A sustainable ongoing maintenance community ( CCRC ), sometimes known as the community of life care , is a type of retirement community in the US where the continuum needs aging care - from independent living, assisted living, and skilled care - all can be fulfilled in society. These different levels of shelters and treatments can be placed on different floors or wings from single tall buildings or in adjacent buildings physically, such as garden apartments, cottages, duplexes, low and middle buildings, or scattered in a campus setting. The emphasis of the CCRC model is to allow residents to avoid moving, except to another level of care within the community, if their needs change.
Video Continuing care retirement communities in the United States
Description
Typically, all life options (independent living, assisted life, and skilled nursing) from the Sustainable Care Pensions Community (CCRC) are on one campus. The average CCRC in the United States contains more than 330 units, consisting of 231 self-regulated or assembled living units, 34 assisted guest beds and 70 skilled bedding beds. On average, older residents in the United States will stay in coexisting facilities for more than three years, one-year assisted living facilities, and nine-month nursing care facilities (American Senior Housing Association, 2002).
In 2010, there were about 1,900 CCRCs in the United States, located in 48 states and the District of Columbia; Alaska and Wyoming do not have it. The top ten states with the largest number of CCRC are Pennsylvania, Ohio, California, Illinois, Florida, Texas, Kansas, Indiana, Iowa, and North Carolina - in that order.
Typically, the elderly move to the CCRC while still living independently, with little health risk or health care needs, and will remain until the end of life. Most CCRCs require health and financial security to be accepted. As advances in old age, and medical needs change, care levels and nursing services increase proportionately in response. In such a way, the needs of the elderly are consistently monitored and fulfilled, especially as the need becomes more intensive. If a larger illness or injury guarantees hospitalization (not available in CCRC), seniors may return to the CCRC's residence after recovery, and should receive appropriate rehabilitation care.
A sustainable retirement community appeals to the elderly who find themselves living in social isolation as they age, wanting to be immersed in a friendly environment with others of the same age and wanting to plan for their long-term health care needs.. Typically, various activities and facilities are provided for recreation and resources. However, CCRCs are expensive, and vary greatly in entry and recurrent costs.
Maps Continuing care retirement communities in the United States
Help and attention type
In most CCRCs there are three levels of care:
- independent living, where residents take care of themselves and enjoy the services of housekeeping and a variety of other services and facilities in the community. Some CCRCs have special programs, for example, in partnership with Masterpiece Living, to help residents with successful aging.
- assisted living, where citizens were provided with necessary assistance with daily chores such as bathing and dressing in residential units or in special facilities in the community.
- Treatment in a 24-hour nursing home, usually in dedicated dedicated care facilities.
In addition, many CCRCs have a fourth level of care support memory, in addition to assisted care and skilled care; some offer home-based care and communities, extending their reach to larger communities; and some provide lasting end-of-life care.
Contract type
Often, life care contracts are required, and the terms of the contract may also vary in terms of service. Contracts typically determine residential arrangements, housing services, personal care and health, and care guaranteed during their stay in the CCRC. These agreements also determine the current costs for people living in their communities and use their resources, conditions in which costs can be increased, and conditions in which people must move between levels of care. These contracts are designed to protect the rights of older occupants, but they also give the CCRC owners great influence over what long-term care benefits are received by older residents.
The American Senior Housing Association (ASHA) distinguishes three major types of contracts: Type A or life care (also known as extensive or all-inclusive); Type B or modified; and Type C or cost-for-service (ASHA, 2002). These contracts reflect differences in how CCRC costs for personal assistance and care, and the extent to which they guarantee the availability of these treatments at no additional cost to the population. In practice, CCRCs often offer contractual arrangements for residents representing a combination of these three types of contracts.
- Type A or Life Care Contracts - CCRC offerings that offer Type A Contracts or life guarantees guarantee their dwellings, housing services, and facilities along with personal assistance and care for the rest of their lives in return for the initial entry fee and monthly payment schedule. The CCRC usually offers this contract to the elderly who initially occupy their live or independent living units. The entrance fee may not be refundable or refunded partly depending on the length of stay of the guests. Under a life-care contract, residents who move to a nursing home or a nursing home from the CCRC continue to pay a monthly fee similar to what they have for their independent living accommodations. CCRC agrees to raise these costs just to offset normal operating cost increases. In this way, the CCRCs absorb the risks of increasing the cost of providing long-term health care to people with Type A contracts.
- Type B or Changed contract - often have lower monthly fees than Type A contracts, while including the same housing and residence as Type A contract. However, only some health care services included in the initial monthly fee. Under the modified contract, when the population moves to a higher level of care, the CCRC agrees to impose an independent living tariff for only a certain period of time, after which the occupant must pay the full tariff or discount per diem. For example, an occupant may receive 30, 60, or 90 days of assisted care or maintenance at no increased cost. After that, the population will pay the daily market rate or discounted daily rate, as determined by the CCRC, for all assisted care or necessary care and at risk of having to pay a higher fee for the required treatment.
- Type C or Fee-for-Service contract - often requires a lower entry fee than Type A or B or not at all. Under the Fee-for-Service contract, residents receive priority or acceptance guarantees to a higher level of care than the CCRC, but they are not eligible for discounted health services or live help services. Conversely, when entering a living facility assisted by the CCRC or a nursing home, they pay per diem regular market prices and are usually higher. Older residents who claim directly to living facilities assisted by CCRC or nursing homes will typically sign a cost-for-service contract. Under the Type C contract, the risk of high long-term care costs is on the population.
Some CCRCs offer a fourth type of contract, Type D or rental agreement , which generally does not require entry fees, but monthly fees for basic basic living facilities, with guaranteed access to CCRC services and health care. Type D contracts are basically pay-as-you-go, and the population assumes the risk of all expenses and increases in exchange for little or no entry fee.
Some CCRCs offer a equity model , in which the population owns resale units later.
Most CCRCs offer more than one type of contract with several options introduced in response to recent economic conditions. The choice of consumer contract types seems to favor the type of contract CCRC offers longer than the specific analysis. Although the CCRC entry fee (in Type A, B, and sometimes C contracts) represents a portion of a long-term care insurance premium (or prepayment of future expenses) paid by all non-rent residents after admission for health care at a given time by only a small subgroup, the "sweet spot" for entry fees seems to be determined not actuarially but by whether it resembles affordable local housing, that is, whether the cost of entry is in or below the local market value of the house. The entrance fee is sometimes marketed as a fee for "ordering your home". Most residents collect money for entrance fees by selling their homes. Ziegler reported in a March 2017 poll that Type A and C contracts are gaining in popularity and that entry fees have been and will increase.
A simple and crude way to compare contracts is to calculate the combined total entrance and monthly costs expected during the life of the expected population in the community, that is, a simple actuary model.
Rules and risks
In 2010, the US Government Accountability Office (GAO) reported to the US Senate Special Committee on Aging that the CCRC could benefit older Americans, but not without risk. Specific risks vary by CCRC and by country. The CCRC is primarily governed by the state not by the federal government. Countries generally license CCRC providers, monitor and monitor their financial condition, and have regulatory provisions designed to inform and protect consumers. California, Florida, Illinois, New York, Pennsylvania, Texas, and Wisconsin all have regulatory authorities to financially check CCRCs for assessing financial or survival conditions. The US Department of Health and Human Services provides the supervision of a nursing facility that is usually part of the CCRC, but this oversight focuses on the quality of care and safety of residents at the facility receiving payment under the Medicare and Medicaid program. If a community participates in Medicare and/or Medicaid (not just for personal payments), a skilled nursing unit will be assessed by the US government on health, staffing, and population appraisals.
Prospective residents, or their current caregivers, should inquire about licensing reports, prior checks and verified complaints to help inform their opinions about a particular CCRC. It is also advisable for prospective residents and their caregivers to openly discuss with the current population and receive their opinions on the CCRC concerned. Given the complexity of the CCRC, checklists or worksheets are very useful.
The list of accredited CCRCs (approximately 300 from 1,900) can be obtained from the Commission on Accreditation of Rehabilitation Facilities, which also provides resources to help evaluate the CCRC option.
This is important when considering a CCRC contract to have an elder lawyer review its terms and ensure its validity.
In its report in 2010, GAO identifies some of the risks that CCRC residents may encounter, including: loss of shelter and their surroundings when CCRC closure occurs; loss of part of the refundable entrance fee - which may amount to hundreds of thousands of dollars or more - if the CCRC is experiencing financial difficulties; face a larger-than-expected increase in monthly and other costs that could erode existing assets or make CCRCs unaffordable for them. The greatest risk to CCRC residents is that CCRCs may fail and do not provide the promised and paid care.
The CCRC's residents should know that management's ability to fill an empty unit directly affects the level of fees they have to pay and the ability of CCRC to operate on a sound and sustainable financial basis. One way citizens of the CCRC can develop confidence in information and decisions coming from their leadership is to have a representative of the population on the council that governs the CCRC. Countries that require citizens to be represented on the CCRC board include New Jersey, Maryland, the District of Columbia, California, Ohio, and Oregon, although representatives of residents in the last three states have a non-voting position.
Although rare, the closure and bankruptcy of the CCRC really happened, so did the class action suit. The class action lawsuit 2014, which alleges that the CCRC, Vi Senior Living, channeled the entry fee that a resident can return to his parent company without forming a reserve fund as required by state law, has been rejected by a US District Court judge, who decides that, CCRC may violate state law by not maintaining cash reserves, plaintiffs (CCRC residents) "do not have their civil claims" because they do not indicate that the loss has occurred or is imminent and that the state "has jurisdiction over any action to bring the CCRC facility under compliance "and may, if CCRC is found in violation," choose to condition, suspend, or revoke the license of the facility ".
Population demographics
The average age of CCRC participants has shown a steady increase over time, from 76 in the 1970s, to 78 in the 1980s, to 79 in the 1990s. In 2009, the average age of immigrants was about 80 years; in 2015 slightly above 81, continuing the trend of increasing over time. Also on average, Type C entrants are older than Type B, which is older than Type A. Given the increasing average age of entry, future CCRC outcome projections and demands/contracts for the CCRC should be re-evaluated.
At admission, the average life expectancy is 10 to 12 years, although the individual's life expectancy may vary with age of entry, sex, health, etc. The average citizen can expect to spend about 3/4 of their lifetime in CCRC in independent life, 1/8 in assisted life, and 1/8 in skilled nursing, which can again vary with age of entry, sex, health , etc.
By 2015, the average annual income of new residents ranges from a low of about $ 20,000 to a high of about $ 264,000, with a median of about $ 66,000. The average net worth of new residents ranges from a low of about $ 223,000 to a high of about $ 5.9 million, with a median of about $ 1,120,000. Although these figures are only from 46 CCRC, they indicate that some CCRCs appeal to the rich.
The average age of the CCRC population also increased over time, from about 80 in the 1980s to over 85 in the 2010s.
See also
References
Attribution
- The above article incorporates texts from the United States Government Accountability Office Report to the Chair, the Special Committee for Aging, the US Senate (June 2010) Older Americans: Community Maintenance Prevention The community can provide benefits, but not without risks. , which is in the public domain.
External links
- Resources to help you evaluate your ongoing pension care options - carf.org
- Consumer Guidelines for Understanding Financial Performance and Reporting in CCRCs (June 2016) pdf - carf.org
- The Beginners Beginners Guide - Caring.com
- A Guide to CCRC Financial Statements (January 2014) - California Advocate for Nursing Home Reform
- Continuing Retirement Maintenance Community Consumer Guide - California Advocate for Home Nursing Reform
- The Retired Community of Sustainable Care Can Provide Benefits, but Not Without Some Risks (June 2010) - The U.S. Government Accountability Office
- Sustainable Care - US Department of Health
Source of the article : Wikipedia
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