There is a shift away from interest in AAHA types A and B advance fee CCRC's in favor of more traditional fee-for-service approaches. Analysis of incentives to both providers and users provides insight into the causes of this shift. Providers wish to transfer the economic risk of care to users, and users increasingly perceive personal assumption of these risks as preferable to the risks borne through payment of advance fees. Key factors are experience with facility failure and the ability to recover assets, withdrawal from contracts, actuarial difficulties, new financial disclosure requirements, regulatory changes, the nebulous nature of contracts, estate considerations, tax implications, economic disincentive to provide care, improved access to long-term care insurance, the cost and lifestyle advantages of home care and congregate living alternatives, and preservation of life choices.
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