Levels of Care: CCRC Monthly Fee Adjustments for Couples

One of the major draws of a continuing care retirement community (CCRC, aka, a life plan community) is the on-site availability of a continuum of care services, should a resident need it. It’s a key feature that defines this type of senior living community.

You may have seen our recent video on how a CCRC handles a couple’s monthly service fee should one person require care services — be it assisted living, nursing care, or memory care — while the other person is able to remain in the couple’s independent living (IL) residence.

View the full 3-minute video here:

How monthly fee adjustments work

This is a question I have been asked a number of times over the years, and it is obviously an important topic to understand if you are considering a CCRC move. It could impact the community you choose, the type of CCRC contract you opt for, as well as your long-term finances.

>> Related: A Primer on CCRC Residency Contracts

For CCRC Type C contracts

If the couple has a fee-for-service contract, also called a Type C contract, and one person needs care services, the monthly rate for the person who is still living independently will drop from the double occupancy rate down to the single occupancy rate.

For the other person who is now receiving care services, they will now pay the full cost of care that is being received, which can vary depending on the level of care needed (e.g., assisted living versus skilled nursing care).

There is one additional detail that is important to understand regarding this issue as it relates to Type C contracts. It is based on whether a person is deemed a “temporary” or “permanent” resident of the healthcare center. If the resident is receiving rehab services in the healthcare center and is expected to return to the independent living residence, then this would be deemed a temporary situation. In this case, the couple will continue paying the double occupancy rate for the independent living unit, while the resident receiving care services will also pay the additional cost for that care. (Of course, if it is a short-term stay for medically-necessary nursing care, then Medicare may well cover some or all of the cost.)

>> Related: What’s the Difference Between Assisted Living and Nursing Care?

For CCRC Type A contracts

Now, let’s suppose a couple lives in a CCRC that offers the option for a lifecare contract, also referred to as a Type A contract. A true lifecare contract means that your monthly service fee is the same regardless of whether you are living in an independent living residence or receiving care services in the healthcare center.

For a couple in a lifecare community, no matter whether one resident or both require care in the healthcare center, they will continue to pay that same double-occupancy monthly rate that they were paying when they were in IL. Yet, unlike in the first example with the Type C contract, there is no additional cost for care services. It’s included in the double occupancy rate. Note: There may be some additional charges beyond the base monthly service fee, such as the cost of additional meals provided in the healthcare center.

>> Related: CCRCs Keep Couples Close in Sickness and Health

For CCRC Type B contracts

Type B residency contracts in a CCRC retirement community are essentially a blend of the previous two options, in the sense that if care is received in the healthcare center, there will be an additional cost, but the cost of such care is discounted in some way. This may come in the form of a stated discount rate or a stated number of days in the healthcare center at no additional cost.

In terms of how the cost adjustments work for couples, it will typically work much like what I described above for a Type C contract. The difference is that the additional cost for care will be discounted to some degree.

Care close to home

One big advantage to having access to on-site care services is that couples are able to remain close to each other (and close to friends within the community) even if one person requires a higher level of care than their partner. The ability to easily see one another can offer benefits to the mental and physical health of a couple that has spent their lives together.

Again, there can be nuances to how these CCRC contracts work in this scenario, depending on the community you choose and the contract language. But generally speaking, one of the two above scenarios is the standard for couples living in a CCRC who require differing levels of care.