Continuing care in a retirement community is a comprehensive system designed to meet a resident’s evolving health and housing needs across the entire aging process. This model establishes a full continuum of services, allowing individuals to access different levels of support as their requirements change. It represents a long-term approach to retirement living, integrating residential options with access to higher levels of care within a single organizational structure. The objective is to provide a smooth transition through various stages of care, removing the burden of finding new accommodations or providers later in life.
The Core Concept and Purpose of Continuing Care
The fundamental philosophy behind continuing care is “aging in place,” which provides security and stability for residents. By entering a continuing care agreement, residents guarantee access to a full spectrum of healthcare and personal support services, regardless of how their health status changes. This integrated system prevents the need for a disruptive relocation to an unfamiliar facility when a higher level of care becomes necessary.
This approach contrasts with traditional long-term care, which operates on an episodic, fee-for-service basis, requiring residents to move between different institutions. Continuing care pre-plans for future health needs, providing peace of mind to the resident and their family. The system ensures the individual can remain within a familiar community environment, maintaining established social connections even when transitioning to a medically intensive setting.
Continuing Care Retirement Communities: The Integrated Model
Continuing care is most often delivered through a specific residential format known as a Continuing Care Retirement Community (CCRC), or a Life Plan Community. These communities are structured as integrated campuses that consolidate various living arrangements and care facilities into one location. The physical layout includes separate areas dedicated to different levels of support, all managed under the same administration.
A CCRC campus features residential units like apartments, cottages, or villas for independent living, separate wings for assisted living, and a dedicated health center for skilled nursing and rehabilitation services. Residents begin their tenure in the independent living section but are guaranteed priority access to the higher levels of care on the campus. The transition between these levels keeps the resident within the same community, helping preserve their social network and routines.
Defining the Progressive Levels of Care
The continuing care model is defined by three progressive levels of service available to residents based on an ongoing health assessment.
Independent Living (IL)
The first stage, Independent Living (IL), is designed for active seniors who require minimal assistance with daily activities. Residents in IL typically reside in private homes or apartments and benefit from community amenities, social programs, housekeeping, and maintenance services.
Assisted Living (AL)
As health needs increase, residents transition to Assisted Living (AL), which provides support with Activities of Daily Living (ADLs). This includes help with tasks like bathing, dressing, grooming, and medication management. Assisted living ensures 24-hour staff availability to respond to personal needs, balancing support with the resident’s desire for autonomy.
Skilled Nursing Facility (SNF)
The highest level of service is the Skilled Nursing Facility (SNF) or long-term care unit, which provides 24-hour medical attention from licensed nurses and therapists. This setting is appropriate for residents requiring post-acute care, such as rehabilitation after a surgery or illness, or for those with chronic conditions needing clinical oversight. The SNF component ensures that complex medical needs can be addressed without the resident having to leave the community.
Understanding Continuing Care Contracts and Costs
The financial structure of continuing care involves two main components: a substantial one-time entrance fee and subsequent ongoing monthly fees. The entrance fee secures the resident’s living unit and guarantees the future availability and cost structure of long-term care services. The monthly fee covers housing, meals, utilities, amenities, and various residential services.
Continuing care contracts are categorized into three types, reflecting how the financial risk of future health care is allocated.
Type A (Life Care)
A Type A, or Life Care, contract features the highest entrance and monthly fees but provides unlimited long-term care at little to no increase in the monthly rate. This structure offers the greatest financial predictability, with the community absorbing most of the cost risk.
Type B (Modified)
A Type B, or Modified, contract has lower initial fees but includes a specified amount of long-term care at a discounted rate. After this specified amount is used, the resident pays a reduced daily rate.
Type C (Fee-for-Service)
The Type C, or Fee-for-Service contract, has the lowest entrance and monthly fees. However, the resident pays the full market rate for assisted living or skilled nursing care as it is used. These contract types allow prospective residents to choose a financial model that aligns with their risk tolerance and expectations for future health expenditures.