From the window of Randy and Charlotte Sherman's new apartment at Carroll Lutheran Village in Westminster, the couple can look out across rolling farmland in a setting that is not so different from the 30-acre farm they called home for 21 years.
"We were accustomed to the silence, to the sunrises and sunsets that go with a rural setting," said Mr. Sherman, who is 75. "We were used to wide open spaces," agreed his 76-year-old wife. "We fell in love with Carroll Lutheran Village because of that."
So early last year, the couple sold their farm and left behind the responsibilities of home ownership. Now they're residents of a fee-for-service continuing care retirement community, where an entrance fee plus monthly charges buys limited services and assurances of the availability of future health care.
Continuing care retirement communities generally provide housing for independent living and nursing home care -- and sometimes for assisted living -- all at one central location.
"We're very, very happy we're here," Mrs. Sherman said. "We made the decision to do this quite some time ago. We had seen friends go through the painful experience of having to make decisions for their parents because the parents did not make those decisions when they were mentally capable. We agreed that we did not want to put our children through that."
The entrance fees at Carroll Lutheran Village range from $43,000 to $159,000 and purchase the right to live in units varying from a studio apartment to a three-bedroom cottage. Monthly fees between $180 and $805 include maintenance, a medical emergency response system, transportation, lots of social activities and, in some cases, meals and utilities.
"We have pull cords in the bedroom and bathroom that will get an immediate response from someone in the health care center," Mrs. Sherman said. "I think that kind of response is more important to us than the possibility of long term care. But it does make me feel more secure knowing that long-term care is available if we need it."
Many people come to the community in their 70's after "a medical scare," says Breta Marie Crumbacker, director of marketing for Carroll Lutheran Village.
"People want to hold onto their homes," she said. "That's real important to them. They see the home as independence. But when you ask them if they still drive, or if they have to depend on their neighbors or how often they're able to get out, they begin to see that the home can be like a prison. A community offers lots of activities, choices and freedom."
As health care needs arise, she says, a medical services coordinator at the community can help arrange for home health care. And residents receive priority for admission to the Carroll Lutheran Village Health Care Center, which also provides nursing home care to the public.
"People like the idea that they're not paying for medical expenses if they're healthy," Mrs. Crumbacker says. "They only pay for medical care if they need it."
Continuing care retirement communities vary greatly in the size of their entrance and monthly fees and the services that are covered. Some offer full or partial refunds of entrance fees; others give no refunds at all.
Communities like Carroll Lutheran Village have lower fees and make health care services available for purchase. Other communities have fees which include a limited amount of health care. And then there are life care communities where higher entrance fees and monthly charges pre-purchase a lifetime of health care and many more services. Fees remain basically the same regardless of how much or how little health care is required.
"For a one-time entrance fee and a monthly service fee, people are given a contract that guarantees them care on any level they need for the rest of their lives -- under the same fee structure," said Gloria Melanson, admissions coordinator at Roland Park Place.
Residents receive many benefits and services, including lifetime use of an apartment, maintenance, utilities, one meal per day, housecleaning services, transportation and valet service.
"People want to be independent for the rest of their lives," Ms. Melanson said. "They do not want to have to depend on their children. When they come here, they know they have made a decision that will carry them through any emergency or change of circumstance."
Broadmead is a similar life care community where entrance fees range from $54,000 to $153,250 with monthly charges between $1,280 and $2,816. Residents receive long-term care, routine medical care, home health care, prescriptions, transportation, daily meals and housecleaning services.
Broadmead even handles the filing of insurance claims, so residents have more time to enjoy a wide range of activities. There's a swimming pool and exercise room as well as clubs for people who enjoy sewing, ceramics, oil painting, bird watching, photography and flower arranging. There are discussion groups and educational programs, field trips and volunteer opportunities.