The Refundable Entrance Fee

Stay home: 30 hours × $28 = $840 a week, about $3,640 a month on a 4.33-week month, plus taxes, insurance, utilities, and maintenance on a $430,000 house - call it a few hundred more, so roughly $4,100 to $4,300 - and the care hours will rise.

Assisted living: $6,200 base, plus a la carte care, medication management, and possibly a second-person or community fee.

CCRC: $4,400 plus the amortized entrance fee. The 90% figure is $279,000; declining 2% a year for five years brings the refund to roughly $252,000, so about $58,000 is consumed in five years - roughly $960 a month. Effective cost early is therefore around $5,360, falling the longer she stays.

On arithmetic alone the CCRC is competitive now and clearly best if she needs skilled nursing, worst if she dies in year one with the fee locked up.

What the arithmetic misses: Type A transfers the catastrophic risk - a $9,000-plus monthly skilled nursing stay - to the community. Assisted living does not transfer it. Staying home transfers nothing; it just exposes her to rising labor costs and leaves a house she can sell later if she keeps the option open.

The largest risk is provider solvency: an entrance fee is effectively an unsecured loan to the community. Verify audited financial statements for at least three years, occupancy (below roughly 90% is a warning sign), debt and any pending refinancing, the actuarial study, whether the state requires escrow or reserve of entrance fees and what the regulator's most recent report says, and whether fees have ever been raised above any contractual cap.

Then read the contract for:

• What "Type A" actually covers, and the exclusions - dementia care, private-duty hours, Medicare-required skilled days.
• What happens if she outlives her assets: is there a benevolent policy or a Medicaid-pending clause, and can she be asked to leave?
• The refund schedule, whether the refund is payable to her or to her estate, and how long payment takes.
• Who decides when she transfers to a higher level of care, and whether she can appeal.
• The escalation clause on the monthly fee.

Also visit twice unannounced, eat a meal, and talk to current residents without staff present.

"I don't want to be a burden" is a motivation, not a plan - test it. Her current plan already leans on someone: who drives her to appointments, who fills the gaps when the aide cancels, who is on the phone at midnight? If the answer is a daughter an hour away with a job, then the real question is what happens when 30 hours a week becomes 60.

"Lose my house for nothing" is a fear about the fee being at risk. The refundable structure partly answers it, but she should understand plainly that the 10% she forfeits - about $31,000 - is a nonrefundable use fee, and the 2% annual decline is the price of the option. She is not losing the house for nothing; she is paying to transfer risk.

Frame the decision as risk transfer: she is buying protection against the $9,000-a-month skilled nursing scenario and against outliving her money, paid for with liquidity and a measure of control.

Practically: do not list the house until the CCRC contract is signed and the move date is known; bridge with a short rental if the timing slips. Send her to a preparer on two tax questions - the Section 121 exclusion on the house sale, and whether the portion of the CCRC fee allocable to medical care is deductible as a medical expense. That is the preparer's call, not yours.