A Continuing Care Retirement Community (CCRC) offers older adults emotional and physical
security against unknown future healthcare needs.
It also provides freedom from the demands of home maintenance and allows older adults to have some control over their remaining years without
burdening their loved ones.
Moving to a CCRC may
prevent the need to make a major decision or move at a time of crisis, when it may be more
difficult to determine the right choice.
What is Continuing Care?
As of January 1, 2023, there are 38 operating or approved Continuing Care Retirement Communities (CCRCs) in Maryland. The CCRCs, both operating and under construction, contain over 16,000 continuing care units that are comprised of more than 12,000 independent living units, over 2,000 assisted living units, and over 2,000 nursing care units.
The Maryland Department of Aging is the agency charged with administering the continuing care laws. The primary continuing care laws are located at Title 10, Subtitle 4, of the Human Services Article (“HSA”), Annotated Code of Maryland, and Code of Maryland Regulations (COMAR) 32.02.01.
Although the legal definition of “continuing care” is complex, in general, “continuing care” exists when all three of the following are present:
- The consumer pays an entrance fee that is, at a minimum, three times the average monthly fee;
- The provider furnishes or makes available shelter and health-related services to persons 60 years of age or older; and
- The shelter and services are offered under a contract that lasts for a period of more than one year, usually for life.
The contract that is entered into between a CCRC provider and a resident is known as a continuing care agreement. Continuing care agreements are legally binding contracts between the provider and the resident that outline the responsibilities between the provider and the resident. Only a portion of the content of continuing care agreements is regulated by continuing care laws. Much of the content of the continuing care agreements will vary from community to community, as does the scope of the continuing care offered at these communities. For example, some CCRCs may provide full coverage nursing care in an on-site health center at no additional charge to the resident, while other CCRCs may provide priority admission to a nursing facility on a fee-for-service basis.
Entrance fees and monthly fees also vary widely. Generally, these fees are based on the level of care (independent living, assisted living, or nursing care), size of the unit, number of residents living in the unit, and type of contract entered into. Depending on the provider, these fees may or may not cover a wide range of services.
There is financial risk involved in choosing a CCRC, as large sums of money are paid in advance for future services. Also, some continuing care agreements provide for a refundable entrance fee, which may require that the unit be reoccupied (and, possibly, that a new entrance fee be paid by the new occupant) before a refund is paid. There is a risk that these units may not be reoccupied (or a new entrance fee may not be paid) in a timely manner.
The Department urges anyone who is considering moving into a CCRC to consult with an attorney and a financial advisor familiar with these types of agreements before signing any documents.
