Continuing care retirement communities in North Carolina.

Over the next 25 years, the number of seniors in North Carolina will double. North Carolina ranks third among the states for in-migration of retirees, and the majority of these retirees are seeking an active, independent lifestyle with support services they will need.1 While it is true that an overwhelming majority of older adults live in a community without the benefit of any formal services or support, it is also known that over one-third of the 65 and older population will have at least one disability and will experience functional loss increase with age, requiring them to seek assistance at some point.2 Continuing care retirement communities (CCRCs) offer a long-term care option that incorporates various levels of health care and related services in addition to providing independent housing, usually offered in one location. For the most part, they are designed for older people who are still independent, in reasonably good health, and can afford to pay an entry fee and a monthly service fee in return for a place to live and access to various levels of care for the duration of their lives. The amount of entry fee and monthly fee paid is usually reflective of the contract type, size of housing unit, refund policy, and inclusiveness of services (particularly health care). In 1989, North Carolina enacted a statute (General Statute Article 64 Section 58) that defines continuing care as “furnishing to an individual other than an individual related by blood, marriage, or adoption to the person furnishing the care, of lodging together with nursing services, medical services, or other health related services, under an agreement effective for the life of the individual or for a period longer than one year.” Not all states regulate or monitor CCRCs, and there is no federal legislation regulating CCRCs.3 However, North Carolina does, and the regulatory body that oversees this long-term care option is the North Carolina Department of Insurance. While some may believe that CCRCs are a fairly recent phenomenon, the reality is that many CCRCs across the country have been in existence for decades, with a handful in existence for over 100 years.4 In 2009, Kathryn Brod, senior vice president and director of research for Ziegler Capital Markets, and Harvey Singer, principal NIC-REDMARK economist, presented the “National CCRC Listing and Profile Findings.”4 In their presentation, they explained that approximately 1,860 entities across the country fell within the general definition of CCRC, 82% of these were not-for-