The Ultimate Guide to Continuing Care Communities

Are you looking into long-term continuing care communities for you or your parents and feeling a bit daunted by the process?

We get it. It’s so important to choose the right care facility that offers a supportive and stimulating environment and meets the specific situation and needs of the aging person. We found a helpful and comprehensive evaluation aid, courtesy of Ohio State University, and had to share!

4 Main Types of Continuing Care Facilities

Continuing care facilities include the following options:

1. Independent living for residents who can function without assistance. These apartment or condo-style units provide additional services such as meals, basic housekeeping and laundry.

2. Assisted living for residents who have limited mobility and need assistance with bathing, dressing eating or taking medications.

3. Skilled Care (also referred to as nursing or health care) is typically for individuals with chronic debilitating conditions and very limited mobility and who need skilled nursing.

4. Special Care centers feature care for individuals with Alzheimer’s, dementia or other memory conditions.

Although you or  your loved one may be in excellent health today you will want to evaluate continuing care communities as if you or they were unable to drive or handle financial matters since you may have difficulty with these things at some point in the future and those difficulties could disqualify you for entry.

And consider your options if there is a family history of chronic or debilitating diseases such as Parkinson’s, stroke or Alzheimer’s. Most continuing care centers require residents to meet certain health and financial entry requirements, so you may wish to move in while still in relatively good health.

Related: How to Avoid Caregiver Burnout While Supporting Your Aging Parents

Questions to Ask and Answer in Your Search for a Continuing Care Community

From care level to on-site amenities, there are several questions you’ll want to ask as you search for the best fit facility for you or your loved one.

What care level(s) do they  offer?

  1. What care levels does the facility have and are there financial, physical or mental requirements for entry?
  2. Is there an assessment process for entry and how and by whom is it conducted?
  3. What conditions might disqualify a person for residence in independent or assisted living?

What residence plans exist and what are their financial implications?

  1. Entrance fee: How much is returned if a person dies or decides to leave the facility?
  2. Endowment or return capital options: How much will survivors receive? How much will the resident receive if he or she decides to leave the facility?
  3. What are the entry and monthly fees? What have been the average increase in monthly fees over the past five years?
  4. What are the rental fees? What is the average increase over the past five years?
  5. What are the additional costs for a second person?
  6. What basic services are provided with monthly fees?
  7. Do residents own or rent their unit and what are the tax implications?
  8. Do monthly and/or entrance fees include health and medical care and what portion of each is tax deductible?
  9. Are assisted living and nursing care facilities available to non-residents and do residents have preference over non-residents when needed?
  10. Is there a waiting period after admission to the continuing care center before entry fee residents have access to nursing care without a financial penalty?
  11. Does the facility have a trial period or satisfaction guarantee whereby new residents can leave without financial penalty?
  12. To what extend does duplication of coverage exist for residents with long term care insurance?

Is the facility a “not-for-profit” or a “for profit” corporation?

  1. Who owns the facility and how long has it been held by the current owner?
  2. How is the facility managed (professional management company or local employees) and how long has the current management been in place?
  3. If ownership/management changes occur, how will existing residents be affected by potential policy changes? Would grandfather clauses exist?
  4. What is the current financial condition and for the past five years? (Ask for a copy of the financial statement).
  5. What types of accreditation or licensing does the facility and care levels at the facility hold, i.e., Continuous Care Accreditation Committee, Commission on Accreditation of Rehabilitation Facilities, Joint Commission on Accreditation of Healthcare Organizations, others.
  6. How are residents involved in decision making and information sharing?
  7. For “non-profits” is here a local Board of Directors?

What type of living units are available?

  1. What is the size and layout of the units? (Persons sensitive to noise might want to select a top floor unit).
  2. To what extent do units, especially bathrooms, accommodate wheelchairs, walkers and mobility devices?
  3. What utilities are include in monthly fees? Are there cable, internet and telephone hookups?
  4. Do units have kitchens with refrigerators, sinks and ranges?
  5. To what extent can residents decorate and furnish units (at all care levels)?
  6. What types of security and emergency notification systems exist for residents?
  7. What is covered by facility insurance and what coverage does the individual resident need?
  8. Can assisted living or nursing care units be shared with a spouse or sibling?
  9. What is the policy on overnight guests? Are guest rooms available? How many rooms? What is the cost?
  10. Is additional storage space available and at what cost?
  11. Are pets allowed? Restrictions?

What are the meal plans, cost of the plans and are they optional?

  1. How many daily meals are included with each plan and level of care?
  2. What is the monthly fee for the meal package? Is there credit for meals not eaten?
  3. How are special diets accommodated?
  4. Is there a registered dietitian on staff? Full or part time?
  5. What are the hours for meal service? Are snacks available throughout the day?
  6. If residents are ill, is a tray service available? Additional charges for tray service?
  7. Are guests permitted in the dining room?
  8. Ask to see a sample menu for the week.

What types of on-site services are provided for resident’ convenience and what costs are associated with each?

  1. Is laundry service provided? How often? Types? Costs? Dry cleaning?
  2. Is housecleaning provided? How often?
  3. Is there a bank on the premises for residents? Name bank(s) and hours?
  4. Are there beauty/barber shops on site?
  5. Is there a gift shop or “store” and is there a snack bar/luncheonette on premises?
  6. Is there a health clinic for general medical care on site? Who staffs it and what type of training have they had? What are the hours? What is the schedule for doctors to see patients? How many and what types of doctors are there (specialists, podiatrists, dentists, etc.)
  7. Is there a pharmacy associated with the facility that delivers prescriptions?
  8. What type of transportation is provided for shopping, recreational activities, medical/dental appointments, etc.? Is there a cost for this transportation? Distance limit? Does the facility own a wheelchair van?
  9. How are special transportation needs handled, such as to airport, concerts, etc.?
  10. Does the facility have a concierge to help with travel, tickets, activities, etc.?
  11. What parking and garage facilities exist? Are there associated fees?
  12. Ask for a printed schedule of fees for extra services.

What social, recreational and spiritual programs does the facility have?

  1. Does the facility have a full time activities directory? For the entire facility? Separate activity directors for assisted living, nursing or special care units?
  2. What types of activities are offered on-site and off-site? Ask for a printed sample of activities schedules.
  3. How often and what type of activities are planned on site for residents who have difficulty leaving the facility both in independent living and other care levels?
  4. What types of facilities/instruction/assistance exist for special interest activities such as woodworking, computer interests, fitness, gardening or crafts?
  5. Are religious services held on site? What denominations? How often? Is transportation to off- site services provided? What denominations?
  6. Do volunteer or community based programs for residents exist, e.g. bringing in or interaction with pets or children, informational programs, etc.?

What type of medical care is provided in the assisted living and skilled nursing areas?

  1. Is the center affiliated with a specific hospital? Which one?
  2. How many doctors and types of doctors (i.e. medical, specialists, podiatrists, dentists) are on staff and are they certified in geriatric medicine?
  3. What is the number of RNs on duty on any given shift?
  4. What is the number of RNs on duty on any given shift?
  5. What is the ratio of aides to patients in assisted living, nursing care and Alzheimer’s or special care units? What type of training and certification is required for aides?
  6. How often are residents in assisted living or nursing care visited by doctors on a regular basis and evaluated? To what extent are family members involved?
  7. Is there a daily plan for care of residents and how often is it checked and re-evaluated?
  8. What facilities are on site for rehabilitation? Are there physical, occupational or speech therapists on staff? Full or part time?
  9. Is the facility approved for Medicare and Medicaid patients?
  10. Does the facility have an ombudsman to handle concerns?
  11. See to check ratings of specific skilled nursing facilities.

What happens when a change in health status occurs, mentally or physically, for you or your spouse that will require an enhanced level of care, short of long term?

  1. How are costs, such as monthly fees affected for both the person in good health and he incapacitated person?
  2. What are the implications for fees for care of incapacitated person including meals, personal laundry (is laundry done separately?), nursing care or assistance from aides (both independent unit and nursing care), care supplies such as bandages or incontinence products, medications (can resident’s prescription insurance program be used or must site pharmacy supplier be used? What are the cost implications?), transportation for medical care, such as tests, visits to specialists or dentists.
  3. Who makes the decision about need for additional care or transfer to additional care level and how is the decision made? Who makes the final decision and how is the situation resolved if the family disagrees with the recommendations of facility?
  4. Is there a waiting period after admission to the continuing care center before entry fee residents have access to nursing care without a financial penalty?
  5. How are emergency situations handled? What is the protocol?
  6. To what extent does Medicare, Medicaid or long term care insurance cover costs of additional care expenses?
  7. What type of assistance with daily living activities is provided for residents in independent living on a short or long term basis?
  8. Is private duty assistance (hourly or live-in) at expense of resident permitted? If yes, must private duty assistance be with a specific service with which the facility contracts?

During a Site Visit

Evaluate the general/overall environment and location of the facility. When visiting a facility, do so formally with facility representatives but also return and do so informally on your own.

  1. Note the people living at the facility and types of people attracted to the community.
  2. Talk to residents informally. What do they like and dislike about living in the facility? What is the quality of health care, meal offerings, variety and frequency of social and cultural activities and timeliness of maintenance are possible areas of inquiry.
  3. Is the general environment positive and upbeat?
  4. Note general maintenance indoors and outdoors. Are areas attractive, clean and free of odors?
  5. Are there general areas indoors and outdoors for residents to socialize and interact with each other?
  6. Note how residents interact with each other and with staff.
  7. Note if staff dress and interactions with each other and residents is in a professional manor.
  8. Is the facility convenient to bus lines, shopping, entertainment, medical appointments?
  9. Note security provisions.
  10. Ask for a sample contract and resident handbook.

Additional Resources

Most continuing care centers have a website you can visit to get basic information about them. Here are some more useful references that may be helpful to you in your decision making process:

And here’s a nifty infographic from that helps explain senior living (or senior care) and how they overlap.


Plan for the Future with Clarity

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