In talking with residents of continuing care retirement communities (CCRCs, or life plan communities) around the country, I often hear stories about how happy people are with their decision to move to the community. They talk about the benefits like wellness programs, the sense of community, amenities that make life easier and more enjoyable, and the peace of mind they have knowing that they have ready access to a continuum of care services if they should need them.

But on occasion, I also hear stories about how someone is disappointed with some aspect of their life in a CCRC. Just this past week, a resident shared a story with me about a friend who had moved to a CCRC and absolutely loved everything about it until they eventually needed to go into the community’s healthcare center. Then it became an entirely different experience—so much so that the friend ended up leaving the CCRC.

Keeping a promise

The care at a CCRC’s healthcare center, traditionally referred to as a “nursing home,” is provided by licensed practical nurses (LPNs), licensed vocational nurses (LVNs), as well as registered nurses (RNs). The quality of that care is often heavily tied to 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.

The healthcare centers at most CCRCs are top notch, and negative stories such as the one shared with me last week are rare. But when I do hear them, they typically revolve around issues with staffing expected they would receive when they chose to move to the CCRC in the first place.

In my view, this is inexcusable for a CCRC. People are making a big commitment when they decide to move to a CCRC—it’s a large financial and emotional investment. In exchange, residents put their trust in the community to provide the best care possible when needed. And they should be able to count on the CCRC upholding their end of that bargain.

>> Related: A Primer on CCRC Residency Contracts

How to research the CCRC healthcare center

I understand that many people don’t want to think about the healthcare center, much less see it, until they need it, even though many nursing homes today are a far cry from what people think about from the past. But the quality of care provided by the healthcare center really should be an important consideration that informs your CCRC decision. Afterall, it is one of the distinguishing features that sets CCRCs apart from other retirement communities.

But how can you know whether the quality of the healthcare center will be up to snuff before you move to a CCRC? Well, you will need to do some research to get an objective answer to that question. When evaluating the healthcare services at a CCRC, here are a few things to consider:

CMS rating

If the community is Medicare-certified (as opposed to private pay only), you can review their Center for Medicare and Medicaid Services (CMS) rating, which uses a five-star system to rate nursing homes. Go to, and then scroll down to the button that says “Quality, planning & compare tool.”

In addition to information on things like quality measures, safety inspections, and fines, the CMS rating includes staffing ratios, which reveal the average amount of time per day that residents in the healthcare center spend with an RN, as opposed to a nurse’s aide. For private pay communities—which are not Medicare-certified—CMS does not provide this type of information.

>> Related: How Does Nursing Home Billing Work?

Records of complaint

The long-term care ombudsman program for the state in which the retirement community is located is a valuable resource, though few people seem to know about. Long-term care ombudsmen are volunteer advocates for people living in nursing care facilities. They provide residents and their loved ones with a process to file formal complaints against a facility.

As mentioned above, complaints against CCRCs are uncommon, but the state’s long-term care ombudsman is a great source of information, allowing you to inquire about regulatory violations or complaints that have been lodged against the CCRC you are considering. You also can ask the community directly if they maintain a list of any complaints that have been filed against them. Their level of transparency on this topic can be telling.

Observe for yourself

Visit the healthcare center for the community or communities you are considering. Again, while I understand that many people prefer not to think about their potential future care needs, I strongly encourage prospective CCRC residents to take a first-hand look inside the healthcare center. You can learn a lot even with a quick tour.

Note whether the nursing staff seems happy and engaged and if the facility appears clean and free of unpleasant odors. Notice if the surroundings are comfortable and welcoming and if the residents seem well taken care of. Also observe if the patient rooms are private or only semi-private and whether they have adequate space for personal belongings.

Staff pride…and turnover

You can tell a lot about a place by the satisfaction and tenure of their employees. That’s why I suggest asking the CCRC’s management about staff tenure in their healthcare facility. In general, take notice of whether management is proud to talk about their healthcare services and the innovative things they are doing…or if they tend to avoid talking about the topic.

There’s no denying that working in nursing care is a sometimes-challenging, often low-paid job, which is why the average turnover rate for the industry hovers around 30 percent. A higher than average turnover rate might indicate an unhappy staff, which may be the result of poor management, and could translate into unsatisfactory care.

Ask others

If you know someone who has received care in the facility, or whose loved one has, ask about their first-hand experience. You’ll likely get an unbiased perspective on the healthcare services being provided within the CCRC.

Get what you paid for

Just as beauty is only skin deep, a CCRC can have the most luxurious buildings and high-end amenities, but if they cannot hire and retain the best nursing staff, the quality of care that residents receive in the healthcare facility will no doubt be impacted.

You invest a lot of money when you opt to move to a CCRC and pay the entry fee, but in exchange, you are securing your potential future care needs with that investment. That’s why it’s important to do your due diligence when it comes to researching the community’s healthcare center. You want to ensure you will get your money’s worth with the quality of care you receive should you ever need it.

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

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