Continuing Care Retirement Communities

Background and Status

The earliest communities offering a continuum of shelter and care date from the late 19th century in the United States. They were operated by religious and charitable organizations and were known as life care communities because residents would turn over all their assets in return for the promise of secure housing and comprehensive care for life. This asset transfer arrangement is today uncommon. The first use of the modern CCRC terminology occurred during the 1960s and early 1970s. Residents were also promised shelter and long-term care for the rest of their lives, but usually it was for a substantial one-time up-front entrance payment and regular monthly fees.

Some of the early CCRCs that evolved from nursing homes had fewer than 200 units but only a small share of independent living community units. Since the 1980s, properties designed as CCRCs (i.e., purpose built) contain mostly independent living units with the assisted living units and nursing home beds combined composing less than 20% of the total. According to 2009 data from Ziegler Capital Markets, 35% of CCRCs had under 200 total units, 43% had between 200 to 400 units, and 17% had over 400 units (5% of CCRCs had unknown sizes). About 18 CCRCs were very large, consisting of over 1,000 units. Altogether, the data show there were just under 1,900 CCRCs in operation, accommodating about 600,000 older persons.

Most CCRCs (82%) are owned by not-for-profit companies and have faith-based affiliations. A significant minority of these organizations also represent military veterans, fraternal (e.g., Masons), and ethnic groups. The decade of the 2000s saw a growing number of CCRCs that had organizational ties with academic universities. Most CCRCs (60%) are owned by a parent organization that operates CCRCs at multiple sites throughout the United States. The owners and management of CCRCs are also sometimes different entities. Although most are self-managed, about 15% employ outside managers with expertise operating senior housing properties. Thus, even as a nonprofit owns a CCRC, a for-profit company may manage it.

CCRCs are located in all states and the District of Columbia with the exception of Alaska and Wyoming. The states with the largest numbers include Pennsylvania, Ohio, California, Illinois, Florida, Texas, Kansas, Indiana, Iowa, and North Carolina. Nearly 90% of CCRCs are located within metropolitan statistical areas. The location of CCRCs largely reflects the demographics of consumer demand, particularly the presence of very old and higher income older persons. Additionally, developers favor those states with friendlier regulatory and financial environments.

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