CCRCs and Prospective Resident Health Evaluations
If you are considering a continuing care retirement community (CCRC, also called a life plan community), you may be aware that there are certain health requirements that you may have to meet in order to enter the community under a continuing care contract. Health assessments are mainly used by CCRCs offering a lifecare (Type A) residency contract, and to a lesser degree, a modified (Type B) contracts. They are not, and likely should not, be used by CCRCs offering a fee-for-service (Type C) contract.
To confirm that you meet the health requirements of a CCRC offering lifecare or modified contracts, you may be asked to complete a health questionnaire and/or undergo a medical exam. The community may also request a copy of your medical records from the previous two years.
Healthy residents help to manage risk
Why do CCRCs have this health requirement? Well, The primary reason for new resident health evaluations is that CCRCs offering lifecare and modified contracts operate much like insurance companies: The healthy (i.e., independent living) residents help offset a portion of the cost for those residents who require care services (i.e., those in assisted living or the community's healthcare facility). Another way to look at it is that residents in independent living are pre-paying for some portion of care to be received in the future. CCRCs offering these contracts must hedge their bets as they determine the level of "risk" they are taking on when a new resident moves in, therefore it is critical that the CCRC accurately assess seniors' healthcare status. For CCRCs offering fee-for-service (Type C) contracts, it is highly questionable whether there is any legal basis for health evaluations of prospective residents since there is no pre-payment by the resident for future care and the community is not responsible for covering any of the cost of such care.
In the simplest terms, these comprehensive wellness evaluations are basically trying to ascertain whether the resident will be able to live for a period of time without the need for advanced care services. If too many new residents require a higher level of care, the community can encounter financial challenges and likely will not have enough space within the care center to accommodate everyone's care needs.
Are you medically eligible for move-in?
In order to determine your overall healthboth physically and mentallythe CCRC may assess some or all of the following:
- Information provided by your personal physician and/or an exam performed by the CCRC's own medical staff
- Information collected from you by the medical staff at the CCRC
- Blood tests and other lab work
- A cognitive ability test
- An assessment of your independence with activities of daily living (also called ADLs)
A few examples of the illnesses or conditions that may preclude entry into a continuing care under a lifecare, and possibly a modified residency contract, are: Parkinson's disease, dementia, osteoporosis with a history of fractures, COPD including emphysema, congestive heart failure, or metastatic cancer.
Legal implications and restrictions
There is some debate about whether CCRCs of any type have a legal basis for health screening to determine eligibility for acceptance under a CCRC contract. Since CCRCs offer independent senior living, which is subject to the Fair Housing Act, and also assisted living and nursing care, which are subject to the Americans with Disabilities Act, the guidance isn't completely clear. But, again, for CCRCs offering a contract with healthcare services provided under an insurance-like arrangement there seems to be a more logical argument that some form of health screening is necessary.
Almost all CCRCs and other types of senior living providers have a health screening process to assure that the resident can meet the general "requirements of tenancy" and to determine the appropriate level of care required. By law it is necessary that all prospective residents are asked the same questions, and that no one is singled out due to their appearance or disability. CCRCs also should only ask health questions that are relevant to the health care services offered, and not questions about things that might help determine, for instance, if the resident will require extra staffing needs.
Yet, using such a screening process to determine whether a resident will be accepted for occupancy is a different topic altogether. CCRC should be very familiar with the fair housing and discrimination laws in this regard. For residents who do not meet the health requirements of a CCRC offering a lifecare or modified contract, the community is still required to offer acceptance under a fee-for-service arrangement, if accommodations are available. This means that the resident would not be a part of the continuing care contract, but may still reside within the community and pay for necessary care services out of pocket. In this regard, a CCRC really has little basis for denying anyone entry, although they do not necessarily have to offer residency under a CCRC contract.
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