Key takeaways:
- A continuing care retirement community is one of the few senior living arrangements designed to keep couples together when their care needs diverge.
- The financial impact of a care transition depends on the contract type, and it can be substantial.
- Ask the hard questions before you sign, not after a health event occurs.
One of the most common concerns couples have when considering a continuing care retirement community, or CCRC, is what happens if their care needs diverge. One spouse may remain healthy and independent for years. The other may develop a condition that requires assisted living, memory care or skilled nursing. It is a realistic scenario, and it is worth understanding how communities handle it before you sign a contract.
Continuing care communities are generally structured to accommodate situations in which spouses need different levels of care. But the details vary by community, and the financial and emotional implications are worth thinking through carefully before you opt for one.
Related content:
- What is a continuing care retirement community?
- What is the cost of a continuing care retirement community?
How the communities are structured for couples
A continuing care retirement community is one of the most comprehensive senior-living models for accommodating couples whose care needs diverge. Independent living, assisted living, memory care and skilled nursing are typically all available within the same community. That structure exists, in part, because the people who move in as healthy, independent adults will not all stay that way, and their needs will not always change at the same time.
When one spouse needs a higher level of care, they can transition to the appropriate unit within the community while the other spouse remains in their independent living residence. In most communities, they are still living on the same campus. They can visit each other daily, share meals when possible and maintain their relationship without the disruption of one spouse moving to a completely different facility.
When one spouse moves to memory care, couples typically do not continue living together because memory-care areas are usually secured for safety reasons. However, they often remain on the same campus and can visit regularly.
What changes financially
The financial impact of a care transition depends almost entirely on the contract type.
Under a Type A (life care) contract, the monthly fee for the couple may increase modestly when one spouse moves to a higher level of care, but it does not jump to full market rates. The entrance fee the couple paid at move-in was designed to prepay for this kind of transition. This is the most financially predictable arrangement for couples with diverging needs.
Under a Type B (modified) contract, the couple has a limited amount of prepaid care. If one spouse moves to assisted living or memory care, the contract may cover a set number of days or months at a reduced rate. After that allotment runs out, the couple pays closer to market rates for the higher level of care, which can increase their monthly costs significantly.
Under a Type C (fee-for-service) contract, there is no prepaid care. When one spouse transitions to assisted living or memory care, the couple begins paying the full market rate for that care on top of the monthly fee for the independent living unit.
"In effect, this means that the couple will have to deal with two very costly monthly payments: the independent-living payment for the healthy spouse, and the full cost of the higher level of care for the other spouse," said Evan Farr, elder law attorney and retirement planner at Farr Law Firm P.C. in Washington, D.C.
In all three scenarios, the spouse who remains in independent living typically continues to pay their share of the monthly fee for the original unit. The couple is now effectively paying for two living arrangements within the same community: one independent living unit and one assisted living or memory care unit.
Some communities offer a reduced monthly fee for the spouse who remains in independent living, since the unit is now occupied by one person instead of two. Others do not. This is a specific question to ask before signing a contract.
What changes emotionally
Even in the best-designed CCRC, a care transition is difficult. There are many questions couples must ask themselves, said Farr:
- Can the couple move together to assisted living?
- Are there circumstances under which the healthier spouse can visit their spouse in their new facility?
- Can the healthier spouse spend overnight(s) in the new facility?
- Will there be any restrictions on where they can dine together?
- How easy is it for them to see each other?
- Are there any arrangements for transporting them around the campus?
- What are their options for participating in social and recreational events together?
Many continuing care communities offer social workers, counseling resources or support groups. Some communities actively encourage the independent spouse to participate in activities in the memory care unit, eat meals with their partner or spend time in shared spaces. Others have more structured visiting arrangements.
If you are evaluating communities, ask how they support the spouse who remains in independent living after their partner moves to a higher level of care. Ask whether couples in this situation have access to counseling. Ask whether the community facilitates regular contact or whether it is left entirely to the family to manage.
What to ask before you sign
If you are a couple considering a CCRC, the possibility of diverging care needs should be part of every conversation you have with the community.
Why this matters before you move in
It is tempting to defer these questions. When both spouses are healthy and active, thinking about memory care or skilled nursing can feel premature. But a CCRC contract is a long-term commitment, and the terms you agree to now will determine your options later.
Couples who understand the financial and logistical implications of diverging care needs before they move in are better positioned to choose the right contract type, budget accurately for the years ahead and avoid surprises during what is already a difficult transition.