Read the entire "Gray Area: Utah as it ages" series of reports here.

Roz and Zell McGee would love to grow old in Utah — but they also want to live in a continuing-care retirement community, the kind of bucolic but invigorating campus that would let them age in stages. Earlier this decade, when they were still in their early 60s, they put in applications for two CCRCs on the East Coast.

She and Zell never want to be a burden to their children, Roz explains, and they want to make decisions about their possible future care now, rather than leaving their children guessing. They're drawn to CCRCs because, as Roz says, "in a thoughtful way they provide for changing life conditions as you grow older," letting residents move from independent apartment to assisted living to skilled nursing should the need arise, all on the same campus. If one spouse needs to move to assisted living, the other spouse would still live close by.

Utah doesn't have an accredited CCRC, although some programs, like Christus St. Joseph Villa, do have a range of residences. None provides the amenities of the two CCRCs the McGees have looked at, one on the eastern shore of Maryland (it has scenic Chesapeake Bay views and college classes) and another in Chapel Hill, N.C. (this one is a bird sanctuary and has a community garden and a 6,500-book library).

There's no one type of CCRC or one-size-fits-all operating plan or fee structure, just as there's no one type of growing old. The campuses and the contracts are different from place to place, but they do have certain crucial points in common, according to Susanne Matthiesen, manager director of CARF-CCAC, which accredits the programs. These include providing a continuum of services — "seniors tend not to like the paternalistic term 'care,"' she says — as one grows older and possibly more frail. The bottom line is living as independently as possible, with the supportive services in place as needed. The CCRC typically has the right to decide if you need to move out of your independent apartment into a higher level of care.

Long-term contracts are at the heart of the CCRC programs, and there are many types of agreements. Type A, an extensive agreement, is "pretty prevalent" in CCRCs, says Matthiesen. There's usually an up-front entrance fee, which might be in the tens of thousands of dollars (she says they can be as high as $1 million, although that's not common), and a monthly fee that could include all of your health care, a meal plan, housekeeping and the property. It stays "relatively stable" throughout time, regardless of the level of care needed, but there are annual increases to the monthly fee, and people should be asking what those increases have run in the last few years, she advises.

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You have to ask a lot of questions and not just financial ones, Matthiesen says, noting that everyone considering a CCRC needs to have a trusted financial planner look over the fine print before signing an agreement, since it's long-term and binding. Among the nonfinancial questions: Can you see an outside doctor or does your care transfer to the on-campus clinic? "Many times people look at the beautiful campus but don't focus on health services. They don't ask others about quality of the care they've received. And it's important for families to have some planning discussions."

Other questions: If you're buying your property, what happens to it when you die or have to move up to another level of service? How financially sound is the program, since you're counting on it to be there for perhaps decades. (Matthiesen says certification includes a hard look at financial issues.) Will the property hold its value? And, perhaps most important, what happens if you outlive your funds? One of the CCRCs the McGees are considering has a fund for this contingency, Roz says, so no one will be kicked out. They may not all do that, so ask.


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