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Life-Care Communities

By Barbara Resnick, PhD, CRNP, Professor, OSAH, Sonya Ziporkin Gershowitz Chair in Gerontology, University of Maryland School of Nursing

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Life-care communities offer a contract intended to remain in effect for the resident’s lifetime and, at a minimum, to guarantee shelter and access to various health care services.

Life-care communities (continuing care retirement communities) offer different levels of care:

  • For people who can live independently

  • For those who need assistance

  • For those who need skilled nursing care

Generally, people pay a substantial entrance fee ($50,000 to $500,000) when moving to the community and monthly fees thereafter. In some communities, residents pay only a monthly fee for rent plus service or health packages. In others, residents can purchase a condominium, cooperative, or membership; service or health packages are purchased separately.

There are 3 main types of communities:

  • Those covered by an all-inclusive contract

  • Those covered by a modified contract limiting the amount of long-term care provided before the monthly fee is increased

  • Those covered by a fee-for-service contract with billing for health services as they are used

If well-financed and well-managed, life-care communities provide a broad range of housing, social, supportive, and health services that enable their residents to live comfortably. However, some communities are not well-regulated; in some, residents’ assets have been wiped out because of unscrupulous real estate dealers or well-intentioned but inept management.

Communities may occupy a single building or be spread across multiacre campuses with housing options ranging from efficiency apartments to cottages with several rooms. Many have community buildings for organized social events, dining rooms, clubs, sports facilities, planned outings, and vacation options. Access to physicians is usually provided, and most programs are affiliated with local acute care facilities.

Medicare and Medicaid usually do not pay for residence in a life-care community but may help pay for skilled nursing care when it is needed. Long-term care insurance may reimburse residents for monthly fees as well as personal care services.