If you’re considering a move to a continuing care retirement community (CCRC, also known as a life plan community), you’ve likely heard about the required health evaluation that takes place before move-in. For many prospective CCRC residents, this requirement can feel intimidating or even confusing. Why does it exist? What are communities looking for? And how does your current health influence your eligibility, or even the timing, of your decision to move to a CCRC?
To help you make an informed and confident senior living move decision, let’s take a closer look at how the CCRC health evaluation works, the health factors that are considered by the community, and the resultant pros and cons of moving to a CCRC sooner rather than later.
What is the CCRC health evaluation?
The defining characteristic that sets a CCRC apart from other types of retirement communities is residents’ access to a full continuum of care under a continuing care contract (which sometimes includes discounted rates of care for residents), typically including independent living, assisted living, and skilled nursing care. Because of this structure, most CCRCs require that new residents be healthy enough to safely live at the community’s independent living level.
To make sure that independent living is an appropriate fit for the prospective resident’s unique situation, CCRCs typically conduct a health evaluation during the prospective resident’s application process.
The reason behind the health evaluation process at a CCRC
The CCRC health evaluation isn’t meant to exclude people arbitrarily. In fact, it benefits both the community and its residents.
According to actuarial analysts from risk management experts Milliman, CCRCs face greater risk exposures than most other types of senior housing. The health of incoming residents has a direct effect on a CCRC’s long-term operational and financial sustainability, particularly in communities that offer lifetime care contracts. By maintaining a healthy independent-living population, the CCRC can plan effectively for future care transitions and costs.
On the other hand, if numerous CCRC residents’ future care needs are greater than expected, occur sooner than expected, and/or last longer than expected, it can spell financial trouble for the CCRC. The health evaluation is therefore actually a way for the community to safeguard residents’ investment, ensuring incoming residents are healthy enough to enjoy independent living safely while also planning responsibly for the community’s long-term financial viability, which in turn protects all residents.
The health evaluation process can be especially important in communities that offer a Type A contract. With Type A contracts (sometimes called “life care” contracts), residents pay an entry fee and a monthly service fee. However, the monthly fee does not increase (other than inflationary increases) even if a resident needs to transfer from independent living to assisted living or skilled nursing care. Because the CCRC incurs more financial risk, the health requirements are often stricter for new residents seeking this contract type.
Ultimately, the evaluation helps bolster resident satisfaction as well. The CCRC health requirement ensures that when new residents move in, they’ll be in an environment suited to their current abilities — one that encourages independence but provides a safety net for the future if needs evolve.
Legal implications and restrictions
There’s ongoing debate about whether CCRCs have legal grounds to use health screenings when determining eligibility for certain types of contracts. Because CCRCs combine independent living (covered by the Fair Housing Act) with assisted living and nursing care (covered by the Americans with Disabilities Act), the guidance isn’t entirely clear. However, for CCRCs offering healthcare under an insurance-style Type A/lifecare contract, health requirements and screenings appear more justifiable.
Most CCRCs and other senior living providers conduct health assessments to ensure new residents meet general “tenancy requirements” and to determine appropriate care levels. Legally, all applicants must be asked the same questions, and only health information relevant to provided services may be requested — never questions about potential staffing burdens or disabilities.
Using health screenings to decide who can live in a community is a separate legal issue, however. CCRCs still must understand and adhere to fair housing and anti-discrimination laws. If a prospective resident doesn’t meet the health criteria for a Type A/lifecare or Type B/modified contract, the community must still offer admission under a Type C/fee-for-service arrangement, if space allows. In essence, a CCRC has limited grounds to deny residency altogether; it may simply decline to offer an insurance-like contract type.
What CCRCs look for during the health evaluation
Typically, the CCRC health evaluation involves a health questionnaire, a review of your medical history and medications, and sometimes a brief physical or cognitive screening, a doctor’s statement, and/or recent medical records. If there’s a long waiting list, they may even recheck a new resident’s health just before move-in to ensure you’re still able to safely live in an independent living residence and not yet in need of care services.
A few examples of the illnesses or conditions that may preclude entry into a CCRC under a Type A/lifecare, and possibly a Type B/modified residency contract, are: Parkinson’s disease, dementia, osteoporosis with a history of fractures, COPD including emphysema, congestive heart failure, or metastatic cancer.
While every community has its own standards, most CCRC health evaluations focus on three broad areas:
Physical ability
Physical ability refers to how independently a person can perform activities of daily living (ADLs) — tasks such as bathing, dressing, or moving around safely. A CCRC typically wants reassurance that new residents can safely live independently without needing frequent help. They may look at mobility, balance, or history of falls to determine the person’s risk of injury or hospitalization.
Cognitive status
Cognitive and mental health are also evaluated since cognitive decline can affect a person’s ability to live safely without supervision. A brief screening or interview may assess a new resident’s memory, orientation, and judgment. While mild forgetfulness is common as we age, more advanced cognitive issues like dementia may affect a prospective resident’s eligibility for independent living.
Overall medical stability
Medical stability refers to how well chronic conditions are controlled. Someone with diabetes or heart disease, for example, might still qualify for move-in if their condition is well managed and they can still independently perform activities of daily living (ADLs). However, frequent hospitalizations or conditions likely to progress quickly could raise concerns about a person needing a higher level of care soon after move-in.
A note about couples’ health and CCRC eligibility
It’s important to know that if you’re applying to a CCRC as a couple, both partners’ health is considered together. For instance, in some cases, a healthier spouse may be able to provide informal support for a less healthy spouse, allowing them to remain in independent living for longer. This couple’s health levels may “offset” one another, so to speak, helping them qualify for move-in even if the less healthy partner would not be eligible on their own.
Similarly, a couple’s age may be a factor in their eligibility determination. CCRCs are age-restricted communities, meaning all residents must meet age requirements. But according to a report by the Society of Actuaries (PDF) in collaboration with the National Institute on Aging, variables such as “age, gender … [and] medical screening” are all considered in a prospect’s morbidity/mortality analysis and their expected duration to safely live within independent living. However, in cases where one partner is younger than the other, it may potentially impact qualification since the younger spouse could potentially provide some degree of care for the older one.
Finally, the contract type a couple wants contributes to their move-in eligibility. As previously discussed, a CCRC incurs more financial risk with a Type A contract. As a result, the community may have more stringent health requirements for couples seeking this type of contract.
The timing question: Moving to a CCRC sooner vs. later
Perhaps the most important question is when to move to a CCRC. Many people wait until their health declines or home maintenance becomes overwhelming before considering a CCRC, but waiting too long can backfire.
The health evaluation requirement means that if you wait until you already need assistance, you may not qualify for independent living at all. You could be offered a place in assisted living or skilled nursing care instead, however, that typically comes with different costs and has limited availability.
Waiting until later may feel financially or emotionally comfortable for some people. You can delay costs and make the move only when you truly feel ready. But the risk is that by the time you apply, your health might no longer meet the community’s admission criteria.
According to AARP’s 2024 Home and Community Preferences Survey (PDF), 3 out of 4 (75%) of adults age 50+ say they want to remain in their homes as long as possible. Yet the reality is that unexpected health changes often force quick, stressful decisions about care and housing. Planning ahead allows you to proactively make choices about where you’ll receive the care you may one day require.
Finding your right time to move
It’s important to understand that the health evaluation at a CCRC is not meant to discourage prospective residents from applying for residency or moving there. On the contrary: It’s meant to help both the community and its residents succeed.
Before applying to a CCRC, talk with your doctor about your current health and long-term outlook. Ask the doctor (and yourself) whether your daily living activities, mobility, and memory are stable, and whether you might expect to still live independently for the next few years.
Next, speak directly with the CCRCs you’re considering to learn about their specific health criteria and potential timelines for move-in. Some communities allow early deposits or have waiting lists that can secure your eligibility while you’re still healthy.
In the end, the “right time” to move to a CCRC is highly individual. Moving earlier can give you peace of mind, social engagement, and guaranteed access to care down the road. Waiting can preserve flexibility and independence, but risks closing off choices if your health changes unexpectedly. The key is to make the decision from a position of strength, not during a time of crisis.
By understanding CCRC health evaluation requirements now, you’ll be better prepared to plan your future senior living move strategically, ensuring that when the time comes, you’re both healthy enough and ready enough to make the transition a smooth one.
By myLifeSite