The Evolution of Continuing Care at Home (CCAH)

seniormen_0.jpgThe CCAH concept emerged from concern among Philadelphia-area members of the Society of Friends (Quakers) that no affordable alternative to continuing care retirement communities (CCRCs) existed that could provide the same financial and health care securities. With over $2M in grants, FRC Management, Inc.—a subsidiary of Quaker-operated Foulkeways at Gwynedd, the first CCRC on the East Coast—and the health policy center at Brandeis University researched and developed the CCAH business model.

As a result of these efforts, the first CCAH plan was launched in 1985 through a joint venture by Jeanes Hospital, a Quaker community hospital in Northeast Philadelphia, and Foulkeways at Gwynedd, located in the city's suburbs. In 1987, the Pennsylvania Department of Insurance licensed the operation as a CCRC without walls.

In 1990, when the plan was operational, the joint venture became an independent nonprofit and changed its name to Friends Life Care at Home. The early service area encompassed only a five-mile radius.

The Original CCAH Plan Structure

The original plan incorporated a number of key features of CCRCs:

  • Pricing based on a significant upfront entrance fee and ongoing monthly fees
  • No maximum limit on the lifetime amount the plan would pay toward a member’s care
  • A full continuum of care in addition to home care services, including care in a nursing home or assisted living facility
  • Minimum enrollment age of 60 years with no maximum age limit
  • Financial and health screenings required for eligibility

The Encroachment of Long-Term Care Insurance

Initially, the Friends Life Care at Home plan filled a unique market niche. The earliest long-term care insurance policies served primarily to pay for nursing home care. The second generation of insurance coverage, which emerged in the 1980s, recognized the need for home care and included very limited riders for this kind of reimbursement; care coordination was unheard of. 

By the late 1990s, long-term care insurance had integrated a full range of benefits, including home health care, adult day care and facility care; some carriers added care coordination through an 800-number service.

Refining the CCAH Model

In 2003, with stiff competition from long-term care insurance, Friends Life Care at Home revised the CCAH model, taking into account numerous considerations, among them:

  • Long-term care insurance does not require an upfront entrance fee
  • Americans are accustomed to choice
  • The existing CCAH model presented a significant actuarial risk
  • Long-term care insurance targets consumers beginning in their 50s

The revised (and current) CCAH model incorporates the following changes:

  • The upfront entrance fee has been eliminated; members pay the entrance fee over the first five years as part of the flat annual rate
  • Members choose the dollar amount of coverage vs. the amount that they will pay themselves—a liberty that also limits the organization’s actuarial risk (the lifetime benefit was eliminated in 2011 to further limit it)
  • Minimum age for enrollment has been changed to 40, with a maximum age of 81

As a result of these changes, new enrollments average 250 per year—nearly double the rate during the early 2000s, and 50% higher than the annual rate in the first 10 years of operation. The average age at enrollment has dropped from mid-70s to mid-60s. 

A New Generation, A New Approach

By 2006 Friends Life Care at Home was gearing up to serve the baby boom generation. The organization conducted research and tested pilot programs.

In 2009 the company shortened its name to Friends Life Care and shifted from an exclusive focus on long-term care protection to one that includes partnering in support of healthy aging. Most recently, Friends Life Care introduced the VigR™ program. The acronym stands for vitality, independence, growth and resilience—four keys to “successful” aging. Designed to help participating members improve their long-term health, the research-based program launched its first component, VigR Enrichment Workshops, in spring 2011. Other program elements include eMeetinghouse, an online health information resource and social community, and VigR Benchmarks, a wellness assessment tool. Development of additional components is underway.

A Model for Our Time

Today, Friends Life Care serves the five-county Philadelphia area and Newcastle County, Delaware. Its secondary market includes the entire state of Delaware and five additional counties in eastern Pennsylvania. With more than 2,400 members, it is the largest, most successful CCAH plan in the nation, offering leading-edge benefits to meet the changing needs of the largest aging population in U.S. history.