There are countless benefits to living in a continuing care retirement community (CCRC, also called a life plan community)–from engaging and fun social opportunities to top-notch amenities and services–but one of the chief reasons for considering a move to a CCRC is the accessibility of healthcare services if and when you need them.

A CCRC is the only type of retirement community that by definition provides services spanning the continuum of care, meaning residents can live completely independently, utilize assisted living services, or receive skilled nursing care in a healthcare center, all offered right on the CCRC campus.

A CCRC’s healthcare center, traditionally known as a “nursing home,” utilizes licensed practical nurses (LPNs), licensed vocational nurses (LVNs), as well as registered nurses (RNs). The quality of care is often quite dependent on the average hours of care per day that a resident receives from an RN versus an LPN/LVN or nurse’s aide, as well as the quality of those staff members. A community can have the nicest buildings and amenities, but if they aren’t able to attract and retain the kindest, most knowledgeable and professional staff members, residents’ care and quality of life will inevitably be impacted.

>> Related: How Does Nursing Home Billing Work?

Doing your CCRC healthcare center research

So, when you are considering your CCRC options, how can you tell which ones have high-quality care provided at their healthcare center? It’s really no different than the research you might do for any other healthcare facility, such as a hospital or stand-alone nursing care center. Here are a few things to examine:

CMS ratings

If the CCRC’s healthcare facility is Medicare-certified (as opposed to private pay only), then be sure to check out their Center for Medicare and Medicaid Services (CMS) rating; they use a five-star system to rate nursing homes. Go to then scroll down to the button that says “Quality, planning & compare tool.” In addition to information on quality measures and safety inspections, the CMS rating includes staffing ratios, which reveal the average amount of time per day that residents spend with an RN as opposed to a nurse’s aide, and any penalties they’ve had to pay. For private pay communities—which are not Medicare-certified—CMS does not provide this type of information.

Records of complaint

The long-term care ombudsman program for the state in which the retirement community is located is a fantastic resource, which I find few people know about. Long-term care ombudsmen serve as volunteer advocates for people living in care facilities, offering residents and their loved ones a way to file a formal grievance against an area facility if needed. While in reality, complaints against CCRCs are pretty rare, your local ombudsman is a great resource allowing you to inquire about regulatory violations or complaints that have been lodged against the CCRC you are considering.

>> The Long-Term Care Ombudsmen Program: Advocating for Seniors


I know that some people prefer not to see the healthcare facility until they need care, and while I understand this mentality, I would strongly encourage prospective residents to consider visiting the healthcare center for the community they are considering. Is the nursing staff happy and engaged? Does the facility appear clean, tidy, and free of odors? Today’s nursing care centers often look nothing like they did just 10 or 15 years ago. So check to see if the space offers a comfortable, warm environment. Also, do the residents seem well taken care of? Are they clean and appropriately dressed? How are the residents’ rooms? Do they seem comfortable with adequate space for belongings? Are private accommodations available or only semi-private?

Ask management

It’s a significant “tell” if representatives of a CCRC are open to discussing their community’s healthcare services…or not. Are they proud of their healthcare services and do they want to show them off, or do they tend to avoid talking about the subject? Can they tell you what distinguishes their healthcare services and physical building design from their competition? Since high staff turnover can be indicative of intrinsic issues with the healthcare center, inquire about their turnover rate (the industry average is roughly 30 percent). It is also worth asking the community’s reps directly if they maintain a list of any complaints that have been filed; their transparency on this topic speaks volumes. Also consider what their plans are for the future. Are they adopting a green house or household model with person-centered care? Are they renovating the facility and doing away with nursing stations so that it feels less institutional?

Talk with current residents

The “locals” are always a fantastic resource for first-hand accounts of the care and services provided by a CCRC. If they themselves haven’t been cared for in the healthcare center, you can bet they know someone who has, so talking with residents can give you an unbiased perspective on the healthcare services being provided within the CCRC.

Understand your CCRC contract

It’s worth noting that CCRCs rarely provide guaranteed access to their healthcare center’s services. Typically, the contract language will read something like, “As a resident of the community, you are offered lifetime use of your residence and lifetime access to the healthcare center…You will be given priority access to the healthcare center over nonresidents.”

Most CCRC contracts will stipulate that if there is no availability in the on-site healthcare center at the time you require such care, then the CCRC will coordinate arrangements with an alternate facility until such time as space becomes available. You should inquire about the likelihood of this happening and what the alternative facility is. Payment for the cost of care in an alternate facility will depend on what type of residency contract you have.

>> Related: Explanation of CCRC Contracts

The importance of a quality healthcare center

Selecting a CCRC is a major decision–one that impacts your happiness, care, and wallet–so you want to be sure you have all of the facts when it comes to the quality of the community’s healthcare center, just in case you need their services someday. After all, availability of skilled nursing care is one of the big reasons people choose this particular senior living option!

To learn more about CCRCs in your area, visit our free online community search tool, which includes profiles on over 500 CCRCs across the county.

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