This is the first of three blog posts in which University of North Carolina–Chapel Hill Professor James H. Johnson, Jr., PhD, lays out the current landscape facing Continuing Care Retirement Communities, from placement challenges for older adults to strained workforce issues to strategies for the future.
Continuing Care Retirement Communities (CCRCs) are an attractive retirement option for older adults with financial resources. Most CCRCs have waiting lists, considering that they guarantee a continuum of aging care services tied to life stages, embedded in independent living, assisting living and skilled nursing care residential options.
Research confirms, however, that older adults are aging in place (in private homes) for longer today than they did in the past. Consequently, those moving into CCRC independent-living spaces are older on average and increasingly require services for age-related infirmities normally experienced by CCRC residents who have already transitioned to assisted living—and in some instances, to skilled-nursing care.
That’s one of the major findings of a study commissioned by a statewide association representing CCRCs in a common retirement destination state in the Southern United States. Designed to assess the impact of the COVID-19 crisis on the climate, culture and daily operations of member CCRCs, the study’s findings are based on qualitative insights gathered via 12 in-person focus groups with frontline workers and 4 virtual focus groups with managers, supervisors and residents in 6 of the state’s CCRCs.
‘There’s a lot of people that are moving in [who] should have been here a year ago and so that’s a big problem.’
Neither the business model nor the workforce of most CCRCs is sufficiently robust, agile or flexible enough to accommodate the care needs of today’s independent living residents. This creates major financial, human resource, and crisis-management challenges that are difficult for these communities to manage and resolve.
One CCRC manager articulated the problem in the following way:
“I have concern that we are growing the number of people in independent living. And there’s the promise that you’re here for life … that you [are] going to be moved to assisted living when your need it. [But] there’s not talk of growing any assisted living [space], and we are already so full. They have people in living rooms that they’ve made into makeshift bedrooms. So where are all of these people going to go if they need care?”
Another CCRC manager elaborated:
“The threat is even bigger because many of the new members entering through independent living have serious health challenges that [actually] require the type of care offered in assisted living. Our motto is keeping them independent as long as possible, so they don’t have to go to the med center. But I think there’s a lot of people that are moving in [who] should have been here a year ago and so that’s a big problem. They’ll move in and they won’t be independent, and we have to step up our services and we don’t have a lot of CNAs for that many residents.”
The same CCRC manager continued:
“This week alone there’s been times where emergencies have been going off [in independent living] and we don’t have someone to really sit there because you are busy with another resident, but you really can’t hire anybody. I think that is a problem that really needs to be assessed: Residents who need to go up [to a different level of care] sooner, but we can’t force them up. I know that sounds horrible.”
Further complicating matters, owing to the extended longevity of existing CCRC members, residential units in CCRC assisted living communities and beds in CCRC skilled nursing care units are not turning over or being added through expansion as quickly as needed to accommodate the burgeoning demand.
Commenting on the extended life span of residents in a skilled nursing care unit, another CCRC supervisor noted:
“When I started here, our average age in healthcare was like 82, 83, and it’s like 92 [now]. We have 7 that are 100 or older and 10 that will be 100 in the next year. So, they’re living longer. They’re staying longer. And, unfortunately, our bed space is limited. So, it’s forcing our independent living to keep people that really should be in assisted living or skilled nursing longer because we don’t have a bed to put them in.”
Not only do these CCRCs not have sufficient space—assisted living units and skill nursing unit beds—to house the sharp rise in members with deteriorating health status. They also do not have the requisite workforce to accommodate this increased demand for care.
Watch for my second blog post on strains to the CCRC workforce, on April 1.
James H. Johnson, Jr., PhD, is a William Rand Kenan, Jr. Distinguished Professor in UNC-Chapel Hill’s Kenan-Flagler Business School.
Photo credit: Shutterstock/WOSUNAN
