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Paying for Long-term Care: Money Madness

Updated: Jan 10

No one told us how expensive long-term care is! Growing older or caring for an aging loved one requires so much out-of-pocket spending. This is a major surprise to most families, which contributes to some pretty strong feelings of overwhelm and stress. Here I share some of the realities surrounding the costs of long-term care.

Why is long-term care so expensive?

There is a perfect storm brewing in the U.S. driving the rapid growth of families taking on the burden of both long-term care and paying for it.

  1. Today, most long-term care for our aging loved ones is happening in our homes. There has long been a push in healthcare to shorten inpatient and institutionalized care in exchange for home and community-based care. What does this mean for families? Healthcare is doing everything it can to ensure that the majority of care is happening in your or your loved one's home.

  2. Our largest generation, The Baby Boomers, are now senior citizens. What does this mean for families? More seniors equals more care needs. The ratio of aging loved ones that need help with care to the family members/friends that can help them is dropping rapidly.

  3. Another special case for The Baby Boomers, they are the first generation to go through modern healthcare their entire lives! Our aging loved ones today are experiencing a longer late chapter of life than any generation before them. Individuals 65+ years old today are living on average 18 years longer than their counterparts in the previous generation. In one generation two decades of life were gained! What does this mean for families? Aging and caring for an aging loved one are LONG journeys.

  4. The type of care today's aging individuals require looks different. They are not experiencing acute conditions. Instead, most individuals 65+ years old are living with chronic conditions, or health issues that require long treatment plans to manage. Today's chronic conditions were death sentences only a few decades ago. Diagnoses like diabetes, heart issues, lung disease, kidney disease, even cancer are now classified as chronic conditions and an individual can live many years with the condition well-managed. What does this mean for families? These types of conditions require care that looks like this. Help with mobility, healthy eating, errands, bathing, dressing, medication management, etc. This is long-term care. And, this is largely UNCOVERED financially.

The result: Families are responsible for care that once was taking place in clinical settings, by professional caregivers, and now for longer periods of time and for many more aging people. Throw in the severely underfunded and fragmented long-term care support services in our country and wham! Aging and caring for an aging loved one are overwhelming, long-lived, and expensive undertakings.

Let me break down long-term care and its costs.

Type of care

What it is

Costs / Coverage options

Home Care | Personal Care | Homemaker services

Help when you need an extra hand.

Home care staff typically includes certified nursing assistants to support individuals staying at home.

Usually available 24-hours a day and 7-day a week, including holidays

Will create tailored care plans for occasional or ongoing assistance.

Services can be scheduled in increments (i.e. 2-hour block up to 24 hours)

Types of care tasks provided:


Dog walking


Taking out garbage

Making bed

Changing linens

Organizing/cleaning closets

Meal preparation

Transportation for errands, shopping, doctor appointments




National average hourly rate is $26/hour

Covered by Long-term Care Insurance policy: SOMETIMES

Covered by Medicare: NO (unless you are also getting skilled nursing care)

Covered by Medicaid: YES

Covered by VA benefits: SOMETIMES

Adult Day Care

Daytime care for loved ones that can not stay home alone safely.

Usually available for a 12-hour window during the day (i.e. 7AM to 7PM).

Have professional staff to assist with various health needs during the day.

Enrichment activities are offered including music, group outings, art, exercise, games, etc.

Provide meals and snacks during the day.

Individualized care plans.

Most have support groups for family caregivers.

Types of care tasks provided:

Medication management

Memory stimulation


Health assessments

Health monitoring

Dementia care

Post-hospitalization recovery care

Physical, occupational, and speech therapy

National average: $78 per day

Covered by Long-term Care Insurance policy: SOMETIMES

Covered by Medicare: NO

Covered by Medicaid: YES

Covered by VA benefits: YES

Home Health

Comprehensive care for individuals with the aim to get better from their illnesses.

Available 24-hours a day and 7-days a week.

Professional nursing and therapy services.

Individualized care plans.

Many provide family caregiver and patient education.

Types of care tasks provided:

Medication management

Pain management

Care coordination

Wound care