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4 things to know: Continuing care at home

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Some of the consumers who think hardest about long-term care (LTC) needs choose continuing care retirement communities (CCRCs): Providers that offer ordinary apartments, assisted living facilities and nursing home beds all on the same campus.

Other families are considering a newer, less common option: continuing care at home (CCAH) programs.

Setting up a CCAH program is a way for a CCRC to serve more people without having to add facility beds. The CCRC that runs a CCAH offers the users many different home care services, such as care coordination, help with household chores and errands, transportation and in-home nursing services. 

Even many nursing home managers, home care providers, and managers of traditional CCRCs are just starting to learn about the CCAH concept. LeadingAge, a LTC provider trade group, offered two CCAH sessions at its annual meeting, in Nashville, Tenn.

Here’s a look at four key points from CCAH presentations given by Sarah Spellman, a principal at CliftonLarsonAllen, an accounting firm; by Brad Paulis and Chris Borcik of CCRC Actuaries; and by Alwyn Powell and Amy Lampo.


1. CCAH programs offer many different plan designs and pricing strategies.

The CCRC running the CCAH program may offer only home-based services, or some combination of home-based services, community-based services, and access to assisted living facility or nursing home services, Spellman said.

A plan that provides all care for life might cost about $400 or $500 per month.

Another CCRC provider might develop a CCAH plan that charges a 15 percent co-payment for home care, and a 30 percent co-payment for community-based care.

See also: 7 things Harvard housing researchers can tell you about older adults.

One hand clasping another

2. CCAH managers know about private long-term care insurance (LTCI).

In the acute medicine world, doctors, hospitals and insurers talk about each other, and complain about each other, all the time.

LTC providers and LTCI issuers seem to have a more distant relationship, in part because the people getting the care and their relatives usually file the claims with the insurers.

But Spellman said a typical CCAH manager may look at any private LTCI coverage an individual has and use the LTCI benefits to pay part or all of the CCAH costs.

Piggy bank with the money out

3. CCAH managers often use LTCI actuaries to manage care resources.

Paulis and Borcik said CCAH managers face many of the same concerns that LTCI issuers face, such as dealing with the possibility that residents will be sicker than expected, or live longer than expected.

CCAH managers also rely on some of the same risk-management strategies that LTCI issuers use, such as strong marketing and careful medical underwriting, the actuaries said.

Older man

4. The Actuarial Standards Board has developed a reporting standard for CCAH.

A CCAH is supposed to report on its operations using Actuarial Standard of Practice Number 3, which was developed in 2007 and updated in 2011.

A CCAH must report on its actuarial funded status, its pricing margin, and expected cash flows.

Powell and Lampo said managers of a CCAH may have a hard time using early experience to project what overall experience will be like. They said good CCAH managers should set conservative assumptions, analyze experience data and validate projections every year, and collaborate with others to get data they can use to benchmark the performance of their own CCAH.


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