One common question we receive at myLifeSite is which health conditions might prevent someone from moving into a life plan retirement community (traditionally called a continuing care retirement community or CCRC). In some cases, people delay their move until their health declines or an acute event occurs, and then they no longer qualify for a continuing care or life plan contract.
How a CCRC health evaluation works
If you are considering a life plan retirement community, be aware that certain health requirements often must be met to enter under a continuing care or life plan contract. Health evaluations—medical assessments of overall health—are most commonly used by CCRCs that offer lifecare (Type A) contracts and, to a lesser extent, by those offering modified (Type B) or fee-for-service (Type C) contracts. The process varies by community but typically includes items such as:
- Completing a health questionnaire
- Undergoing a cognitive assessment
- Providing recent medical records
- Having a short medical exam
Common age-related conditions do not automatically disqualify an applicant. The evaluation takes a holistic, actuarial view of a person’s health to determine their current ability to live independently and their likelihood of needing higher levels of care in the future.
For example, conditions like Parkinson’s disease, cognitive decline, osteoporosis, COPD, congestive heart failure, or cancer are not uncommon among older adults. Two applicants with the same diagnosis may receive different decisions depending on their overall health, functional ability, age, and the community’s assessment of risk.
>> Related: Fit for Move-In? The CCRC Health Evaluation Requirement
Healthy residents help manage a community’s overall risk
It helps to understand why life plan communities conduct health evaluations. Communities that offer lifecare (Type A) and modified (Type B) contracts in effect operate with insurance-like financial structures: fees paid by independent-living residents help offset care costs for residents who need assisted living or skilled nursing. In this sense, healthier independent-living residents are prepaying for potential future care. Health screenings are a form of underwriting that helps communities manage the financial risk of accepting new residents.
By contrast, fee-for-service (Type C) communities typically do not require health evaluations because residents do not prepay for care and the community is not financially responsible for covering those costs.
A practical look at CCRC health evaluations and qualification
At myLifeSite, former CCRC sales and marketing directors on our team bring firsthand experience with the evaluation process. Newell Bowman Dickerman, a customer success representative, shared examples of conditions that have strongly influenced qualification decisions: progressed Parkinson’s disease, Alzheimer’s disease, end-stage cancers, repeated falls or multiple rehab stays within a year, significant mobility limitations, behavioral or safety concerns, undiagnosed cognitive symptoms, ALS, and certain advanced heart conditions.
Decisions are made case by case, weighing the total health picture and the community’s current resident mix and risk tolerance. Even within the same senior living organization, different campuses may interpret similar health situations differently. One community may decline applicants with a cancer diagnosis within the past five years, while another may accept someone with an early-stage diagnosis.
>> Related: Evaluating Care, Quality, and Access at a CCRC’s Healthcare Center
An important caveat for couples
Couples should know there is a distinction between qualifying to live independently in a community and qualifying for the care benefits provided by a life plan contract. Failing a health evaluation does not always prevent someone from living at a CCRC, but it can affect eligibility for lifecare (Type A) benefits. It is possible for one spouse to qualify for contractual care benefits while the other does not, yet both may still live independently in the community. In such cases, monthly fees and services are typically the same until one spouse requires higher levels of care; the spouse who did not qualify for contract benefits would generally pay market rates for those services when needed.
>> Related: A Senior Living Solution That Keeps Couples with Different Care Needs Together
Legality of CCRC health requirements and restrictions
CCRCs provide a continuum of care—independent living, assisted living, and skilled nursing—and are subject to the Fair Housing Act and the Americans with Disabilities Act, which prohibit discrimination. Administrators must understand and adhere to these laws when working with prospects and residents. There has been debate over whether CCRCs can legally require health evaluations for life plan contract eligibility, but because lifecare contracts resemble insurance arrangements, communities have an actuarial basis for screening applicants to manage financial risk.
>> Related: Levels of Care: CCRC Monthly Fee Adjustments for Couples
Shades of gray in the CCRC health assessment process
The CCRC health evaluation and approval process is nuanced. Many factors influence whether a prospective resident is accepted under a particular contract type. Couples may face mixed outcomes where one qualifies for a life plan contract and the other does not, yet both are allowed to move in. Understanding the process helps, but a pre-existing medical condition does not automatically rule someone out of CCRC living.
Because each community applies its own standards and risk tolerance, you might be declined by one CCRC and accepted by another. The pre-move health evaluation also serves the broader purpose of helping communities assess long-term financial viability by estimating the likelihood that new residents will require costly care—an assessment that ultimately supports the stability and peace of mind of all residents.