Continuing care retirement communities in the United States

The emphasis of the CCRC model is to enable residents to avoid having to move, except to another level of care within the community, if their needs change.

The top ten states with the greatest number of CCRCs are Pennsylvania, Ohio, California, Illinois, Florida, Texas, Kansas, Indiana, Iowa, and North Carolina—in that order.

[4] Typically, seniors move into a CCRC while still living independently, with few health risks or healthcare needs, and will remain there until end of life.

As seniors progress in age, and medical needs change, the level of nursing care and service increases proportionally in response.

If greater illness or injury warrants hospitalization (not available in CCRCs), the senior may return to his or her CCRC residence after recovery, and should receive appropriate rehabilitative care.

Type D contracts are essentially pay-as-you-go, and residents take on the risk of all expenses and their increases in exchange for little or no entrance fee.

Even though a CCRC's entrance fees (in Type A, B, and sometimes C contracts) represent in part lump-sum long-term care insurance premiums[14] (or prepayments of future costs) paid by all non-rental residents upon entry for health care that is used at any given time by only a small subgroup,[1] the "sweet spot" for the entrance fees appears to be determined not actuarially but by whether it resembles locally affordable housing, viz., whether the entry fee is at or below the local market home values.

[16][17] In 2010, the US Government Accountability Office (GAO) reported to the US Senate's Special Committee on Aging that CCRCs can provide benefits to older Americans, but not without some risk.

States generally license CCRC providers, monitor and oversee their financial condition, and have regulatory provisions designed to inform and protect consumers.

[12] If the community participates in Medicare and/or Medicaid (as opposed to private pay only), then the skilled nursing unit will be rated by the U.S. government on the basis of health inspections, staffing, and resident assessments.

[19] Potential residents, or their current caregivers, should inquire about licensing reports, prior inspections and verified complaints to help inform their opinion of a particular CCRC.

[31] A 2014 class-action lawsuit, which alleged that the CCRC Vi at Palo Alto funneled the residents' refundable entrance fees to its parent company without establishing a reserve fund as required by state law, was dismissed by a US District Court judge who ruled that, while the CCRC might be in violation of state law by not maintaining a cash reserve, the plaintiffs (CCRC residents) "lack[ed] standing in their civil claim" because they did not show that harm was done or was imminent.

[32] The residents appealed and in April 2020 the Appeals Court found that "the statutory violation of failing to maintain a refund reserve harms Residents by putting them in the distressing position of choosing between vacating the Vi and potentially risking non-repayment, or continuing to live at the Vi in a state of perceived financial insecurity.