Many older adults need some form of support as they age — whether it’s help with daily tasks or more intensive medical care. There’s a spectrum of senior living options available to meet these needs, with independent living facilities, assisted living communities and nursing homes being the most familiar.
These options can address the needs for older adults who would prefer not to live alone, could use a little extra help or who require round-the-clock care.
But there’s another, lesser-known option designed to accommodate a senior’s evolving needs: continuing care retirement communities (CCRCs), a sort of one-stop-shop alternative to more conventional nursing homes and assisted living communities.
What Are Continuing Care Retirement Communities?
CCRCs, sometimes called life plan communities, are a senior living option that typically house independent living, assisted living and nursing care facilities on a single campus. This proximity to a range of options means that as residents age and their care needs change, they can easily transition to the next level.
CCRCs “are designed to provide comprehensive support for seniors and others through different retirement and care stages,” explains Bob Rees, chief sales officer with eHealth Inc., a health insurance broker and online resource provider headquartered in Santa Clara, California.
This progression of care — which sets CCRCs apart from other types of senior living arrangements — gives older adults the chance to develop friendships and communities that remain intact, no matter how their health needs change over time.
[READ: A Checklist for Choosing the Best CCRC Facility]
What Is the Purpose of a CCRC?
The big idea driving CCRCs is that they are designed to be the last move a senior needs to make to get all of their future health and well-being needs met.
As such, these communities provide on-site medical care and other benefits, notes Dr. Barbara Bawer, a clinical assistant professor at the Ohio State University Wexner Medical Center in Columbus.
CCRCs also come with easy access to a variety of amenities, such as:
— Outings
— Fitness classes
— Hobby and crafting sessions
— Opportunities to socialize peers, which can help reduce loneliness
[READ: 7 Signs It’s Time to Move to a Senior Living Facility]
What Levels of Care Do Continuing Care Retirement Communities Offer?
CCRCs offer a broad range of care levels for residents. Typically, these include:
— Level 1: Independent living. This is the first level most residents enter when moving to a CCRC, and it involves the least amount of care. Seniors gain access to all the amenities of the community and still live independently in their own apartment or condo.
— Level 2: Assisted living. This second level offers more support for activities of daily living as needed. Many seniors progress to this level when they need more help with certain tasks, such as cooking, bathing or medication management.
— Level 3: Skilled nursing care. Some seniors may need even more day-to-day support than assisted living can generally offer. They may move to a nursing-centric portion of the CCRC that provides more intensive support with daily tasks and round-the-clock nursing care.
— Memory care. For seniors experiencing cognitive decline or dementia, memory care is an added level of care provided by most CCRCs to support residents as their health needs change.
[READ What Are the Levels of Senior Living?]
Why Move to a CCRC Sooner Rather Than Later?
It’s difficult to pinpoint the best time to move to a CCRC, because your needs will be different from someone else your same age. New residents entering a CCRC may range in age from 65 to 95, with most residents being in their 80s.
However, you may get much more out of your stay in a CCRC if you opt to move in earlier. Moving into a CCRC while you’re younger, say between ages 55 and 65 while you’re still fully independent, possibly still working and don’t need day-to-day care, can provide specific benefits versus waiting until you’re in your 80s.
There are several reasons why this is the case, including:
— Property entry requirements
— Financial advantages
— Social benefits
Property entry requirements
CCRCs typically require that prospective residents undergo a health assessment, and they can deny an application if the applicant doesn’t meet the health requirements, says Jennifer Avila, executive director of Custom Home Care, a home services and home nursing agency in the Chicago area.
What’s more, because many CCRCs have long waiting lists, “you may be denied if your health condition has changed by the time an apartment is available,” she adds. “You should have a backup plan in mind.”
Financial advantages
Moving into a CCRC earlier also offers a tangible financial benefit because your monthly fee is typically locked in at the market rate when you first move in. This fee won’t change despite escalating care needs in future years.
The financial specifics vary by community, and your monthly rate will depend on:
— Where the facility is located
— What the buy-in rate is
— Other factors specific to your situation
However, as Rees notes, “a lot of seniors are anxious about how they will pay for long-term care when the need arises. It’s important to note that Medicare does not cover CCRCs, though it may cover skilled nursing care when that care is rendered in a CCRC, in some circumstances.”
Anything you can do now to prepare for rising health care costs in the future is a smart move.
Social benefits
Most CCRCs are big, highly social settings, says Dr. Susan D. Leonard, a geriatric medicine specialist at the UCLA Medical Center in Los Angeles.
“Those who like social activities will also get the benefits of a more lively and interactive setting,” she explains. “Once someone is better adjusted, the services can be customized over time to meet their needs at any point in their life.”
Plus, moving to a CCRC early can allow residents the opportunity to form relationships with other community members from the get-go.
“This helps seniors maintain an active life and limit the sense of isolation that often comes with retirement and aging,” she notes.
This approach can be especially helpful for seniors who may have recently lost a spouse. CCRCs can provide these individuals with a strong social network to help them get through the grief of losing a partner.
Timing Your Move to a CCRC
Timing the move depends on when you feel ready, Leonard says. But again, moving earlier allows you more time to settle in and find your way around before health conditions develop or worsen.
Compared with other types of senior living, CCRCs and independent living communities generally appeal to a younger population, as these individuals are typically more able to take care of themselves, which is a move-in requirement at such facilities.
With age, however, typically comes a need for more hands-on, day-to-day care and support, such as what an assisted living community might offer. According to the American Health Care Association/National Center for Assisted Living, more than half of residents in assisted living communities are age 85 and older.
But numerical age isn’t necessarily the best way to determine where someone should live. A 2023 study published in JAMA Internal Medicine found the average age at time of move-in to assisted living was 85, while the average age for nursing homes was 83. The average age for entry to independent living communities was 82.
The individual’s level of disability in the months leading up to the move-in were a more important factor in determining when the person would move and into which facility type, the study noted.
In short, how much care you need should dictate entry to a long-term care facility more than numerical age.
Research has also shown that moving into a facility can actually prolong your life. That’s because many of these communities, including many CCRCs, offer health and wellness programs, such as nutritional counseling and fitness programs, adds Dr. Steven Tam, a geriatrician with UCI Health and associate clinical professor at the UCI School of Medicine in Irvine, California. Taking advantage of those programs early can be beneficial for your overall well-being over the long term.
Ultimately, Tam says, “the timing of moving to a CCRC may be different for each individual.”
Costs and Contracts for CCRCs
While CCRCs can be a one-stop shop for virtually any senior care need, that care doesn’t come cheap. CCRCs almost always involve a significant, upfront financial commitment, called a buy-in (as mentioned above). In addition, residents pay a monthly fee that varies depending on location, services and level of care.
Buy-in fees typically range from the low six figures to more than $1 million at some swankier properties. These buy-ins do not include the monthly fees that CCRCs charge, but once a resident has paid the upfront fee, the monthly rates are locked in at a predetermined level — no matter the type of care required.
Locking in a low monthly fee over the course of many years can be a wise financial decision given the costs of skilled nursing facilities, which are only expected to rise. Genworth and CareScout’s 2024 Cost of Care Survey notes that skilled nursing in a private room costs $127,752 annually on average.
What to know about CCRC contracts
CCRC contract options depend on the services, amenities and living arrangements available. Some common types of contracts include:
— Type A, or life care contracts. These comprehensive contracts cover senior housing, residential services and amenities, and access to health care without a big increase in monthly payments. While these contracts often leave room for annual inflation-based increases, they also offer the least amount of financial volatility for seniors as their needs change. Type A contracts usually come with a higher initial buy-in fee and may require that the senior undergo a medical clearance and meet certain financial qualifications.
— Type B, or modified life care contracts. These plans cover only specified levels of care. As a result, they limit which aspects of the community a senior will be able to access unless they pay extra when services are rendered. There’s more financial risk to the resident with this type of contract, so the initial buy-in fee is often a little less than with a Type A contract.
— Type C, or fee-for-service contracts. This option usually costs less for the initial buy-in but doesn’t offer seniors the same financial security over the long term that a Type A contract can. As a senior moves from one level of care to the next, their monthly costs will increase with this type of contract.
— Type D, or rental contracts. This option offered by some CCRCs allows the senior to rent the residence month-to-month. There usually isn’t a large upfront buy-in with this approach. However, the monthly rate will be higher than in a Type A contract, and certain services may not be guaranteed.
— Type E, or equity or co-op agreements. These contracts allow the resident to purchase the residence instead of paying an upfront entry fee. They will also pay a monthly service fee. Additional services, such as health care, can be purchased as needed, usually at market rate or slightly below.
It’s critical to read any contract carefully before signing. Bawer says that some CCRC contracts can be complex and you may need to have a financial advisor or lawyer review them.
“You could have financial loss if the CCRC goes bankrupt for any reason,” she adds, because you don’t own your home within the CCRC.
Planning to Move to a CCRC
Before you choose to move into a CCRC, it’s important to research and ask questions.
“Visit and look around to find a place that would be comfortable for you or your loved one,” Leonard advises. “Some may allow a trial weekend or week stay.”
Questions you should consider asking include:
— Can you see yourself living here for the rest of your life?
— Do the residents seem like the type of people you’d enjoy living with or around?
— Can you envision being friends with them?
— What sorts of activities are available on the campus, and do they sound appealing?
— What sort of transportation options will you have if you’re no longer driving?
— Can the staff accommodate particular requests or personal preferences?
— Have there been any complaints lodged against the property or staff, and are inspection reports available?
— Are there any other outstanding issues or concerns regarding the property or how the business is being run?
— What types of housing are available? (i.e., apartments, townhouses, stand-alone houses, etc.)
— Is your entrance fee refundable if you decide you want to move out?
— What happens to your unit after you die?
— What health care services are available, and how does a resident move through the various levels of care?
— Are pets allowed?
— What’s included in the monthly fee, and what costs extra?
— What protocols and procedures are in place in case of emergency?
Avila adds that it’s important to check the quality of the health care facilities, such as skilled nursing and rehab, that are part of the CCRC. She recommends sitting in on one of the resident meetings or town hall meetings to see how management and residents interact and conduct business.
“Most communities have these meetings monthly,” she says, “and you will find out what the residents really think about the food and the amenities.”
Alternatives to CCRCs
CCRCs tend to be more expensive overall than more conventional nursing homes and assisted living communities, particularly because of the sometimes shockingly high buy-in investment required to enter the community.
If the buy-in price at a CCRC is too steep, there are some alternatives. Avila suggests checking out rental retirement or assisted living communities that don’t require a hefty upfront fee or long-term commitment.
“These are good options for seniors who may decide to relocate in the future to be near family, who don’t have the funds for a CCRC or who want to keep their nest egg invested,” she points out.
Some non-CCRC senior living properties also have more than one level of care available on-site. For example, Benchmark Senior Living at Waltham Crossings in Waltham, Massachusetts, offers independent living, assisted living and memory care services all under one roof.
At this property, residents are not required to pay a large buy-in fee but can access additional services and supports as their care needs change. The resident will have to pay a higher monthly rate as those services are added on — which is not typically the case with a CCRC.
Many facilities around the country offer similar tiered levels of care, so it’s worth taking a look at other communities near you to see if some offer a CCRC-like care-escalation option without the hefty upfront investment.
Risks to Understand Before Moving to a CCRC
While CCRCs can be a great option, prospective residents should be sure to fully understand the business model of a potential CCRC. Traditionally, CCRCs have been run as nonprofit organizations tied to religious or service groups, but some are run by for-profit corporations or investment groups.
This distinction is important because a for-profit CCRC is more likely to be sold at some point during your loved one’s tenure. If that happens, it could have implications for the resident and their contract, such as a negation of the contract or a forced renegotiation of the terms.
Some CCRCs also have clauses in their contracts regarding whether or not you can get your money back if you decide it’s not the right fit. Some will provide a full refund up to a few months after move-in; others have stricter limits. This is why it’s critical to read everything and ask questions before you sign on the dotted line. When it comes to this kind of financial commitment, buyer beware and do your homework.
Tam also recommends taking your time in making this big decision.
“Review and compare the different options as well as the requirements and services provided at the different facilities and care levels,” he advises. “Take the time to tour the community and meet people there and get their opinions of the community.”
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When?s the Right Time to Move Into a Continuing Care Retirement Community? originally appeared on usnews.com
Update 10/10/25: This story was previously published at an earlier date and has been updated with new information.
