Would you rather live in a Life Plan Community or a Continuing Care Retirement Community (CCRC)? The market research folks have the answer: Most older adults, especially those under 65, would much rather live in a Life Plan Community than a CCRC.
Even though they are exactly the same thing.
A group of facility owners has concluded they need a name change because the phrase “continuing care communities” makes prospective residents think about sickness and dependency rather than independence. And few seniors want to think about frail old age even though millions of us will eventually need to rely on others for care. At least two-thirds of those 65 and older will need some personal assistance before they die. And about half will need a high level of care, according to new research by my Urban Institute colleague Melissa Favreault. You can’t change the reality. But, it seems, you can deny it.
Continuing care communities are a form of senior housing that combines independent and assisted living and nursing homes in the same building or campus. The idea: You move in as a relatively young, healthy senior and, as you age, you receive extra care without having to leave the community. It makes good sense. But it sounds grim–at least the focus groups think so.
Some CCRCs are rentals. But many require residents to pay a large entry fee (often several hundred thousand dollars) for the right to live in a unit. The fees are often fully- or partially-refundable when the resident leaves the community or dies. In effect, residents make facilities an interest-free loan that may not be repaid for decades.
Because operators want their residents to stay for as long as possible, they aggressively market themselves as homes for healthy, active seniors. But many consumers have been reluctant to buy the sales pitch.
Continuing Care Communities have had a rough time in recent years. Overall the number of CCRCs has increased almost 10-fold since the idea was hatched in the early 1980s, but the number of residents has risen only six-fold, to about 600,000 or about 2 percent of those age 70-plus, according to those behind the renaming initiative.
Some reasons were beyond the control of the facilities. For example, the 2008 housing crash wiped out much of the home equity that prospective residents would have used to pay their entry fees. And consumers want to stay in their own homes for longer than ever. But the industry created some challenges of its own. The glut of new communities is creating intense competition in some markets and the bankruptcies of some communities have left residents uneasy.
Clearly, the industry also felt that branding was a big part of the problem. As a result, Leading Age, a group that represents many non-profit senior service providers, headed an effort to find a new name for the product.
And what the market research people learned is instructive. They asked seniors, especially younger ones, what they thought of the name Continuing Care Retirement Community. And the response was pretty grim. They were OK with communities. But they hated “care” and many didn’t much like “retirement” either. Some didn’t even like “continuing,” which they equated with “endless” and “until death.”
Thus, Life Plan Community. Life sounds good. Plan sounds empowering. And community? Well, they were willing to keep that.
This entire exercise, however, is deeply troubling. I’m not criticizing the operators of CCRCs, whose concept is actually quite a good one, at least for those who can afford it. The problem is with those consumers, who are deeply in denial. And that’s an attitude that the senior living communities enable, at least until a resident’s need for personal assistance becomes so high that it is undeniable.
Yesterday, I got an email from a friend who lives in an independent living facility that also includes assisted living. He told me that in his upscale building, increasing numbers of residents who first entered as independent and active now need private duty aides. And some new residents are moving in with aides, even though the facility is heavily marketed as independent living. Something important is going on here, and it says as much about consumers as it does about senior living companies.
Branding matters and the operators of these facilities must do what they need to do to bring in business. But somehow, some way, we need to confront our real need for help in old age. Denial, as they say, ain’t just a river in Egypt.