June 20, 2020

When Is The Right Time To Move Into a CCRC?

Friendship Village, Tempe, AZ

OK, let's start with an important definition: what is a CCRC? This is the abbreviation for a Continuing Care Retirement Community, a type of retirement environment that provides living and health care through three stages of aging needs: independent living, assisted living, and nursing home care. If you'd like an excellent overview of how this type of community operates, costs, and what types of questions to ask of those you may be considering, click this link.

While all three styles of living arrangements can be found separately, a CCRC makes the transition from one stage to the next easier and prearranged. All sorts of places offer independent and assisted living. But, finding space in a well-run nursing home is not an easy task. There could be a lengthy waiting list or other limitations. The costs are quite substantial and few insurance options exist.

A reader has decided this three-stage community is best for him and his wife. One of the toughest decisions to make is when to move into a CCRC. Knowing that Betty and I plan on such a move at some point,  he asked me to provide a few guidelines and the factors I will be considering when we decide it is the time to proceed.

Like many of the important decisions in life, deciding when to move into a CCRC is not a simple one to make. There are several factors to consider. Let's see if I can identify the ones that might be giving you pause.


* I want to stay in my own home. Moving to any type of retirement community is not in the cards. This is common for many of us. Home is often where we raised a family, made memories, or have a space that welcomes and comforts us. Unfortunately, it can also be dangerous if the house isn't altered to be made safer as we age. And, at some point, our needs for nursing or daily health needs cannot be safely met in our own home. 


* Those places are expensive. I can't afford such a choice. There is no argument: CCRCs are expensive. Most require a "buying" fee, an amount of money that allows you to move into the community. That charge guarantees your space in all levels of care when appropriate for you and helps pay to maintain the facilities. Usually in the range of $200-400,000, this initial charge is either refundable to your estate upon death, or a one time fee that you cannot recover.  If you choose the returnable option, this one time charge will be higher. 
Also, expect to pay a monthly rental fee of $2,500-$4,500. This fee normally does not change as you move from independent to assisted to nursing center living. It covers maintenance and repair of where you live, meals, and facility use. Think of it as what you would pay for an upscale apartment.

* I'm too young. Most CCRC's require at least one member of a couple to be over 55. Adult or grandchildren are not allowed to live with you permanently. If you are younger than 55 and aren't ready to live with only older folks, you are probably too young (either physically or mentally) for such a choice. Of course, if you have just turned 55. 

* I'm too old. This is the risk you might face if you wait too long to move to a CCRC. Most have requirements that you must be able to perform at least a few of the basic functions of daily care on your own. You can move directly into an assisted living environment, but not directly to a nursing care facility. Wait too long and you may be denied entry. For Betty and me, when I turn 80 is probably the time when such a move is best.

* What happens if it goes bankrupt or out of business after I move in? This risk is one that is faced by all of us who must depend on someone or some service. An insurance company can decide it can't continue to pay your monthly annuity. A nursing home may default on a loan or the owners decide to close the business. A CCRC can fail. It is up to you to perform basic due diligence before agreeing to sign on the dotted line. How many years have they been in business? Has ownership changed often, or recently? Why? Tour the facility, all of it, and ask questions of residents.

* What are CCRC's like? I don't want a warehouse for old people or something with constant activities and meetings. I can only speak with some authority about the one I know best: my parents lived in one for ten years, until their deaths. I visited them often, ate in the restaurants, buffets, and cafes, saw the facilities, and was able to experience, firsthand, the hands-on, caring quality of care from the nurses.

There was a mix of those who were active and those who preferred a quiet lifestyle. There were plenty of clubs and groups if one was so inclined. A nearby University held classes at the community center for lifetime learners. A well-stocked library, bank branch, space for a weekly church service, pool, fitness center, an on-site small grocery store, beauty salon, and barbershop were available.

Frequent shuttles to doctors' offices, pharmacies, or off-site restaurants and shopping made life easy for those without a car or family nearby. A full-service hospital was next door. Located in the suburb of a major city, the ability to go to concerts, museums, plays, and sporting events was there for those who wanted to partake.

OK, now to answer the reader's specific question about knowing when it is time to move into a CCRC, the answer depends:

  • On finding a place you can spend the rest of your life,
  • that you can afford, 
  • that includes the services and amenities that are important to you and,
  • that is financially stable and has a solid history

Do your homework, decide what will make you feel happy, safe, and taken care of, and then go for it.


36 comments:

  1. I wasn't really looking for a CCRC when I first started touring them. My local senior hall was sponsoring a series of trips where they'd take you to two CCRC in a day, eating a free lunch at one of the two and over the course of several years, I manged to visit most of CCRC in town. Then one of the places---a non-profit---announced they were building a new CCRC in the perfect location for me, and long story short, put down a deposit and picked out a 1,057 sq feet unit on their master plan. Being a non-profit the buy-in cost and the monthly fees are 1/3 lower than the for-profit places. Plus signing up before the building was even built we got all kinds of free stuff---$10,000 right off the top and $5,000 worth of upgrades in our units, etc. I never would have recognized what a great deal I'll be getting without touring all the other places. This non-profit has been in the health care business for over 100 years and has an excellent reputation. When I signed up I started following their Facebook page and monthly newsletter and I get more and more impressed by all they do for their employees and their residents. The pandemic has slowed down the building and projected move-in dates but no one could have predicted that.

    Bottom line, your advice to do your homework is spot on. There is a world of difference between these CCRC. I toured places with a buy-in fee of $5,000 down to mine with a $200,000 buy-in fee and you couldn't pay me to live in the $5,000 place.

    My advice is to do that homework long before you think you're ready to move into a CCRC because once you're ready you might not have the time or energy to do that homework. Pick out a couple you'd consider then follow them online until you are ready to take that next step.

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    1. Deciding where you want to move well before the need becomes critical is the most thing anyone can do. Waiting too long may mean certain facilities will not accept you, or the waiting list is too long. AS you detail, the quality of communities that appear to be similar can vary tremendously.

      You did your homework, found a great deal, and took care of this important task in a timely matter. Well done, Jean.

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  2. A good friend of mine moved into Friendship Village when she turned 78. She was in good health, and worked part time as a social worker.Still drove. Now she is 83 and no longer comfortable with driving. She retired.But she swims daily, attends water aerobics, is in a walking group,and uses their transportation to see all the plays and concerts in downtown Phoenix (well, pre-Covid.) She has a “happy hour” group she meets for a daily martini or a Kilt-lifter beer in their English pub style bar and grill every day. She does free “life coaching/counseling” for some of the other neighbors who go through various life situations and could use some support. I meet her for lunch (pre covid) and enjoy the entire complex.. .so well kept,caring and kind staff in dining rooms, and throughout. I think if I lose my spouse I might consider a move there in my future.. but for now, we’re planning to age in place as long as we can. My in laws had caregivers come to their home int heir final days.We all felt they would have spent their money better in a CCRC but they refused. Once you tour one of the good ones, Like Fr.Village , it is easy to think it may be a good choice,depending on situation.

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    1. The complex you mention is in the midst of a $60 million dollar overhaul and expansion. Once complete, it won't look like the place my parents lived for ten years!

      Like Jean's comment above, you suggest exploring all the possible activities and options before deciding. Some residents, like your friend, want to be very active for as long as possible. Others are content for a relaxed and secure lifestyle. Good CCRC's satisfy both approaches.

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  3. When is the right time to move into a (fill in the blank)? The crystal ball doesn't readily predict the future so that decision will be made by you while you're still capable or by someone else when you're no longer capable. Do you want to be proactive about your decisions? Most aged people I know fall into the first category - age in place in their own homes. Unfortunately, many of them overstay their ability to function in their own homes independently. Not only are they reluctant to move but they're reluctant to accept help in the home. Their health and their homes deteriorate and the downward trajectory is often rapid at that stage of life. I offer this based on my experience in health care and more recently my experience with my aged mom. She moved into an assisted living lodge a year ago. We're still tending to the house and property that she could no longer manage, something that was obvious to everyone but her. Something a staff member said when my mom went to the lodge rings in my head - most people come here too late. People should consider this type of living while they can still enjoy it. That, and the goal of being proactive, will hopefully guide my decisions to give up my home.

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    1. My parents moved to a CCRC earlier than they needed to, but wanted to ensure their sons wouldn't have the type of problems you describe. As these things happen, within two years my mom began to go blind from macular degeneration. Two years after that she was virtually without sight and began to suffer from other ailments. If they had waited a few years it is likely they would not have been permitted entry.

      In this situation I think it is wiser to err on the side of caution and move before you think you might want to.

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  4. Such an important topic and one that people often avoid until it's too late but the "when" is a tough decision. As I have often said: "You are fine until you're not and it seems to happen all at once." It is so hard to decide that you won't be able to do much longer what you've done all your life, and that you continue to do, even if it takes more effort. I think we are all pretty good at denial when it comes to our own abilities. For most people, as long as you can manage you do, until you can't.

    Both of my parents stayed in their own homes too long and both had a day of reckoning with a fall that put them in hospital. My father never left hospital and died there a few months after his fall and hip surgery. After her hospital stay (no broken bones) my mother had 6 weeks in a physical rehabilitation center to get her in good enough shape that a retirement residence would take her, and we had a 6 week scramble to find a place for her to go. Shortly after moving my mother into the retirement residence we've had to put her on a waiting list for a higher level of care than this residence is able to provide. While she in managing where she is now (just) we can see it won't be for long.

    Will I be able to make that decision for myself when the time comes? It's hard to say. As I sit here in our home of 35 years in good physical and mental health it's hard to visualize. Logically I can understand there's a time to move into something with more supports but it's so hard to imagine it being "me". I'll have to see how it goes and hope that I have the good sense to realize when, or should I say before, the time comes.

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    1. You summarize nicely the dilemma in your final paragraph: we are fine until we are not. It is hard to visualize ourselves being ready for a place like that. We know we are not invincible, but believe we will beat the odds.

      That is a risky gamble; your parent's stories confirm that.

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  5. Bob, thanks for posting on this topic. Having a plan to manage your lifestyle and healthcare needs as you enter the later stages of life is critical for everyone, but it is particularly important for someone like myself…..I am an only-child who has no children, so there is no family support group to fall back upon. After a lot of research over the last few years, my wife and I decided that the CCRC concept was probably the right answer for us as we get older. But we do recognize that actually making the commitment and moving into a CCRC is a difficult step to take. You literally are making a decision that “this will be the last place that I will ever live”; it is a life-long obligation. Like other living arrangements, CCRCs run the full spectrum from shabby to luxurious, from dreary to full of activity; so if you plan to move into a CCRC it is important that you find one that harmonizes with your specific needs….from services offered to activities available to meshing with your personal/cultural preferences.

    For people looking to research CCRCs or just trying to find out if the CCRC concept is right for them, I would recommend looking at a site created by Brad Breeding:

    https://www.mylifesite.net/

    The site is designed to provide comparison data on specific CCRCs as well as information on how CCRCs differ from traditional “Senior Living” facilities. While some of the more critical information on the site is hidden behind a “pay wall”, much of the comparison data and all of the general information is available for free. A person in the final stages of selecting a CCRC might find it useful to pay for “premium membership” for a month or two, but anyone can do basic research using the free part of the site. Brad’s blog postings can also be useful:

    https://www.mylifesite.net/blog/

    You certainly don’t want to move into a CCRC too early, if you are too young to ‘fit in’ with the other residents. But based on many comments that I saw while researching CCRCs, I want to re-state a comment from Mona McGinnis’ post where she quotes a CCRC staff member as saying “most people come here too late”. Many comments that I saw from CCRC residents contained words to the effect of “I wish I had come here years earlier”. There are real benefits and joys in being able to live without worrying about home maintenance, yard work, medical bills, housekeeping, etc. while you are still living an active life.

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    1. One of the fears, or areas of concern, for some is living in a place with nothing but older people. Occasionally my mom, before her decline, would say it was a little disconcerting to see so many neighbors or acquaintances die. Over time, though, she saw the benefit of being in a place where activities and facilities were designed for her age group.

      Also, it seems that many CCRCs allow for a more active lifestyle than might have been the case a decade or two ago. I get the sense that one can be as active or sedentary as one chooses. If one moves to such a community earlier rather than later and if driving a car is still an option, there is no reason a resident couldn't be in places with any age group they choose.

      In my case, having family nearby means we will continue to interact with younger people on a regular basis. The feeling of being cut off from others might be stronger if we were without relatives in the area.

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  6. I am not looking forward to making this decision in the future. My MIL resides in an assisted living complex now and is very satisfied. If not for her daughter she could never have found it on her own. No buy in, monthly fee only. She has zero financial risk and my wife to fall back on if something goes wrong and she needs to move.
    You stated most of my concerns.
    Buy in fees. If you decide to move out it could take months to get this fee back. Units can only be sold by the company. No listings with realtors. MIL has several neighbors who moved out of one of these extremely large units and there was quite a delay in getting their money back. If they go out of business good luck.
    Ownership changes hands frequently. The whole vibe of the place can change quickly.
    Staff to resident ratio. SIL works in management in this industry. This ratio is almost useless. Staff typically has very low pay rate. The ratio can literally degrade in a 24hr period. Lots of turnover.
    Taking all the risks into account I still may have to make this choice in the future. When I am least able to handle risk I may have to take the biggest risk in my life. Hoping for the best.



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    1. You have highlighted several important issues, Fred. The place we are likely to move to is owned locally, is non-profit, and has been stable for over 40 years. But, things happen and there is always a risk.

      I was very impressed with the standard of care in the nursing center that my mom receieved over the course of her last year. The people she (and I) interacted with were consistently pleasant and available. But, that isn't always the case and an important factor to do your homework on.

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  7. This is a great post Bob. Thanks for providing so much relevant information. For me, it will be critical to make the move before things become unmanageable at home. I'm 68, so lots of time to research this. I'm drawn to a warmer climate, but as a new widow, do I really want to make a major move to another part of the country where I don't really know anyone? I'm grateful for my financial security that will allow me to consider such options.

    My mom, who died last year, waited way too long, insisting on staying in her home. The stress it created on the siblings was unbearable at times. I feel so strongly about not being a burden to anyone. I'm all about being in control, as much as I can be. By planning ahead, I believe it allows you the freedom to make your own choices for how you wish to live your end years.

    The other thing I think about (and I know this will be controversial), I want to make sure that I live in a state where I have the option to end my life medical with assistance, should the circumstances warrant it. NY does not allow this at this time, but I'm hopeful that the honest, frank conversations can continue about this very important issue.

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    1. Addressing your last point first, yes, this is an issue that is controversial. With both religious and legal issues involved I wouldn't expect a mass movement in this direction. But, I tend to agree with you. To suffer needlessly when there is no hope of recovery, to drain financial resources for no purpose, and to be kept alive by machines is the antithesis of what a life is.

      The argument that suicide is a mortal sin is one made by most religious traditions, but for me doesn't pass the logical test: why? If one believes in some form of live after this one, then to delay the next step in an eternal journey is pointless. I can't believe that a supreme being wants a human to suffer needlessly. And, if there is no god, then whose business is it if I decide to end the suffering?

      Betty and I will do everything in our power to make sure our kids don't have to go through the stress that you mentioned. Speaking just for me, I would much rather err on the side of moving a few years too early, then even one year too late.

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    2. By the way, Carole, I just clicked over to your blog that I gather you stopped about a year ago when your husband died. I found what you had written during his decline and final days to be so well written and moving. For others, take some time to read what Carole wrote at oneoflifeslittlesurprises.blogspot.com

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    3. I had to remove my comment after reading your blog Carol. It was not an appropriate way of addressing the issue as you painted. Bob is right, what an amazing writer you are. And person Carol, amazing. The love oozes.
      I do think often about letting life go. I think how our society seems to do everything to keep people alive. My desire is to slip away- no non human interaction (which is totally OK with my religion). I think I worry the most about what you went through. You are a very rare person, who could see the love to the end. Some would say we should give others the chance to do so. I just don't know.

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    4. It is a difficult subject, that is for sure. I'm glad, Janette, you looked at Carole's blog.

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    5. Dear Bob, your questions/doubts are pondered by for-real born-again Christians. The difference is, the for-real remnant know that anytime there are questions/doubts, and even bristling, (oh yeah...) the for-real believer knows the Scripture isn't the problem - the Bible is right, always! and the person (me too, bigtime) is wrong. Is what it is.

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    6. My blog was incredibly therapeutic for me, and a great source of support. I just added one final (I think) entry to bring closure to the many wonderful folks who supported me during this journey. https://oneoflifeslittlesurprises.blogspot.com

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  8. Great article Bob. We currently live in an excellent CCRC and are very happy we moved here. Doing all your homework early is very important. The CCRC that we choose after doing our homework is close to where we used to live, so we could keep our same church, circles of friends, and local activities. There are a large number of activities available inside the community, and you can be as involved as you want to be. They have taken incredibly good care of us during this pandemic and kept us safe. No resident in independent living, assisted living, or skilled nursing has yet to get COVID-19.

    We only made one mistake which I would urge anyone strongly to avoid. We were aware of the community because we would occasionally drive by it, and several members of our church lived here. We used to say when we drove by that maybe we should move there when we were "older." Around the time my husband turned 70 we even took a tour and were impressed by what we saw. But it was still a "someday" thing that we filed at the back of our mind. Three years later my husband was diagnosed with Parkinson's Disease and a neurological psychologist who did his testing and concluded "Mild Cognitive Impairment" told us that we should start researching future living arrangements. So we did a thorough study of all the options in our area (one of our children lives near us) and concluded that the CCRC we had visited once earlier was where we wanted to move to. So we put a deposit down and got on the waiting list. We waited a year and a half for the type of unit that we wanted. By the time they called with an alternate unit which we could move into and wait there for the one we wanted, my husband had started to show signs of dementia. You can only enter most CCRC's if you are capable of living in independent living to start with. Since dementia disqualifies you, we were getting very concerned and took the temporary unit. We're still in that same unit 2 years later because my husband's dementia progressed quickly enough that moving him was not a good idea. And here we will stay. When the time comes that he needs to move to Memory Care or Assisted Living he will be a 5 minute walk away from me. And I can stay in our apartment. If anyone is wondering, the Parkinson's diagnosis before entry makes him ineligible for the "no additional cost" of moving to a higher level of care. But thankfully we have Long Term Care insurance.

    So what did we do wrong? I wish we had put a deposit down after our first visit. It was a fully refundable deposit, so we should have done our homework on where we really wanted to live right then. If we had, we would have been at the top of the waiting list to get the type of unit we wanted by the time he was diagnosed with Parkinson's. We know several residents here who had deposits at more than one community before they were ready to move and chose which one they wanted.

    Yes, we are some of the youngest residents, but age is just a number and the friends that we've made here are all still very active people.

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    1. A good cautionary tale. The idea of putting down a deposit to get on a waiting list, knowing you can always pass, or ask them to put you back at the bottom of the list is an important suggestion. I know my parents waited about 4 months, but that was almost 20 years ago. I'm sure every community of this type is dealing with a major surge due to Baby Boomers coming of age.

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  9. Interesting article. I will not be moving to such. I'll be downsizing and moving to what I suppose is an active apartment community and staying there as long as I can, or for a few years depending, then living with family (one kid and I have discussed her buying a large house with either a mother in law suite or a second mater and I would either do the down payment or do something else to buy in. But i realize this would not be comfortable for many, and I do have family in a position to do that and who actually want me around al the time. Obviously if and when the time comes that she feels to make another decision, then she will do that but meanwhile my income will cover basic and even nurse aid companion type needs and whatever other assistance is required although like everyone else not needing thta assistnce is the goal. At this pint in life I dont have LTC. I have looked at life insurance with a LTC convertible policy but I'm not at all sure Iam not better doing it other ways.

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    1. We are planning the same thing. My mom is in a continuing care community. It has been very good for her. The buy in ($250k + 1 Mil in assets+ services care -about $5k a month right now) is out of our reach. We plan on doing the same as Barb. Our daughter and son in law want to add to their house or buy something with us. We will probably do something in about five years with the idea that we will not use it full time for another five after that (my early 70's). We are all thinking a separate entrance apartment with a robot or human care giver when the time comes...

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    2. The multi-generational situation is one that is a viable option for families willing to make those arrangements. Living with someone who loves you and is family is probably always better than a "professional" situation. As long as everyone involved understands the commitments this would be the first choice for many. The prices and asset figures you cite Janette would make a first rate CCRC out of the reach of most of us.

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  10. What do people who can’t afford these types of things..CCRC...do? Many do not have that type of money or at least not for longer than a year or two at best.

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    1. I would assume that most retirees don't have the type of resources and cash flow these facilities require. The options would be aging in place and having in-home nursing care for as long as possible before a move into a nursing home. Barb and Janette mention moving in with family and sharing space as a possibility.

      There are assisted living apartment complexes that are operated just like any apartment. You would pay a security deposit and then a monthly rent. There would be no large upfront cost. These places do not generally have a nursing care facility on site, but often have made arrangements with one in the area. This is a good option to consider.

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    2. Mary. Im moving into an (absolutely beautiful) price controlled retirement community.during the tour as we chatted the director said that this was the last stop for msny and they were prepared to spend the last of their lives there unless or until full time care was required. I've made other arrangements but this place serves mesld and offers programs and is well tended and i could see staying at a place like this for the long haul.they help make accommodations for skilled care or simply assistance and from what I can see most of the residents have family and or supportive friends nearby.

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  11. Bob, interesting article. Have always wondered what happens if/when these places go belly-up. No guarantees in life, just another reason to stick close to the Lord Jesus. i can only pray that the Lord will let me die at home, because i want my the kids to inherit this place - both debt and drama free. There's something in the Old Testament about leaving an inheritance to one's grandchildren. But whatever the Lord plans...is what it is.

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    1. My preference would be to simply "wake up dead" one day. No pain, no drama, just a worn out body lets go. I imagine that happens more than we know since it is rarely reported.

      My nightmare is being trapped in a body that is kept alive by tubes, forced feeding and drugs, can't communicate, and can't react yet the mind is still functioning. No thanks.

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    2. Oh I agree with you, Bob 1000%
      I will find a way out before I ever live with tubes, drugs, force feeding. We absolutely should have a choice in our own ending of our life.

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  12. Hello all. My husband and I may move from Iowa to Ft Collins, CO to be nearer to family once I hit my 80's in 2 years. All these paragraphs hold special meaning to me as we ponder the decision. A good friend was a CCRC Administrator for a number of years in the 80's and 90's and said that too many people waited till the urgent need arrived and should have gotten on the waiting list earlier. It was then too long a wait OR their health prevented acceptance, or both!

    In the meantime I want to share a link from the NYTimes that gives (negative) insight into the newest trend of Assisted Living Centers, separate from CCRC's and yet another factor in the decision making of how long to wait before transitioning.

    Having had terrible experiences through both family and friends with For-Profit Nursing Homes, I will do whatever it takes to find acceptance into a Non-Profit Home, of whatever category!!! Once burnt, twice shy as they say.
    Jeannine in Iowa

    https://www.nytimes.com/2018/12/13/business/assisted-living-violations-dementia-alzheimers.html

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    1. Thanks for the article link. Alzheimer care is an unpleasant subject to think about but one too many of us may face. The problem in some assisted living centers is a serious one; the article is worth reading.

      Like you, I will do everything in my power to avoid those who are the business of elder care to turn a profit. There are too many motivations to cut corners to trust them. Of course, not all are shady or look for profit at the expense of people. But, I don't know how to determine in which ones I should place my trust.

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  13. I am a widow and have lived in a CCRC since I was 79. My husband had died 4 years before. I'm now 85 and am glad to be here. I think I came in at the right time. It is very strenuous to down size and sell a house as I had to do. If one is very old, I think it would almost be impossible unless one had kids to arrange for most of it. Lately I have noticed that several residents who have been hospitalized with severe heart attacks, have requested no treatment, and have died within a few days. If one is still lucid, that might be a reasonable thing to do.

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    1. Both my wife and I have DNR orders in our health directives. If either of us must be kept alive with heroic measures with no hope of recovery, we do not want that to occur. At one point my mom refused further treatment and requested hospice care. She was gone within 4 months.

      Downsizing and decluttering are major stumbling blocks for many of us. Our children have already told us they want very little of our stuff, but, it is still hard to begin tossing all those memories.

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  14. I want to echo Jean's comments above about starting to plan early and doing your homework. I began planning early because I am aging alone and know there is no one to take care of me if/when I can no longer manage on my own. I visited several local retirement communities with two friends, which was very helpful. Each of us had different concerns and asked different questions, which meant that we all learned more than we would have on our own. The CCRCs in my area typically have waiting lists, which means that you have to get yourself on the list a year or more before you want to move in. My trigger for actually making the move is when the hassles of maintaining my rural house alone become greater than the rewards of living in it.

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    1. Going to a CCRC with a friend or two and each asking questions about different areas of concern is an excellent idea.

      I gather a one year wait list is pretty standard. That is a little unsettling but really emphasizes the importance of starting a search well in advance of when you think you might be ready to move.

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