Foster Article


Considering Continuing Care Retirement Communities

By Pauline Foster, Ph. D.

The decision to move to a retirement community is a complex one, and involves different considerations for each person. Having access to "life care," as one's health may change, can play a primary role in the decision-making process. This is one reason why Continuing Care Retirement Communities (CCRC's) have gained in popularity. They offer a long-term contract that provides for housing, services and nursing care, usually all in one location.

When an individual or couple chooses a CCRC, it is important that each individual, as long as he or she is able, must be an active participant in setting and pursuing their own health goals, working closely with the clinical staff and Outpatient Department at the community. Prevention is truly the best medicine. Should problems arise, the clinical staff will recommend the level of care indicated by the individual's physical, mental, emotional and social needs.

Let's take the case of a couple who move into a continuing care retirement community and are both in good health. Their health-care requirements will be met by the Outpatient Department for starters. It is there that they can review their present and future insurance needs with the Office Manager. They will be urged to schedule a yearly physical which can be arranged by the Outpatient staff. And they will choose a primary care physician. If they have been with a physician in the area for many years, they may decide to continue without change. In that case they should inform their physician about their move and request that reports of all treatments and medications be sent to the community to be available in case of emergency. Or the couple may decide on the convenience of selecting one of the physicians "connected" to the community as their primary care physician.

It is likely that the in-house clinical staff (nurses and nurse practitioner) will meet all of the couple's medical needs and answer their health questions, such as: Is that recurring ache or pain something serious? What do we do about treating painful bunions? Can you help manage the medicines we are taking? How often should we have our blood pressure checked?

As time moves on, more serious health problems may arise. This may bring into question the ability of either husband or wife to continue living independently. Usually if one partner is still in good health it is possible for them to continue living together, with perhaps some part-time help. At this point the spouse becomes the primary caregiver. If at a later time it becomes evident that the ailing member needs a higher level of care than the spouse can provide, a decision must be made as to what level of care should be considered.

The most logical step is into Personal Care, designed for those who do not need constant skilled nursing care but who are unable to function satisfactorily on their own. Ongoing needs may include difficulty in dressing or feeding oneself. One may have trouble maintaining medication schedules, or may be unable to get in and out of bed without assistance. There may be signs of decreasing mental ability: forgetfulness, confusion, a tendency to get lost. Or the individual may need support on a short-term basis as they recover from surgery or an illness.

When personal care is recommended, a resident may have the choice of moving to a dedicated personal care location or floor or the individual may choose to continue to live in his or her own apartment, villa (or other type of residence such as a cottage) and employ caregivers specifically approved by the community to supply the support needed.

Skilled nursing care becomes the next transitional option for individuals who need full-time nursing care and close supervision by professional staff. Individuals who move to a skilled nursing floor (or Health Center as it is often referred), can reside there on a temporary, long-term, or permanent basis depending on the health needs of the individual.

Often individuals who move to skilled nursing care include postoperative patients, those recovering from a stroke or heart attack, or persons with moderate to late stages of cognitive impairment.

A continuing care retirement community can provide peace of mind to residents and family members with its ongoing life care options. CCRC's that are accredited by CARF-CCAC are often viewed favorably as they have demonstrated ongoing innovation with a commitment to continuous quality improvement in their governance and the care and services they provide to older adults.

Pauline Foster, Ph. D., is a resident of Beaumont at Bryn Mawr, a resident-run CCRC in Bryn Mawr, PA

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