✨✨General Discussions

You might find the attached article useful, on the topic. Independent ALFs and SNFs follow the same regulations as those in CCRCs, at least in Oregon.

https://nypost.com/2014/07/20/10-things-retirement-communities-wont-tell-you-2-2/

Thanks. Would you know if the Department of Human Services has a database where one can look up the Annual Disclosure Statement? Thanks.

Thank you, M. Farkas. Oregon also requires each CCRC to file, yearly, a Department of Human Services "Annual Disclosure Statement" (ORS 101.052 (1), ORS 101.050, which goes into great detail about services provided and past resident meetings. This form must be accompanied by current financial statements, and copies of all notices of changes in regular periodic charges or notices of proposed changes in fees or services that were given to residents during the provider's most recently completed fiscal year.

Prospective residents must be given a copy of the current form before signing their residency agreement, and they may request subsequent or prior years' copies. These forms are the legally binding, standardized summaries that facilitate comparisons across CCRCs.

In Oregon, licensed facilities have to provide on request a "Consumer Summary Statement". A sample is attached. If you enlarge the attached file, you will see a section that tells you about services not provided (regardless what marketing tells you) and another section which tells you what happens if you need them. There is some degree of ambiguity about them, but this is what governs.

My guess is the resident gets what is in their contract.

Good points and well put. So the thing I'm wondering about is what happens to a CCRC resident who can't get the care they need (like SNF) at the CCRC?

Yes, it’s clear that skilled nursing services and assisted living services, and their licensing requirements, are very different.

But even so, I wonder if some CCRCs might try to provide both of these very different sets of services in the same physical facility.

This was suggested by the FTJ spokesperson saying "The plan is to be able to provide that kind of [skilled nursing] care in Asst Living."

And Richmond Shreve said “It sounds like FT is contemplating a hybrid where a continuum of personal care through skilled nursing care would be provided in a flexible facility.”

This might not necessarily involve any change in licensing. That would depend on how the licensing regulations are written.

And I wonder how many of those in a CCRC’s SNF are in need of the services that John Doherty has listed for SNFs. My father was originally in his CCRC’s ALF, but fell and broke his hip. After hip replacement surgery, he went into the SNF to recuperate from that, but then had to stay on there because his dementia had significantly worsened, and AL staffing wasn’t adequate for handling that. From discussions with CCRC staff, it was clear that those needing more intensive custodial (i.e. non-medical) care were destined for the SNF.

Going back to the original topic that John Doherty posted (the right of CCRCs to just discontinue levels of care that are not profitable) and their potential impact:

• it is critical for anyone planning to join a CCRC to check their state's licensing terms for SNFs and ALFs. Licensing standards and requirements for them are different and as a result the care you will get is different. Assuming that you can get the same in ALF as in SNF is an incorrect assumption. See the summary John provided and do your homework.
• However, if you are an optimist (or you have a crystal ball) and you are convinced that you will not need the levels of care available only in the SNF, then you should be OK with the level of care available in the ALF. The CCRC will try to sell you on accepting that what you get in the ALF will be the same as in the SNF. You can accept that at your own risk.

The links and referenced articles will be in the "Documents" tab of the site. There is a search feature there. If I do a summary or an opinion piece, that will be a Blog post. There is also a search function there.

Richmond Shreve

NaCCRA Board Member

Forum Moderator

Kay,

Your post piqued my interest. We are in rapidly changing times, in a rapidly changing demographic, in a rapidly changing industry. There are no easy and clear answers. That is why NaCCRA promotes these Forums where residents from all over the US can get together, share ideas, ask questions and seek solutions to difficult dilemmas.

There are over 30,000 retirement communities across the nation, all quite different from one another. Regulation of these facilities is dependent on which State one lives in and the type of facility. This is why each of us can benefit from keeping ourselves informed as we are doing here.

Richmond, when you save this info be sure to tell how to get it.

Maura,

You said “Medical facilities are not allowed to cast patients out with nowhere to go.”

Would this apply to someone getting custodial care, rather than medical care, in a CCRC skilled nursing facility?

Twenty years ago my father ended up in the SNF of his CCRC, because of dementia. The CCRC had an assisted living unit, but he needed more attention than they could give. Unfortunately, it turned out that he needed more attention than the SNF could provide, and we were told that unless things improved they would not be able to continue to care for him. They suggested that we look into the SNF of another specific CCRC nearby, but that was all that was said about there being any other alternative.

We (my brother and I), solved the problem by hiring round-the-clock personal caregivers. 

I'm enjoying these rich communications from so many.

NaCCRA is doing what it can do. We are connecting residents from across the USA to share their knowledge and expertise. When a question goes out on the Forum, retired experts from different disciplines jump in to help with solid information.

Thank you for adding to the discussion.

Medical facilities are not allowed to cast patients out with nowhere to go. It's called "discharging to the curb." It did happen in the past when patients were discharged to taxis with disastrous consequences. Discharge planning is a skill that requires significant expertise and experience. Patients are discharged to somewhere that is documented in their medical record.

That said, medical facilities are licensed for specific levels of care. Patients requiring skilled care greater that the licensing, must be discharged to other facilities that are licensed for that higher level of care.

Think about it. Would you want to receive care from service providers with inadequate training or licensure? Patients with complex needs are regularly discharged to other facilities where they can get the care they need. Such transfers are typically mediated by licensed social workers or trained discharge planners working with a licensed professional.

It is a big deal involving patient, family, medical personnel, insurance providers, and the other facility must be able to accept them. These are complex cases, difficult to resolve, and take considerable time.

I agree that we need NaCCRA to tell us what we can do to regulate CCRCs. I live in New Jersey CCRC located in the state of New Jersey and know that CCRCs are loosely regulated by laws that apply only to this state. Are resident-owned CCRCs any better places to live out our senior years?

I would seem to be a good topic for NaCCRA to provide us information as to the fiduciary requirements of a CCRC.

I am sure they vary (if existing at all) by State. In CT there are at least very strict requirements for how potential resident wait list deposits are handled. It would seem that for Class A & B CCRCs, the contract should be viewed as basically a Long Term Care Insurance like contract.

I'll make sure this discussion get summarized and the documents remain accessible.

Richmond Shreve

NaCCRA Board Member

Forum Moderator

Here is the full text of my query to FTJ about discontinuing skilled nursing:

We have heard that FTJ is planning on discontinuing its skilled nursing program - is this the case?

thanks, John and Dianne

And here is the full text of her reply:

John an Dianne, 

Yes, it will change from what it is now.  The plan is to be able to provide that kind of care in Asst Living. I don't have a lot of information on this. As we get closer to the finial plans I will let you know.  

There are a number of services that can be provided in SN that can't be provided in AL:

24-hour medical care (licensed nurses and medical staff)

Rehabilitation services

Wound care

IV therapy

Specialized medical equipment (ventilators, oxygen therapy)

Palliative and hospice care

Assisted living facilities do not offer the extensive medical and rehabilitative services found in skilled nursing facilities.

Thank you Ms. Lore and Mr. Cumming for this extremely helpful and insightful reportage. The issue of CCRC's perceiving that they have no fiduciary responsibility, if that indeed is the case in the industry, seems like a serious problem that needs to be addressed. I have raised the issue of a non-profit board's fiduciary role and responsibility with the RA and management in light of certain matters that will likely have signifiant negative financial impact on residents. To date, it appears that the board is choosing to ignore this responsibility. Does anyone have access to a legal opinion that could be shared with the rest of us? I would be grateful for any guidance that may be available. I'm assuming that at least part of the answer lies within each state's enabling legislation. At the same time, a precedent or two could be helpful.

I asked a friend who lives in the Independent Living part of Frank Tobey. This is her reply. Interesting to hear from a resident's perspective, based on what they were told by their management. She hasn't been there long and I don't know how versed she is in CCRC issues in general. And I don't know if the percentages quoted are accurate. This is just her take on it.

No, skilled nursing won't disappear. What we were told is quite a different story. The usual percentage of care residents in CCRC's is about 25%. We have 124 health care units and 97 independent living units. When the new care facility (memory care and skilled nursing) was opened, MC, SN, and AL were opened to the public in order to get bodies into beds. Usually, you start independent and migrate to care services if/when they are needed. Because of the current long waiting lists for the independent buildings, the plan is to convert the (large) AL building to independent apartments (by replacing the current building piece-wise with new construction of 113 units) and move AL into the care building. Attrition is expected to make the space available by the time it's needed. They're looking at about 5 years for all this to happen. We've recently had two general meetings about the plan, with diagrams and all. 

I myself don't know the difference between what assisted living does and what skilled nursing does. Because we are a small facility, we can't provide the critical nursing services that some larger facilities may do, and because of our size (I'm told), we don't have a Medicare license. They say that what we do provide for AL and SN can be handled in the same place. Nothing changes except having it all in the same building. Nothing is being discontinued.