I enjoy receiving comments and feedback from people who read our blog and use the myLifeSite tools; they offer so many valuable insights into the senior living decision process. I recently got an email from a myLifeSite reader who told me that she and her husband are fully committed to moving to a continuing care retirement community (CCRC, also called a life plan community) in the coming years, but she voiced a concern that I’ve also heard from others.

She explained that despite her confidence in their decision to relocate to a CCRC, where she knows that she and her husband will be provided the care they need for the duration of their lives, she still has one fear: “…that ‘they’ will move me or my husband into assisted living or skilled nursing care too soon. It is similar to the fear people have of being put in a ‘home’ too soon, say, by their kids.”

The email I received goes on to tell the story of a friend’s mother who lived in a CCRC in the southeast and was eventually moved to the community’s skilled nursing facility after a broken hip. Following this injury and rehab, the community did not believe the mother could safely return to her independent living residence, but the woman and her family disagreed and fought for her to be allowed to live on her own (with some assistance) once again.

This situation highlights an understandable worry about who ultimately makes the decision about a person’s ability to live independently—one that may be shared by others who are considering a CCRC—but let’s take a closer look to see if there’s a basis for this concern.

An innate desire for independence

From the toddler years on, humans have a natural and healthy desire to make their own choices and live autonomously. This craving for independence is at the heart of the reason a huge majority of seniors (about 90 percent, according to AARP data) plan to remain in their own home as they grow older.

>> Related: Is “Aging Independently” a Myth?

Many people have a misperception that moving to a CCRC or other retirement community is equated to sacrificing your independence. I would make the case that, for many, living in a CCRC actually allows seniors to remain independent for longer as a result of comprehensive wellness programs, social interactions, community involvement, and on-site supportive services. However, as recounted in the email I received from our reader, there are instances when a CCRC and a resident and/or their family may disagree about a person’s ability to live on their own.

The final say in determining care needs

Looking at the predominant trend within the CCRC industry, more and more communities say they want to help keep their residents in independent living for as long as possible. I reached out to a contact of mine who is a representative of a CCRC on the west coast, and she echoed this philosophy. “Within our community, we try to bring services to the resident (in-home care, medication management, etc.) for as long as it remains practical and safe for the resident because we know they will thrive in their own environment,” she explained.

Almost all CCRCs will tell you they sit down to consult with the resident, their family, and medical professionals, taking a holistic approach to determine a person’s care needs. In fact, most CCRC residency contracts have very similar language around this topic. The contracts will typically say something like, “When evaluating the resident’s need to be transferred to a higher level of care, the community will consult with the resident to the extent possible, along with the resident’s family, personal representative, and attending physician; however, the community’s decision is binding.”

Ultimately, it comes down to the health and safety of the resident and those around them. And in reality, that can mean a number of things such as physical safety—like being able to get out of an independent living residence if there was a fire—or memory care issues, which can make it unsafe to stay alone in their home or apartment.

In some cases, it may be that a CCRC resident or their family is experiencing some level of denial about the person’s ability to live on their own. A lawsuit around this issue made headlines a few years ago with the judge ultimately ruling in favor of the CCRC’s right to dictate that an elderly wheelchair-bound resident with dementia would be moved to a higher level of care despite her desire to remain in her independent living apartment.

From their subjective standpoint, it is completely understandable that people think (or perhaps are hoping) that a senior is still capable of living independently, but professionals who are looking at the situation more objectively may not agree. As exemplified by the mother who was recovering from the broken hip and wanted to return to her apartment, as well as the aforementioned lawsuit, there are instances where there is a difference of opinion, but ultimately, it is at the discretion of the community to determine if they believe a person can live alone safely.

>> Related: Who Decides if a CCRC Resident Needs a Higher Level of Care?

Easing concerns about progressive care

An industry contact of mine, Julie Davis, who is the marketing director at Concordia, a CCRC in Oklahoma City, recently put this conundrum into perspective and made a great point that may allay some people’s fear that they will be moved to a higher level of care “too soon.”

I mentioned to Julie that I’ve heard people ask, “What if there are people on the wait list to move in to independent living? Will they move me to a higher level of care just to get a new entry fee?” While I can understand that concern, Julie made an excellent point about the fallacy of this logic. “For us, it’s more expensive for the community to provide services for someone at a higher level of care, so it would not make good business sense to encourage a resident to move prematurely.”

Julie continued: “Additionally, there is a cost associated when a resident makes an internal move from one area to another. Refurbishing the apartment they are vacating requires time and money. I would prefer to have independent living units occupied along with a wait list than to move someone to a higher care level unnecessarily.”

Care tailored to residents’ needs

Each CCRC must factor in things like state regulatory requirements, their own residential contract policies, and even the resident’s financial resources when making decisions about how to provide a wide spectrum of care and services. As Julie explains, her community has an approach that strives to support the residents’ desire to thrive by providing an opportunity to safely reside in an independent living setting. However other CCRCs may require residents to permanently transfer to the community’s assisted living facilities to receive certain long-term care services.

But, while there may be occasions where there is disagreement between a resident/their family and a CCRC about what level of care is needed, communities use a variety of means to ensure that a person is provided with the appropriate degree of assistance on the continuum of care. From a holistic approach that includes the resident and their family as well as their medical team in making care and housing decisions

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