Comparison Study on Functional Outcomes and Perceived Quality of Life Between All-Inclusive and Fee-For-Service Continuing Care Retirement Communities

Abstract

To examine the associations between 2 types of continuing care retirement communities' (CCRC) residents regarding physical function and perceived quality of life. Cross-sectional study (n=406). Eligibility criteria include age 65 years or older, residents of independent living units, and intact cognition (MMSE>or=24). All-inclusive CCRCs provide unlimited access to home health services and nursing home care as needed in return for the entry and monthly fee. Fee-for-service CCRCs offer home health and nursing home services at a full fee-for-service rate. Outcomes were functional status (ADLs and IADLs) and perceived quality of life. Multivariate regressions were used to examine the associations between residents of different types of CCRCs on selected outcomes while adjusting for covariates. The all-inclusive CCRC sample was more likely to be married (53.8% versus 33.4%; P < .001), with more years of education (17.9 versus 14.4; P < .0001), and had few physician visits in the previous year in comparison to the FFS CCRC sample. Multivariate results indicate that the FFS group had worse ADL (beta=0.95; P=.0003), IADL (beta=0.57; P=.02) function than the all-inclusive group. There was no significant difference in perceived quality of life scores between the 2 groups. Residents of both CCRCs reported equally good quality of life scores. Residents of the all-inclusive CCRC seem to have had better ADL and IADL function than the FFS CCRC residents. Prepaid home health services and nursing home care in the all-inclusive CCRC may facilitate ADL and IADL functional independence.