✨✨General Discussions

My wife and I have made a deposit putting us on the wait list for Frank Tobey Jones (FTJ) CCRC in Tacoma, Washington. Since making the deposit we've learned (and confirmed) that FTJ has plans to discontinue the existing skilled nursing facility. On query, one of the comments from an FTJ spokesperson was, "The plan is to be able to provide that kind of [skilled nursing] care in Asst Living." The situation brings up some questions for us - especially after current residents have paid a significant 6 figure entry fee, can facilities like FTJ arbitrarily discontinue services that existed at the time of entry? Can skilled nursing care really be provided in assisted living? And what is there that would keep FTJ and similar facilities from arbitrarily discontinuing memory care services for current or future residents?

This is a problem nation wide, and one of the reasons states should have more regulatory oversight on the CCRC industry. Many contracts have an escape clause that is one-way. The provider gets to change the terms unilaterally and on short notice, often as little as 30 days. This leaves few options for residents who have committed most of their nest egg to the provider.

From the provider's perspective, the skilled nursing demand tanked with COVID-19. It became hard to maintain an economically viable SNF if you can't keep a high percentage of the beds occupied. Even the most benevolent of providers must cover costs.

Many residents want to be cared for at home, not in an institutional setting, these days. Providers are looking for economical ways of serving resident's medical needs at home. 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 is not necessarily bad. It may be less socially isolating than the typical SNF, for example. In many states such a hybrid would encounter regulatory barriers.

Another approach is the "Green Home" model.

The focus should be on delivering the best possible quality of life with a continuum of care from full independence to skilled nursing. One of the key reasons for joining a CCRC is to avoid wrenching transitions if or when health deteriorates. We don't want to be separated from those we love, particularly when they and we most need eachother.

Richmond Shreve

NaCCRA Board Member

Forum Moderator

It is quite doable in Washington State to provide the same level of (custodial) care in a facility licensed for Assisted Living as most receive in a skilled care facility. Rather than become concerned simply because of the change of licensure, dig deeper and learn about intended staffing levels and level of care that will be provided (ie things like 2 person transfers, etc).

I did some research on the varying capabilities of Skilled Nursing vs. Assisted Living in CCRCs, my findings attached. Noting that these are generic findings and not specific to the State of Washington.

Vary helpful research. Thanks.

Anyone considering a CCRC should read the contract VERY carefully, ask many questions and pass it by a lawyer they trust who is familiar with CCRCs.

Notice and count how many times you will see in the contract statements such as:

-"We reserve the right to make certain adjustments"

- "We may make any such adjustments in our sole discretion"

- "We may modify at any time we reasonably determine existing factors necessitate such a change, which are not limited to..."

- "We alone may modify schedules, exhibits, attachments to the Residence and Care Agreement (that are part of it); they are subject to change from time to time as determined by the needs of the business"

- "Our Guidelines may be amended from time to time";

-"We reserve the right to modify any and all services. including the type, frequency and the cost of such services"

-"We may require that you be transferred within the Community or to a facility outside of the Community, as appropriate for the following reasons:.... this is not intended to be an exhaustive list"

-We reserve the right to make certain adjustments to fees and services. Any such modifications are not considered amendments to the Agreement that would otherwise require your consent".

Then, try to figure out what rights you have. Samples from one contract:

• "Basic Services" means those items and services GENERALLY available to Residents that are described in Schedule 1"
• "You acknowledge and agree that you shall have no vote regarding Community policies, no right to make policies for the Community, or vote upon management decisions. "
• "You have the right, as a resident, to access personal and healthcare services that we provide"
• "We reserve the right to substitute your residence with another comparable residence if it is necessary to do so for proper operation of the Community, or for any other purpose. In the event you object to a transfer initiated pursuant to this section, your sole remedy is to terminate this agreement"
• " In case a transfer is required, you, your family or guardian shall determine based on OUR criteria for evaluation or placement, whether your transfer shall remain temporary or become permanent"

Note that there is no option in most cases to opt out from the included arbitration clause.

Also, I strongly suggest reading the attached article. Deciding about moving into a CCRC is probably one of the most difficult and riskiest decisions one makes during their lives, particularly if it requires selling one's home in order to pay the entry fee.

I suggest searching for specific CCRCs in the attached article, which has copious foot notes. I did, and turned up three in my area, including residents' lawsuits against two of them.

What a powerful article. This is why our Forums are so important in the sharing of critical information.

I agree.

It does sound like FTJ is just physically relocating skilled nursing services, rather than discontinuing them.

Re "And what is there that would keep FTJ and similar facilities from arbitrarily discontinuing memory care services for current or future residents?"

The answer to that would be in the FTJ contract. and in the state regulations. Skilled nursing, assisted living, memory care, and the overall CCRC may be governed by different sets of state regulations and overseen by different state agencies. 

The Washington Continuing Care Residents Association may be able to help you with this.  

https://waccra.org

Their Consumer Guide can be found in the “Documents” section of the NaCCRA website. Scroll down to “State Consumer Guides”.

I am interested in John Dougherty’s post. It’s time to know what our CCRC contracts mean in our states.

I have encountered something like this while evaluating and investigating CCRCs. What some CCRCs do is NOT relocation or a hybrid, but switching to a lower level of licensed care to provide much more limited care than usually a SNF provides. By doing this, they have to comply with only ALF licensing rules, not with the much stricter SNF licensing rules. This saves them money.

As mentioned before, unfortunately most contracts make sure that all rights belong to the provider with the resident having just about none. As a result, someone can move into a CCRC expecting what used to be care to the end of their life and one day wake up being told that the CCRC cannot provide for them anymore and they have 30 days to move out.

BUYER BEWARE!

Giving up skilled nursing beds (SNF) is all about Medicare, what it pays for, what it doesn’t pay for, what it costs to comply with federal CMS regulations to qualify as a facility that can provide Medicare covered treatment.

General rules:

·         Medicare pays for care in a SNF only if it is for short-term rehab following a 3-night qualifying stay in an acute care hospital.  If a patient does not qualify, Medicare pays for short-term rehab services only on an outpatient basis (physical therapy, occupational therapy, speech therapy), which you may get at home, or in an assisted living facility, or even in a SNF.  Medicare is just not picking up an AL or SNF daily room and board rate for care in a facility.  (Certain ACO's and certain Medicare Advantage Plans can waive the 3-day requirement.) 

·         If you qualify, what does Medicare pay for SNF care in 2024?  If you have Original Medicare, you pay these amounts for each benefit period:

o   • Days 1–20: $0

o   • Days 21–100: $204 each day

o    • After day 100: You pay all costs

·         Medicare has never paid for long-term or custodial care in a SNF nor for Assisted Living.

Collington in Maryland gave up its SNF licenses in 2023 and applied for additional AL licenses for several reasons. 

·         The first is declining SNF occupancy particularly for short-term rehab.  Changes in medical practices and  policies mean that fewer patients qualify under Medicare for inpatient short-term rehab in a SNF.  They go home and get Medicare-covered short-term rehab on an outpatient basis (physical therapy, occupational therapy, speech therapy).  Not only are their own residents not qualifying for Medicare-covered SNF care, CCRCs with SNFs that take external patients are getting fewer and fewer of these patients.  Empty beds are a financial drain.

·         The high cost of complying with federal Medicare regulations covering SNFs.  The reporting requirements alone are burdensome.  State regs for assisted living are generally less burdensome.

·         Changes in medical practices and changes in state regulations have made it possible to care for patients with more complex needs in assisted living who formerly would have had to be cared for in skilled nursing.

What does their CCRC giving up their SNF mean for residents? If you don’t have the Medicare-required 3-night acute care hospital stay to qualify for Medicare reimbursement in a SNF, then you most likely get short-term rehab or respite care in your CCRC’s Assisted Living. If you reach a point where you need the round the clock care formerly provided in the SNF, you will receive that care in AL. We were told that Collington would maintain SNF level staffing in its AL, specifically that there would be an RN 24/7, which Maryland does not require for Assisted Living facilities.

What if you do have the 3-night qualifying stay and doctor’s orders for short-term rehab?  The answer largely depends on the type contact you have.  Collington has both type A (lifecare) contracts and type C (fee for service). 

If you have a type C contract, you pay the appropriate daily rate for the level of care.  When the CCRC has a SNF, Medicare reimburses for the daily rate.  When it doesn’t and you get your short-term rehab in AL, you pay the CCRC daily rate.  If you qualify for Medicare, it would be to your financial advantage to go an off-campus SNF where Medicare will pay.

If you have a type A lifecare contract, your monthly rate doesn’t change as you move through levels of care.  Your contract likely provides for a temporary stay in a higher level of care for short-term rehab or respite with a return to your IL unit.  So you can happily return to campus at no cost (perhaps a charge for additional meals). However, it would be to the CCRC's financial advantage to have you at an off-campus SNF where Medicare would reimburse.

At Collington, most residents have signed privacy waivers to allow the community to be informed when they are hospitalized or discharged or in rehab off campus or temporarily in our Health Cener etc.  A social worker emails transition notices a couple of times a week.  So we get to see some residents going to off-campus SNFs (Collington has informal relationships with two nearby ones) and other residents coming straight back to the Health Center for rehab or respite.  Of course, we don’t know why any given resident is going anywhere. I speculate that it is those with type C contracts who go off-campus and those with type A who come home. It may also depend on how intense their therapy needs are. I have heard that at least one of the off-campus SNFs provides more intensive, twice a day, 7 days a week therapy. But certainly a great many are being discharged from a hospital stay and coming straight back to a temporary stay in AL for rehab or respite and those who comment on their stay in a post on the resident listserve are generally very positive.

Theoretically, Collington is providing transportation for spouses and friends to visit residents in off-campus SNF rehab.  It was much discussed on the resident listserve a year ago but I have not seen any commentary lately.  Given our staff shortages, my guess is that spouses and friends are coping on their own and have given up expecting Collington to provide transportation. I see posts from residents who no longer drive saying If you are going to Future Care to visit someone, I would love a ride so I can visit .___.

There are all sorts of combinations of possibilities and it is worth sitting down with your marketing person and going through a variety of what ifs to be sure that you understand your particular CCRCs contracts.  I would not view discontinuing the SNF as a deal breaker. But you do want a clear understanding of what to expect in a variety of circumstances 

Lorrie Rogers

Collington

Thoughtful posts help so many people, Lorrie. The more we understand the system, the better we can intelligently make decisions and manage our lives. Thank you

The “Exercising Control or Giving it Up?” article provided by Susan Farkas and Lorraine Rogers’ explanation of how and why CCRCs are changing how they provide skilled nursing services are immensly informative.

But they will be “gone with the wind” unless action is taken to preserve them in a form easily accessible in the future by all NaCCRA members. Could they be included in the “Documents” section of the NaCCRA website? 

Where are these articles by Susan Farkas and Lorraine Rogers? I cannot find them. Perhaps I missed them in the thread. Will someone please send them to or to the group.

Thank you,

Roberta

Susan’s Oct. 13 post “Attachment (1)” at the end.

Lorraine’s Oct. 14 post - the message itself.

The information Lorraine shared about Medicare is very helpful.

Otherwise, as prospects hopefully know, there are no two CCRCs that function the same way. Whatever applies to one, might not be true someplace else. The contract rules.

At one of the CCRCs where I put down a deposit, they only have licensed ALF and MC. Prior to COVID, they had a few rooms for short term SNF (rehab). During COVID they discontinued that and it has not been restored to-date. I was told by some staff that due to this, if residents need short term SNF, they get help to find what they need someplace else. From residents I learned that after a hospital stay they were left on their own... Also I was told that two person transfers are a maybe and if the ALF can offer safe longer term "nursing home type" care, they might provide it. However, "it depends". The contract doesn't spell that out. If the facility decides that the needs exceed what they can offer, you have 30 days to find another place or solution. So again, make sure you understand the implications of no SNF (short or long term) at the CCRC you are looking at. Once you payed the entry fee, depending on the contract you signed, you might not be able to change your mind.

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

Richmond Shreve

NaCCRA Board Member

Forum Moderator

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 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?

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.

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.

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

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

Before the Social Security Act, there were no nursing homes in America. They are now and have been dependent on government financing. Community nursing homes are supported about half by Medicaid and half by private pay. Medicare rehab funding is a source of supplemental income for many CCRC nursing homes. They work with hospitals and provide PT, OT, cardiac rehab, and Speech Therapy. Nursing homes are generally more expensive than the funds provided by Life Care contracts, and the supplemental income is helpful. Some CCRCs built more beds than needed, and nursing staff are both hard to find and increasingly expensive. The progressive switch of beneficiaries to Medicare Advantage also decreases nursing home income because the private corporations often provide only partial rehabilitation and then notify the nursing home that they will no longer pay for the beneficiaries' beds. The community nursing home industry suffers from inadequate staffing, which motivates seniors to do everything they can to rehab at home or in assisted living with the minimal support they can muster (family, church, Medicare caregivers). The Center for Medicare Advocacy just published that the nursing home industry has filed its third legal challenge to the nurse staffing rule (see below). By not providing the staff needed to care for patients, care is inadequate.

https://medicareadvocacy.org/nursing-home-industry-files-third-legal-challenge-to-nurse-staffing-rule/?emci=35ad5aaa-fe87-ef11-8474-6045bda8aae9&emdi=b390e703-a78c-ef11-8474-000d3a98fa6b&ceid=8356491

"Conclusion The nursing home industry may win one or more of these lawsuits, or it may get Congress to enact legislation to stop enforcement of the final rule. But there is no question that if the nursing home industry continues to fight changes that would improve care for residents, it will continue to dwindle and decline, as people increasingly choose any long-term care option other than a nursing home."

I wonder about a statement that “Before Social Security Act, there were no nursing homes in America”.  My father spent his final years in a nursing home as did my grandfather before him. Both were private pay, neither received any government payments for their care. I do agree, however, that Medicare paying for rehab in a SNF resulted in the growth of the industry and in the conversion of many long-term custodial care nursing homes into dual use, long-term care and short-term rehab. Needing to meet Medicare requirements resulted in improved conditions in many nursing homes.

I agree that inadequate staffing is an issue for nursing homes and applaud the new regs with increased staffing requirements. However, I take issue with the contention that people are avoiding nursing homes and getting rehab anywhere else due to poor care in nursing homes. It’s about the money honey. If Medicare isn’t paying for rehab in a SNF, then people choose a less expensive option. 

Certainly, back in the day,  being too young for Medicare meant that I recovered from life-threatening surgery at home, while in recent years now being old and on Medicare meant that I rehabbed in a SNF following 4 surgeries. Did I actually need nursing care? Perhaps following the first two, but not really following the two hip replacements -- I needed help but not the care of an RN. I was lucky that I had the qualifying 3-night hospital stay each time and got to stay in a SNF for a few days at taxpayer expense. 

With changes in medical practice and Medicare payment protocols, fewer and fewer patients are qualifying for Medicare covered rehab in a SNF. That’s the major factor in the decreasing census.

Lorrie Rogers

Collington

Related to the topic:

________

Medicare Publishes Final Rule for Hospital Observation Status Appeals

As a result of the Center for Medicare Advocacy’s class action litigation, the Centers for Medicare and Medicaid Services (CMS) issued a final rule this week to establish appeals for hospital patients whose status is changed from inpatient to observation. The appeals will open the door to medically necessary services in nursing homes that many have had to forgo, or pay thousands of dollars for, due to their designation as “observation status.”

https://medicareadvocacy.org/medicare-publishes-final-rule-for-hospital-observation-status-appeals/?emci=35ad5aaa-fe87-ef11-8474-6045bda8aae9&emdi=b390e703-a78c-ef11-8474-000d3a98fa6b&ceid=8557747

First, I want to thank Maura Conry for writing to remind us of the forum. It's nice to get a direct message from NaCCRA.

Second, the industry trade associations have lobbied successfully to allow CCRCs to revise their commitments with impunity. Regulation of fiannces and contracts is inadequate. The unilateral ability to delete a service like skilled nursing without a regulator ensuring that an equivalent capability is in place is an example of the lack of trustworthy performance which the industry through its trade associations has not only long condoned but actually encouraged.

If ever there were an industry that ought to be held to a high fiduciary standard, it's the CCRC industry. Yet, CCRCs deny that they are fiduciaries. Many are allowed to operate with liabilities greater than their assets which depleting entrance fee investments to provide cash to pay current costs including executive salaries and board fees. That's scandalous.

Now we have the controversy over the closing of skilled nursing, which really means that licensed facilities on campus surrender their licenses so they don't have to cope with inadequate reimbursement rates and questionable federal regs like staffing ratios. Staffing ratios put a chill on the use of technology to improve care and lower the cost of care, yet the federal focus is on such ratios rather than the quality of care.

Here's where it gets really bad. Most CCRC contracts, perhaps all, have a provision that a resident can be expelled if they need care that the CCRC is not licensed to provide. When a CCRC gives up its skilled nursing license, it can conclude that a resident needs care that the CCRC is no longer licensed to provide. How would you feel, if you reached the stage at which you needed skilled care only to find that meant that you were cast out on the street.

At some point, the persistent actiivity of the industry associations,the operators, and the firms that finance the industry to give operators full authorization to cast people out when they reach the stage of needing the care that their entrance fees prepaid needs to be called to account. Prospective residents need to be warned in bold type of these hazards to their wellbeing that may arise as they near their most vulnerable life stage.

In the meantime, no one should be complacent in residency imagining that they have full peace of mind. Some operators do rise to that high responsibility but many others do not, and even a highly responsible operator may fall into the hands of new executives or new owners who do not share those values.

The skilled nursing controversy is only the latest in a long list of risks, beginning perhaps with the bankruptcy of Pacific Homes in the 1970s when the residents lost their investments and the provider was required to pay damages only a lawsuit concluded that the management had acted fraudulently. Nothing was done then to prevent a similar occurrence so the residents of Air Force Village West, much more recently, similarly lost all though it was presented to them as something very different.

Until their is a nationwide set of contract and financial standards in place, residents are at risk and should be fully aware of the risks of residency. Such standards need not be federal. Life insurance is regulated at the state level with reasonably uniform laws across all states and jurisdictions with the result that life insurance death benefits are something that people can trust will be paid when due.

Those of us who are residents in CCRCs trusting in providers to do what's right deserve to have nothing less than the integrity and financial performance that is standard practice in other industries.

We need NaCCRA.

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.

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.

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.

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.

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.

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?

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

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.

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.

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

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/

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.

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.