Understanding a CCRC’s “permanent transfer” policy

There are three things that I think everyone should understand about their move into a CCRC: the community’s amount of debt, the community’s entrance fee refund policy, and the community’s policy on permanent transfers to assisted living or nursing.  Today we’ll talk a bit more about the third one: permanent transfers.
When you move into a CCRC, you agree to move to a higher level of care in the event that you can’t stay in live alone anymore.  It’s called “permanent transfer” because they assume that you will never move back into independent living and thus can resell your apartment to someone else.
There are a few things you should note about CCRCs permanent transfer policy:
The community will decide when you have to move. By and large, almost all CCRC contracts have policies regarding residents who can no longer live on their own.  Due to the sensitive nature of the decision, most contracts require that the community’s executive director and its director of nursing sign off on the transfer.
You don’t have much say in the process. While the community will often consult you and your family about the move, you generally won’t have too much of a say.  This makes sense if you think about it.  Especially for residents who have dementia or other cognitive problems, it can be hard to spot one’s own inability to live independently. However, some seniors bristle at the idea of someone else telling them when they must move out of their independent living apartments.

Read your contract.  Policies vary from community to community, so read your documents carefully. In most cases, your doctor, the community’s head nurse, and administrators must “vote” in favor of your permanent move.  If you disagree, then you’ll have to either prove your independence or move out.  It sounds drastic, but that’s the way it’s handled in most places.

The benefits to the CCRC are many.  For one, the community can ensure resident safety by moving people who need more care to assisted living or nursing.  They can also resell the apartment, which improves their bottom line.

While permanent transfer policies help residents who are in denial of their conditions get the additional help that they need, sometimes there are disagreements.  Unfortunately, they usually work out in favor of the community.  So, if you’re not moving into a community that allows aging in place, it’s in your best interest to read and understand the permanent transfer policy.  It’s probably one of the most important things that you can do before signing on the dotted line.

Want to learn more about senior housing? Check out these posts:

Is it cheaper to stay at home or move into a CCRC?

How do I time my move into a CCRC?

Thoughts on the Frontline documentary about assisted living.

The naked truth about entrance fee refunds.

Who owns CCRCs?

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For many years, CCRCs were owned by local or regional companies or nonprofits.  By some estimates, up to 80% of CCRCs were nonprofits.  But, that’s been changing recently. When the housing market crashed, so did a lot of new nonprofit CCRC developments.  This caused a wave of acquisitions by for-profit providers between 2009 and today, which has forever altered the landscape of senior housing.

Here are some of the big players in the senior housing industry and a summary of who owns them: (Note that this list is certainly not exhaustive.  If there’s a big one that I’ve left off, please let me know.)

Also, as more and more retirement communities become more professionally-managed, companies have sprung up offering management services.  Life Care Services is one of the largest in the country.  They manage care for over 28,000 seniors.

Why does this matter for seniors?  For the most part, it won’t change life for seniors all that much.  But, there are some things to keep in mind:

  • Communities that used to be owned by small, local companies are now owned and operated by much larger companies. This doesn’t necessarily make that a bad thing.  Rather, it’s a fact that senior should keep in mind when shopping for retirement housing.
  • It isn’t always clear who owns what. Olive Garden is owned by Darden Restaurants, but you never really see their name.  It’s not that they’re being secretive.  It’s just that Darden owns about ten other chains of restaurants.  Similarly, Sunrise and Erickson are owned by much larger companies.  So, when you go visit the campus, remember that you’re visiting part of a much, much larger company that has service lines in dozens of other aspects of real estate and senior housing.
  • Get ready for that “big company” feel.  On the one hand, large companies having significant ownership stakes in restaurants, shopping centers, and other facets of American life has worked out well for us.  We see a Wal-Mart sign, and we know instinctively what types of things we can buy there.  It sets our expectations and helps us to understand the types of services offered in one location.  On the other hand, we’ve all had the experience of eating at a restaurant that “got too big.”  There will be senior housing chains that fail because they cut costs too much and service gets sloppy.  There will be others that people flock to because they offer the best service for the best price.

Seniors housing is undergoing a major change.  But, at the end of the day, you’ll still be looking for the same things when shopping for senior housing: good care, professional staff, a history of safety, well-kept facilities, and happy residents.

Want to learn more about CCRCs? Check out some more articles:

Should retirement communities be run like McDonalds? Part 1 Part 2

Signs of trouble in any community.

Helping friends find the right community.

Should retirement communities be owned and run like a McDonald’s? (Part 2)

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 Note: This is Part 2 of two. Read “Should retirement communities be owned and run like a McDonald’s? (Part 1)” here.

The Bad News:

Managers don’t always care as much about customers. To be fair, this is an issue that every company faces. As a business owner or manager, your goal is to make money. Most of the time, you do that by making the customer happy. But, sometimes that goal can be obscured, especially when managers have bonuses or other competing interests at hand.

It’s worse in corporate situations where managers get bonuses based on financial performance. This can sometimes lead to short-term thinking, which is not always in the best interest of the customer.

For example, real estate investors and hedge funds are under enormous pressure to improve their return on investment, and sometimes this means taking more aggressive approaches to investing. Some of these plays will pay off. Others will blow up.

Risk is magnified.  Aggressive growth strategies in a large provider of senior housing can blow up quickly if the market shifts at the wrong time.  What’s worse is that communities that are perfectly healthy and vibrant can be dragged down by disasters in other parts of the country.  For instance, declines in real estate in one part of the country can impact sales at retirement communities in that area.  If these communities are owned by a regional provider, then no one outside of that area is really impacted.  However, a national provider that has trouble in one market might be tempted to pull cash from an otherwise healthy community to help cover the costs.

Parting Thoughts:

None of these benefits or drawbacks are set in stone.  There are plenty of corporations that begin shaving services and customer care as they get bigger.  Also, there are plenty of companies that are huge behemoths and yet still manage to make customers happy every single day.  The success or failure of a national chain of senior housing communities depends largely on the way the company is run, which is why it’s really, really important that these companies hire good managers.

I can’t say for sure if the consolidation trend is good or bad. In fact, it doesn’t matter because it’s going to happen one way or another. It will certainly impact residents’ lives, although not necessarily in bad ways.

My instinct is to rattle my saber and declare war against the invasion of Wall Street. Seniors shouldn’t have to worry about their home being sold at a bankruptcy auction after hotshot managers make silly decisions and invest foolishly. But, then again, that sort of thing happened in the industry prior to Wall Street arriving.

Ultimately, I think the rules of the game will have to be rewritten a bit, and, unfortunately, it will be big corporations wielding the pen.  Competition will continue. Consolidation will continue. There will be bankruptcies, but, by and large, the ramifications will be felt only for managers and debt holders, not seniors themselves. However, the benefits of consolidation mean that seniors might see better amenities and more activities.

Read Should retirement communities be owned and run like a McDonald’s? (Part 1)

Want to learn more about senior housing? Check out these articles:

Five questions to ask during your visit to senior housing.

Why do CCRCs charge an entrance fee?

What is adult daycare?

Take your pet with you to the retirement community.

Should retirement communities be owned and run like a McDonald’s? (Part 1)

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Note: This is Part 1 of two. Read “Should retirement communities be owned and run like a McDonald’s? (Part 2)” here.

Five or ten years ago, there weren’t that many really large companies building continuing care retirement communities. Sure, Brookdale and Sunrise were big, as was (and is) Emeritus and Atria. But, they largely focused on nursing homes and assisted living.  Most CCRCs were owned by smaller, regional companies or by nonprofits.

Since the market crashed in 2008, that has changed dramatically. Senior housing has become an increasingly attractive play for anyone from hedge funds to real estate investors.  This has spurred a round of consolidation that is relatively unprecedented.  It’s very possible that in the next decade, the majority of retirement communities in the United States could be owned by the same two or three companies.

Is that a bad thing? 

We tend to distrust big corporations, and I think for good reason.  But, yet, we all tend to eat at chain restaurants, shop at chain stores, and buy products from the same big online retailers.  Is it really a big deal if retirement communities follow suit? Would having a few national chains control the entire market impact consumers?

I see several benefits and drawbacks to this scenario:

Most large firms have better access to capital. Smaller retirement communities have to work harder to get credit in the event of financial difficulty, and it’s more expensive.  Larger firms can negotiate for loans and financing on a much more national basis, making it easier to finance campus improvements or new communities.  They also have better access to development consulting and other services, which might be prohibitively expensive for smaller companies. Overall this is good for residents, since providers can get the funding their need in a more efficient manner.

Standards and procedures will be more uniform. Ever visited a family restaurant that just didn’t function well? The cash register was too close to the buffet line, and the tables didn’t leave enough room for servers to walk? Well, most of those issues have been solved in chain restaurants.

As firms get larger, they learn which strategies work the best, and they optimize their organizations.  That’s good news for senior housing where staff have to handle a large array of situations and can benefit from additional training that smaller companies might not have been able to provide.

Lifestyle improvements. Larger corporations will probably be better-suited for creating amenities and activities that improve residents’ quality of life:

  • Better activities:  Smaller companies usually rely on one dedicated activity coordinator to handle all aspects of resident life.  If there were a few national providers, these organizations could pay a department of people to craft activities, travel, or other amenities that would help improve resident quality of life.  Since large corporations can negotiate on a grand scale, these services might also be cheaper.
  • Travel agreements among communities in the same chain would allow seniors to effectively visit any city in the country and always have a place to stay.
  • Large corporations can afford to investment in aging in place technology, which might help seniors stay independent for longer.

Read Should retirement communities be owned and run like a McDonald’s? (Part 2)

Want to learn more about senior housing? Check out these articles:

What to expect on your first visit to a retirement community.

Three sneaky sales tactics and your best defense!

How to find a CCRC.

What is LifeCare?

Signs of Trouble in any Community

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It doesn’t matter if you’re looking at independent living, assisted living, or skilled nursing, there are some things that are bad news in every community:

Lack of maintenance. Communities in financial danger or communities with incompetent management will sometimes postpone maintaining the property in order to save some cash in the short term.  This is a bad idea, since small maintenance issues can grow quickly into large problems.  If you see things like unkempt grass, out-of-order toilets, torn carpet, trash in the hallways, or other indicators of maintenance problems, you can bet that there are other things that are wrong that staff isn’t working to fix.

Bad odors. You might be tempted to forgive foul smells in a nursing home, but doing so is a mistake.  The only aroma that you should smell in any retirement community is that from cleaning supplies or food service.  Anything else is a sign that something is awry.  Even nursing homes, where staff have to change adult diapers, should have measures in place to remove the soiled linens from the building.  While there are exceptions to this rule, it’s generally a good bet to skip communities that have a foul smell in the air.

Ill-tempered staff. Regardless of wage rates and turnover, no one wants to live in a place where angry, unhappy people work.  If you see any staff member lose their temper or lash out (especially if management is around to see the episode), see yourself to the door.

Thinly-stretched staff.  There is a lot of staff turnover in the senior housing industry.  For one, most people who work at retirement communities aren’t paid very much.  They also do manual labor jobs like lifting patients or cleaning rooms.  As competition has increased in the senior housing industry, managers are forced to cut wages and staffing ratios even more.  That means that people burn out faster at their jobs.

Staffing ratios (the number of patients to one nurse) have been stretched in recent years due to market pressures.  But, good communities will make sure that staff members aren’t overworked such that they can’t care for patients.  So, if you visit a community where everyone always appears to be in a state of panic, consider other options.

Untrained staff. Unfortunately, staff in retirement communities need to know how to handle many different types of situations not normally experienced in other unskilled positions. When emergencies occur, untrained staff can be downright hazardous to themselves and to residents.  Make sure to ask about the training and background checks that staff members receive prior to joining the community’s workforce.

Angry residents or families. While there will always be at least one resident who is not happy living in the community, pay attention to the attitude and demeanor of the folks who live on the property.  If they’re not happy, then you probably won’t be happy either.

Please remember that it’s ok to listen to your instincts.  If something doesn’t feel right, then you’re perfectly fine to end the meeting and leave.  Also, remember that your decision doesn’t have to be made in one day.  Feel free to do multiple visits to the community.  You can also request lunch or dinner with some current residents to get a feel for the place.  Sometimes retirement communities will also offer you a one night stay in their guest suite to give you an idea of what it’s like to live there.  Feel free to take them up on this offer and to get an idea for how the community functions on a daily basis.

Want to learn more about senior housing? Check out these other articles:

Pushing for a move to senior housing isn’t a good idea.

What is adult daycare?

How to “test drive” a community.

Pets and senior housing.

Paying for a CCRC.

Pushing for a move to senior housing isn’t a good idea

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If anyone should win an award for being too pushy, it’s probably me.  I can’t seem to take “no” for an answer, and I don’t mind throwing all of my powers of logic and persuasion into the argument to help make it harder for the other person to deny my position.  But, when it comes to senior housing, trying to convince someone who doesn’t want to move is a bad idea.  Here’s why:

  1. Their stubbornness isn’t based on logic.  Well, at least not the type of logic that you’re probably employing.  The problem with arguing about a person’s safety and comfort is that they don’t view the decision in those terms.  A large number of seniors view the move to assisted living or a nursing home as an admission of weakness, or worse, that the end is near.  Giving up one’s home and autonomy isn’t something that they want to do because it implies that they’ve lost relevance. So, any arguments you make, no matter how persuasive, will likely fall on deaf ears.
  2. For every action, there is an equal and opposite reaction. The more you push, the more they’ll push, the more they’ll hate you.  Your best bet is to help them discover senior housing on their own.
  3. Do you really want to be “that” person? There is a fine line between being a crusading child who cares about a loved one and being a crusading child trying to push through his/her own agenda.  While you may see yourself as the savior in the situation, you might also be turning people off with your tactics.

If you feel that there are safety concerns associated with your loved one staying home alone, then you have some options:

  1. Begin documenting health and behavioral problems. The more data that you can bring to the table, the better prepared you’ll be for future discussions.  Having a demonstrated pattern of behavior or health problems can help convince otherwise reticent family members that there is truly a problem.
  2. Call a family meeting. Inevitably, there will be one family member who says, “Everything is fine, Mom’s just a little confused.” There will be another family member who wants to send Mom to a nursing home as soon as possible.  The trick is to lay out all of the information and craft a plan so that everyone feels more comfortable with the situation.
  3. Considering hiring help. The easiest way to delay a move to a nursing home is to hire someone to come in and help on a daily basis.  This has a few benefits: not only will someone be there to report back on Mom’s progress, but Mom will also have someone making sure that she eats and bathes on a regular basis.
  4. Focus on quality of life. Being able to prepare your loved one for life in a new community is your greatest asset as a caregiver.  Having scheduled transportation and an active social calendar can help give seniors back some of the independence they may be losing by staying at home.  Focusing on the benefits of such an arrangement is to your advantage.  Another option, especially for seniors who have had surgery or need short-term help, is to emphasize how temporary the move can be.  Once they regain their strength, they’ll head back home.

While almost all seniors have qualms with giving up their independence, most will eventually realize when they can no longer live on their own.  Unfortunately, that realization may take longer than you would like.  Rather than try to force someone to move when they aren’t ready, take time to understand why they’re reluctant to move.  Don’t try to reach a conclusion in one sitting.  Instead, focus on small changes that can improve your loved one’s quality of life and help give you peace of mind.

New Personalized Senior Housing Report!

Dear Readers,

I’ve been revamping some of my offerings, and many of you have asked for a more personalized approach to your senior housing needs.  So, I’ve created a personalized senior housing report just for readers of this blog.  This means that you don’t have to wait for me to write about your community. You can just print out the questionnaire below, fill it out, and mail it to me. I’ll send you back your personalized report within two weeks of receipt, and I’ll be available to answer all of your questions after I finish.

Personalized Report Questionnaire

Sample Report

As always, you can email me any time with questions or concerns, and I’ll do my best to answer them: questions@SeniorHousingMove.com.

If you want to learn even more, check out my books (“Continuing Care Retirement Communities: An Insider Tells All” and The Financial & Estate Planners’ Guide to Continuing Care Retirement Communities“) on Amazon.

Virginia speaking to the The Financial Planning Association of Oregon and Southwest Washington.

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Some of the comments:

“I found your presentation extremely valuable and relevant to my practice.”

“I loved your presentation today, excellent information and you were so engaging, my whole table was very impressed with you.”

Thanks, Portland!

Older minds retain more information, residents suing CCRC, a third of patients are harmed during treatment, and the worst aspect of dementia

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Older minds retain more information.

Residents are suing Vi, a CCRC chain over the use of their entrance fees.

One third of nursing home patients are harmed during treatment.

One of the worst aspects of dementia: Sometimes patients don’t even know that they’re ill.