Navigating the Future: Our Checklist for Choosing a Continuing Care Retirement Community By Kathleen Rehl

By Kathleen M. Rehl, Ph.D., CFP®

“Where do you want to live when we’re old?” I asked my husband two years ago. That was before my 75th birthday. Charlie replied, “Our grandkids already think we’re old!”

Conversations followed over the coming days and months, resulting in our plans to move into a continuing care retirement community (CCC). 

Because many friends and extended family have asked us how we made this decision, I wrote this article to share with them, including a practical checklist. I hope you’ll find our saga interesting also.

We’ve Been Caregivers

I was my late husband’s caregiver in home hospice during the final months of his life. Three decades ago, I cared for Grandpa while he lived with our family for two years before passing in his sleep at home. Growing up in a multi-generational family, we cared for our grandparents. Similarly, Charlie cared for his late wife for five years before her death and his ailing mother for almost the same length of time.

My Firsthand Experience with CCRCs 

When Dad died, my then 82-year-old mother realized she was terribly lonely and couldn’t manage her home alone. When she flew 1,200 miles to visit me soon afterward in Florida, Mom said she wanted to live near me but be on her own. Bingo. The door opened to discussing the benefits of a CCRC. After tours of three possibilities and our evaluations, she selected an affordable facility with a short waiting list a few miles from my place. I helped Mom sell her house, and she moved nearby to the CCRC independent apartment, which became available sooner than expected. She enjoyed two great years in her cozy little apartment before she passed. Mom made new friends, participated in group activities, enjoyed the amenities, and frequently did off-campus things with my husband and me. During her final few months, she needed skilled nursing care and assisted living after a fall shattered her femur. Having care coordinated at her CCRC campus was a lifesaver for me since my husband was simultaneously in home hospice.

Time to Plan for Our Future Aging and Care

I’m a planner. Literally. That’s because I’m a semi-retired certified financial planner™. I understand the benefits of CCRCs, having helped many clients transition to these facilities over the years.

In our mid-70s, Charlie and I believed we should make proactive decisions about our future, focused on securing a comfortable and supportive environment for our 80s and beyond. Heartfelt discussions, research, and thoughtful consideration of various factors marked our journey. In this article, I’ll outline our particular concerns and provide a checklist to help you select a CCRC if you decide a life plan community fits your future living arrangements.

Here’s a bit more information about our situation and our preferences:

• We’ve experienced widowhood. Charlie and I connected online as widowed persons more than a dozen years ago. Seven years later, we married, officially blending our family of four adult children and their spouses, plus two grandkids. My husband and I spend winters at our St. Petersburg, FL condo, which we own as joint tenants with right of survivorship. Summertime finds us living in a large house Charlie has owned for 37 years in historic Saratoga Springs, New York. Ten years ago, we rebuilt and expanded that house to better accommodate many summer guests and families we host. Charlie loves caring for our expansive gardens, flower beds, and lawns and doing all home maintenance. However, he won’t be able to do all this work in the future.
• We’re healthy now, but circumstances can change. Although Charlie has mild arthritis and I have early osteoporosis, we are otherwise quite healthy. Our lifestyle includes daily exercise, excellent nutrition, staying connected with family and friends, and leading purposeful lives. We love Florida’s mild winters, where we walk in the sunshine rather than shovel New York snow. Realizing many folks spend up to one-third of all lifetime healthcare expenditures in the final few years of life, we want to be in a place providing excellent care as needed beyond independent living—assisted living, skilled nursing, and memory care. Also worth noting is that I bought good long-term care insurance 20 years ago. Charlie doesn’t have this coverage, but his financial assets will pay for future healthcare expenses.
• I may outlive Charlie. The longevity line in my family runs further than Charlie’s line. My mother, grandmother, great-aunt, and great-grandmother outlived their husbands. Even though I’m a year older than Charlie, statistical trends say most widows who remarry also survive their new spouse. Suppose I become a surviving spouse again in the distant future. In that case, I expect to follow my Mom’s approach to living independently rather than with a relative. I prefer to be part of a supportive community in the future rather than dependent on someone.
• Climate change impacts our choices. In Florida, we live a few blocks from Tampa Bay and several miles from the Gulf of Mexico. Tropical storms and hurricanes are not infrequent, bringing rising water surges. Projections for the next decade indicate sea waters will continue to rise, even without the storms. Therefore, we didn’t want a CCRC located close to the coast.
• Based on much research, we only considered nonprofit CCRC life plan communities with a positive track record of at least five years. We opted out of looking at for-profit and brand-new facilities. 
• We prioritized finding a CCRC affiliated with a university. We wanted a comprehensive approach to research about aging, intellectually stimulating classes, events, and programs. Understandably, this lifelong learning focus sometimes limited our options, but this component was essential for us. We also wanted a facility allowing us to use our skills and talents in a volunteer capacity.
• We’ll sell our Florida condominium. We purchased the condo seven years ago, at the start of a growth spurt in St. Petersburg. Since then, it’s doubled in value. Our increased equity will cover the CCRC entrance fee when we sell that residence.
• Charlie’s New York house will go to his daughter. In a few years, he will give her this home. She wants to move back to Saratoga to live where she grew up. 
• We will not create a horror story like a couple we know. These acquaintances and their adult offspring are in disarray. The parents refuse to move from the home they’ve lived in for almost 50 years. The husband has been diagnosed with Alzheimer’s, diabetes, and other health issues. He won’t give up his car keys even after a couple of fender benders. The wife can no longer climb stairs to the bedroom and full bathroom or the basement laundry room in their three-story home. She has fallen multiple times, breaking bones. Their two adult adult children live on the opposite side of the country. They must travel frequently to arrange their parents’ personal and home health care. They have to juggle doctor and emergency hospital visits, too. It’s a huge responsibility, disrupting their personal and professional lives.

OUR CCRC CHECKLIST

Using a checklist like this may be helpful as you think about moving to a CCRC Life Plan Community.

• Describe Your Situation and Special Considerations in Writing

Just as I outlined several of our essential concerns above, it may help you to write your list of important factors impacting your decisions. This step will help narrow your options and make decision-making more manageable. It’s essential to outline what you want in a CCRC. Consider factors such as location, the level of care needed, amenities, and social activities.

• Start Early

Starting your search early is crucial in moving toward a life plan community. Ideally, this process should begin well before you need CCRC services. Allow ample time to explore options, make informed decisions, and secure a position on the waiting list of your desired facility.

• Understand the Waiting List

Most CCRCs have a waiting list, like the one my husband and I are on. Understand the process and the timeline for entry. Knowing what to expect can ease your transition. Since you’ll likely need to wait a few years before your desired unit is available, this is another reason not to delay your search unnecessarily. I wrote a poem about our “Waiting List,” which you can read here.

• Research Different CCRCs

Begin by browsing websites and reading brochures. Talk with folks who recommend various facilities. My husband and I compiled a list of potential life plan communities, making folders for those we wanted to investigate further. We noted what special features stood out for each one. Keeping a spreadsheet of sorts to track these features was useful.

• Attend Information Sessions

Informational sessions held at CCRCs or done virtually can be educational. It’s an excellent opportunity to be aware of the staff’s friendliness and helpfulness. Several information programs and luncheons for prospective residents were insightful. Initially, we often opted for virtual tours because some of our possibilities were far away.

• Visit Communities in Person

After screening CCRCs with online research and information sessions, schedule tours of your shortlisted life plan communities to see the facilities, meet staff and residents, and assess the overall ambiance. This step will give you a firsthand feel for each place. Meet folks, ask them questions, and understand the community’s vibe.

• Evaluate the Levels of Care

One of the distinguishing features of CCRCs is the availability of different levels of care, including independent living, assisted living, skilled nursing, and memory care. Consider the range of care options offered and how seamlessly you can transition between them as your needs change. Flexibility is vital in ensuring you receive the care you require now and what you may need in the future. 

• Inquire About Costs

CCRCs typically involve a significant financial commitment, so it’s crucial to understand the costs involved. Inquire about entrance fees, monthly fees, and the refundable nature of those fees. Determine whether long-term care insurance or other financial strategies are needed to cover your expenses. You’ll complete a financial and health status review with the CCRC before being accepted as a resident. Also, be aware you may qualify for substantial tax benefits since part of your entry and monthly fees can be deductible on your federal income tax return.

• Understand the Contract

The contract is a binding document outlining your rights and responsibilities as a resident. Be sure you fully understand the terms, including fees, refund policies, and the process for transitioning between care levels. 

• Talk to Current Residents

Ask about the community’s strengths and weaknesses, their satisfaction with the staff and services, and how well the CCRC has met their needs. These candid conversations can provide invaluable perspective.

• Assess Location and Surroundings

Think about proximity to family, friends, and cultural, educational, and recreational activities important to you. The location should enhance your quality of life and access to essential services. Is the area walkable, or can you ride your bicycle? Is it in the country or a bustling downtown location, and which works for you? Although our CCRC is not close to family, a regional airport is nearby.

• Think About Future Health Needs

As you age, your health needs will most likely change. Consider how each CCRC can accommodate these changes. Access to healthcare services, specialized care units, and the ability to receive care in your residence should be part of your evaluation. We liked that, short of an entire hospital, almost everything we might need was available on the same campus. 

• Evaluate Social Activities

Social engagement is a vital component of a fulfilling life plan community. Check the CCRC’s social calendar and the availability of activities that interest you. A vibrant social community can significantly enhance your overall well-being. How about off-campus social events? Is transportation available for nearby cultural activities if you don’t drive?

• Review Dining Options

Food is a big deal; the dining experience is super important for many residents. Evaluate the quality and variety of food and the flexibility in meal plans and dining venues. I’m a pescatarian, while Charlie eats everything. I also like to bake and cook, so I wanted a fine kitchen in our apartment where I could prepare many of our meals. At the same time, I wanted fish and vegetarian choices on the community dining room menus.

• Consider Security and Safety

Safety is a top priority for anyone moving into a CCRC. Investigate the community’s security measures, including emergency response systems and safety protocols.

• Review the Staff-to-Resident Ratio

The staff-to-resident ratio can impact the level of personalized care you receive. Ask about the number of staff members available in each care area and assess whether it meets your needs.

• Seek Legal and Financial Advice

It’s wise to consult legal and financial experts when making a significant commitment, like moving into a CCRC. They can help you navigate the contract, estate planning, and financial arrangements. We asked our estate attorney to review the contract and have spoken with our financial advisor about our plans. 

• Reflect on Your Decision

Take your time to think about your decision. Discuss your options, pros, and cons with your spouse, partner, or trusted friends and family. It’s a significant step, and it’s essential to be sure it’s the right choice for you.

• Choose Your Community and Make the Reservation Deposit

After thorough research, reflection, and consultation, decide and secure your place at your chosen CCRC. Ensure you have a clear understanding of the move-in process and the timeline. We signed the Wait List Agreement form and paid our fully refundable $1,500 deposit to start the clock.

• Declutter Your Current Residence(s) in Preparation for Your Move

Well before your anticipated transition into the CCRC, declutter your current residence. This step will simplify your transition as you downsize your belongings. Sorting through your possessions gradually over time reduces the stress associated with last-minute decisions. You can take your time and choose what to keep, donate, sell, or discard. This includes your physical stuff as well as your important documents. We’re scanning and then shredding lots of paper in preparation for the next chapter in our lives. We’ve consolidated various financial investments to simplify management. Our Florida condo is already pared down. We’ve gradually worked on the New York house and will go full-tilt next summer, moving out more “treasures” none of the family needs or wants. Charlie and I will not be like many folks who fill a storage unit with stuff for which they pay a monthly fee, only to have that stuff thrown out when they die.

• Share news about your CCRC decision with family and friends when the time is right. 

We told our children about our decision after we joined our CCRC’s waiting list. Everyone is supportive, although it seemed a surprise to one. I believe they all would like to think Charlie and I will live forever, always being self-sufficient, capable, and continuing to be strong in the same way they’ve always known us to be. But we understand we’ll change in the new chapter ahead. That’s why we’re positioning ourselves for that transition now rather than later. We like being proactive rather than reactive as we continue to age.

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Conclusion

Deciding to move into a CCRC life plan was a significant decision for me and my husband. It took much thoughtful planning and consideration. After embarking on this journey, we feel prepared to transition into our chosen life plan community in a few years, by the year we celebrate my 80th birthday.

As you consider your planning, remember the process is highly individual. Your needs and preferences are unique. Following this checklist, you can navigate the path toward a life plan home, giving you peace of mind where you can enjoy a vibrant, supportive community in some of the best years of your life.

Kathleen M. Rehl, Ph.D., CFP®, wrote the award-winning book, Moving Forward on Your Own: A Financial Guidebook for Widows. She owned Rehl Financial Advisors for 18 years, followed by an encore career empowering widows. Now “reFired,” Rehl writes legacy stories and assists nonprofits. Her work has appeared in the New York Times, Wall Street Journal, Kiplinger’s, CNBC, and more. She’s adjunct faculty at The American College of Financial Services. As a zesty Boomer practicing positive aging, she gratefully continues to create and contribute . . . happily using her skills and experiences to encourage others to live their best lives, too. Her website is www.KathleenRehl.com.