Like many healthy retirees, William and Myrtle Kingsbury of Moorestown, N.J., weren’t ready for senior citizen housing until they hit their mid-80s.
But they had known for a decade what they wanted: a spot in a continuing-care retirement community, or CCRC.
There, they would get condominium-style living plus a guarantee of receiving care if they could no longer manage on their own.
This promise of lifetime care is what draws residents to CCRCs, but such communities are vastly different from nursing homes.
Incoming residents must be able to live independently, and most lead active lives–swimming, doing volunteer work, traveling. Mary Harper, of Foulkeways at Gwynedd, even sailed singlehandedly around Newfoundland a few years ago at the age of 78–after high seas forced her to abandon her plans to cross the Atlantic.
But even such live wires will eventually cool a little, and many will eventually require either nursing care or help with daily tasks such as bathing or keeping track of medications. So all CCRC’s provide such care, usually–although not always–in on-site facilities.
To cater to their active residents, and to help residents stay active as long as possible, CCRCs provide amenities that may include swimming pools and biking trails, visiting speakers and entertainment, computer lessons and bus trips to theaters and casinos.
William Kingsbury, 87, a retired chemical engineer, and his wife Myrtle, 88, still lead busy lives. They drive to visit friends, and William Kingsbury swims three times a week.
But two years ago they moved to Cadbury, a CCRC in Cherry Hill, N.J., because it offered on-site care.
“We knew there would be medical care if we became ill, and if one of us was in the health center, the other could visit every day,” William Kingsbury said.
Besides being convenient, having such care at hand means “your children don’t have to worry,” he said. The Kingsburys have a son, Robert, who lives in Medford, Pa.
Melvina Oehlers, 86, tested the value of the lifetime care concept–and of joining a close-knit community of the kind that often forms in a CCRC–when she broke her foot shortly after moving to Cadbury two years ago with her cat, Samantha.
Oehlers was reassured when she was quickly moved to the health center and when another resident took over Samantha’s care for a month while Oehlers recuperated.
“I was new, and I didn’t know what would happen, but it was just fine,” she says.
Such reassurance doesn’t come cheaply. The typical Philadelphia-area CCRC charges an entrance fee of $35,000 to $200,000, depending on the size and features of the apartment, the number of occupants and whether part of the fee will be refundable under certain conditions.
There also are monthly charges that range from $1,000 to $3,500, and that usually cover one or more meals a day in a common dining room, housecleaning service and some social events. CCRCs differ in their policies about which services are included in the monthly fee and which carry an extra charge.
Residents don’t have equity in their apartments, whose ownership reverts to the community when they die. Instead, the fees effectively buy long-term care insurance, because the CCRC typically doesn’t levy an additional charge for either assisted care or nursing care services.
The CCRC idea was popularized by the Society of Friends (Quakers) in the Philadelphia area, beginning about 30 years ago.
Today there are 46 CCRCs, including seven sponsored by Friends, in Philadelphia and the seven surrounding counties.
Nationwide, there are more than 2,100, including 202 in Pennsylvania, according to the American Association of Homes and Services for the Aging.
And more are on the drawing board, to cater to the increasing numbers of elderly and well-off Americans, said Robert Greenwood of AAHSA.
Most CCRCs are individually owned by not-for-profit organizations. But a few for-profit enterprises are getting into the business, and both are beginning to create chains.
Among the for-profit operators is Marriott Corp., whose chain includes the Quadrangle in Haverford, Pa.
The range of ownership and locations means CCRCs can differ markedly, even while providing roughly similar services.
Some, like Medford Leas in Burlington County, Pa., feature biking and walking trails in semirural settings; others have close ties to universities and appeal to alumni; a few, like Logan Square East in Philadelphia, are center-city high-rises with easy access to cultural events.
Many are church-related. Mennonites, Methodists, Presbyterians and Episcopalians are among the denominations that have sponsored CCRCs, often in close relationship with a church of that denomination.
Newer communities also tend to have younger residents, said Kathryn Brod of the AAHSA. That’s partly because younger retirees want bigger living quarters, according to Harrison.
One similarity among CCRCs is that their residents are almost all white.
Robert E. Moose Sr., 84, a former federal probation officer, said he has been happy in his year at Cadbury, in part because the community is close to his church, St. Andrews United Methodist.
“I can get out of church and be here for the noon meal,” he says with a chuckle.
But he also said it’s been difficult to make friends because he’s the only black resident.
“I have a few friends here, but they’re not people I could borrow money from,” he says.
Now, he’s been enlisted by Friends Services for the Aging, an association of 20 Philadelphia area facilities including CCRCs, in an effort to attract a more diverse population into those homes.
Executive director Warren Witte said the organization’s members feel this is the right time for such an effort because of growing affluence in minority communities and because “traditional patterns of families taking care of senior members have become less doable” in those communities.
One inescapable feature of CCRCs that may trouble outsiders is residents are always dying. But it rarely worries residents, who are facing the loss of friends and spouses wherever they live, said Brod of the AAHSA.
In her days as a marketing director for a CCRC, she found staff members were sometimes upset by a resident’s death but residents rarely were.
“Dying isn’t a problem,” said Oehlers. “We all realize we will die here. You just accept it.”
A more serious issue, says Brod, is some residents don’t read the contract carefully and are surprised to find some activities may carry a charge the resident can’t afford.
However, being evicted for inability to pay isn’t a problem. Most CCRCs promise not to turn out any resident, even if he or she can’t pay. In return, however, they do careful financial screening to assure residents will be able to afford the costs, including fee increases, barring unforeseen circumstances.
Applicants who don’t meet the requirements may be turned down or offered a smaller unit than they had hoped for.
Of course, prospective residents might want to be assured of the financial soundness of the community they are considering. One way to do that is to seek out an accredited community. The Continuing Care Accreditation Commission, which is sponsored by the AAHSA, reviews the financial status of accredited communities every year.
Only 230 CCRCs, or about one in every 10, is accredited.
“Lack of accreditation doesn’t mean there is anything wrong with a community, nor does accreditation guarantee nothing will ever go wrong,” said Brod. “But it does give an indication the community has met the accrediting standards,” which cover governance, resident health and resident services, as well as finance.
