Deciding to move into a continuing care retirement community (CCRC), also known as a life plan community, is a proactive step to prepare for the uncertainties of aging. Such communities offer a continuum of care—independent living, assisted living, memory care, and skilled nursing—so residents and families can plan ahead and access the support they may need. But questions arise when administrators determine a resident requires a higher level of care, and the resident or their family disagree with that assessment.
That dilemma has been appearing more often in public discussion. A recent San Diego Union-Tribune article recounted the experience of Jan Brown, who had lived in independent living since 2011 and broke her leg. The community’s staff wanted to move her to the on-site healthcare center, while Ms. Brown resisted. Her physician intervened and persuaded the community to allow her to remain in independent living, but the episode left her distrustful of the community’s management. She subsequently sought a refund of her entrance fee to move elsewhere, but she has been unsuccessful in challenging the contractual terms.
A costly decision
From my visits to many CCRCs and conversations with hundreds of residents, situations like Ms. Brown’s are generally the exception rather than the norm. People tend to hear more about negative incidents, so isolated cases can loom disproportionately large. Similar disputes also occur in other care settings, such as stand-alone assisted living communities, but the dynamics differ; in those cases the debate is often about leaving the community entirely rather than moving between care levels within the same community.
Most CCRCs include policies that grant administrators authority to determine when residents should transition to a higher level of care—whether assisted living, memory care, or skilled nursing. That authority can be perceived as a potential conflict of interest because a permanent move from independent living frees up that residence to be marketed to a new incoming resident.
It’s important to note that many contracts distinguish between temporary and permanent transfers. If a transfer is classified as temporary, the original residence typically will not be marketed to a new resident. Because of such distinctions, prospective residents should carefully review how their contract and the community’s policies define and handle transfers.
Too often, disclosure language in contracts is vague, framed as a collaborative decision involving the resident, family, staff, and physician. My concerns are twofold: first, prospective residents may not read contract language closely enough to catch these clauses; second, vague wording can lead to misunderstandings when a care decision becomes necessary.
Prospective residents should ask for a clear, detailed policy that explains how transfer decisions are made and lists the kinds of circumstances that would prompt a required move. While no policy can predict every scenario, greater specificity at the outset reduces the potential for conflict later. It’s also wise to involve close family members in these discussions early, since they are often consulted when a health crisis occurs.
Painting a negative picture of the CCRC industry
Articles that highlight disputed moves can harm the reputation of the CCRC industry, even though most communities provide a positive quality of life and peace of mind through guaranteed access to a continuum of care. Balanced, transparent communication about transfer policies can help address prospective residents’ concerns and clarify how decisions are made and potential conflicts of interest are managed.
That said, management cannot—and should not—always defer to a resident’s preferences if doing so would create an unsafe situation for the resident or for other residents. Allowing someone to remain in an unsafe setting can increase legal liability and generate serious negative publicity. This is why written, clear, and fair policies are essential: they protect residents and the community and provide an agreed framework for decision-making before a crisis occurs.
What’s best for all parties
Transfer decisions require balancing the staff’s professional judgment about safety and appropriate care with the resident’s wishes and family perspectives. Emotions often run high during a health crisis, and stress can cloud the judgment of both residents and loved ones about what level of care is most appropriate.
Doing due diligence before moving into a CCRC helps ensure that you understand how the community handles transfer situations and that your priorities and expectations are aligned with the provider’s policies. A CCRC is a resident’s home, and policies should be designed to keep residents safe while respecting their dignity and preferences. Clear, transparent policies and open communication with family and care providers make it more likely that any transition—temporary or permanent—will be handled fairly and with compassion.