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CCRC shopping: One couple's view

February 26, 2014
by Donald H. Hoffman, EdD, and Sandra Hoffman, RN
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Donald and Sandra Hoffman

[Editor’s note: This article is the first part of an ongoing conversation on how CCRCs can better serve the incoming census and how LTC facilities can learn what matters to incoming consumers.]

Sandi and I are both in our mid-70s—We are not old by today’s standards. Both of us have been involved with aging issues, not only through our personal explorations but also through our professional involvement during our work years with various programs designed to support older adults.

For several years, we have looked into privately run communities offering independent living to people aged 55+. Mostly self-sufficient and self-contained, these communities offer opportunities for personal growth, recreation, friendship and independence. In many instances, these communities can be quite large, approaching 10,000 individual units, with multiple clubhouses and pools, golf courses and extensive opportunities for residents develop artistically and intellectually. Many other, smaller retirement villages control their size to provide more intimate communities for retirees. We knew that other options for an independent lifestyle existed that we had not yet examined, so we searched further for our future retirement site.

Recently, we toured several continuing care retirement communities (CCRCs) and independent living complexes designed for the 55+ audience. Our trip took us through six states: Alabama, Florida, Georgia, Kentucky, North Carolina and South Carolina. All of our site visits, seven in total, were to "for-profit" retirement communities. Our visits ranged from one-night/one-day visits to four-night/five-days, with the majority being two-night/three-day stays—long enough to see how a community really operates around the clock.

CCRCs are designed to include a continuum of care, offering independent living, assisted living, skilled nursing and, in many cases, memory and Alzheimer’s care. Although private, individually run homes exist in many areas, most are corporate-run with multiple units in many states, some with nationwide coverage and as many as 350+ locations. Almost all CCRCs and independent living-only communities allow prospective clients to visit and stay for little or no cost—a "try before you buy" arrangement well worth taking advantage of by prospective residents.

Conditions at the facilities we visited varied greatly, with the best of those we encountered being extraordinary in their quality, and with the worst of our visited sites being absolutely horrid. We were both gratified and shocked by what we encountered.


Across all six states, the high points of our CCRC visits were the extraordinary residents we encountered—many of whom were in their 80s and above, each and every resident possessive of life experiences and skills worth sharing. Most were friendly and outgoing, whereas others were withdrawn and fighting to survive illnesses, some of them fatal. There were younger residents as well, living by choice and for various reasons as an integrated aspect of each community. We expected to see high percentages of single female residents but were surprised to find large populations of single males as well. The average age of residents reported to us by staff varied from 82 to 84, meaning that each facility had portions of its population above and/or below the average estimated national age for CCRC demographics.

We have always sought to find and live in communities with diverse populations. Diversity adds vibrancy, and the intermixing of a variety of international and ethnic populations adds interest to conversation, lifestyle and programming. We exulted when we observed residential communities with a variety of races, ethnic origins and religions, with different skills, occupations, education and beliefs. Thankfully, most communities we visited on our trip met our criteria for diversity and presented an interesting mix of residents.


In some cases, our CCRC visits revealed that residents' attitudes toward their own aging (coupled with corporate and staff attitudes) had a direct effect on facility policies, the scope of activities and the living conditions. Yet in many of the facilities we visited, older adults continued to be "treated as children," leading to limitations in activity choices, food selection/delivery and personal interaction. Where healthier attitudes prevailed, usually at the higher-end facilities, there was a noticeable difference in self-determination, personal interaction, level of conversation, activities, food preparation and delivery, facility management and cleanliness.

Let’s face it, no independent living situation (with the possible exception of buying a home within a retirement community) will approach or become an adequate substitute for living in one's own home. In CCRCs and some stand-alone independent living facilities, the nature of the situation automatically changes a person's independence to dependence. The transition in some facilities is almost immediate, but in most situations, the transition is subtle and takes place over a longer period of time.