Resources for Residents and Families
A continuing care provider is an individual, partnership, corporation or other entity that has applied for, and received, a Certificate of Authority from the Department of Social Services to enter into continuing care contracts with persons 60 years or older at a continuing care retirement community.
A continuing care contract is an agreement between a person 60 years or older and a continuing care provider. Contracts include a promise to provide a range of services at a continuing care retirement community for a period longer than one year, in exchange for payment. Usually, but not always, the promises is effective for the life of the resident. A continuing care contract may consist of one or a series of agreements.
A continuing care retirement community is a facility where services promised in a continuing care contract are provided. Continuing care retirement communities can be apartment-type dwellings, high-rise buildings, a subdivision setting, or any other housing design. Most continuing care communities have designated assisted living units and a skilled nursing facility either on or near the facility.
Continuing care contract provisions can vary extensively from provider-to-provider and community-to-community. Contracts can provide for a refund of a portion of the entrance fee when the contract is terminated, or specify that the entrance fee is fully amortized over a certain period of time and residents or their heirs are not entitled to a refund after that time. Contracts can entitle residents to a membership arrangement, a proprietary interest in their living unit, or a party to a master trust agreement.
The Department reviews each provider's continuing care contract form to assure they contain all provisions required by Health and Safety Code section 1788. You may view the Health and Safety Code requirements by clicking on the "Statutes" tab on the left side of your screen. The basis of the Department's approval is a determination that the provider has submitted a contract that complies with the minimum statutory requirements. Approval by the Department is NOT a guarantee of performance or an endorsement of any continuing care contract provisions.
NOTE: PROSPECTIVE RESIDENTS ARE STRONGLY ENCOURAGED TO CONSIDER THE BENEFITS AND RISKS OF A CONTINUING CARE CONTRACT AND TO SEEK FINANCIAL AND LEGAL ADVICE BEFORE SIGNING A CONTINUING CARE CONTRACT.
Continuing Care Fees
Most continuing care contracts call for an entrance fee and monthly service fees. An entrance fee is the consideration made by a person entering into a continuing care contract for the purpose of assuring care or related services pursuant to a continuing care contract. Monthly service fees are the fees charged to a resident for current accommodations and services. Providers, NOT the Department, determine entrance fee and monthly fee amounts.
Any change to monthly fees, however, must be based on projected costs, prior year per capita costs, and economic indicators as specified by the Health and Safety Code. Providers must give residents 30 day advance written notices to any change in monthly service fees or in the price or scope of any component of care or other services and must meet with all residents to discuss the reasons for the increase and the date used for calculating the increase. At least 14 days prior to that meeting, the provider must make available to residents comparative data showing the budget for the upcoming year, the current year's budget and actual and projected expenses for the current year.
The statutes contemplate that resident input into decisions made by providers is an important factor in creating an environment of cooperation. To foster this environment providers are required to:
Encourage residents to form a resident association;
Quickly resolve any dispute, claim or grievance;
Hold semiannual meetings with residents for the purpose of free discussion of subjects including, but not limited to, income, expenditures, and financial trends and issues as they apply to the continuing care retirement community and proposed changes in policies, programs and services;
Semiannually make available to the resident association a financial statement of activities for that facility comparing actual costs to budgeted costs broken down by expense category and consult with the resident association during the annual budget process. This process shall be evaluated every two years by the provider and the evaluation shall be made available to the residents;
Provide a copy of its annual report, including annual audited financial statements to residents within 10 days after filing with the Department; and,
Make available minutes of the provider board of director's meetings; and,
Accept a resident of the continuing care retirement community to participate as a nonvoting resident representative to the provider's governing body.
Retirement Community Residents` Rights—(Health and Safety Code Section 1771.78)
(a) No resident of any continuing care retirement community shall be deprived of any civil or legal right, benefit, or privilege guaranteed by law, by the California Constitution, or by the United States Constitution solely by reason of status as a resident of a community. In addition, because of the discretely different character of residential living unit programs that are a part of continuing care retirement communities, this section shall augment Chapter 3.9 (commencing with Section 1599), Section 73523 of Title 22 of the California Code of Regulations, and applicable federal law and regulations.
(b) All residents in residential living units shall have all of the following rights:
(1) To live in an attractive, safe, and well maintained physical environment.
(2) To live in an environment that enhances personal dignity, maintains independence, and encourages self-determination.
(3) To participate in activities that meet individual physical, intellectual, social, and spiritual needs.
(4) To expect effective channels of communication between residents and staff, and between residents and the administration or provider's governing body.
(5) To receive a clear and complete written contract that establishes the mutual rights and obligations of the resident and the continuing care retirement community.
(6) To maintain and establish ties to the local community.
(7) To organize and participate freely in the operation of resident associations.
(c) A continuing care retirement community shall maintain an environment that enhances the residents' self-determination and independence. The provider shall do both of the following:
(1) Permit the formation of a resident association by interested residents who may elect a governing body. The provider shall provide space and post notices for meetings, and provide assistance in attending meetings for those residents who request it. In order to permit a free exchange of ideas, at least part of each meeting shall be conducted without the presence of any continuing care retirement community personnel. The association may, among other things, make recommendations to management regarding resident issues that impact the residents' quality of life. Meetings shall be open to all residents to attend as well as to present issues. Executive sessions of the governing body shall be attended only by the governing body.
(2) Establish policies and procedures that promote the sharing of information, dialogue between residents and management, and access to the provider's governing body. The provider shall biannually conduct a resident satisfaction survey that shall be made available to the resident association or its governing body, or, if neither exists, to a committee of residents at least 14 days prior to the next semiannual meeting of residents and the governing board of the provider required by subdivision (c) of Section 1771.8. A copy of the survey shall be posted in a conspicuous location at each facility.
(d) In addition to any statutory or regulatory bill of rights required to be provided to residents of residential care facilities for the elderly or skilled nursing facilities, the provider shall provide a copy of the bill of rights prescribed by this section to each resident at or before the resident's admission to the community.
(e) The department may, upon receiving a complaint of a violation of this section, request a copy of the policies and procedures along with documentation on the conduct and findings of any self-evaluations and consult with the Continuing Care Advisory Committee for determination of compliance.
(f) Failure to comply with this section shall be grounds for suspension, condition, or revocation of the provisional certificate of authority or certificate of authority pursuant to Section 1793.21.
Also, please refer to Health and Safety Code Section 1599 and Title 22, California Code of Regulations, Section 73523 for rights of residents living in the assisted living and skilled nursing facility units of a continuing care retirement community.
If you have further questions, please contact us at (916) 654-0591
Questions to Ask
American Association of Homes and Services for the Aging
California Continuing Care Residents Association
California Department of Aging—Ombudsman