Continuing Care Retirement Communities in Nashville: How Life Plan Communities Work

What a Continuing Care Retirement Community Actually Is

A Continuing Care Retirement Community, increasingly marketed as a "Life Plan Community," is not a single licensed facility the way an assisted living community or nursing home is. It's a campus that bundles several levels of care together: independent living (unlicensed housing, essentially an apartment or cottage with amenities), assisted living licensed by the Tennessee Department of Health as an Assisted Care Living Facility (ACLF) under Rule 1200-08-25, and often a skilled nursing wing licensed as a nursing home under Rule 1200-08-06. The idea is that a resident can move into independent living while healthy and transition to assisted living or skilled nursing on the same campus if their needs increase, without having to relocate to an unfamiliar building across town.

In the Nashville and Middle Tennessee market, this model tends to appeal to couples where one spouse needs more care than the other, and to people who want to lock in a housing and care plan well before a crisis forces the decision. It's a very different financial commitment than month-to-month assisted living, so it deserves its own research process.

Entrance Fees and the Three Common Contract Types

Most CCRCs charge a large upfront entrance fee, often ranging from the low six figures into the high six figures depending on unit size and contract type, on top of an ongoing monthly service fee. The entrance fee is what makes these communities structurally different from a typical senior living lease, and it's worth understanding the three contract styles you'll typically be offered:

A Type A, or "life care," contract charges the highest entrance fee and monthly fee but caps what you pay if you need assisted living or skilled nursing later, care is bundled in at little to no cost increase. A Type B, or "modified" contract, offers a lower entrance fee with a set amount of higher-level care included, after which you pay market rates. A Type C, or "fee-for-service" contract, has the lowest entrance fee but you pay full market rate for assisted living or nursing care if you ever need it. None of these is automatically the right answer, it depends on your health outlook, other assets, and risk tolerance, and this is a decision worth reviewing with a fee-only financial planner or elder law attorney rather than deciding from the sales brochure alone.

Refundability, and What Happens to Your Entrance Fee

Ask directly what percentage of the entrance fee is refundable, to whom, and under what circumstances, some contracts refund 0%, some refund a declining percentage over several years, and some (usually the most expensive) refund 90% or more to your estate whenever you leave or pass away. Also ask what happens if the community itself runs into financial trouble. Because entrance fees function similarly to a loan the resident makes to the community, request the community's most recent audited financial statements and actuarial report, and ask how the campus is funding its long-term care obligations. This is standard, expected due diligence, a well-run community will hand you these documents without hesitation.

How This Differs From Regular Assisted Living or a Residential Home for the Aged

Only the licensed portions of a CCRC campus (the assisted living wing and any nursing wing) are inspected and regulated by the Tennessee Department of Health the way a standalone Assisted Care Living Facility or Residential Home for the Aged (Rule 1200-08-11) would be. The independent living apartments are not licensed or inspected as a health care facility, because residents there are considered to be living independently, not receiving care. When you're comparing a CCRC to a standalone assisted living community, ask to see the licensed wing's most recent Tennessee Department of Health survey and complaint history, you can request this directly from the facility or from TDH's Board for Licensing Health Care Facilities.

Questions Worth Asking on a Tour

Bring a written list and don't rely on memory once you're in the sales office: What is the entrance fee for the specific unit I want, and is it refundable? What is included in the monthly fee, and how often has it increased in the last five years? If I need assisted living or memory care later, is a bed guaranteed on this campus, or could I be waitlisted? What happens if I run out of money before I run out of health, does the community have a benevolent fund or Medicaid pathway, and how many residents currently use it? Can I see the licensed wing's most recent state survey? What's the occupancy rate campus-wide, and has the community ever been in financial distress? A community confident in its answers will walk you through all of this without pressure to sign quickly.

Frequently Asked Questions

Are there Continuing Care Retirement Communities in the Nashville area?

Yes, the Life Plan Community model exists in Middle Tennessee, though it's less common here than the standalone assisted living and independent living communities that make up most of the market. Because entrance-fee CCRCs are a significant financial commitment, verify current offerings, pricing, and licensing status directly with any specific community rather than relying on older listings, and confirm the assisted living or nursing portion's license and survey history with the Tennessee Department of Health.

Is a CCRC entrance fee tax-deductible?

A portion of a CCRC entrance fee and monthly fee may be deductible as a prepaid medical expense in some cases, but the rules are specific and the community's own accountant is not a substitute for your own tax advisor. Ask the community for the IRS-deductibility percentage they report to residents, and confirm the treatment with a CPA or tax attorney before you rely on it in your planning.

What's the difference between a CCRC and just moving between separate assisted living and nursing facilities as needed?

The main tradeoffs are continuity versus flexibility and cost structure. A CCRC lets you stay in one community and social network as your needs change and, with a life-care contract, caps your future care costs, but it requires a large upfront payment and locks you into that specific campus. Moving between separate facilities as needs arise avoids the large entrance fee and keeps your options open, but you pay market rates for each level of care and may need to relocate more than once.

Does TennCare cover CCRC care?

TennCare CHOICES can cover the licensed assisted living or nursing portions of a campus if that specific facility participates in TennCare and you meet the financial and functional eligibility rules, but it does not cover independent living or entrance fees. If a CCRC's long-term affordability plan depends on transitioning to TennCare later, ask in writing whether the specific licensed units you'd move into are TennCare-certified, since not all beds on a campus are necessarily certified.