Terms of Art and Definitions by CCRC LifeCast.  How to Untangle Terms of Art in an Already Confusing Industry.

The Senior Living field is littered with terms of art. Some of them are a function of federal or state statutes and regulations. Some of them relate to retirement generally. Some of them are marketing speak. Some of them a product of technical fields that touch on retirees, including health care and information technology. Some of them are just inside baseball shortcuts to long noun strings or big concepts.

You’d say CCRC too if the regulators called what you do a Continuing Care Retirement Community. Otherwise, you’d run out of breath before you really get to a verb.

There are many synonyms or closely-related terms with similar if not identical meanings. We point those out.

We try for a plain language translation of technical concepts, but it may still pay to know the lingo. Here’s our evolving cut at key terms of art. Ask if you don’t see a term or concept you want explained. We’ll add it.

Glossary: Terms of Art

Alzheimer’s Unit Alzheimer units or beds are designed for those residents with significant cognitive impairment as a result of having Alzheimer’s or related dementia.

Alzheimer’s beds are not licensed as nursing beds, but may have additional state licensure requirements, depending on the state. May also be called Memory Care or Dementia unit, beds, or facility.

Common features include wander alarms or secured exits to control wandering patients who can get lost.

(HealthTrust, LeadingAge, American Seniors Housing Association, National Investment Center for Seniors Housing & Care, Argentum, National Center for Assisted Living, 2016)

Assisted Living Assisted Living is designed for frail seniors who need assistance with Activities of Daily Living, but do not require skilled nursing care.  Assisted Living units or beds can be offered in a separate wing, separate floor (or part of a floor), or separate building, and typically have state licensure requirements for the delivery of assisted living services.

This is one of the regulatory derived terms of art.

(HealthTrust, LeadingAge, American Seniors Housing Association, National Investment Center for Seniors Housing & Care, Argentum, National Center for Assisted Living, 2016)

Continuing Care Retirement Community (CCRC) Continuing Care Retirement Community (CCRC) refers to a senior living community that offers more than one level of care from Independent Living, to Assisted Living, to Memory Care, to full Skilled Nursing.

Most full-continuum of full spectrum CCRCs offer the four levels on a single campus or even within a single structure. Some communities have one or more levels of care available off-site on a different campus, often due to space limitations in the course of a development’s evolution. Because spouses don’t always age at the same rate, the proximity of different levels of care can be very important.

CCRC is the broad or generic term covering multiple types of senior living communities offering either or both a substantial entry fee or a continuum of care.

States vary in whether they regulate and the extent to which they regulate CCRCs. The technical definition of what is a regulated CCRC can vary state-to-state. The minimum amount of the entrance fee is a common legal measuring stick distinguishing CCRCs from other forms of Senior Housing like rental Senior Apartments. Another common legal benchmark is the inclusion of support or health care services within the contract promises, not just real estate.

This is one of those regulatory and industry terms of art describing a range of offerings. Recently LeadingAge proposed a replacement label, “Life Plan Community,” but this synonym has yet to catch on. It may be too long in the era of Twitter.

Contract Type
Life Care Contract

Type A

Type A or Life Care contracts require a substantial entrance fee or buy-in. In addition, the resident typically pays an upfront fee and an ongoing monthly fee in exchange for the right to lifetime occupancy of an independent living unit and for certain services and amenities.

Residents who require assisted living or nursing care may transfer to the appropriate level and continue to pay essentially the same monthly fee they had been paying for independent living.

Type A contracts are almost always associated with not-for-profit CCRCs and are called “extensive care contracts” by some.  Although fees may increase over time due to inflation, they are not to do so because the resident’s care needs change. It’s one fee structure regardless of the resident’s current level of care.

Modified Contract

Type B

Type B or Modified contracts also require an upfront fee and an ongoing monthly service fee for the right to stay in an independent living unit and receive certain services and amenities.

A modified contract obligates a CCRC to provide the appropriate level of assisted living or nursing care to residents who entered independent living units, as in an extensive care contract, but only for a specified period of time at a specified rate that may or may not be tied directly to the independent living rate.

In other words, the fee structure may change with the resident’s current level of care and then current needs.

Fee-for-Service Contract

Type C

Type C Fee-for-Service Contracts require a substantial entrance fee but do not include any discounted health care or assisted living services as part of the monthly unit fee.

Concierge or hospitality services, ADL services, or healthcare related services may be offered separately from a menu of fee-for-service offerings, available on a pay-as-you-go basis to residents as needed and as available.

There are generally no guarantees that what is currently offered will be available in the future. Or that if offered there will be space or time for you when you need it.

Typically, in a Type C community residents receive priority admission and may receive guaranteed admission on a space available basis for these services, but residents who require assisted living or nursing care pay the regular per diem rate paid by those admitted from outside the CCRC. There’s no cost advantage or insurance aspect for Assisted Living or Nursing Care for starting in Independent Living on campus.

Rental Contract

Type D

Type D or Rental Contracts are more like a Senior Apartment Lease. Any deposit is nominal, more like the deposit for an apartment than buying a house. The lease is typically for no more than a year and often renewed month-to-month. The monthly fee does not include any assisted living services or healthcare, provide any guaranteed discounts to future levels of care, or guarantee access to future levels of care.

Service offerings such as concierge or hospital services, ADL services, and healthcare services are typically available on a strictly pay-as-you-go, fee-for-service basis offered entirely separately from the unit contract.

Occupancy Type
Independent Living Independent Living units are apartments are designed for seniors who pay for some services (e.g., housekeeping, transportation, meals) as part of a monthly fee or rental rate, and who require little, if any, assistance with Activities of Daily Living.

Typically, independent living units are not licensed for health care.  Residents of independent living units may receive home health care services provided to them by either an outside agency or an affiliate of the property management.

In order to qualify as an independent living property, the community must contain a common dining facility that provides at least one daily meal as part of the monthly fee. If no common dining is bundled in the monthly fee, the unit is a Senior Apartment, not Independent Living.

(HealthTrust, LeadingAge, American Seniors Housing Association, National Investment Center for Seniors Housing & Care, Argentum, National Center for Assisted Living, 2016)




Private Private Unit means an apartment or unit that is occupied by one or more persons who are related or who choose to live together.
Semi-Private Semi-private unit means an apartment or unit that is occupied by two or more persons who are unrelated. This means your roommate may be assigned to you, like it or not.
Skilled Nursing Facility (SNF) Skilled Nursing Facility (SNF – pronounced SNIFF) provides licensed nursing beds. SNF is another name for a licensed nursing home. SNF must be licensed and rated by Medicare to receive payment for rehabilitation or short-term stays. It will be on the Medicare Star Rating system unless it is exclusively private-pay and does not accept Medicare.

This is one of Medicare regulatory terms of art. To be a skilled nursing facility the nursing home must be inspected and licensed. Some nursing homes are strictly private-pay and are not licensed as a SNF. Medicaid has a related concept, a licensed nursing facility (NF).

 

Senior Apartment Senior Apartment means an apartment or unit in an age-restricted, Age-55 or older, a community that does not include a common dining facility providing, at least, one daily meal as part of the monthly fee or rent.

Senior Apartments are different from Independent Living, Assisted Living, Memory Care or Skilled Nursing facilities.

Senior Apartments include all other age-restricted apartments where at least 80% of the residents are 55 years of age or older. Federal Fair Housing Law generally prohibits age-discrimination in housing, but specifically permits a property to limit residents to those over Age-55. Senior Apartments are one type of Age-Restricted Apartments.

Physically, the properties are similar to traditional apartments and may have a clubhouse, perhaps exercise facilities, covered or garage parking, and a swimming pool. Although optional meal plans may be offered, the base monthly fee does not include meals in a common dining facility.

Common dining is the separation line between a Senior Apartment (eat in your own unit) and Independent Living (at least one meal a day included and offered in a common or shared dining facility).

(HealthTrust, LeadingAge, American Seniors Housing Association, National Investment Center for Seniors Housing & Care, Argentum, National Center for Assisted Living, 2016)