Smart Senior Living: Your Guide to Continuing Care Communities and At-Home Programs

What to Know, What to Ask, and How to Choose the Right Retirement Community for You

Continuing Care Retirement Communities (CCRCs) and Continuing Care at Home (CCAH) programs represent two of the most comprehensive options available for seniors planning their long-term care needs. Both offer the peace of mind that comes from knowing your future care is secured, but they do so in fundamentally different ways—one on a residential campus, the other in the comfort of your own home.​

What Are Continuing Care Retirement Communities (CCRCs)?

A Continuing Care Retirement Community, also known as a Life Plan Community, is a senior living option designed to provide a full continuum of care in one location. The fundamental premise is simple but powerful: you can “age in place” without ever having to move to a different facility as your care needs change.​

CCRCs typically offer three to four levels of care on a single campus:​

Independent Living: For active seniors who need minimal assistance with daily activities and want to enjoy a maintenance-free lifestyle with social activities, dining options, and amenities.​

Assisted Living: For residents who require help with activities of daily living such as bathing, dressing, medication management, or mobility.​

Memory Care: Specialized care and programming for residents with Alzheimer’s disease or other forms of dementia.​

Skilled Nursing Care: 24/7 professional medical care for residents with significant health needs, chronic conditions, or those recovering from illness, injury, or surgery.​

Housing Options at CCRCs

One of the appealing aspects of CCRCs is the variety of housing options available to suit different lifestyles, preferences, and budgets. Understanding these options helps you envision how you’d actually live in a CCRC environment.​

Apartments and Condominiums: The most common housing type in CCRCs, apartments range from studio units to spacious two or three-bedroom residences. These units typically feature full kitchens or kitchenettes, modern bathrooms, and living areas. High-rise apartment buildings have become increasingly popular in recent years, offering convenience and proximity to community amenities. Apartments are ideal for those transitioning from smaller homes or who prefer low-maintenance living with everything under one roof.​

Cottages and Villas: For those who want more space and a greater sense of privacy while still enjoying community benefits, cottages and villas provide an excellent middle ground. These housing options typically range from 800 to 3,000 square feet and may be standalone structures or duplexes. Cottages and villas usually include two to three bedrooms, one to two bathrooms, a den, and either an attached or detached garage—often large enough for a car and even a golf cart. Many communities allow residents to maintain small gardens and personalized outdoor spaces, appealing to those who enjoy gardening or outdoor hobbies. This option particularly attracts couples or individuals downsizing from larger homes who aren’t quite ready to give up all their living space.​

Townhomes and Terrace Homes: These mid-sized options blend elements of cottage and apartment living. Townhomes typically share one or more walls with neighboring units and may have shared entryways, while offering more square footage than standard apartments. Some feature underground parking garages rather than individual driveways.​

Lodges and Estate Homes: At the luxury end of the spectrum, some CCRCs offer lodges or large estate homes ranging from 1,000 to 5,000 square feet. These standalone homes feature individual lots, driveways, and two-car garages. They often include gourmet kitchens, premium finishes, signature architectural designs, and green building features such as solar panels. While not common at every CCRC, these options exist for those seeking the highest level of space and amenities.​

The housing type you choose typically affects your entrance fee and monthly costs, with larger standalone homes commanding higher prices than apartments. However, the level of access to care and community services remains the same regardless of housing type.​

Types of CCRC Contracts

CCRCs offer different contract types that significantly impact both your upfront costs and how much you’ll pay if you need higher levels of care in the future. Understanding these differences is crucial to making an informed decision.​

Type A (Life Care or Extensive Contract): This is considered the gold standard and most comprehensive option. Type A contracts require the highest upfront entry fee and higher monthly service fees, but in exchange, most future healthcare services are covered at little or no additional cost. This provides the greatest predictability for long-term costs and peace of mind, as you won’t face dramatically increased expenses if you need assisted living or skilled nursing care. The prepaid healthcare costs included in Type A contracts qualify for IRS medical deductions.​

Type B (Modified or Modified Fee-for-Service Contract): Type B contracts are similar to Type A but with lower entry and monthly fees. The key difference lies in how much healthcare risk the CCRC absorbs - Type B contracts typically limit the number of days per year you can reside in assisted living or skilled nursing before additional fees apply. This option works well for those who believe they have sufficient financial resources to cover potential future healthcare costs beyond what’s included, or who anticipate not needing extensive higher-level care.​

Type C (Fee-for-Service Contract): This option offers the lowest entry and monthly fees, with some communities only charging monthly fees without an entrance fee. However, Type C residents pay the full cost of any time spent in assisted living or skilled nursing care, taking on the complete risk of healthcare costs. Some Type C contracts may draw from the entry fee to partially offset care costs until it’s depleted. This unbundled approach appeals to those who want maximum flexibility and control over which services they use, but it requires substantial personal financial resources or long-term care insurance, as custodial nursing home care can exceed $9,000 monthly.​

CCRC Costs and Price Ranges

Understanding the financial commitment required for CCRC living is essential for planning purposes. CCRC costs typically consist of two primary components: an entrance fee and ongoing monthly fees.​

Entrance Fees: The one-time entrance fee can range dramatically from tens of thousands to over $1 million, depending on location, housing type, apartment size, amenities, and contract type. The national average for CCRC entrance fees is approximately $300,000 to $400,000. Type A contracts command the highest entrance fees due to their comprehensive prepaid healthcare coverage, while Type C contracts have the lowest. Larger housing units like cottages and villas require higher entrance fees than standard apartments. It’s important to note that entrance fees may be partially or fully refundable depending on the contract terms, with common refund percentages being 50%, 75%, or 90%.​

Monthly Fees: Ongoing monthly fees typically range from $2,000 to $6,000, with an average of approximately $3,450. These fees cover housing, meals, utilities, maintenance, amenities, activities, and varying levels of healthcare access depending on contract type. Monthly fees generally increase annually to account for inflation and rising operating costs.​

The significant financial commitment CCRCs require makes it imperative to thoroughly review all costs and contract terms with qualified professionals before making this important decision.​

Benefits of CCRCs

Seamless Transitions Between Care Levels: One of the most significant advantages is the ability to move between different levels of care without leaving the community. This eliminates the stress, disruption, and uncertainty of finding a new facility when your needs change.​

Comprehensive Healthcare Services: Many CCRCs offer healthcare services directly on the premises, including dental, optometry, podiatry, audiology, and 24/7 access to doctors and nurses. This convenience saves time and reduces the burden of managing multiple healthcare appointments.​

No Home Maintenance Worries: Residents no longer need to worry about home repairs, yard work, snow removal, or other property maintenance tasks.​

Rich Social Environment: CCRCs provide extensive opportunities for social connection through activities, clubs, educational programs, fitness classes, excursions, and dining experiences. This helps combat isolation and supports mental and emotional well-being.​

Cost Savings Over Time: By joining a CCRC while still physically independent and healthy, seniors can realize significant cost savings compared to paying market rates for assisted living or nursing care later.​

Financial Predictability: Especially with Type A contracts, CCRCs provide predictable costs that make long-term financial planning easier.​

Peace of Mind for Families: CCRCs reduce the burden on adult children, who gain peace of mind knowing their parents have access to all necessary care levels in one secure location.​

Things to Watch Out for with CCRCs

High Upfront Costs: Entry fees can range from tens of thousands to several hundred thousand dollars, depending on the contract type, housing size, and community. This represents a substantial financial commitment that may not be feasible for everyone.​

Monthly Fee Increases: While some costs are predictable, monthly fees typically increase annually to keep pace with inflation and operating costs.​

Contract Complexity: CCRC contracts can be lengthy and complicated, with important details about refund provisions, fee structures, and healthcare coverage that require careful review. These contracts are legally binding agreements with significant financial implications—it’s essential to have an experienced eldercare attorney review the contract before signing. Additionally, consulting with a financial advisor can help ensure the costs align with your long-term financial plan and that you have sufficient assets to cover the commitment over your lifetime.​

Financial Stability of the Community: Not all CCRCs are equally financially sound, and it’s essential to review the community’s financial statements, actuarial reports, and credit ratings to ensure long-term viability.​

Limited Flexibility: Once you’ve moved into a CCRC and paid a substantial entry fee, relocating elsewhere can be difficult and may result in financial loss depending on the refund provisions in your contract.​

Type C Risk: If you choose a Type C contract, you bear the full financial risk of potentially expensive long-term care, which could exhaust your savings if you need extended skilled nursing care.​

The Crucial Importance of Professional Review

Given the complexity and significant financial commitment involved in CCRC contracts, it cannot be overstated: you should always have the contract reviewed by an experienced eldercare attorney and a qualified financial advisor before signing. These professionals can identify potential red flags, clarify confusing terms, ensure you understand your financial obligations, and help you evaluate whether the contract aligns with your goals and resources.​

Additionally, involving your loved ones—adult children, family members, or trusted friends—in the decision-making process provides valuable perspective and support. Your family should understand the financial commitment you’re making and have the opportunity to ask questions and voice concerns before you proceed. This collaborative approach helps ensure everyone is on the same page and reduces the risk of misunderstandings or family conflicts later.​

How to Find CCRCs

There are approximately 2,000 CCRCs across the United States, with varying availability by state. Pennsylvania has the most CCRCs of any state with nearly 200, followed by Ohio, California, Florida, Illinois, North Carolina, Texas, Virginia, New York, and New Jersey. CCRCs can be found in 25 or more states where they are most common, though Wyoming is the only state without any CCRCs. Most CCRCs—approximately 78%—are sponsored by nonprofit organizations, while 22% are for-profit.​

Finding the right CCRC requires research and careful evaluation. Start by identifying communities within your desired geographic area—proximity to family members is often a key consideration. Use online resources and directories to screen communities, reviewing their websites, amenities, contract types, and available housing options. Tools like myLifeSite’s CCRC search, US News Best Senior Living finder, and FindContinuingCare.com allow you to search for CCRCs by state, city, or zip code. Many CCRCs now offer virtual tours that allow you to explore community spaces remotely.​

Read online reviews to get a sense of resident satisfaction regarding staff quality, care standards, and facility cleanliness. Look for communities that are accredited by organizations like CARF (Commission on Accreditation of Rehabilitation Facilities), which indicates they’ve passed rigorous quality standards. Check financial ratings from agencies like Fitch Ratings to assess the community’s financial health and stability.​

Once you’ve narrowed your options, schedule in-person visits to tour the facilities, see the various housing options, meet with staff, talk to current residents, and experience meals in the dining room. This firsthand experience is invaluable for assessing whether a community feels like the right fit for your lifestyle and personality.​

What Is Continuing Care at Home (CCAH)?

Continuing Care at Home programs represent an innovative alternative to traditional residential CCRCs, designed for the 77 percent of adults age 50 and older who want to age in place in their own homes. CCAH is a hybrid model that brings the safety net and resources of a Life Plan Community directly to your home.​

As a membership-based program, CCAH provides comprehensive care coordination, an array of home care services, financial protection against rising long-term care costs, and proactive wellness programming—all designed to support aging in place safely and comfortably.​

How CCAH Works

CCAH programs are typically structured similarly to life-care contracts at traditional CCRCs, with upfront membership fees and monthly fees. Members receive personalized care coordination from nurses who create individualized care plans that evolve as needs change. Services can include personal care assistance, skilled nursing care, medication management, rehabilitation, and other support tailored to each member’s situation.​

The beauty of CCAH is its flexibility—services can scale up during health setbacks and scale down during periods of improvement, without requiring major life transitions. Many programs also offer social activities, educational programs, and wellness initiatives to help members stay connected and engaged.​

CCAH Costs and Price Ranges

While specific pricing for CCAH programs varies by provider and geographic location, they typically follow a similar financial structure to CCRCs with entrance fees and monthly fees. However, because CCAH members remain in their own homes rather than moving to a residential campus, the costs are generally lower than traditional CCRC entrance fees. Members avoid the expense of campus housing while still gaining access to coordinated care services and financial protection against escalating long-term care costs. It’s essential to carefully review the membership agreement to understand exactly what services are included in the fees versus which require additional payment.​

Benefits of CCAH Programs

Aging in the Comfort of Your Own Home: The primary benefit is remaining in the familiar environment you love, surrounded by your belongings, memories, and neighborhood.​

Financial Protection: CCAH provides structured fees and cost caps for future care, protecting against the unpredictable and potentially catastrophic costs of long-term care. This predictability allows for confident financial planning.​

Comprehensive Care Coordination: A dedicated care team coordinates all aspects of your care, eliminating the overwhelming task of managing multiple providers, appointments, and services.​

Reduced Family Caregiver Burden: CCAH takes the coordination burden off adult children, allowing them to focus on emotional support and quality time rather than managing complex logistics.​

Flexibility and Scalability: Services adapt to your changing needs, whether temporary or permanent, without forcing major transitions.​

Priority Access to Residential Care: Many CCAH programs, including Givens Choice in Asheville, NC, are affiliated with established CCRCs and provide priority access to residential care if circumstances eventually require moving to a facility.​

Social Connection: Despite aging at home, members can participate in social activities and wellness programs that combat isolation and promote healthy aging.​

Things to Watch Out for with CCAH

Actuarial Uncertainty: Because CCAH programs are relatively new, some critics have raised concerns that they function as unregulated insurance products, and the long-term actuarial soundness of these programs remains unproven in many states.​

Regulatory Gaps: Unlike long-term care insurance, which is heavily regulated, most states do not regulate CCAH programs as insurance products, creating potential risks for consumers.​

Home Care Workforce Challenges: CCAH requires reliable, trained direct care workers who can perform their duties without direct supervision. This raises concerns about worker training, quality, patient safety, and potential issues like injuries, abuse, theft, or misconduct.​

Privacy and Technology Risks: While remote monitoring technology enables better at-home care, it also increases risks related to patient data and privacy.​

Contractual Complexity: Understanding whether the CCAH provider employs its own workforce or outsources to third parties is crucial, as this affects quality control and liability. As with CCRCs, having an eldercare attorney review the CCAH membership agreement before signing is strongly recommended.​

Different Consumer Profile: Early data suggest CCAH members tend to be committed to staying in their homes with no intention of moving to a residential CCRC until they need full-time assisted living or nursing care. This means they may not transition until they’re quite frail, potentially affecting the program’s financial model.​

Significant Financial Commitment: Like traditional CCRCs, CCAH programs require substantial upfront investment, and it’s essential to ensure costs align with your budget and long-term financial goals. Consulting with a financial advisor can help you evaluate whether CCAH membership fits your overall retirement plan.​

The Crucial Importance of Professional Review for CCAH

Just as with CCRC contracts, you should never sign a CCAH membership agreement without first having it reviewed by an experienced eldercare attorney and discussing the financial implications with a qualified financial advisor. These relatively new programs have unique contractual provisions and potential risks that require professional expertise to evaluate. Additionally, discussing your decision with loved ones ensures they understand your care plan and can provide support as your needs evolve.​

How to Find CCAH Programs

CCAH programs are less common than traditional CCRCs but are growing in popularity. According to specialty bank Ziegler, there are now more than 30 CCAH programs available across 17 states. States known to offer CCAH programs include North Carolina, Pennsylvania, New Jersey, Ohio, Tennessee, Maryland, Delaware, and California. Many programs offer portability within the United States after you’ve been a member for a year or more.​

Start by researching whether any established CCRCs in your area offer CCAH affiliates - many Life Plan Communities have begun offering these programs to serve seniors who want to age at home. Givens Choice in Asheville, North Carolina, is one example, affiliated with the well-established Givens Estates CCRC.​

Contact local aging services organizations, eldercare attorneys, or financial advisors who specialize in senior living to ask about CCAH options in your region. You can also search online directories and resources focused on aging in place alternatives. As these programs grow in popularity, more communities are developing them, so staying informed about new offerings is important.​

When evaluating CCAH programs, carefully review the membership agreement, fee structure, services included versus additional charges, and the provider’s connection to residential care facilities should you eventually need that level of support.​

CCRC and CCAH Evaluation Checklist

Use this comprehensive checklist to evaluate Continuing Care Retirement Communities and Continuing Care at Home programs:

Location and Accessibility

• Is the community within a reasonable distance from family and friends?

• Is it close to healthcare facilities, shopping, cultural attractions, and places of worship?

• Is the location in a climate and setting (urban, suburban, rural) that appeals to you?

• Is public transportation available, or does the community provide transportation services?

Financial Considerations

• What type of contract is offered (Type A, B, C, or rental)?

• What is the entrance fee, and is any portion refundable? Under what conditions?

• What are the monthly service fees, and what do they cover?

• How frequently have monthly fees increased historically?

• Are there additional fees for specific services or amenities?

• Is the community’s financial health strong? (Request financial statements, actuarial reports, and credit ratings)

• What happens financially if you need to move out or if your spouse passes away?

• Does the contract qualify for IRS medical deductions?

• Do you have sufficient assets to cover the costs over your lifetime?

• Have you reviewed the financial commitment with a qualified financial advisor who specializes in retirement planning?

• Does your financial advisor confirm that this commitment aligns with your long-term financial goals and resources?

Contract and Legal Review

• Have you had an experienced eldercare attorney thoroughly review the contract before signing?

• Does your attorney understand the specific implications of the contract type and refund provisions?

• Do you understand the residency requirements and conditions under which you could be asked to leave?

• What are the refund provisions if you decide to leave or pass away?

• Are there provisions for contract changes or community rule modifications?

• What happens to your contract if the community is sold or changes ownership?

• For CCAH: Who employs the caregivers—the program directly or a third-party contractor?

Family Involvement and Support

• Have you discussed this decision thoroughly with your loved ones (adult children, family members, trusted friends)?

• Do your family members understand the financial commitment and care arrangements?

• Have you invited family members to accompany you on community tours and to meet with advisors?

• Are your loved ones supportive of your decision and aware of how they can assist if needed?

Healthcare Services

• What levels of care are available (independent living, assisted living, memory care, skilled nursing)?

• Are transitions between care levels seamless and guaranteed?

• What healthcare services are provided on-site (dental, podiatry, optometry, physical therapy)?

• Is there 24/7 access to medical staff?

• What is the staff-to-resident ratio in assisted living and skilled nursing?

• Are residents allowed to keep their personal physicians?

• How does the community handle emergencies?

• For CCAH: What specific home care services are included? How quickly can services be increased?

Quality and Accreditation

• Is the community accredited by CARF or other recognized organizations?

• What quality ratings has the community received from state inspectors?

• Are there any outstanding violations or complaints?

• What do online reviews say about the community?

• Can you speak with current residents and their families about their experiences?

Housing Options (For CCRCs)

• What types of housing are available (apartments, cottages, villas, townhomes, standalone homes)?

• Which housing type best suits your lifestyle, space needs, and budget?

• Are the living spaces well-maintained, clean, and appropriately sized?

• Are apartments/homes customizable to your preferences?

• Do cottages and villas offer outdoor space for gardening or personal hobbies?

• What is included with each housing type (garage, patio, balcony, storage)?

• How do costs differ between housing types?

Facilities and Amenities

• Are common areas inviting and well-kept?

• Are outdoor spaces accessible and well-landscaped?

• Is the community easy to navigate for those with mobility limitations?

• What amenities are available (fitness center, pool, library, workshop spaces, gardens)?

• Is the dining quality excellent, with varied and nutritious menu options?

• Are special dietary needs accommodated?

Social and Cultural Environment

• Does the community offer a robust calendar of activities, classes, and events?

• Are there opportunities for continuing education and intellectual engagement?

• Can you pursue your hobbies and interests?

• Does the community culture align with your values and lifestyle preferences?

• Are volunteer opportunities available within the community and in the broader area?

• Is there an active resident council or resident involvement in community decisions?

• Did you feel a positive connection with residents you met during your visit?

Staff Quality

• Are staff members friendly, professional, and attentive?

• What is the staff turnover rate?

• How are staff trained and supervised?

• Are staff members responsive to resident concerns?

• For CCAH: What training do home care workers receive? How is quality monitored?

Care Coordination (Especially for CCAH)

• Is there a dedicated care coordinator or nurse assigned to you?

• How often are care plans reviewed and updated?

• How does the program coordinate with your existing healthcare providers?

• What happens if you need services beyond what the program offers?

• Is there 24/7 availability for urgent needs?

Technology and Safety (Especially for CCAH)

• What remote monitoring technology is available?

• How is your privacy and data security protected?

• What emergency response systems are in place?

• How quickly can help arrive in an emergency?

Resident Rights and Advocacy

• Are resident rights clearly outlined in the contract?

• Is there a resident advocate or ombudsman?

• How are disputes or complaints handled?

• Can residents participate in governance or advisory committees?

Trial Period and Move-In Process

• Is there an opportunity for a trial stay before committing?

• What support is provided during the move-in transition?

• How long is the adjustment period typically?

• Can you terminate the contract during a trial period with a refund?

Future Planning

• For CCRC: What happens if your care needs exceed what the community can provide?

• For CCAH: Is there guaranteed access to residential care at an affiliated CCRC if needed?

• How does the community handle end-of-life care and hospice services?

• Are there provisions in your contract that protect you as you age?

Personal Gut Check

• Do you feel comfortable and welcome in this community or program?

• Can you envision yourself thriving here for years to come?

• Does the community or program align with your values and vision for your retirement?

• Have all your questions been answered thoroughly and transparently?

• Do you trust the leadership and staff to provide excellent care?

Final Professional Review Reminder

• Before signing any contract or membership agreement, have you completed reviews with:

  • An experienced eldercare attorney?

  • A qualified financial advisor specializing in retirement planning?

  • Your loved ones and family members?

This checklist provides a structured framework for evaluating your options, but remember that choosing where and how you’ll age is deeply personal. Take your time, involve family members in the process, consult with financial and legal professionals, and trust your instincts about what feels right for your unique situation. The investment of time in thorough evaluation and professional review will provide peace of mind and help ensure you make the best decision for your future.