CCRC Contract Pitfalls: Tennessee Court Ruling Highlights Risks for Seniors and the Power of Proactive Planning

Imagine signing a life care contract with a continuing care retirement community (CCRC), paying a hefty "lifetime use fee" for the promise of seamless care from independent living to nursing home, all under one roof, without escalating costs. Now picture this: Your spouse passes away early, your health declines, and despite available beds, you're stuck in your apartment, shelling out $137,000 for private nurses because your conservator honors your wish to stay put until a "better" facility opens. When you sue for reimbursement, the court sides with the CCRC, citing the contract's fine print—no refund, no breach. This isn't a nightmare scenario; it's the reality for Susan Anderson in the recent Tennessee Court of Appeals case Susan Anderson v. Ascension Health-IS, Inc., decided September 11, 2025. 
For seniors and families navigating aging in place or CCRC options, this ruling is a wake-up call: Contracts can lock you into obligations that prioritize facility benefits over your autonomy, potentially draining savings and sparking costly disputes.  This article unpacks the case, its consumer consequences, and strategies beyond aging in place to mitigate risks, emphasizing prevention over litigation.The Case: A 'Lifetime' Promise That Didn't Deliver
In 2011, Susan and Ralph Anderson signed a Lifecare Plan with Alexian Village of Tennessee, a CCRC owned by Ascension Health-IS, paying $237,200 upfront for unlimited access to independent living, assisted living, and nursing care, plus monthly fees for amenities. The contract promised no additional charges for escalating needs, with a refund schedule if terminated, but only if all residents occupying the apartment ended the agreement. Ralph died in 2013, just 18 months in. Susan's health soon deteriorated, requiring constant care. From April to October 2014, she stayed in her apartment, incurring over $137,000 in private nursing costs (including from Alexian staff) because no nursing bed was "ideal" despite available rooms communicated to her conservator.
The conservator was appointed in April 2014, but the 2011 contract nonetheless governed. Susan sued in 2018, claiming breach (no refund after Ralph's death, overcharges, and failure to transfer), financial exploitation of the elderly, negligence (i.e., personal injury or malpractice), and improper fees. Alexian countered by filing a motion for partial summary judgment, arguing that the contract's plain language barred refunds and transfers, which were optional. The trial court agreed and certified the ruling as final. On appeal, the Tennessee Court of Appeals affirmed, emphasizing unambiguous contract interpretation: No refund without complete termination (no written notice given); transfers were "permissive," not mandatory; and the conservator's choice to delay amid available beds negated breach. Financial exploitation failed as derivative of the contract claims. Health liability claims proceed, but the ruling protects the CCRC.Consequences for Consumers: Financial Traps and Autonomy Erosion
For seniors eyeing CCRCs, this case exposes harsh realities: "Lifetime" fees aren't refunds on death, and "seamless care" isn't guaranteed.  Delays can bankrupt you or worse. 
Consequences include:

• Unexpected Costs: No partial refund after a spouse's death leaves survivors paying full monthly fees for unused space, plus private care bills ($137K here). With CCRCs averaging $300K+ entry fees, this can wipe out savings meant for home care or heirs.
• Exploitation Risks: The ruling dismisses financial exploitation tied to contract breaches, but it signals how facilities can exploit ambiguity, e.g., permissive transfers shifting the burdens of risk and loss to residents. Amid a 2024 OIG report showing 24% of facilities failing staffing standards, delays exacerbate neglect risks.
• Autonomy Loss: Conservators or courts interpret "best interests" narrowly, often overriding wishes without directives. Here, Susan's preference to wait for a more suitable room cost dearly; without planning, families face similar dilemmas amid caregiver burnout.
• Litigation Toll: Even partial wins for providers drag cases, with costs exceeding $50K, eroding estates and delaying care.

The problem is widespread: A 2023 GAO report notes inconsistent CCRC regulations, with 20% of contracts lacking clear refund terms, leading to $500M+ in disputes annually. Financially strained facilities (80% operating at 90% capacity per 2025 Argentum data) prioritize revenue, delaying transfers amid $159K/year nursing home costs.

How Delays Exacerbate Neglect RisksDelays refer to situations when care isn’t provided promptly, whether it’s waiting for a transfer to a higher care level (like from independent living to nursing care), a staff response to a fall, or medical attention for a worsening condition. In the context of the Anderson case, Susan Anderson’s delay in moving to an available nursing bed, given her declining health, led to $137,000 in private care costs and her eventual vulnerability. Here’s how and why these delays amplify neglect when staffing is inadequate:

• Slower Response Times

• Why: With only 76% of the required staff, nurses and aides are stretched thin, juggling multiple residents. A call for help might wait 20 minutes rather than 5.
• How it Hurts: A senior who falls and lies unattended risks physical injuries, pressure sores, as well as psychological or emotional trauma. In Susan’s case, delayed nursing care likely worsened her frailty, mirroring the statistical findings of more fall-related injuries in understaffed facilities.

• Unaddressed Health Decline

• Why: Fewer staff means less time for regular checks, blood pressure, hydration, or wound care might be skipped.
• How it Hurts: Conditions like infections or malnutrition (as in the Kansas neglect case) fester. Susan’s risk of emaciation could have escalated without timely intervention, a pattern also associated with staffing shortages.

• Overwhelmed Care Coordination

• Why: Delays in transferring to higher care (e.g., waiting for a “better” facility) strain existing staff, who can’t adapt to escalating needs.
• How it Hurts: In Susan’s situation, the conservator’s choice to delay despite an available bed left her dependent on costly private care, while understaffing at Alexian might have delayed basic support, heightening neglect risks like untreated pneumonia.

• Emotional and Physical Isolation
  • Why: Staff shortages limit social interaction or assistance with mobility, leaving residents isolated longer.
  • How it Hurts: Isolation worsens mental health, reducing a senior’s ability to signal distress. Higher depression rates are often linked to understaffed homes, a neglect precursor.

The Connection: Why Delays Amplify the ProblemDelays don’t just slow care; they compound the effects of understaffing. With only 80% staffing, a facility might manage routine days, but delays (e.g., waiting for a transfer or a staff shift) create bottlenecks. Residents with urgent needs like falls, infections, or dementia episodes wait longer, and the already thin staff can’t catch up. This creates a vicious cycle: neglect (e.g., missed meals) leads to worse health (e.g., weakness), which demands more care that the facility can’t provide, deepening the neglect. In Susan’s case, the delay in transfer, even if voluntary, amid a potentially understaffed environment, likely contributed to her vulnerability, aligning with findings that staffing failures directly correlate with higher neglect incidents.Takeaway for SeniorsThis interplay means delays aren’t just inconveniences.  They’re neglect amplifiers in understaffed settings. For aging in place, it’s a reminder to avoid facilities where staffing risks lurk by carefully evaluating institutions.  Use our toolkit, "Choosing a Nursing Home or Skilled Nursing Facility: Navigating the Long-Term Care Crisis." Of course, aging in place is still a superior plan to avoid the risks altogether, starting with legal tools such as advance directives regarding aging in place, dementia care, guardianship, and health/end-of-life care incorporating supported decision-making (SDM), and trusts and powers of attorneys for asset and property management and preservation. 

Strategies to Avoid CCRC Risks: Beyond Aging in PlaceWhile aging in place is ideal, not all can; here are strategies to sidestep CCRC traps:

• Scrutinize Contracts Pre-Signing: Demand clear refund/termination clauses (e.g., partial on death); use attorneys to negotiate "permissive" language into mandatory. Review with elder law attorneys before signing.

• Build in Conservatorship/Guardianship Safeguards: Nominate a trusted agent in a durable power of attorney; include "veto rights" for transfers, and fund private care via trusts.  Draft trusts to eliminate a guardian exercising your rights to, among other things, amend your trust or remove assets from the trust.

• Use Trusts for Financial Firewalls: Create trusts with preferences and incentives for non-institutional care clauses, earmarking funds for home or alternative care; irrevocable trusts shield assets from penalties.  Permit and encourage private care plans, empowering your agents with guidelines and authority to negotiate and execute them. 

• Leverage SDM Agreements: Formalize family input via SDM, ensuring decisions reflect wishes without court; nominate supporters for care disputes.

• Explore Alternatives: Consider life care at home via Medicaid HCBS waivers.  Explore hybrid models like "pocket neighborhoods" that blend community without full CCRC commitment.

• Financial Exploitation Shields: Include penalties in trusts for family/facility actions violating wishes; report suspicions via state APS.

• Leverage Medicare Advantage Plans: Explore and select MA plans that fund hospital at home, Smart Home Health Care, home health, disability, and in-home exercise.

• Protect your Cognitive Health:  Make lifestyle changes, and embrace technology!

These steps empower consumers, turning "lifetime" contracts and decisions into true lifelines. Implement a plan today!