"Today's CCRCs are like a cruise ship on land" - Mitch Possinger

Aging ain't what it used to be. Years ago, older Americans either lived with their families, remained stubbornly independent or—if neither of those was practical—went to the 'old folks home.' Statistically speaking, they didn't stay there long because the self-selecting process that determined 'old folks home' populations pretty much guaranteed a preponderance of the sick, the feeble and the incapacitated. No wonder the popular view of these places was that 'you went there to die.'

Those attitudes began changing in the face of post-World-War-II population and demographic trends, evolving cultural attitudes and sheer necessity. Demand for a middle way between complete on-your-own independence and the rigid institutional environment of the traditional nursing home sparked the emergence of the so-called "assisted living" market in the 1970s and 1980s. That model soon spun off a hybrid alternative, the continuous care retirement community, or CCRC.

Unlike assisted living facilities or nursing homes, where residents are locked into a fairly rigid level of care, CCRCs offer flexibility. Residents can live almost completely independently in apartments, townhouses or individual cottages located on the property. Then, if their needs change, they have the security of knowing they can move into an onsite assisted living or skilled nursing unit.

It's a tidy sales pitch, but not an airtight one. With seniors living longer and generally in better health, CCRCs—which prefer that most of their residents reside in the independent living units—must overcome the traditional view of eldercare facilities that says you only go there after you can't live on your own.

So to convince still-healthy seniors to sell their homes and move into their communities, CCRCs must lay out an attractive array of services and amenities ranging from help with everyday chores and maintaining standby emergency medical services, to offering plenty of options for socializing, amusement and personal development. One of the most important is the quality of the onsite dining operations.

Making CCRCs' task even more difficult is the generational turnover that is changing customer expectations and forcing operators to expand the services they offer, all while keeping costs—especially increasingly expensive labor—in line.

"I think the retirement community generally is in transition," offers Mitch Possinger, president of Cura Hospitality Services, a foodservice management firm based in Oreville, PA, that manages 70 retirement communities, including 20 CCRCs. "There's a generational shift going on, and the old model of having some 300 independent living apartment style units complete with skilled nursing and assisted living sections is being upgraded. Now it's more like a cruise ship on land, with an array of services targeted to different individual needs."

Hard to Define Numbers
The specific number of CCRCs currently in operation is difficult to determine because the concept remains somewhat self-defined. "Not every state licenses CCRCs as a separate entity," explains Douglas Pace, director of assisted living and continued care at the American Association of Homes & Services for the Aging (AAHSA). "While the higher levels of care, the assisted living and skilled nursing, are licensed, the independent living component often is not."

On its website, AAHSA cites 2,100 as the number of CCRCs currently in operation, but the Continuing Care Accreditation Commission (CCAC) has accredited only about 350, according to Business Development Executive Susanne Matthiesen. Matthiesen estmates that there may be some 2,500 such facilities around the country, "and I've heard estimates as high as 3,000," she adds.

The growth in the CCRC sector overall has been matched by the growth of its foodservice component. According to the Technomic, Inc., foodservice research and consulting organization, the CCRC segment's food and non-alcoholic beverage purchases has shown a healthy six percent annual rate of increase over the past five years, more than double the 2.5% annual growth rate of the eldercare segment overall. Currently, CCRCs account for about $1.5 billion of eldercare's annual $4 billion in food and beverage purchases, says Technomic Senior Principal Joseph Pawlak.

Pawlak says CCRCs have grown faster than the other eldercare sectors because they enjoy a competitive edge when marketing to seniors.

"Nursing homes have had negative stigma," he explains. "Because of the clinical component, they're associated with illness and frailty. By contrast, CCRCs don't position themselves as nursing homes, or at least not primarily as healthcare providers, but rather as 'lifestyle' providers for people who may need a little more assistance with their lives than they did when they were younger. That's much more positive."

Dining Operations
For foodservice professionals, dining operations in CCRCs are significantly more complex than in the typical eldercare facility because they have to accommodate different populations. Bedridden patients in the skilled nursing unit may require threemealsa-day patient tray service, while others who are more mobile, along with those in the assisted living sections, generally take congregate meals in central dining areas at set meal times.

"Meals are ways to build community, and they become as important as the healthcare aspect when potential residents evaluate the different communities," says Doug Tweddale,CEO of Foulkeways Retirement Community, one of the country's oldest CCRCs (it opened in 1967).

Meanwhile, independent living residents generally are required to eat only a certain number of meals in the community dining rooms each month, but food must be available at each daypart nevertheless.

In an effort to offer differentiation and attract new residents, CCRC dining operations are experimenting with a variety of food-related services ranging from special events like high teas and cooking classes to the incorporation of branded concepts, cafès and bistros on site.

"Special events and catering are huge aspects of our operations," notes Mary Ann Miller, director of business development for Aramark Senior Dining. "Choice, fresh food, lots of options, grab-and-go—these are all things that we increasingly are looked on to provide in order to meet customer expectations. At one of our sites, we're even looking at putting in a Starbucks."