What is a Continuum of Care?
Demand for retirement options is increasing rapidly as the population of older adults in the U.S. skyrockets. In 2010, those age 65 and older made up about 13% of the population, according to the U.S. Census Bureau. That figure is now over 17%, and is expected to rise to 22% by 2040, the federal Administration for Community Living notes. That means more people than ever are researching their options.
Proactively planning ahead is a good idea, but it can feel overwhelming. As you look into options for yourself or for a family member, you’ll likely come across a wide variety of communities and plans.
One option growing in popularity in recent years is a community that offers multiple levels of independence and healthcare within a single location. You may see places like this referred to as a Continuing Care Retirement Community (CCRC) or a Life Plan community. If you’re new to these terms, they may seem confusing and technical.
What exactly is a continuum of care, and what do these communities offer?
The Basics
A continuum of care community usually offers a range of residence options, from independent living in houses or apartments to rooms in rehab, skilled nursing, or assisted living. Prospective residents complete a health screening to determine if they can move into an independent living situation or if they should receive a different level of care. The communities also review finances with the prospective resident to ensure a good fit. New residents typically invest an up-front fee, and pay a monthly fee while living in their new accommodations.
In the past, a senior care facility might offer only skilled nursing or assisted living. In the continuum of care, many of these options are available alongside fully independent residential housing. Residents often move in while they are still relatively healthy and are able to take advantage of a range of amenities. Once they join a community, they will have access to various levels of healthcare and memory care all in one place, if and when they need them.
Below are some common questions (and answers) regarding senior living options.
Why Choose a Continuum of Care Community?
The continuum of care model offers a number of important benefits, including a financial and physical safety net. Residents can enjoy independent retirement living with the peace of mind of knowing that if their health needs change in the future, they’ll have priority access to a range of care options.
Other Benefits:
Instead of trying to navigate Medicare or health insurance and the various options for home assistance on their own, residents can turn to expert staff to walk them through the options and set up the care they need. CCRCs take various approaches to health coverage, so staff can explain that too when prospective residents are exploring the community.
If residents need medical care, they can get it while remaining in the same community and maintaining connections with friends and family. Providing additional reassurance, the professionals on their campus who set up and carry out care will already be familiar with the resident and their individual medical history.
The care is nuanced: They may visit an outpatient clinic, receive increased care that allows them to remain in their home, temporarily stay in skilled nursing for rehab, or move long-term into assisted living, for example.
It gives family members peace of mind. They know that as their loved ones' needs increase, they won’t have to move to another community, and that experienced professionals will be on hand to evaluate needs and provide emergency care if needed.
Residents enjoy friendships within a community of peers rather than living alone. Typically, they can participate in a wide range of social activities, and there’s always someone nearby who can drop by to check on them.
Many communities offer amenities like gyms, fitness classes, pools, outdoor recreation, lifelong learning, and cultural arts programming.
Everyday maintenance, such as lawn care, leaf and snow removal, and home upkeep, is taken care of. Communities have different policies on whether these come at an additional cost, so it’s good to check the details before moving in.
What are the different levels of care?
- Independent Living
Residents live in their own homes or apartments and can choose to take advantage of services they want, such as dining or housekeeping.
- Assisted Living
Residents live in a setting where staff provide regular assistance with activities of daily living, which may include medical care, medications, laundry, cleaning, cooking, and other tasks, such as bathing and dressing, as needed.
- Skilled Nursing
Residents stay in a healthcare facility to receive round-the-clock medical care as long as they need it.
- Memory Care
Residents live in a secure facility with staff trained to assist those dealing with various forms of cognitive changes. They can often take advantage of programming designed to maintain and improve their cognitive abilities and strengthen emotional connections.
Do all continuum of care communities have the same structure?
While there are many similarities between communities that offer a continuum of care, there are also important differences. Some are owned by for-profit companies, while others are run by nonprofit organizations and governed by a board of directors. Some are independent communities with one or several sites, while others are part of a much larger organization with sites in multiple states.
It’s important to research the ownership of a community when comparing options. Prospective residents or their families should find out what they can about the reputation of the company or organization, especially since it involves a long-term agreement on both sides.
Residents may prefer a smaller organization that faces less pressure to increase profits, and is able to focus on the unique needs of a community. Some may also feel comfort in knowing decisions that impact their community are being made locally instead of at a regional or national level.
What are alternatives to the continuum of care?
Some older adults choose to remain in their own home for as long as possible, then move into a traditional assisted living or skilled nursing facility only when necessary. This may require moving between facilities as their needs change, for example, from assisted living to a skilled nursing facility.
Some communities offer the option to rent homes or apartments with limited services, but without comprehensive options or advanced healthcare. These can be an intermediate option.
Seniors who choose to remain at home can take advantage of a number of services that offer in-home support, such as transportation, limited medical care and rehabilitation, household chores, companionship, or meal delivery.
There are standalone senior living options, as well. Condo communities for 55+ seniors are an option for seniors that may not be interested in a full suite of amenities and care options that a continuum of care offers. There are also standalone assisted living buildings, and memory cares.
What are the different kinds of continuum of care contracts?
Not all continuum of care arrangements are the same. Here are some common options:
- Type A: Life care contracts
In this comprehensive option, residents invest a significant up-front fee and an ongoing monthly fee. In return, they enjoy a full spectrum of care and various housing options to meet their changing needs. When they need more healthcare, they can get it without an increase in fees.
Note: Communities may increase rates incrementally each year, but will not raise it because a resident needs more care.
Some contracts offer refunds on some level if residents decide to leave, but these will vary by community.
- Type B: Modified contracts
These options may offer similar housing and community options, along with access to care. However, if residents need healthcare, they may pay the market rate (the amount a healthcare facility would bill external clients for services.)
Some communities offer a limited amount of time in healthcare at a lower rate, after which residents on the Type B contract will pay the market rate. - Type C: Fee-for-service contracts
These contracts often offer lower initial and monthly fees. Residents enjoy housing and amenities, but higher levels of care come with increased costs. They will pay extra for services and healthcare as needed, at market rates. - Co-op or equity contracts
In some communities, residents purchase their homes and can leave them to their heirs. They may have similar arrangements to Type B or C contracts, where they pay monthly fees and have access to healthcare at market rates.
When evaluating various plans, the National Institute on Aging offers resources to help get started, and individual communities can explain their options in more detail.
Key takeaways
Communities with a continuum of care typically offer a range of options at various price levels, from full access to services to more à la carte options.
Residents have access to independent living homes or apartments with various levels of care available should additional services be needed.
Levels of care frequently include independent living, assisted living, memory care, and skilled nursing.
The community reviews finances, health status, and contract options with prospective residents.
Other types of senior communities offer options like month-to-month rentals or a limited number of care levels.
Some seniors opt to remain at home and hire home-based support services as long as possible.
About us
Oakwood Village is a nonprofit, continuing care community with two campuses in Madison, Wisconsin, operated by Oakwood Lutheran Senior Ministries. For over 77 years, Oakwood has helped older adults lead lives of personal growth, happiness, health, and security.
