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At age 74, I like to think our retirement is pretty much set in stone. Most of the big health and financial decisions—Medicare, Social Security, Roth conversions—have already been made. But there’s one concern I’ve been thinking about a lot lately: how will Rachel and I get the help we need if we can no longer take care of ourselves?
Our family is spread out across the country, and we have no plans to move closer to them. Even if we did, we wouldn’t want to burden them with caring for us.
The odds are that one of us will need care as we age. According to the Center for Retirement Research at Boston College, about 80% of retirees will require some level of long-term care—ranging from minimal help to extensive support.
Many seniors face this health care challenge. The U.S. Census Bureau estimates that the number of elderly people aged 85 and older will nearly double by 2035 (from 6.5 million to 11.8 million) and almost triple by 2060 (to 19 million).
At the same time, The New York Times reports a shortage of workers in the care industry, largely driven by low wages. This issue could be worsened by the current administration’s immigration crackdown, which affects a workforce where 28% of long-term care workers are immigrants.
According to CareScout, the price of some long-term care services—such as assisted living communities and nursing home care—rose as much as 10% in 2024, while the general inflation rate rose by 2.9%. A CareScout survey found that the national median monthly cost in 2024 was $6,483 for a home health aide, $5,900 for an assisted living community, and $10,646 for a private nursing home room.
Facing a future with both a shortage of long-term care aides and rising costs makes getting the help you need a difficult task.
We’ve looked into Continuing Care Retirement Communities, or CCRCs, which offer a range of care—from independent living to skilled nursing—all in one location. At first, we thought it was a smart solution, and it still might be. However, most CCRCs require large entry fees—sometimes hundreds of thousands of dollars—which we feel is a significant financial gamble.
Yes, some contracts offer refundable fees, but they usually come at an even higher cost. Our biggest concern is whether a CCRC can uphold the terms of a Type A contract, which states that they will not evict you if you run out of money or significantly raise your fees—except for cost-of-living adjustments—even when you require a higher level of care, such as assisted living or skilled nursing.
Will this type of model be sustainable when we’re facing a future with a shortage of workers and rising costs? Or will it resemble the long-term care insurance industry, where we’ve seen significantly higher premium increases and reduced coverage over time?
There are other types of CCRC contracts, but we would only be interested in one that guarantees lifetime care with predictable costs.
Instead of a CCRC, we’re considering another option: avoiding entry fees and paying a monthly fee for an assisted living and memory care community. There’s one not far from where we currently live, and if we needed more care, there’s a skilled nursing facility and a hospital nearby.
This type of care also presents its own set of problems. Will there be room when we need it? And when is the right time to move—especially if we’re still mostly independent? There’s also the risk that we could run out of money under this arrangement.
There’s always the option of staying in our home and hiring a home health aide. To plan for that possibility, we would follow the financial guidelines recommended by Carolyn McClanahan, a physician and certified financial planner who was interviewed for The New York Times article.
She suggests “planning for two to three years of long-term care needs, and up to five years for those at higher risk of dementia or with good health and longevity prospects.” We would probably fall into the latter category, which would require us to set aside five years of funds for care for each of us.
To reduce the amount of money that needs to be set aside, Dr. McClanahan advises married couples that one spouse should apply for long-term care insurance. That’s something we’re considering. Rachel is still in her 60s and has no preexisting conditions, so she would likely qualify for coverage.
Our current healthcare system doesn’t seem to offer a perfect solution. There are uncertainties no matter which direction we go.
Over lunch recently, a close friend shared how difficult it has been to care for his wife, who has dementia. After our conversation, I realized his journey is about more than just finding long-term care—it’s also about seeking peace of mind and preserving dignity.
Whatever we decide, we want to make the choice on our terms—while we still can.
Dennis, This is an excellent forum question. There have been many forum discussions in HD on this topic, including this one: https://humbledollar.com/forum/assisted-living-how-will-you-choose/
After visiting more than a dozen CCRCs and assisted living facilities, I have short listed a couple of non-profits, and will do more research.
“the current administration’s immigration crackdown, which affects a workforce where 28% of long-term care workers are immigrants” only affects illegals who should not be in the country. Immigrants who follow the rules and laws of the US will have no problem finding work in healthcare.
My wife is a geriatric care manager specializing in dementia. Families come to her to help them navigate the wide array of AL options as well as memory care. Not only that, but being an advocate for their loved one and keeping up with medical appointments, med lists, taking them to their doctor appts and keeping notes from each visit. Her mantra is “you just be the child or spouse, let me handle the rest”. I’m not saying it is cheap by any reason, but it removes a huge weight from some, especially when parents and their children are in different locations.
If you are a true Humble Dollar investor you will be able to care for yourself, and when that changes be ready to get help from Family or like us live in a CCRC, Continuing Care Retirement Community, which currently is Independent Living, but ours also has Assisted Living, Memory Care, and Skilled nursing. First just like the CCRC checks your net worth, make sure you check their Financials and that they are fiscally very responsible, ours had a 5 star rating. Most contracts are buy in for say $500,000, with a return of 90% after you pass. Then there is a monthly fee. Within the contracts, you can choose insurance for low price nursing care, very reasonable cost to you. Our contract also includes, if by chance you run out of all your money, you will be taken care of and continue living at the facility. A very small percentage have this issue, somewhat less than 1%. CCRC living is not for everybody, but it is turning out to be just right for us. The average age is at our facility is about 83, and we moved in at 75. Keep reading Humble Dollar as it offers a host of ideas on this subject.
My wife and I live in a 55+ community and have been here 7 years. This is the second 55+ community for me. I am not aware of any health requirements, but most 55+ communities that I know of advertise themselves as active adults. Now that we are in our mid-70’s, we have joined a CCRC waiting list. We will use proceeds from our house to pay the entrance fees. We both have LTC insurance and a healthy income. We don’t have family to care for us, and I would not want them to have to do so. We don’t foresee problems, but you never know. Life goes in its own direction
It is a question and a challenge. While costs can be high, determining a stable location may be more difficult. The situation with Continuing Care Retirement Communities may be similar to that of the RV resorts and campgrounds we live at. As boomers retired many decided to RV. When we began RVing in 2013 reservations were not mandatory but for popular areas near National Parks, or during peak times. Today reservations are difficult to obtain and there are more RVs owned than there are sites to accommodate them.
In 2014 and 2015 we anticipated this and became annuals at two RV locations. One was a smaller campground on the eastern shore of Lake Michigan adjacent to a popular state park. The other is a 50+ “mega resort”. Doing this assured us of our same site each year and we upgraded both with a deck, or roof, etc. with the approval of management. We purchased and situated RVs that would be stationary and neither moved for 10+ years. That’s not unusual in these situations. (I periodically spun the wheels, performed other maintenance, etc.). One was 2BR, 1-1/2 baths, etc. and last year we sold it, it was removed the family that bought it is travelling full time in it; we also sold the site because we owned all improvements. The resort has procedures in place for this.
What we noticed in the mega resort was that it was a popular place for the elderly, with a substantial number in their 80s and 90s. Some have been here for decades, others more recent. Costs were manageable. One could purchase a 400 sq. ft. or larger “Park Model” which some affectionately call “candominiums”. After that modest expenditure (somewhere between $25 and $50K) there was an annual resort fee, which increases about 5% each year. This is well within the means of many on social security. The only other expense was metered electricity. This was substantially less costly than a CRCC, there was a nurse practitioner with an office in the resort, daily wellness checks for those who wanted them, a small market and restaurant/bar. There are structured fitness activities for the elderly, too.
I was on the board of a large private urban development HOA with 44 buildings and 336 units. The setting was park like within a small city with all of the amenities and everything nearby. The association became a popular alternate to CRCC living and the board was cognizant of every sale, and basic data about every owner or resident. There were complaints for more park benches, etc. One group also pushed for the addition of a “community center”. The bylaws allowed rentals and so some families would purchase and move mom or dad in, to spend the rest of their days. This didn’t always work well because the HOA was not equipped for elderly who lived alone and needed some care.
As to restrictions, no one could be discriminated based on age, so people purchased, came and left. We noticed an increase in the frequency of ambulance visits.
One concern I have about CRCCs which provide guarantees is that they can be sold, nullifying contracts. This has occurred in the RV industry and there are increasing complaints about campgrounds and resorts being sold. The new owners decide to renovate or convert the property to other purposes. At the end of the annual contract all residents must remove their RVs, some stationary for a decade or more and no longer towable. They have nowhere to go and no means to get there. Because the site rents were low (sometimes only $400 per month plus electric) it is impossible to find another location to rent at that cost. There have been complaints to government agencies, but with current laws this is legal.
I prefer non-profit to for-profit CCRCs partly because I think a for-profit is more likely to be sold. Apparently my non-profit gets frequent offers, but I think a sale is highly unlikely. Also, in NC transfer of ownership has to be approved by the Department of Insurance.
Norman, thanks for the interesting account of the economics of the RV community. We have friends who sold their farm in NE PA and have been RV full time since pre-Covid. This is partly to deal with 3 children spread across the country (Pittsburgh, Houston, Portland, OR). They can follow the seasons somewhat. We haven’t spoke to them in some time; it will be interesting to see their experience.
My late mother-in-law’s situation was a clinic in how not to handle this, as I’ve written here at points. To recap, her husband (my husband’s stepfather) was in denial about her advancing Alzheimer’s for far too long—she didn’t get a formal diagnosis until 2022, passed away in 2024, but had been showing cognitive decline symptoms since (at least) 2015 or so. He did everything he could to avoid residential care, but in the end it became too much for him, and she spent the last three months of her life in a memory care facility.
There was no available family support. We live 400 miles north of them and so does my husband’s sister, and we were all still working. His son, my husband’s stepbrother, lives in Virginia (we’re in California).
A few points from this experience:
Observing this experience has definitely highlighted for us the need for better planning and for being brutally honest with yourself about the range of possibilities while you’re still able enough to make some decisions.
Thanks for your excellent post about your mother-in-law’s battle with Alzheimer’s. I’m glad your MIL got the help she needed. A friend told me how difficult it was to care for his father who had Alzheimer’s—even when he was in a memory care facility. His father escaped multiple times, and one time he was found wandering a couple of miles from the facility.
My MIL was wandering for several years before finally moving to memory care and one time was missing for nearly five hours. It was terrifying.
I’m very surprised to read that your in-laws needed HOA approval to move to a 55+ community. It is certainly the case that you need to pass both financial and health checks to move to a CCRC (at least to Type A and B ones), but I’ve never heard of such a thing for a 55+ community. It’s not as if they are going to provide care. This is a popular 55+ community near me and the only requirement I can see is that the owner of a dwelling unit be 55 or older. Several people have moved from that community to my CCRC.
I live in a 55+ and there’s no such thing as an entrance interview. As you point out, they are not providing care, so that would not even be appropriate. A CCRC, however, requires that and more to move into independent living units.
This is some info about the community—see the “health and background checks.”
https://www.sealbeachleisureworldrealestate.com/understanding-the-qualifications-to-move-to-leisure-world-seal-beach
I’ve never seen anything like that before! None of the 55+ communities in New Jersey, and I live in one, require medical information to buy a home, whether it’s a condo, single family house or a townhouse. In fact, I once lived in a 55+ that had a full time nurse on staff and they only took a medical history if you opted to use the service.
There’s one just being built here in our town, and as far as I know, if you’re over 55 and can afford it, you can buy a home there.
Interesting. It sounds like qualifying for a CCRC, but without the health care. I haven’t heard of a 55+ community in this area with those requirements, but I believe they are usually stand alone houses.
Yes, from what I understand, they run a tight ship and want people to be healthy and independent when they first move there. If they decline later, that’s how it goes, but when they move in, they need to be pretty self-sufficient. Anyway, he told us about the interview.
I take it the logic is that the community wants a certain standard of living—e.g., not Alzheimer’s patients wandering the streets or burning down the building (the units are connected and have common walls. When my MIL was there, she was in a phase where she was ripping up paper and shoving it down the sinks, and the on-call plumber had to come several times, and my FIL’s friend who was on the HOA board told him he had to get that under control or there would be fines or more serious measures.
Dennis:
Our circumstances almost mirror yours. I am 74 (75 in October) and my wife is 70 (71 in September.) Our kids, 47 and 41, live in MD and TX…we are in NC. We have no grandkids and we do not plan to move again in retirement.
I have an excellent LTCI policy which I obtained as an employment fringe in 2005. It costs $1,695 annually. My wife doesn’t have LTCI, and couldn’t qualify for a hybrid life/LTC policy either. We do have 4 annuities however, each of which has a “doubler”attached to it for a period of 5 years. It would increase our $36,562 to $54,843 annually, if either of us qualified for LTC.
If Rachel can qualify for a policy, get one. You might consider looking at the hybrid life/LTCI policies, if you are concerned about “what happens if we never beed it…” My favorite policy in that category comes from OneAmerica. (That’s the one I tried getting for my wife.)
We built our “forever” home in 2018, in anticipation of retirement. We have 36 in wide doors, no stairs anywhere, wooden floors, walk in shower with a built in bench, (we have a jacuzzi bath tub and regular tub as well) and it is built such that if we needed a live in aide, their is a bedroom, bath, and sitting room separated from the main home area, by a pocket door. It was built with the idea of retiring in place.
I may consider the CCRC option later on, but my wife is not enamored of the idea. She has not yet embraced the fact that we are old, and says she doesn’t want to live with “a bunch of old people.”
My step dad lived with us for 5 of the last 6 years of his life. His final year was in a memory care unit. He lived until 93. He would have reached 100 this year. The assisted living facility he lived in cost $6,150 a month and he was a self pay resident. As you mentioned if I were to consider a CCRC, I would want the guaranteed care option, and the financial strength and stability of the facility would be foremost in any considerations.
Your article is an important one, because as you said, we are living longer, and there will be a shortage of health care aides in the future, worse than the one we are experiencing today.
Kevin,
Thanks for the recommendation of a hybrid long-term care policy—OneAmerica. I’ll check it out. You were smart to build your house with amenities that will make it easier for both of you to age in place. From your post, it looks like you’re in a good place.
Dennis, thanks for another thoughtful topic. We think about this a lot. Our best solution is a CCRC, and getting on a list at one or more long before we think we’ll need it.
You wrote that most require large entry fees, “which we feel is a significant financial gamble.” How is it a gamble? We see it as the cost of doing business, and ensuring we have a place that will work for us through our buck and thin. Yes, if we die shortly after becoming residents, that money is gone. But it’s not as if we had another use for it for ourselves.
To us the more significant gamble is the one you allude to later, planning on renting monthly at an assisted living or memory care facility, only to find that when we need it there’s no space, or that we’re not in good shape to make the move or maybe even the decision.
All four of our parents are in their late 80s. Two are in a house they plan on staying in but which is way too big for them; only one drives and that’s about to come to an end. They won’t hear about even getting on a list, never mind an actual move.
The other two are in separate CCRCs. One went in before it was really necessary, but did so on their terms, and is satisfied with their decision. The other probably waited too long, but fortunately had at least gotten on a list before a medical event happened that pushed the issue.
I think it’s a no brainer to get on a list for at least one CCRC sooner rather than later. It doesn’t mean any obligation to ever move there, just some insurance.
Michael,
What I meant by a “financial gamble” is that I believe there is a significant risk in putting down hundreds of thousands of dollars on a Type A contract that promises never to evict you and not to raise your fees—except for cost-of-living adjustments—even when you require a higher level of care, all while we’re facing a future of worker shortages and rising costs.
You mentioned that it can be a gamble to rent an assisted living or memory care facility—only to discover that there’s no availability or that you’re not in good enough health to make the move. As I noted in the article, there are uncertainties no matter which path you choose.
I agree—it’s a great idea to get on the waiting list for a CCRC if you’ve found one you like and that is financially stable.
I always find your comments insightful.
Some of these CCRCs have gone bankrupt which would also eliminate your large up front deposit. As you said, financially stable is really important. If necessary, hire a finance person to review their finances.
Thanks Dennis. I get your point on the gamble now. That was interesting data you included and is indeed concerning.
As a resident of a large (28,000 person) 55+ community, I would encourage other retirees to check out similar communities to see what they have to offer. I think many would be viable alternatives to CCRC’s.
In our community, there is a large hospital (with a full emergency department), three fire stations, three grocery stores, two hardware stores, a library and many restaurants and stores. We have four recreation centers, over 100 clubs and concerts/entertainment nearly every day.
There are also many resources to help residents age in place. Residents who need assistance with transportation have at least 20 resources to choose from. There is a volunteer Posse that offers to do welfare checks. There is a community fund that will assist residents with just about any living-related expense they have (mortgage payment, utility bills, etc.) if they are having financial difficulties. There is a large warehouse that provides–free of charge–wheelchairs, walkers and just about any other medical device a resident might need.
In addition, the community itself is a huge asset. People truly look after each other. Neighbors check in on neighbors. Several Facebook groups allow residents to post a note if they need help with something. If an older resident can’t keep up with yard work, a group of resident volunteers will come over and take care of it.
It took living here for three years to begin to appreciate all the offerings available to us. I feel comfortable saying I could likely age in place here without too many issues.
May I ask where you are located?
I visited The Villages Florida in May of 2024, shortly after retiring. I loved it…but unfortunately, my wife did not.
I would rather take your route than the CCRC route, if that were an option.
We are in Sun City West, AZ. There are three “Sun City” communities all next to each other. The original “Sun City” was one of the first (or perhaps the first) 55+ communities in the country. I think most of the homes there were built in the 1960’s. Sun City West was developed and built mostly in the 1980’s, although there are quite a few newer homes here as well. Sun City Grand (aka “The Grand”) is the third–and newest–of the Sun City communities. I believe they allow people as young as 45 to live in “The Grand”.
This sounds like a great situation. But I would still be on at least one CCRC list.
I just discovered there are two CCRC’s within our community. At least one of them offers a guarantee to not kick you out if you run out of money. As you said above, getting on a list for one can be viewed as a type of insurance policy.
Kristine, I remember that you mentioned in a previous post that you could escape the summer heat by driving 3 hours. I’m interested to know a bit more about that as I’ve mentioned Sun City West to my husband as a place to check out and the thought of those high summer temps becomes a conversation stopper. Your community sounds like a special place.
We do love our community.
Getting to a cooler location takes about two to three hours depending on the direction you travel. Up north is Flagstaff. To the east is Show-Low and a few other small communities. At least a few residents in Sun City West own small (park-model mobile homes) in Show Low so they can escape the summer heat.
Thanks! I’ll look into those areas.
Been thinking about this for years. Wife and I have no kids. I wouldn’t want to be a burden to my siblings who are of similar age regardless. Would love in-home care, and have sufficient funds and income (I think) but prospects seem dim in this country. Friends who have hired in home care complain of frequent “no shows”.
My mom was in a nice, highly rated CCRC, but when she declined and moved to memory care it wasn’t really all that nice. Regardless, at that point it’s all down hill.
My current best case scenario is being able to see the decline coming in time to make a Danny Kahneman exit.
Michael,
You shouldn’t assume it’s a foregone conclusion that you’ll need a lot of long-term care. According to the Center for Retirement Research at Boston College, “about one-fifth of retirees will need no assistance at all during their lives, and a fifth will need extensive services. The remaining 60% of seniors will have either low (25%) or moderate care needs (37%).”
Good point. Also, the percentage of seniors in a nursing home for a long period is around 3%. Most of what we call LTC is provided in the home.
Dennis,
The numbers are somewhat comforting and we all hope to be in that top fifth.
I’m not as pessimistic as it may have seemed. I see it as a hope for the best, prepare for the worst situation.
I’m a so-far happy resident of a CCRC. The first article I wrote for HumbleDollar was about how I chose my CCRC, and I have a couple of comments.
The entry fee: Yes, it can be high, but the glitzier the facility the higher the fee, and glitz isn’t what you should be looking for. Most people pay it from the proceeds of selling their house – after all, you don’t need it anymore.
The contract type: Yes, in a Type A facility you pay the same monthly fee in all levels of care, but that fee will still go up as costs go up. If you spend most of your time in Independent Living, it’s a bad deal. My CCRC is a modified Type B, I will pay more for higher levels of care, but less than market rates.
The promise to keep you: My Type B also promises to keep me, has a benevolent fund to back the promise, and has kept it for over 30 years. I trust a non-profit more than a for-profit on this. The Skilled Nursing facility is both Medicare and Medicaid certified (not all are), so the promise applies to Independent and Assisted Living.
Location: CCRCs are regulated by states. Some states do a better job than others. Some residents in mine moved to NC simply because we have good regulations.
Wait lists: There are 1,100+ households on the wait list for my CCRC. This is not a decision to delay too long.
I take your point about the difficulty of finding workers. Sadly, the advance of AI may increase the supply.
Good luck.
Dennis, thanks for a great article about one of the most difficult parts of retirement planning. At almost 68 and 67, we hope we are a long way from needing care. But we have lots of experience with elderly parents and their care needs. We’ve also seen how quickly the need can change, especially with cognitive decline. We currently have several people in our lives that may soon need help due to cognitive issues. It’s extremely important to prepare financially (savings, insurance, estate plans, …). But, as Dennis mentions, how will we know when it’s the right time to execute the plan – whether it means moving form our homes, getting in-home care, or advancing care in a CCRC. I’m guessing many of us have experience with family or friends who struggle with this decision. I think it’s quite common for humans as we age to be in denial about our abilities to care for ourselves, drive, handle finances, and more. I’ve seen occasions where elderly parents, sincerely concerned about not burdening their children, wait too long to acknowledge their challenges, and honestly communicate with their children. At some point the inevitable emergency occurs, and the children now have a more significant burden with little time to plan. Planning to prevent that as best as possible concerns me.
“I’ve seen occasions where elderly parents, sincerely concerned about not burdening their children, wait too long to acknowledge their challenges, and honestly communicate with their children. At some point the inevitable emergency occurs, and the children now have a more significant burden with little time to plan.”
My parents are in a CCRC and were in independent living, and, as they hit their 90s, it was clear to all except perhaps them that they needed to move to the next level of care (assisted living).
I was trying to have this discussion with them. What I said to them was: “right now, there is no immediate urgency, so perhaps you have 5 months to make a decision on where you want to live if “something happens”. If you wait too long and “something happens”, you may find yourself in a position where a decision needs to made in in 5 hours, and, you might not even get a vote.”
Well, with my and my siblings urging (and trying really hard NOT to act like “we know what is good for you”), they ended up transitioning to a higher level of care.
The timing was auspicious. They did move, and, within several months, after some steep mental decline topped off with a bad fall, they are now both in the perhaps the last level of care – full-on nursing care.
So, even if plans don’t work out, the planning process is very important as it allows one to at least familiarize oneself with the all the possibilities and potential steps to be taken.
Very well said—both you and Rick. You want to avoid the “fire drill” where there’s a crisis and you don’t even know what your options are.
Planning is important. Despite having the financial assets to go into a CCRC my Dad refused assistance when my mother was diagnosed with dementia. Mom lived for 10-15 years with the diagnosis, and caring for her in the home led him to go downhill quickly the last year of his life. I correctly said a year before he passed that he was sprinting past my mother in decline. We did eventually in effect force them into assisted living but they were only there for a year before they required care beyond what the facility was able to provide and ended up in a nursing home.
We decided years ago that long term care insurance was too expensive. We have a fair amount of assets, but because of the fear of requiring LTC, unfortunately, will not be giving away our assets to charity or children while we are alive, instead keeping our financial powder dry in case of requiring LTC.
This is coming soon for Spouse’s parents, I think. So far it has been difficult since their mom still thinks she can take care of herself. But got a recent diagnosis of Alzheimer’s and no kids in town. Dad has a support system with stepmom and family members in town. We are starting to look at places. We did some research when my mom had her stroke. We found a lot of the assisted living/memory care type places do not have a plan for when you run out of money so you may get kicked out. So keep that in mind. The place mom is at is nice. I know some folks take their parents in to live with them but Spouse and I don’t want to do that. Chris
A very good assessment of the situation. At nearly 82 and 86 we think about this too.
We both have LTC insurance originally purchased about 35 years ago through a group employer plan. It will cover about half the costs you mention for a nursing home for five years.
I would prefer in home care if at all possible. There are several people in our 55+ condo community with aides. Fortunately the way our condo is set up there is a second bedroom and private bath that could accommodate live in assistance.
Our children are close by, but like you the last thing we want is to burden them. It won’t be financial, but everything else could be worse.
you are right both about capacity and immigrants- especially illegal immigrants. The personal care areas such as this is where many are employed because of low pay and the type of work. Right now we may be helping to create our own crisis.