Choosing a Senior Living Community

The decisions that cause later difficulty are usually contractual: what happens when care needs increase, how fees escalate, and what occurs if private funds run out.

Contract types in continuing care communities

Type A, or life care contracts, involve a higher entry fee and provide access to higher levels of care at little or no increase in monthly fee. The community absorbs the risk of increased care needs.

Type B, or modified contracts, provide a defined amount of higher-level care before market rates apply. Type C, or fee-for-service, has lower entry costs with care charged at full rates when needed.

The choice is essentially an insurance decision. Type A costs more upfront and protects against the risk of extended high-level care; Type C costs less and leaves that risk with you.

Entry fees and refundability

Entry fees can be substantial, and refund provisions vary widely — from non-refundable, through declining refunds over a period, to largely refundable to the estate.

Refundable options carry higher entry fees. Read precisely when refunds are paid, since many are conditional on the unit being re-occupied, which can delay payment considerably.

Ask what happens if you leave voluntarily, if you die shortly after moving in, and if the community's occupancy declines.

Financial health of the operator

This is the check most families omit and the one with the largest downside. Communities have failed, and residents have lost entry fee deposits in bankruptcies.

Request audited financial statements, which reputable operators provide. Look at occupancy rates, debt levels and reserve funding. Ask how long the operator has run the community and whether ownership has changed recently.

Ask about the history of monthly fee increases over the past five to ten years, in writing. Escalation well above inflation is a meaningful long-term cost, and past behaviour is the best available guide.

Staffing

Ask for staff-to-resident ratios by shift, including overnight when they are thinnest. Ask about turnover rates, which correlate with quality of care and continuity of relationships.

Establish which staff are on site versus on call, particularly nursing. Ask how call bells are responded to and what the target response time is, then ask residents whether that matches their experience.

Observe interactions during your visit. Whether staff know residents by name and speak to them as adults is informative.

Care transitions

Understand precisely how care needs are assessed, who assesses them, and what triggers a move to a higher level. Ask whether the resident or family has any say, and what the appeal process is.

Ask what happens if a couple needs different levels of care, since this is common and communities handle it differently. Some allow couples to remain together with services brought in; others require separation.

Ask under what circumstances a resident can be asked to leave, which is a clause worth reading in full.

Investigating properly

Visit unannounced as well as on a scheduled tour, at different times including evenings and weekends. Eat a meal. Attend an activity.

Speak to residents without staff present, and to family members of residents. Ask what they wish they had known before moving in.

Check state licensing and inspection reports, which are public. Look for complaint history and how deficiencies were resolved.

Have an attorney review any contract with a substantial entry fee before signing. This is a significant financial and legal commitment, and the cost of review is small against the amounts involved.