When you make the decision to move to a continuing care retirement community (CCRC or “life plan community”), you are taking the initiative to prepare for the unknowns of your future. You are putting a plan in place to ensure you will receive the care you need in the event of an unexpected injury or illness, while also benefitting from the social and wellness aspects that are so much a part of this lifestyle choice. But what happens when the CCRC’s administrators decide you need a higher level of care…even if you or your family disagrees?

This is a question I am receiving more frequently, and a recent article in The San Diego Union-Tribune highlights this issue. The article tells the story of Jan Brown, a resident of a CCRC in California. Ms. Brown had lived in the community’s independent living apartments since 2011, but then she broke her leg.

As a result of her injury, the community’s administrators wanted to move her to the on-site healthcare center, but Brown adamantly resisted. Fortunately for Ms. Brown, her physician was able to convince the CCRC not to move Brown into the care center, but the episode has soured her opinion of the community and its management. As a result, Ms. Brown has tried to get her entrance fee refunded so she can move, but she hasn’t been successful in fighting the terms of her CCRC contract.

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A costly decision

Based on my travels to many CCRCs and talking with hundreds of residents, my feeling is that situations like Ms. Brown’s are the exception and not the rule in the CCRC industry, and like most things, you tend to hear more about the bad than the good. (I should mention that similar situations also take place in other care settings, such as a free-standing assisted living community. The difference, however, is that the conversation is more about moving out of the community altogether, rather than to a higher care setting, when certain needs cannot be adequately or safely addressed.) However, most CCRCs do have polices that give the community’s administrators the power to decide if and when residents are placed into a higher level of care—such as assisted living, memory care, or skilled nursing care.

And as the newspaper article notes, this authority may be viewed as a conflict of interest because when a resident permanently moves from independent living to a higher level of care, it allows the community administrators to market the entry-level/independent living residence to a new customer.

As an aside, it is important to know that most contracts handle this situation differently depending on whether the transfer is deemed temporary or permanent. If temporary, then the residence will not be marketed to a new resident.

For these reasons, it’s important for consumers to inquire about how circumstances similar to Ms. Brown’s are handled before signing a CCRC contract. The language found in most disclosure statements is vague, saying something along the lines of, “We’ll make the best decision based on a discussion between the resident, staff, family, and doctor.” I have two concerns about this. First, since it is tucked away in the contract, do people really read it as closely as they should. Second, the vagueness of it can lead to problems later when the situation occurs.

Because of this, I recommend CCRC prospects ask if there is a more detailed policy outlining how resident transfers are handled and the types of situations that would cause a CCRC provider to require the resident to transfer. Although circumstances are rarely black and white, and transfer decisions can always be disputed, a more detailed understanding on the front end can help minimize misunderstandings later. Furthermore, it would be wise to make sure your closest family members are involved in this discussion up-front because many times, they are the ones who are brought in when the situation arises.

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Painting a negative picture of the CCRC industry

If you are reading this and represent a CCRC, it’s important to understand how articles like the one in The San Diego Union-Tribune hurt the image of the CCRC industry. This type of bad PR can overshadow the fact that, overall, CCRCs provide a happy, healthy lifestyle for their residents and offer them the peace of mind that comes with having ready access to a continuum of care services.

With more transparency about this and similar topics, it can help dispel CCRC prospects’ apprehensions about how care decisions are made and how any potential conflicts of interest are identified and hopefully eliminated.

Does this mean that management always succumbs to the will of the resident, keeping people in a setting that ultimately may prove unsafe for the resident or others? Of course not. That could be a lawsuit waiting to happen and even worse PR for the community and the industry as a whole. But this goes back to putting policies in writing and making them as clear as possible on the front end for the resident and their family.

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What’s best for all parties

When it comes to decisions about transferring a CCRC resident to a higher level of care, the community must weigh what their staff believes is best for the resident—and even the larger community—with what the resident and their family want. It can be a delicate line to walk.

The reality is that during a health crisis, which can necessitate such a move, emotions can run high, both for the resident and their family. It is understandable that the stress and upset of the situation can sometimes cloud loved ones’ judgment about what is truly the right type of care for the CCRC resident.

But by doing your due diligence upfront, you can get a better understanding of a community’s policies and how they are applied to various situations. A CCRC is its residents’ home, after all, and while policies are put into place to keep people safe and well-cared for, priority number one should be that all residents are treated fairly and with dignity, including taking their wishes about their own care into consideration.

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