CCRC Reference Guide and Listing

Continuing Care Retirement Communities (“CCRCs”) are unique to the area of long-term care in that they provide various levels of care within one community to older adults.

Continuing care is defined by North Carolina General Statute § 58-64-1, as "...the furnishing to an individual other than an individual related by blood, marriage, or adoption to the person furnishing the care, of lodging together with nursing services, medical services, or other health related services, under a contract approved by the Department in accordance with this Article effective for the life of the individual or for a period longer than one year. "Continuing care" may also include home care services provided or arranged by a provider of lodging at a facility to an individual who has entered into a continuing care contract with the provider but is not yet receiving lodging..."

In general, CCRCs are communities that provide a continuum of care to older adults under a contract for the life of an individual or for a period longer than one year. Typically there are three levels/stages of care offered by CCRCs:

1. Independent Living – is for individuals who are capable of doing the basic chores of everyday life but who may need occasional help from others.
2. Assisted Living – provides assistance for residents with chronic care needs excluding complete 24-hour skilled nursing care. Assisted living services include helping a resident with bathing, dressing, taking medications, and other daily activities.
3. Skilled Nursing Care – generally provides 24-hour nursing care, rehabilitative services, and assistance with activities of daily living to the chronically ill as well as those who have been hospitalized for an illness or operation and require a short period of rehabilitation before returning home.

CCRCs are generally a collection of apartments, town homes, or cottages and include common activity areas such as a library, activity and craft rooms, a restaurant-like dining room, an assisted living facility, and a nursing home. Other amenities often include banking services, convenience stores, walking trails, gardens, swimming pool, fitness center, beauty/barber shops, and guest accommodations.

There is usually a large up front payment called an entrance fee required to enter a CCRC. The amount of the entrance fee may depend on the size and type of living unit you choose, your age, or the type of refund plan you choose. Entrance fees for North Carolina CCRCs range from a few thousand dollars to over one million dollars. However, a typical entrance fee would range anywhere from $68,000 to $370,000. Entrance fee refund plans typically fall within one of the following categories:

1. Full Refund – Full refunds are rare, but sometimes offered. A fixed charge may be deducted before the refund is made and the agreement will state for how long the refund is valid and usually under what conditions a refund is due. Entrance fees that are fully refundable are typically more expensive than those that are partially refundable or refundable on a declining basis.
2. Partial Refund – Partially refundable entance fees guarantee that a specific percentage of the entrance fee will be refunded. For example, certain contracts guarantee that ninety percent (90%) or fifty percent (50%) of the entrance fee will be refunded upon the death of the resident or termination of the contract.
3. Declining Refund – With this type of refund, the contract made specifies a period of time during which the entrance fee will be refundable to the resident on a declining basis. For example, if an entrance fee is refundable and declines at the rate of one percent (1%) per month, then eighty-eight percent (88%) of the entrance fee would be refundable after twelve (12) months.
4. No Refund – Under this type of contract no refund is given.

In addition to the entrance fee, a resident is usually expected to pay a monthly fee. Monthly fees for CCRCs in North Carolina can range from $1,000 to over $11,000. However, monthly fees will typically fall within the $2,000 to $5,000 per month range.

The most distinguishing feature of a CCRC is the contract. A contract is typically defined as a binding agreement between two or more persons or parties. In order for a contract to be considered a continuing care contract, it must provide for lodging, together with nursing services, medical services, or other health related services, and be either for the life of an individual or for a period longer than one year.

Types of Contracts

CCRCs typically offer one (or more) of the following types of agreements or contracts:

1. Extensive – Extensive contracts provide housing, residential services, and health related services in exchange for a price, usually consisting of an entrance fee and a monthly fee. No additional fees are generally required as one moves from one level of care to another.
2. Modified – Modified contracts provide housing, residential services, and a specified amount of health-related services in exchange for an entrance fee and a monthly fee. Health-related services are provided at a subsidized rate or are free for a specified number of days.
3. Fee-for-Service – Fee-for-Service contracts provide housing, residential services, and priority access to health-related services in exchange for an entrance fee and a monthly fee. Health related services are provided at the going, full per-diem rate.
4. Equity – Equity contracts involve an actual real estate purchase, with a transfer of ownership of the unit. Health-related service arrangements vary.
5. Rental - Rental contracts usually require no entrance fee but include, at a minimum, preferred or priority access to health-related services at full per-diem rates.

Required Provisions

Although contracts may vary from community to community, all must, according to N.C.G.S. § 58-64-25, contain certain provisions (see Appendix 6 for details).

Pursuant to N.C.G.S. § 58-64-30, every licensed provider must file with the North Carolina Department of Insurance a revised disclosure statement, setting forth current information required pursuant to N.C.G.S. § 58-64-20, within 150 days following the end of each fiscal year. The revised disclosure statement must be made available to all of the residents of the CCRC.

Pursuant to N.C.G.S. § 58-64-80, there is a nine member Continuing Care Advisory Committee that serves in an advisory capacity to both the North Carolina Commissioner of Insurance and the Special Entities Section of the North Carolina Department of Insurance. Members of the Committee are appointed by the Commissioner of Insurance and serve on the Committee for a two-year term. 

By law, the Committee is to consist of at least two facility residents, two representatives of LeadingAge NC, one individual who is a certified public accountant and licensed to practice in the State of North Carolina, one individual skilled in the field of architecture or engineering, and one individual who is a health care professional. 

• List of the current Continuing Care Advisory Committee members

All licensed continuing care providers are required, pursuant to N.C.G.S. § 58-64-33, to maintain, after the opening of a facility, an operating reserve equal to fifty percent ( 50%) of the total operating costs forecasted for the twelve month period following the period covered by the most recent disclosure statement filed with the North Carolina Department of Insurance. However, if a facility maintains an occupancy level (independent and assisted living) in excess of ninety percent (90%), then the provider shall only be required to maintain a twenty-five percent (25%) operating reserve upon the approval of the Commissioner.

Operating reserves may be funded by cash, by invested cash, or by investment grade securities, including bonds, stocks, U.S. Treasury obligations, or obligations of U.S. government agencies.

Operating reserves can only be released upon the approval of the Commissioner.

Self-Organization

A resident living in a facility operated by a provider licensed under N.C.G.S. § 58-64-40 has the right of self-organization, the right to be represented by an individual of his or her own choosing, and the right to engage in concerted activities to keep informed on the operation of the facility in which the resident resides or for other mutual aid or protection.

Semi-Annual Meetings

N.C.G.S. § 58-64-40 requires the board of directors or other governing body of a provider, or its designated representative, to hold semi-annual meetings with the residents of each facility operated by the provider for free discussions of subjects including, but not limited to, income, expenditures, and financial trends and problems as they apply to the facility, and discussions of proposed changes in policies, programs and services. In addition, upon request of the most representative residents’ organization, a member of the governing body of the provider, such as a board member, a general partner, or a principal owner shall attend such meetings. Residents shall be entitled to at least seven days advance notice of each meeting, and any agenda or other materials that will be distributed by the
governing body at the meetings is to remain available upon request to residents.

The facility specific material in this guide is prepared and assembled by each NC CCRC Provider at least annually. The facilities understand that it is their responsibility to update their data in relation to the database as often as deemed necessary to provide accurate information to current and prospective residents. The reference guide is a live document, in which fees, services, occupancy, and amenities may change from time to time dependent on the decisions made by the Provider.

You are urged to contact the Provider if you are interested in receiving additional information outside of what is available in the CCRC database. 

The North Carolina Department of Insurance would like to acknowledge each facility for their assistance with our publication.

For further information you may contact the Financial Analysis and Receivership Division, Special Entities Section, at (919) 807-6632 or (919) 807-6178, or by mail at the following address:

North Carolina Department of Insurance
Financial Analysis and Receivership Division
Special Entities Section
1203 Mail Service Center
Raleigh, NC 27699-1203