When my parents approached or passed 80 years, they lived more than 500 miles from my siblings and me. As they and their friends aged, the writing became clearly written on the wall of their minds. They needed to be closer to family. As they considered their options, the one that seemed to make the most sense was a highly rated CCRC facility only 15 minutes from us that would allow them to live independently in a detached home, with access to Assisted Living, Memory Care, and Skilled Nursing all within the same campus.

The Move Into a CCRC Facility

They paid a significant entry fee of approximately $290,000 in 2009 as well as a monthly fee of around $3,000 that guaranteed them continual care for the remainder of their lives. In addition, future costs were predictable. The fixed monthly fee would only increase slightly each year, but that was much less than the monthly rate they would pay if either of them entered any of the care units only when they needed it.  Prepaying while they were independent also gave them priority status over those who lived outside the CCRC campus on room availability.

About four years later, dad’s dementia got worse, and he moved to the memory care unit just down the street from their house. Not long after that, he was moved to the skilled nursing facility where he died within a year. Mom continued to live in independent housing for the next 10 years and maintained an active social life. 

The Impact of COVID on Facility Staffing

In 2020-2021 during the Covid-19 pandemic, nursing homes around the country were limiting or curtailing visitation of family members. At the same time, nursing homes and other care facilities around the country were experiencing severe shortages of workers, either lost by attrition during the pandemic, or those who were working dropped out of the workforce and either did not return or found work elsewhere. Little did we know how this would impact mom‘s care later.  

Mom's Move to Skilled Nursing Care

In late 2023, at age 94, mom suffered a bad fall resulting in stroke–like cognitive impairment that required her to move into the skilled nursing facility of the CCRC. She was also a fall risk, so leaving her unattended for even the shortest period risks her getting out of the bed or her chair (which she has done on more than one occasion), thus far avoiding a severe injury. We were informed by the staff that they did not have enough workers to monitor mom close enough to prevent a fall, so we were encouraged to hire private, 24/7 sitters for mom, because even at night when she is sleeping, she will try getting out of bed on her own.  

Our Financial Plans Went Off the Rails

Financially, we are blessed. Mom and Dad had enough resources to enter a facility that is not feasible for many. However, the long term plan did not consider that in addition to the CCRC’s cost, we would also need to add private sitter costs on top of the CCRC cost. We believed – rightly or wrongly – that the CCRC would be all they would ever need from the time of their move until they both died. Now, fifteen years after their initial move to the CCRC, they have paid over $1 million to the CCRC and are currently paying nearly $20,000 per month because of the additional care we are having to hire privately.  

As the financial planner for my parents when all of this began, I am lamenting my unpreparedness for this contingency – not because it means less of an inheritance for my siblings and I (we’ve all been given more than we deserve) but because financial planning is largely about adding certainly to uncertain outcomes, and I believed that the CCRC option provided more certainty. We may have still chosen the CCRC  for many other reasons, but it was a mistake to think that costs would be predictable.  After forty years practicing financial planning, if there is one lesson on repeat in my own life, it is that nothing is certain, and financial plans are best made using a pencil with a very fat eraser.  

Moral of the Story

The moral to this story is that long term care is expensive. It is unpredictable, uncertain, and will look different than what you plan for. If receiving care is in your future – meaning you don’t die on the way towards some level of dependency – over-insure for it, over-estimate the cost of it, plan for receiving it longer than you think, and if you do have the resources to self-insure for it, discuss your plans with your heirs or adult children before you need care. Otherwise, that bumper sticker you used to see on the back of an RV traveling down the highway, might best be saved for the door of your room at the care facility.