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 1771.7)
.Resident Rights/Resident Association.
(a) No resident of a 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), Sections 72527 and 87572 of Title 22 of the California Code of
Regulations, and other applicable state and federal law and regulations.
(b) A prospective resident shall
have the right to visit each of the different care levels and to inspect
assisted living and skilled nursing home licensing reports including, but not
limited to, the most recent inspection reports and findings of complaint
investigations covering a period of no less than two years, prior to signing a
continuing care contract.
(c) 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
(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 manage his or her financial
(7) To be assured that all
donations, contributions, gifts, or purchases of provider-sponsored financial
products shall be voluntary, and may not be a condition of acceptance or of
ongoing eligibility for services.
(8) To maintain and establish ties
to the local community.
(9) To organize and participate
freely in the operation of independent resident organizations and
(d) A continuing care retirement
community shall maintain an environment that enhances the residents'
self-determination and independence. The provider shall do both of the
(1) Encourage 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 promote 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, quality of care, exercise of rights, safety and
quality of the physical environment, concerns about the contract, fiscal
matters, or other issues of concern to residents. The management shall
respond, in writing, to a written request or concern of the resident
association within 20 working days of receiving the written request or
concern. 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 biennially 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.
(e) 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 the time or before the resident signs a continuing care
contract, and at any time when the resident is proposed to be moved to a
different level of care.
(f) Each continuing care
retirement community shall prominently post in areas accessible to the
residents and visitors a notice that a copy of rights applicable to residents
pursuant to this section and any governing regulation issued by the Continuing
Care Contracts Branch of the State Department of Social Services is available
upon request from the provider. The notice shall also state that the
residents have a right to file a complaint with the Continuing Care Contracts
Branch for any violation of those rights and shall contain information
explaining how a complaint may be filed, including the telephone number and
address of the Continuing Care Contracts Branch.
(g) The resident has the right to
freely exercise all rights pursuant to this section, in addition to political
rights, without retaliation by the provider.
(h) 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
(i) Failure to comply with
this section shall be grounds for the imposition of conditions on, suspension
of, or revocation of the provisional certificate of authority or certificate of
authority pursuant to Section 1793.21.
(j) Failure to comply with
this section constitutes a violation of residents' rights. Pursuant to
Section 1569.49 of the Health and Safety Code, the department shall impose and
collect a civil penalty of not more than one hundred fifty dollars ($150) per
violation upon a continuing care retirement community that violates a right
guaranteed by this section.
If you have further questions, please contact us at (916) 654-0591
American Association of Homes and Services for the Aging
California Continuing Care Residents Association
California Department of Aging—Ombudsman