and before a real medical crisis forces us to make quick decisions under emotional duress.