Continuing care retirement communities: prospects for reducing institutional long-term care

Area of Science:

• Gerontology
• Health Services Research
• Public Health Policy

Background:

• Continuing care retirement communities (CCRCs) integrate housing with comprehensive long-term care (LTC) services.
• A significant portion of CCRCs offer extensive, fully prepaid LTC contracts.
• CCRCs present a potential model for optimizing LTC delivery by substituting institutional care with supportive services.

Purpose of the Study:

• To investigate the hypothesis that supportive services, especially with capitation, decrease nursing home care utilization.
• To analyze the impact of different LTC contract types and support services on nursing home and personal care utilization within CCRCs.

Main Methods:

• Analysis of data from CCRCs focusing on contract types and provision of support services.
• Comparison of nursing home and personal care utilization across different CCRC contract models.
• Examination of health screening practices to rule out selection bias.

Main Results:

• CCRCs with fully prepaid LTC contracts demonstrated a 13% reduction in nursing home care use and a 5% reduction in personal care use compared to other CCRC types.
• No evidence of "cream-skimming" was found, as CCRCs with prepaid contracts did not employ more stringent health screening.
• Residents with extensive CCRC contracts were found to be wealthier, highlighting affordability as a key factor.

Conclusions:

• Extensive prepaid long-term care contracts in CCRCs effectively reduce nursing home utilization.
• The CCRC model, particularly with comprehensive prepaid services, offers a viable strategy for managing long-term care needs efficiently.
• Affordability and resident socioeconomic status are important considerations for equitable access to these comprehensive care models.