CCRC recommendations draw mixed reviews from senior living, consumer advocates

Although Massachusetts senior living associations said they support new recommendations for continuing care retirement communities in the state, others are calling for state lawmakers to step in and finish the job the state commission could not.

Some people speculated that the Massachusetts Special Commission on Continuing Care Retirement Communities would miss an Aug. 1 deadline to submit a report exploring the structure and regulation of CCRCs, but the commission did file a final report with lawmakers. But the panel missed an opportunity to strengthen the quality of CCRCs and consumer protections, according to critics, by only recommending policy changes on two topics.

The commission was established in 2024 as part of a wide-ranging long-term care reform bill. The body was charged with studying CCRC contracts, the financial viability of CCRCs, the payment and return of entrance fees, statutory and regulatory oversight, marketing practices, and regulations over CCRC closures or ownership changes.

Twenty-nine CCRCs are registered with the Executive Office of Aging and Independence, or AGE, 22 of which are nonprofits. 

Commission members included lawmakers, advocates for senior living residents, CCRC residents, administrators and industry professionals, including representatives from LeadingAge Massachusetts, the Massachusetts Assisted Living Association, the Massachusetts Senior Care Association, the Massachusetts Life Care Residents’ Association, AARP Massachusetts and the Alzheimer’s Association.

Overall, the commission found that CCRCs in the state are financially robust but that those with skilled nursing units are facing financial challenges. The report also noted that CCRCs lack a uniform regulatory body and that the public is confused about the definition of CCRCs.

The report yielded only two recommendations: passing S 478 to increase transparency for consumers around entrance fee refunds, and updating AGE’s consumer guide. The group recommended further discussion on CCRC boards holding annual meetings open to the public, changes to how CCRCs refund entrance fees, and the definition of CCRCs in commonwealth’s statute.

Industry reaction

State senior living associations participated in the commission and said they support recommendations aimed at strengthening the CCRC model, adding that they will continue to work with lawmakers and consumers to better educate them on the setting.

The Massachusetts Assisted Living Association told McKnight’s Senior Living that it supports recommendations that would allow CCRCs to thrive, as well as those that enhance disclosures to educate the public and encourage informed choices about CCRCs. 

“Restrictions on CCRC finances could weaken access to this model at a time when we are not aware of any new CCRCs being in development in Massachusetts,” however, Mass-ALA President and CEO Brian Doherty said.

LeadingAge Massachusetts said it appreciated the opportunity to engage in “meaningful discussions about how to best support and strengthen this important model of senior living.”

“The commission’s robust discussions highlight the complexity of the issues and the diversity of perspectives involved,” LeadingAge Massachusetts President Elissa Sherman told McKnight’s Senior Living. “LeadingAge Massachusetts has continued to advocate for increased transparency and information for consumers. We remain committed to working with policymakers, MLCRA and other stakeholders to strengthen understanding of the CCRC model, ensure appropriate consumer protections, and support providers in delivering high-quality, mission-driven housing and services.”

Dissenting opinions

Two members of the commission submitted letters of dissent over the commission process and report, which were included in the report, over unresolved policy issues, including establishing a clear timeframe for refunding entrance fees and mandating that each CCRC board include at least one resident member with voting rights.

“Delays in refunding these deposits — often high six figures in value — can cause significant financial harm, especially when funds are needed to pay for care in another facility, settle estates or support survivors,” wrote commission member Christine Griffin, vice chair of the Linden Ponds Resident Advisory Council in Hingham. “The lack of a statutory deadline allows providers to delay refunds indefinitely.”

The commission’s failure to follow the lead of other states that have adopted time limits for refunds leaves Massachusetts residents unprotected and “reinforces an unfair power imbalance” between residents and providers, Griffin wrote. She also took issue with the commission’s failure to recommend mandatory resident representation on CCRC governing boards.

“These reforms are not radical — they are responsible, reasonable, and necessary to protect aging adults who have contributed a lifetime of resources and wisdom to the communities they now call home,” Griffin concluded. 

David VanArsdale, a commission member and resident of Edgewood Retirement Community in North Andover, wrote in his dissent that CCRC boards always should include a resident.

“The residents are ‘paying the bills’ and committing much of their life savings to live in the CCRC, they have earned the right to have a voice on the board,” VanArsdale wrote. “Is there a defensive fear that a resident may raise difficult questions for management or reveal actual events or issues affecting everyday living in a CCRC?”

He also called for a standard timetable and procedure for when a resident chooses to leave a CCRC, as well as a standard for the return of the refundable entrance fee to the estate of a CCRC resident upon death.

Another letter included in the report, from AARP Massachusetts, said that by only recommending policy changes that all commission members could agree on, the commission missed an opportunity to “truly strengthen the quality of CCRCs and consumer protections.”

The organization urged lawmakers to “go beyond the consensus recommendations” that were made in the final report and implement policies establishing standards for sound financial planning and management practices, requiring notification to state licensing agencies of developments that could lead to bankruptcy or a change of ownership, and changes to refund policies, marketing practices and the role of resident councils in administering facilities.