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13 Things You Probably Don’t Know About Continuing Care Retirement Communities (CCRCs) in India

1. What is a Continuing Care Retirement Community (CCRC)?

A continuing care retirement community (CCRC) is an alternative residential option for senior citizens (usually 65 years of age and older) that provides flexible housing options, services and amenities, as well as round-the-clock care to address the health and wellness needs of residents as they grow older.

CCRCs include at least three levels of care in one location. These are:

  • Independent Living – where residents live independently on their own while enjoying access to a wide array of services and amenities
  • Assisted Living – where residents receive help with activities of daily living (ADLs), such as eating, bathing and dressing
  • Round-the-clock access to nursing care (in some cases, including home healthcare services)

2. What are the advantages of living in a Continuing Care Retirement Community (CCRC)?

The great thing about the CCRC model is that it enables you to remain within the same community – and if your needs change and you require health care and supervision – shift to another level of care within the same community.

Remaining within the same community has the following advantages:

  • It allows you to continue living in the same place with your spouse and friends
  • It prevents the stress and hassles of moving
  • It allows you to receive medical care – when required – in an environment you know and trust
  • It’s emotionally more reassuring

3. What levels of care are generally provided in senior living in India?
Generally speaking, you can expect 4 levels of care in senior living in India:
1. Independent Living
2. Assisted Living
3. Skilled/Nursing Care
4. Continuing Care Communities

Most projects in India currently focus on Independent Living projects for seniors. However, progressive real estate companies are now realizing the need for continuing care communities because – both because they are becoming a global trend and on account of the benefits they offer.

4. What type of facilities does a Continuing Care Retirement Community (CCRC) provide?

A CCRC typically provides all of these facilities within a single campus:

  • Apartments or cottages – i.e. independent living units
  • Assisted living units – where professional care is provided to help with activities of daily living (ADLs), such as eating, bathing and dressing
  • Medical care facilities – such as a mini nursing home

As care and services continue to evolve – especially in developing markets like India – CCRCs continue to add additional components to their services mix – such as better medical support and wellness programs, dementia care, etc.

5. Why are Continuing Care Retirement Communities growing all over the world – and in India?

Continuing Care Retirement Communities are growing all over the world – and in India – because there’s a growing demand for them. For the first time in history, by 2017 the total number of seniors worldwide will be greater than the number of kids below 5 years of age .

While developed nations will still have a large number of seniors, the rate of growth in senior population in developing nations like India and China will be double that of developed nations.

Also, this model offers many advantages that other types of communities do not, such as (as mentioned above):

  • It allows you to continue living in the same place with your spouse and friends
  • It prevents the stress and hassles of moving
  • It allows you to receive medical care – when required – in an environment you know and trust
  • It’s emotionally more reassuring

6. What should I know about a Continuing Care Retirement Community before moving into it?

Here are some questions to ask (aside from medical care facilities which are a MUST) if you’re considering moving to a continuing care retirement community:

  • (i) Is the community well established or even developed yet?
    If the project is still in its developmental stages, you should check out:
    a. The developer’s financial background
    b. The other projects they’ve completed. A successful track record is a big plus point. The last thing you want is to enter into a litigation with the developer to get your deposit back.
  • (ii) Is the entrance fee refundable – and if yes, under what conditions?
    Generally speaking, if you exit within a specified period after moving in, your entrance fee is either wholly or partially refundable. However, you should know that in some cases, the management withhold your entrance fee until they find a new buyer for your spot. So it pays to do your due diligence on the refund provisions before paying up.
  • (iii) What’s included and what’s not?
    CCRCs will generally offer guaranteed access to health and personal care services, but not all of them include it in their basic monthly fee.
    a. An extensive contract includes all services offered by the community
    b. A modified contract puts a limit to the services offered by the community in terms of assisted living or skilled nursing before, with an add-on fee in case the limit is exceeded
    c. A fee-for-service contract is a pay-per-use model where you pay the full cost of any time spent in the health center
    d. A Rental contract comes without any entrance fee – and everything is a la carte – with no medical care (like a nursing bed, etc.) guaranteed
  • (iv) What type of couples live there?
    Do only old people live there? What type of tie-ups does the community have with hospitals, rehabilitation centers, wellness centers, etc.?
  • (v) How well is the community connected?
    Ideally, the CCRC should located within 20–30 minutes from a good hospital. Also, it should be well-connected to major city hubs – with both existing and proposed infrastructure initiatives within easy, commutable distance. Some of the things you should know are:
    a. Is the site near a public highway, and if not, what type of transportation is provided?
    b. How much will you have to pay for a taxi if you have to visit a specialist?
  • (vi) What other type of special amenities does the community have?
    If you’re going to live in a community, it makes sense to check whether you will be able to keep yourself fruitfully occupied.
  • (vii) Does the community have care facilities for Alzheimer’s patients?
    With India’s rising senior population, the demand for dedicated care for people with Alzheimer’s and other forms of dementia is also increasing. It’s something you should not ignore – even though you may not be suffering from it.
  • (viii) What does the social ecosystem look like?
    The presence of social facilities like temples, clubs, malls, recreational facilities should be within easy access.
  • (ix) What’s the crime rate like?
    Incidence of crime is an important factor, especially for seniors – because under developed areas are risky, in spite of site level security.
  • (x) What’s the traffic and congestion scene like?
    Lower traffic congestion, population density and fewer polluting industries are all positives when selecting a location for seniors.
  • (xi) What’s the growth potential like?
    Growth prospects in terms of infrastructure and civic amenities lead to faster property appreciation – something we all want to benefit from.
  • (xii) What’s the state of employment and educational facilities nearby?
    Access to occupational and educational facilities play an important role for two reasons
    a. it allows seniors in the independent living stage to stay employed on a full- or part-time basis
    b. it leads to faster property appreciation (iii) it results in faster overall growth of the entire area

7. What type of occupants am I likely to find at a Continuing Care Retirement Community?

When you move to a continuing care retirement community, you will most likely come across four types of couples:
(i) Well-to-do “empty nesters ” seeking a better quality life
(ii) Retired seniors with early or advanced signs of health care needs
(iii) NRIs returning from abroad or another state
(iv) Seniors looking for short-term stays every year

8. Through what type of financial models can I enter a Continuing Care Retirement Community?

You will typically find one these 3 financial models on offer:

  • Sales Model: As the name suggests, this model transfers the ownership to you. This means that you can the property for mortgage and collateral purposes – and your investment is automatically transferred to your legal heirs after you. This is generally the most preferred model for most customers, even in the US where such communities are more popular.
  • Lease Model: In the lease model, a part of the capital value is taken upfront – and the balance is paid via monthly rentals. This allows you to enter the community with an upfront fee, and follow it up with regular lease rentals during your stay.
  • Rental Model: In the rental model, you simply take the facility on rent – as you would a normal house – and keep paying monthly rent during the period of your stay in the CCRC.

9. Where are CCRC or CCRC type of projects coming up in India?

CCRC or CCRC type of projects are coming up near most of India’s metros – as well as in towns considered traditionally as retirement towns – such as Goa, Dehradun and Coimbatore.

10. Name some companies that are developing CCRC or CCRC type of projects?

Although many companies are selling active senior living projects in India (see list below), Ashiana Housing is the only company selling CCRC projects in India.

Ashiana Housing – with a presence in both North and South India – is also the largest developer of active senior living projects in India, with:

  • more than 1500 seniors enjoying active post retirement lives in 3 projects
  • 3 more projects under construction in different parts of North India
  • plans to enter West India very soon

Companies selling CCRC projects in India Companies selling active senior living projects in India

Companies selling CCRC projects in India Companies selling active senior living projects in India Ashiana Housing Ashiana Housing   Brindavan Senior Citizen Foundation   Classic Promoters   Covai Properties   Impact Senior Living Estate   Paranjape Schemes

Many CCRC type of projects (i.e. senior living projects) are already operational (or being set up) near major metros like NCR-Delhi, Pune, Bangalore, Amritsar, Coimbatore and Chennai.

11. Can you provide a brief snapshot of the senior population in India?

According to a Jones Lang LaSalle report on Senior Living in India:

  • There are about 98 million elderly people in India today – which is the total population of UK and Canada put together
  • India’s senior population is growing faster than the overall population (i.e. 3.8% pa vs 1.8%)
  • India’s population of 60+ year olds will touch 240 million by 2050
  • The number of seniors in India dependent on others is rising every year (due to a rise in old age dependency ratio)
  • India’s 60+ year olds are fastest growing demographic segment in the world
  • 27 million seniors in India need specialized medical care

Seniors in India are fast evolving into a major market segment – with different needs and wants – which are now gradually being understood and met by the private and public sectors. A very large number of seniors today are well educated, financially independent, stable, well-travelled and socially connected – and are quite clear about how they want to spend time after retirement.

More and more seniors in India are now beginning to view life after retirement as an opportunity – to spend more time with their family, pursue hobbies, develop new interests or even start a new career or business.

Indian seniors present a great opportunity to service providers and entrepreneurs who are now realizing their growing demand for lifestyle services and housing needs.

12. What are some of the major challenges faced by the senior living sector in India?

The senior living sector in India is still in its infancy compared to the US and other developed countries in Europe. Some of the key challenges this sector faces relate to:

  • Social stigma: Most people view senior living facilities in a negative light
  • Affordability: Many people are still unable to afford senior living facilities
  • Lack of trained resources: The concept of senior living being relatively new, the availability of trained and skilled manpower is still quite low – and hard to find
  • Absence of proactive legislation/policies with regard to:
    o living standards
    o service standards
    o proper legal support
    o innovative financial products and incentives to motivate real estate developers to enter this sector, etc.

The entry of quality senior housing projects providing sound professional services will not only change the way people think about senior living in India but also help remove the social stigma associated with it.

13. What’s the future of Continuing Care Retirement Community (CCRCs) in India?

The senior living industry is poised for tremendous growth, so you can expect to see:

  • Many more senior friendly communities in India in the next 3-5 years
  • Greater sophistication and service improvements by existing players
  • More new entrants, including regional real estate developers, corporates (especially from healthcare, hospitality, insurance, and other service sectors) and NGOs
  • Mixed-use residential projects before a full-fledged project launch
  • Partnerships with international players
  • More media coverage and awareness
  • Innovative financial retirement solutions to generate higher demand and volumes
 
 

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