Friday, October 21, 2016

Successful Aging - Helping Your Clients Be All They Can Be

Reshape your conception of what it means to grow old and equip yourself with the tools your clients need to lead a long, healthy, happy life.

Learn the history and latest research on successful aging and how to translate the research into action in the day-to-day. Gain an understanding of Masterpiece Living, how it works, it’s exciting outcomes to date, and how everyone can be a part of the movement. Learn how to quickly identify ageism and how to respond as well as provide immediately applicable tools to inspire clients to age more successfully.

Over a decade ago, a landmark ten-year study by the MacArthur Foundation shattered the stereotypes of aging as a process of slow, genetically determined decline. Researchers found that 70 percent of physical aging, and about 50 percent of mental aging, is determined by lifestyle, the choices we make every day. That means that if we optimize our lifestyles, we can live longer and "die shorter" - compressing the decline period into the very end of a fulfilling, active old age.

Successful Aging Chart Graphic


Teresa Beshwate:

A Master of Public Health with experience in the fitness, acute care and the aging field, Teresa has a passion for helping older adults engage in lifestyles of active, successful aging. Certified in personal fitness training and lifestyle and weight management coaching, Teresa formerly owned and operated an older adult-oriented personal training studio. As an outcomes analyst in the acute care industry, she was responsible for data analysis, outcomes reporting and quality improvement initiatives. A seasoned presenter, former health and fitness newspaper columnist and author of several articles, Teresa has particular interest in data-driven decision making and sharing best practices.

As a Director of Operations, Teresa oversees the daily interactions that actualize the mission of Masterpiece Living. She also serves as the main point of contact for primarily west coast partners, is a member of the Masterpiece Analytics Team and is responsible for Masterpiece Living`s first ever partnership with Affordable Senior Housing communities. This rewarding role allows her the opportunity to collaborate with talented professionals to inspire lifestyles of successful aging and ultimately help to make our country a better place to age. Teresa`s own successful aging pursuits include training in Krav Maga, learning to speak Portuguese, and spending time on horseback.

Lisa Federico:

A Certified Senior Advisor and member of the Ethics and Disciplinary Council, Lisa is the Vice President of the Vision Recovery Center in Las Vegas, a non-profit organization providing financially challenged children and adults with visual aids, therapy, new technology and other services – enabling independence, confidence and hope.

A lean management trained executive and Six Sigma Black Belt with a BFA in Communications supported by Minors in Public Speaking and Creative Writing, Lisa is a longtime advocate of healthy living and successful aging. She dedicates 4 hours weekly to volunteering and is a staunch believer in the impact animals have on older adults. She also sits on the Board of Directors for the Southern Nevada Parrot Education, Rescue and Rehoming Society, is owned by two birds, and has been foster mom to five others. Lisa is also a long time member of K9 Therapists of Las Vegas and Therapy Dogs Inc. She is owned by one adorable pooch who has logged over 1000 hours of visits to hospitals, hospice and senior communities.

Lisa’s successful aging pursuits including reading, gardening, sewing, making jewelry, and pedaling around rural areas on her 3-wheel bike with her therapy dog happily sitting in a basket enjoying the ride!

Thursday, October 20, 2016

Tax Deductions for Medical Care in Health Care Residences

Tax Deductions for Medical Care in Health Care Residences

Tax Deductions for Medical Care in Health Care Residences

Many older adults (90 percent) prefer to live in their own home (AARP 2013). Even if they need daily assistance or health care, most of them (82 percent) say they would still prefer to receive that care in their homes (AARP 2013).

Some older adults choose a Continuing Care Retirement Community (CCRC) as their home – one that offers progressive levels of health care from active, independent living to long-term care. Other older adults stay in their own homes, often with long-term services and supports, until the time comes when a move to assisted living or a long-term care residence is the right thing to do.

The cost of medical care received in continuing care retirement communities, assisted living and long-term care residences (nursing homes) is generally tax deductible. People who pay for these costs should consult with a tax expert to ensure they take and maximize all available deductions – for example, the time of year a person enters an assisted living facility might increase the amount of his or her tax deduction.

In all cases, expenses that are reimbursed by Medicare, Medicaid, long-term care insurance, and other insurance or programs are not tax deductible.

Continuing Care Retirement Community

The portions of continuing care retirement community (CCRC) entry fees and monthly fees that cover prepaid health care and medical expenses are generally tax deductible.

The different types and complexity of CCRC contracts make expert tax and financial advice essential when choosing a CCRC. According to senior housing legal expert Paul Gordon (2012), it can sometimes be difficult to clearly identify which medical expenses are deductible:

The very definition of “medical” expense is malleable, and the middle ground, inhabited by most senior living communities, that lies between traditional, deductible, “institutional” health care and nondeductible residential services and accommodations, is sometimes difficult to categorize. The increasing complexity of resident fee structures and refund arrangements casts further doubt on when a payment should be characterized as an expense, and what fees are attributable to medical care.

Assisted Living

Generally, the cost of direct and substantial medical care (for example, for dementia or special needs) received in an assisted living facility qualifies as a medical deduction if a licensed health care professional certifies the care receiver needs ongoing help to perform at least two activities of daily living or requires supervision because of cognitive impairment, and prescribes a plan of care for the care recipient.

Long-Term Care Residences

The entire cost of nursing home care, including meals and lodging, is a deductible medical expense if a person, or his or her spouse or dependent, is there primarily to receive medical care. A person who is in a nursing home mainly for personal reasons can deduct expenses for medical care but not meals and lodging.

Taxpayers under age 65 who claim a person living in a nursing home as a dependent must reduce the total medical expenses by 10 percent of their AGI. See “Whose Medical Expenses Can You Include” in IRS Publication 502, Medical and Dental Expenses.

Many resources are available online for more information about deductible medical expenses in long-term care residences. In addition to the IRS website, see “Medical Expense Tax Deductions: A Guide for Senior Living Providers and Residents (Gordon, 2012) in the “References” below.


"Livable Community Indicators for Sustainable Aging in Place," AARP (2013).

Gordon, Paul. "Special Issue Brief. Medical Expense Tax Deductions: A Guide for Senior Living Providers and Residents," The American Seniors Housing Association (Summer 2012).

Internal Revenue Service.

Society of Certified Senior Advisors, Working with Older Adults: A Professional’s Guide to Contemporary Issues of Aging (2015).

"Tax Aide Program," AARP.

"Proposed New Requirements for Tax Return Preparers," Tax Information for Tax Professionals (2010).

TaxBook 1040 Edition (2012). 2012 Tax Year. Minnetonka, MN: Tax Materials Inc.

The Working with Older Adults course offered by the Society of Certified Senior Advisors gives professionals a practical, comprehensive understanding of health, social and financial issues that are important to many older adults, including ethical issues specific to aging. For more information, or to enroll in a class, click here.

Wednesday, October 19, 2016

Consumer Dependence on Professionals: Trusted, Qualified Helping Hands Needed

Finding trusted professionals for your clients

I like to think of aging as starting with birth, transitioning into the learning stage, then moving to the earning stage, and when we are ready we evolve into the stage of wisdom (hopefully) and influence until we breathe our last breath. The trajectory can be upward and positive throughout life and assistance from the right professionals can make life easier.

If your existing clients or new clients are approaching or at the end of their earning stage; the demand for high quality resources is ever present in the thinking of consumers of today. They are tech savvy and Google has turned us all into researchers, but the information can be overwhelming for the consumer.

Let’s take a look at the financial sector’s past to demonstrate the current need for professional advice. Since I do not have a financial background, I am going to make a huge assumption here based on personal experience and a little research. After the 401k was established in 1978 and through the 80’s and 90’s as pensions started to disappear the 3 legged retirement stool went from a pension, social security and 401k and turned into a 2 legged stool of social security and 401k. Once this happened it put more of the burden for retirement saving on the individual. The individual found that saving in a bank or investing in CDs was not going to cut it. The money needed to grow faster. The middle class in America knew nothing about investing or finding and dealing with professionals who supposedly did know how to make money grow.

While all this is taking place the complexity of life in the U.S. is greatly increasing. Taxes, investing, insurance, estate planning, medical bills, home ownership, auto payments, insurance, registration, upkeep, and more filled our simple lives with the “job” of life management which is on top of our regular day jobs.

This is the point in American history where average middle class citizens began hiring professionals in the fields of accounting, tax preparation, law, and financial planning. Prior to this time, the wealthy were the majority users of professional services. Life was simple enough that individuals and families were able to take care of their own affairs and did not need to pay a professional to assist them.

I remember the point in time when we changed our own oil, tuned up our own cars, replaced the carburetor and it was simple. Now we open the hood of a car and would not even know where to start. Professional services are now part of the fabric of life in the U.S. for many, not only the top 1%.

As professionals became more and more in demand and their businesses grew, they may not have felt the need to expand their professional network of resources. I have spoken to several professionals in finance, insurance, and law and I asked what professions comprised their network. The answer was finance, insurance, and law. They are not alone; many professions have operated in silos limiting their network of resources.

These industries are finally starting to realize that keeping a narrow focus on resources for their clients is starting to hurt business. Law firms are starting to hire case managers. Certain financial institutions are losing up to 60% of their business as clients pass away because the financial institution did not have an intergenerational program in place. Insurance companies selling annuities are experiencing effects of negative press due to claims of financial exploitation target at older adults.

Older adults and their families or agents need help. They are looking for help beyond the particular area of expertise of the professional they have come to. This does not mean that they want every professional to advise beyond their area of expertise or to be an expert in everything, it is quite the opposite. Consumers are looking for the professional they trust to provide them with highly qualified vetted resources. They just want to be steered in the right direction because they are drowning in information and they don’t know what is trustworthy and what is just good marketing.

How do professionals build a network that works extremely well for them and for their clients? How do they prevent liability issues by locating highly qualified resources? How do they vet these resources to ensure the best outcomes?

Here are 10 steps that can make you and your professional network stand out:

  1. Know your target client and ALL the issues that this demographic faces today as well as their history. For example, in the case of senior clients, study Working with Older Adults: A Professional’s Guide to Contemporary Issues of Aging.

  2. Determine all the resources needed by you in your business and by your client in their lives.

  3. Research and locate 2 or 3 of the top individuals or resources in a particular field.

  4. In each field, determine the definition of the job, the scope of work, the credentials in the field, and how to locate one in a particular geographic area.

  5. Establish a vetting standard and vet every resource.

  6. Set up a database keeping complete notes on how they meet or exceed your vetting standard.

  7. Contact all resources, interview and get to know and understand them.

  8. Establish a drip program for those that you decide to have in your network to keep your brand in their minds.

  9. Give all referrals out with the vetting information, be transparent as to what you know about them and how you have or have not used them.

  10. Once referred, follow up with professional and client and note results.

We all need a helping hand from time to time, let's just make sure it is the most qualified.

Author -  Judy Rough, CSA

- By Judy Rough, CSA

My passion and my life's work is to change the culture of our society by elevating the status of older adults to a national treasure. The more professionals are educated about the contemporary issues of aging the closer I will get to this goal.

Monday, October 17, 2016

Financial Abuse of Older Adults: Recognizing the Red Flags

How to Recognizing Financial Abuse of Older Adults

The growing financial exploitation of seniors involves their income, assets, property, and personal possessions. It comes in the way of theft, fraud, forgery, improper use of a power of attorney, identity theft, and/or undue influence. It is often accompanied with verbal threats and physical abuse.

Financial abuse is the theft or conversion of money or other property by caregivers, relatives, friends, or others in positions of trust.

Just how big a problem is it? In 2011, a landmark study by MetLife Mature Market Institute stated that 51 percent of financial abuse was perpetrated by strangers, 34 percent by family and friends and that 60 percent of the perpetrators were males between the ages of thirty and fifty-nine.

In early 2015, the TrueLink Report on Elder Financial Abuse determined that the cost to seniors through all financial abuse was approximately $36.5 billion annually with 36.9 percent of all seniors over a five-year period having been subjected to financial exploitation—6.9 percent experienced a loss of $10,000 or more with the average being $52,300, and 1.8 percent lost their homes or other major assets. Average losses were:

  • Exploitation - $2,617

  • Identity theft - $7,633

  • Criminal fraud - $13,107

  • Con artists - $13,225

  • Caregivers - $26,879

Different studies have varying numbers about the extent of these crimes and who is committing them. Regardless, the problem is a big one. Unfortunately, there is no nationwide tracking system to determine the exact extent of financial abuse to seniors. Nonetheless, these kinds of numbers have gotten the attention of lawmakers and regulators. In 2012, Health and Human Services Secretary, Kathleen Sebelius, announced an effort to coordinate the various programs within the federal government, and asked that it be led by the department of Justice (DOJ) and the Consumer Financial Protection Bureau (CFPB).

Over the past few years, many states have been beefing up the laws on financial abuse of older adults. The National Association of State Securities Administrators (NASSA) in early 2016 proposed a state model bill that is slowly gaining acceptance. In 2015, the Financial Industry Regulatory Authority (FINRA) proposed a rule that would allow broker-dealer firms to put temporary holds on accounts where there is a concern about suspicious activity. Last year, Rick Fleming, head of the SEC’s Office of Investor Advocate, asked, “More specifically, should federal law allow a financial advisor to refuse or delay a transaction—contrary to the explicit instructions of the client—when it appears that the client is being defrauded or exploited?”

The National Adult Protective Services Association (NAPSA) states that the typical victim of financial abuse is a white female between the ages of seventy and eighty-nine, who is likely frail and/or cognitively impaired and lives alone. Of the abusers, 90 percent are family members or trusted others. The Statistic Brain Research Institute estimates that there are 2.15 million cases of senior abuse each year, affecting about 1 in 10 seniors with 12.3 percent of these cases being financial abuse.

Identifying the Abusers

Just who does the abusing? It can be almost anyone, and often it is the one you would least suspect. Family members, friends, and caregivers are at the forefront. They may have financial problems, substance abuse issues, or a gambling habit. But it can also be professionals and businesses who gain the confidence of an older person and then overcharge for services or sell unnecessary or inappropriate products.

If Abuse Is Suspected

If someone is in immediate danger,
call 911.

To report elder abuse, contact the Adult Protective Services (APS) agency in the state where the victim resides. You can find the APS reporting number for each state by visiting:

Source: Administration for Community Living

A 2012 survey by Investors Protection Trust found that most financial abuse goes unreported primarily because of embarrassment on the part of the victim, but also because the children fail to identify the problem or do something about it. However, the harm is not just financial—it affects the person’s physical and mental health. Due to a lack of funds, 6.7 percent of those who are financially abused cut back on their medical care, and 954,000 are skipping meals, thus causing nutritional issues. Further, there can be a loss of a personal sense of well-being, depression, hopelessness, loss of trust in others, loss of security, and a need to rely on government safety-net programs.

Professional advisers are in a unique position to identify seniors who are being financially abused. They should look for telltale signs of changes in the person’s personal and financial behavior. Often, seniors give hints about financial abuse when they talk about giving gifts or loans to others, changing their will or estate plan, having trouble paying their bills, difficulty making financial decisions, their financial advisor not returning their calls, making large cash withdrawals, or evidence they are being physically abused.

Advisers can help older adults avoid financial exploitation before it happens in many ways. Counsel them to get multiple estimates from several reputable contractors before having work done to their property. Tell them it is important to get a second opinion before making any financial decisions. Advise them to do research on any advisors to determine their credibility and regulatory history. Having acronyms after an advisor’s name may look impressive, but unlike the CSA designation, for example, many are simply not credible.

Most financial abuse comes with intimidation and fear. Often, fraudulent and deceptive acts are accompanied with the perpetrator expressing the immediacy of action to do it now or else the offer will not be available. The abuser will often try to coax the senior to just sign the form without giving them a chance to read it, or perhaps before it’s completed. They’ll also try to get important numbers like the information on a credit or debit card, including the PIN, bank information, or ask for the Social Security or Medicare numbers. There is no end to their ingenuity.

Sometimes door-to-door salespeople are selling insurance products, so-called investments that provide higher income, as well as common items like magazines, knives, vacuum cleaners, and so on that the older adult really doesn’t need or want. High pressure tactics are employed which can border on intimidation.

What are some of the more prevalent forms of financial abuse? At the family or friend level, it often starts with simple acts such as asking for a small loan or gift. This escalates into bigger and more frequent requests for money. It is not unusual for the family ember to have a sense of entitlement to the money because they are taking care of the parent, or because they are going to inherit the assets anyway. If the senior becomes reluctant to provide them with money, then verbal or physical abuse may ensue.

Trusted professionals can also be involved in financial abuse. For example, a lawyer recommends a living trust when a simple will is all that is needed. An accountant recommends making themselves the financial guardian and then pilfers the accounts for personal use. The financial advisor sells annuities with high commissions and surrender charges, instead of an annuity that is in the best interest of the older client. These are just a few examples of so-called professionals taking advantage.

Anyone who uses the Internet can be subject to emails that make an effort to have them part with their money. It could be about winning a foreign lottery where a small processing fee and one’s Social Security number is needed to verify the winnings. The same approach is used with “winners” of phony sweepstakes.

The telephone is also used by unscrupulous predators. In a current national scam, a caller claims to be from the IRS and informs the senior that if they do not pay purported outstanding taxes immediately, they will be arrested. The IRS does not call taxpayers to collect taxes, nor do they do it through emails.

Another common approach is for the caller to claim to be from a large, well-known computer company that has been monitoring the older person’s computer, and the computer is suspected of having a virus. For a small fee they can “fix” the computer online. When the victim logs on to a bogus website, the thieves grab all sorts of information from the computer, including contact information, passwords, banking information, and so on. A more ominous approach is when the thief will load software that locks the victim’s computer and a ransom is demanded to unlock it.

The “Grandparent Scam” is also very popular. In these instances, the caller will often have information about another family member that makes the senior think it is their family member that is calling. The caller will pretend to be the family member who was just in an accident, was arrested, had their wallet stolen, or lost their passport. They need money and they need it NOW! They just need to use the senior’s credit card, or perhaps a wire transfer from the senior’s bank account.

Sometimes it’s the senior’s financial advisor who is approached by these criminals. The advisor will receive an email that speaks to the need to send money right away for a purchase that was just made, to pay some unexpected bills, to pay for a grandchild’s education, or they are traveling and need extra money. The list is endless. The email will say they have lost their cell phone so they can’t be reached, or it will give an unknown number to call to verify the request. The email may actually be the senior’s email address that has been hijacked, or it might be very close to the real email address but be off by one letter. Every financial advisor should have procedures in place to address these situations. At a minimum, they should call the client at a known telephone number to verify any request directly.

The issue of financial abuse is not going away any time soon. As baby boomers age, the mere size of this cohort will increase in magnitude of financial abuse to seniors. When working with older adults, professionals must be aware of the potential signs of financial abuse against their clients.

Author -  Ray Ferrara

- By Ray Ferrara

Ray Ferrara is Chairman and CEO of ProVise Management Group, LLC, in Clearwater, Florida, a full-service financial planning firm that is a Registered Investment Advisor with the Securities and Exchange Commission. A Certified Financial Planner, he served on the Board of Directors for the CFP Board of Standards and was Chair of the Board in 2014.

Contact him at 727-441-9022,, or visit

This article is featured in CSA Journal 66 - Volume 2, 2016

Friday, October 14, 2016

Cruise Through Your Retirement

Retirement living on a cruise ship

A few seniors are choosing life on a cruise ship over years in a retirement community. But is it really cheaper?

Some people love cruise ships so much they are retiring on them. In 2015, 86-year-old Lee Wachtstetter sold her home after her husband died, and moved to a luxury cruise ship (USA Today). In 2008, the BBC reported that 89-year-old Beatrice Muller was residing on the cruise ship Queen Elizabeth 2 (BBC). Other retirees opt to live in a small apartment and spend most of their year onboard.

Those who have chosen the seafaring life claim that living on a cruise ship is cheaper than a retirement home. Not only is it a better deal, they say, but you get housekeeping services, diverse entertainment and programs, meals any time you want, pools and fitness centers. Plus you’re surrounded by hundreds of happy people, and it’s easy to make friends. Frequent or permanent passengers say they get special care from the crew, with whom they may have formed friendships over time. For those with health issues, cruise ships are staffed with doctors and nurses, as well as medical equipment.

In fact, this concept is so popular that last year Crystal Cruises announced plans for "Residences at Sea"—suites that people can buy and live in while they cruise the world in comfort.

Whether life on a cruise ship is a better deal than retirement homes depends on many factors, including the price of the cruise and the cost of an apartment in your senior community. If you have serious health issues, the medical staff onboard might not be in a position to help, and an ambulance ride consists of an expensive airlift and could delay medical assistance.

"I've got full-time maid service, great dining rooms, doctors, medical center (where she volunteers), a spa, beauty salon, computer center, entertainment, cultural activities and, best of all, dancing and bridge," Muller told the BBC.

That’s definitely one way for smooth sailing through your senior years.


My Retirement Plan,” Snopes.

Ahoy matey, more folks retiring on a cruise ship,” July 27, 2016 CNBC.

Is a Cruise Ship Retirement Cheaper than Assisted Living?” Feb. 9, 2015, A Place for Mom.

Blog posting provided by Society of Certified Senior Advisors

Wednesday, October 12, 2016

How to Back Up Your Computer Files

How to Backup Your Computer Files

There are many options for saving your documents, photos and videos. Just make sure they are saved to at least one of them.

Gone are the days when we stored documents in file cabinets and our photos in (real) scrapbooks or shoeboxes. Now our lives revolve around our computers, which means you could lose everything, including family photos and tax documents, if your computer crashes, either due to malware or some other cause beyond your control. Fortunately, there are many ways to back up your computer.

External Hard Drives

The most obvious backup option is external hard drives—hardware that is separate from your computer. These include external hard disks, most of which come with their own backup software, and more portable options such as DVDs, CDs, Blu-ray discs, flash, or thumb, drives. You simply copy files from your computer to the external drive. Two advantages of a local archive are that there is no monthly or annual fee, and you have immediate access to all of your files in case your computer dies.

While external hard drives are often inexpensive and easy to use, you have to remember to back up your files. Windows provides numerous backup and recovery programs, such as Backup and Restore, that you can set up to save files to your external drives. Because these drives usually reside near your computer at home, in the case of a fire or other home damage, you could lose both your computer and external backup. One problem with flash drives is that you can easily lose them because they are so small. Also, because hard drives are hardware, they are subject to wear and tear and may eventually fail.

Cloud Storage

Online programs such as Dropbox, Google Drive and Microsoft OneDrive, were designed to sync your files between computers and devices, backing up your data online in the process. These services are free for a limited amount of data space, and you pay a monthly or annual fee to exceed this storage amount. Google Drive, for example, offers 15 gigabytes (GB) for free; 100 GB is $1.99 a month; and the price increases incrementally from there. If you think you really need 30 terabytes (TB), you’ll pay almost $300 a month.

To use cloud storage, you upload files, such as photos, to the website, which stores them for safekeeping and syncs them with your other electronic devices. So, for example, from your smartphone, you can access a file you created on your laptop. It’s easy to share files, especially those that are too large to send over email. If you make a change to a file, the service automatically updates the file on all computers and devices using the account. Likewise, if you delete a file, it disappears from your online storage as well.

Backup Services

Similar to cloud storage services, internet backup sites such as CrashPlan, Carbonite and BackBlaze back up your files. Unlike Dropbox and the rest, however, they do it automatically. When you initially set up an account, the service backs up all specified files. After that, when you create a new file or change an existing file, the technology detects the update and automatically backs up the new or revised file. Like cloud storage services, you can access your files from any computer or device, as long as you have internet access.

Unlike cloud storage services, these backup sites are not free. They often start at a low monthly or yearly rate and then charge more for a higher storage amount. For example, CrashPlan offers unlimited online storage for $5.99 a month or $59.99 a year, which includes backup on other computers as well as on your external hard drive. Carbonite has three different plans for the amount of data you use, starting also at $59.99. Some services, such as Carbonite, offer “versioning,” in which the service will save different versions of your files, so you can restore the version you want.

If you’re worried about safety, your files are encrypted, so no one else can read them. Still, experts recommend that you back up your computer files on external hard drives as well as in the cloud or on the internet. Your data is too precious to lose.


How to back up your PC, laptop, phone and tablet for free,” March 9, 2016, PC Advisor.

The Beginner's Guide to PC Backup,” March 24, 2016, PC Mag.

The Best Way to Back Up Your Computer,” March 4, 2015, Wall Street Journal.

What’s the Best Way to Back Up My Computer?,” How-to Geek.

Blog posting provided by Society of Certified Senior Advisors

Tuesday, October 11, 2016

Looking for the Perfect Retirement Community

continuing care retirement community

Most people don’t think about finances and other details. Make sure to do your research and ask the most important questions.

When Peter and Laurie Olsen decided, in their early 80s, that it was time to give up the burden of taking care of their home and yard—shoveling snow, mowing the lawn, cleaning out gutters—they found a retirement community that seemed perfect. Their large apartment overlooked a lake, the complex had a beautiful swimming pool, the dining hall was elegant and the people were friendly.

There was just one issue that they didn’t consider: that as they got older, they would need more medical care. Beyond the two doctors that visited once a week, their perfect retirement community provided nothing in terms of long-term care options such as a nursing care unit. After Peter was diagnosed with Alzheimer’s, they had to move, in their late 80s, into a Continuing Care Retirement Center (CCRC). “Life plan community” is another and more recent name for this kind of care.

CCRCs are becoming increasingly popular, especially with older seniors, because they provide different levels of care at different stages of your life without having to move to a different facility. Generally, CCRCs include units for independent living, assisted living, nursing care and memory care. Newer models have one type of apartment and bring in “assisted services” as clients need different levels of care, thus allowing them to age in place. Different levels of care also help couples, because it is likely one will need more care at some point, so spouses can remain in the same community, if not under the same roof.

Planning Ahead

Many seniors can’t imagine or don’t want to plan for failing health or injuries in their later years, but experts warn that people need to be prepared. Having to uproot yourself when you’re older, after a serious diagnosis or injury, is not as easy as when you’re younger. Finding the right CCRC takes time. It’s a complicated process involving a spectrum of issues: What community is best for you (or your parents)? What kind of medical care does it provide? How financially stable is it?

Perhaps because CCRCs are designed to meet different levels of care, they can be expensive. Typically, they require an entrance fee as well as monthly charges. Entrance fees can range from $100,000 to $1 million, and monthly charges can range from $3,000 to $5,000, according to AARP, and these costs can increase as residents’ needs change. However, some CCRCs are more affordable, and many are beginning to offer rental contracts with no entrance fees. Financial experts say to prepare for yearly fee increases, at minimum of around 4 percent.

Financial Issues

Many CCRCs lure prospective clients with their expensive appearances and impressive amenities: beautiful landscaping with ponds, chandeliers in the entryway and a fireplace in the community area, for example, plus activities that include field trips, movie nights and musical entertainment. But beyond the visuals and all the activities are serious issues that need to be checked.

One major concern is the company’s financial viability. Although infrequent, CCRCs, or the companies that manage them, can have financial difficulties, or even go bankrupt, and residents may never see their entrance fees again. Experts recommend due diligence before parting with your money and signing a contract.

  • Review the company’s annual financial report and look for potential problems such as expenses greater than operating income, liabilities that exceed assets or occupancy rates below 85 percent.

  • Check the facility’s licensing survey, which indicates how state regulators assess compliance with licensing requirements and complaint investigations.

  • Ask how long the CCRC has been in business.

  • Find out the number of fee increases over the years.

  • If the CCRC is for-profit and could be sold at some point, ask how that would affect a resident's contract.

  • Determine the CCRC’s policy for refunds if you leave.

Because the skilled nursing unit is regulated by Medicare, use the website to find ratings.

Before you sign any contract, have a lawyer or financial adviser review it, and talk to your Certified Senior Advisor. For more suggested questions to ask the CCRC, see sidebar.

Different Kinds of Contracts

Once you decide on a CCRC, a big decision is the kind of payment plan. CCRCs have three basic contract and payment-plan options, although others may be available.

Additional Questions to Ask

Care Patrol, a free senior housing placement service that helps families find independent living, assisted living, memory care and in-home care options, offers its own checklist of questions to ask when assessing CCRCs. Here are a few questions from its list.

  • Does the community require an application fee? Is it refundable?

  • Does the community require a fee upon move in or move out? Is it refundable?

  • What is included in the basic monthly fee?

  • Are rates based on an all-inclusive level of care?

  • Are rates based on fee for service?

  • What are other fees for other services?

  • Are advanced payments returned if the resident leaves the residence?

  • Does the community accept Medicaid payment without additional contribution from an outside source/family member?

Life care or extended contract: The most expensive option, this gives unlimited assisted living, medical treatment and skilled nursing care without additional charges, and with little or no increase in the monthly maintenance fee.

Modified contract: For a lower fee, this contract offers a set of limited services provided for a set length of time. If you need more services, you pay a higher monthly fee that will still be below the average cost of a stay in other skilled nursing facilities in the area.

Fee-for-service contract: You pay for all healthcare costs separately, after paying either no fee or a low fee. Although initially the least expensive contract, costs can add up for those who have a lot of healthcare issues.

What About Medicaid?

No matter how good your finances are now, you may want to prepare for a time when you can no longer pay for your care and need to use government-funded Medicaid. Many people have been forced to move out of their CCRC (or move a spouse or parent) to a place that accepts Medicaid clients.

You’ll want to find out if the CCRC you’ve chosen will accept Medicaid. Many CCRCs limit the number of Medicaid clients because Medicaid pays less than most CCRCs can charge residents. Some CCRCs agree to accept Medicaid down the line if you can show you have enough funds to live in the community for a set amount of time. Also, different states have different requirements. For example, Ohio and Nevada offer Medicaid for assisted living, but Kentucky does not.

Lack of Oversight

One of the big problems when choosing a CCRC is the lack of independent information. While Medicare oversees nursing homes, states are responsible for managing CCRCs and licensing their assisted living components. Only 38 states regulate CCRCs through divisions such as insurance, financial services, aging or elder services, or social services. Twelve states have no regulation, and some only require CCRCs to submit paperwork.

To further complicate the matter, most states don’t make it easy to find the agency in charge of CCRCs, or don’t post inspection records online. To locate your state’s oversight agency, search online for “(the name of your state) CCRC licensing.” Better yet, contact your local Area Agency on Aging.

One state, Washington, just passed a bill that should increase CCRCs’ transparency and oversight. The bill becomes a law on July 1, 2017.

Where to Get Help

Currently, the only independent organization that analyzes and accredits the entire operation of a CCRC, including financial management and healthcare, is the nonprofit accreditation commission CARF International. But the CCRC must initiate the process of getting CARF-CCAC accreditation and go through a lengthy process that requires renewal every five years, so not many places opt to do so. CARF also provides a consumer guide about CCRCs.

Many people turn for help to senior living placement services such as A Place for Mom or Care Patrol. These services, which generally don’t charge for their assistance in helping you find the right community, have their own inventory and grading of CCRCs.

The website MyLifeSite offers a database of information about each CCRC, including contract details. It’s free for basic information, but $35 and up for more exhaustive information.


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Choosing a Place to Call Home,” AARP.

Researching Aging in Place,” April 22, 2015, A Place for Mom.

Risks and Rewards of Moving to a CCRC,” Dec. 31, 2013, Kiplinger.

10 things retirement communities won’t tell you,” July 20, 2014, MarketWatch.

Choosing a retirement community? Be a snoop,” April 22, 2014, MarketWatch.

Regulation of Continuing Care Retirement Communities (CCRCs) Explained,” July 22, 2013, Mylifesite.

WA moves to increase oversight of CCRCs,” March 06, 2016, McKnight Senior Living.

Blog posting provided by Society of Certified Senior Advisors