Your Complete Guide to Paying for Long-Term Care

How much does long-term care cost?

For most families seeking long-term care, cost is a key consideration. As the U.S. population ages, millions of baby boomers will need some type of care and support in the next decade. This means paying for senior care can quickly become a financial burden to seniors and families who may not know their options.

The monthly median cost of senior care can range from $4,300 at an assisted living facility to about $8,800 at a nursing home, according to a 2020 Genworth Cost of Care Survey.

Planning ahead can better position you to make good choices for your loved one’s care in the future. But if your aging family member needs care now, there are ways to finance the cost of long-term care through a combination of approaches. Families considering how to pay for senior care may rely on options such as retirement income, savings, long-term care insurance, public pay assistance, and other alternatives.

This complete guide to paying for long-term care provides an overview of senior care costs and options to help you evaluate how to cover long-term care expenses.

Care needs and senior living costs

The first step in making a plan for how to pay for elder care is understanding your aging loved one’s care needs. Whether you’re looking for care at a senior living facility or plan to hire an in-home caregiver, care providers will want to discuss your loved one’s health and their care needs and goals during an initial assessment. A care provider may also evaluate your family member’s mobility and ability to perform certain activities of daily living (ADLs). This information will help them develop a care plan that is tailored to your family member.

The level and type of services your family member needs will affect the cost — the more assistance provided, the higher the cost of care. For example, a senior who only needs help with meal preparation or transportation a few times a week is likely to pay less for services than someone who needs daily help with bathing, dressing, or toileting. Costs associated with level of care may also change over time as a resident’s needs evolve.

As you consider care options, start by asking yourself these questions:

• Is my loved one generally healthy? Do they have chronic health conditions — such as diabetes or high blood pressure — that require frequent monitoring or special diets?
• Do they need help with medication management or administration?
• Does my family member need daily help with personal care, like dressing or bathing?
• Do they fall frequently or have problems walking? Do they need help transferring from the bed to a chair, for example?
• Is memory loss a concern? Have they been diagnosed with Alzheimer’s disease or another form of dementia?
• Do they need rehabilitation care after a hospital stay?
• Do they have an illness or health condition that requires skilled nursing care or 24-hour supervision?

Next, seek to learn about the long-term care options available in your area and the services they offer. Each state has specific regulations that govern senior care facilities. This means care services and costs can vary greatly by facility type depending on where you live. If you need help matching your loved one’s needs with adequate care, a Senior Living Advisor can help.

Long-term care services by care type

Senior living has evolved greatly over the years, and many long-term care options with varying degrees of services are available to older adults.

Independent living

Independent living communities are for older adults who are generally healthy, active, and able to live on their own. These communities offer a hassle-free lifestyle that includes restaurant-style meals, housekeeping, transportation, onsite activities and outings, and more. Typically, independent living facilities don’t provide assistance with activities of daily living, such as bathing and toileting. However, many independent living facilities offer onsite home care providers. For an additional fee, independent living residents may receive help with personal care as their needs evolve, while also maintaining a more active and independent lifestyle.

Assisted living

Assisted living facilities provide long-term housing and care for seniors. Older adults in assisted living are generally active, but may need help with certain activities throughout the day, such as bathing or dressing. Some residents may need help managing medications or monitoring chronic conditions. Others may benefit from rehabilitation therapy while recovering from an illness or injury. Assisted living facilities also offer care coordination, nutritious meals, housekeeping, and social activities in a senior-friendly environment.

Memory care

Memory care is for seniors who have Alzheimer’s disease, another form of dementia, or other types of memory impairment. These residential facilities cater to the unique needs of seniors who have progressive memory loss in a safe environment, and are designed to reduce confusion and prevent wandering.

Memory care facilities provide 24-hour specialized dementia care with a focus on improving the quality of life of residents. Many memory care communities offer person-centered dementia care combined with memory-enhancing activities and therapies, which may include occupational therapy, music therapy, and more. Services may also include prepared meals, medication management, and help with personal care.

Nursing home care

Nursing home care is for seniors who are seriously ill or have a severe health condition, or for those recovering from an illness or injury after a hospital stay. Nursing homes provide both short-term and long-term residential care that includes 24-hour nursing and personal care. Nursing home residents typically need a high level of nursing and medical care, but don’t need to be in a hospital. In addition to meals, housekeeping, and social activities, nursing home services may include skilled nursing care, rehabilitation programs, and palliative and hospice care.

Home care

Home care provides non-medical care for seniors who wish to age at home. In-home caregivers are trained in senior care and provide a wide range of services that cater to individual needs. Home care services may include personal care, companionship, cooking, light housekeeping, mobility assistance, and more.

Long-term care costs by care type

Long-term care costs vary significantly based on the type and level of care provided:

• Independent living costs vary based on location, amenities, and size of accommodations. However, the monthly median cost of senior independent living in the U.S. is $2,552, according to A Place for Mom’s 2019 move-in data.
• Assisted living costs vary based on the facility location, amenities, size of apartment, and level of care needed. However, the median monthly cost of assisted living in the U.S. is $4,429, according to Genworth’s Cost of Care Survey.
• The median monthly cost of memory care is $5,250, based on A Place for Mom’s 2019 move-in data. However, like with other senior care types, costs may vary based on facility location, amenities, and the level of care provided.
• Nursing home costs vary based on location and level of care provided. However, the median monthly cost of nursing home care in the U.S. is $7,989 for a semi-private room and $9,086 for a private room, according to Genworth’s Cost of Care Survey.
• The cost of home care varies greatly because it’s based on the type of care needed and how often it’s provided. However, the monthly median cost of home care in the U.S. is $4,615, according to Genworth’s Cost of Care Survey.

Cost comparison by care type at a glance

Sources: Genworth Cost of Care Survey and 2019 A Place for Mom Move-in Data

Other factors that affect senior care price

While the level of care provided at a senior living facility is key in determining the cost of care, other factors affect prices.

• Location. Where your loved one will receive care will significantly impact how much they’ll pay. If living in a different area is an option, it may be worth researching the cost of senior care in surrounding locations or in other cities to determine what areas best fit your loved one’s budget.
• Type and size of accommodations. Seniors moving to a community often have many options when it comes to the type and size of accommodations. Senior living housing may range from a studio apartment to cottages with multiple bedrooms, which may be equipped with a kitchen or kitchenette. In some cases, shared apartments may be an option. When assessing how to pay for elderly residential care, it’s important to understand accommodation options and how they differ in price.
• Pricing structure. Is the community all-inclusive, where rent, meals, utilities, cable, and services are included in the monthly base fee? Is there an option to pay for certain services separately, as needed? Choose a community that fits your loved one’s needs and budget.
• Services. Ask questions to make sure you thoroughly understand what’s included in the monthly base fee and what’s not. Do certain services, such as housekeeping or laundry, cost extra? Is transportation to appointments and outings complimentary?
• Amenities. Community amenities vary widely — from luxury, resort-style to simple, no-frills options. Consider your loved one’s lifestyle and priorities. For example, if your parent likes to stay active, does the community have a pool, garden, or walking paths? Are social activities and outings offered and included in the price?
• Additional fees. Ask about entrance and maintenance fees, as well as other costs, such as pet or parking fees.

Can my loved one afford senior living?

Long-term care can be costly. However, paying for senior living may seem less daunting when you compare it to the costs of living at home, including rent or mortgage payments, taxes, and property upkeep. In many cases, the cost of utilities, meals, transportation, and entertainment is included in the monthly fee charged by senior living communities.

When assessing whether your loved one can afford senior living, seek to understand their financial resources and current expenses. Calculate the costs associated with aging in place:

• Rent or mortgage payments. Seniors who pay rent have a fixed monthly expense that typically increases each year. This may also be true for older adults who own a home. Approximately 38% of seniors ages 65 to 74 and about 28% of those 75 and older still have a mortgage payment on their primary residence, according to the Federal Reserve’s 2019 Survey of Consumer Finances.
• Home ownership and maintenance costs. Even if your loved one’s mortgage is paid off, the American Seniors Housing Association estimates the yearly cost of maintaining a home can reach up to 3% of the property’s value. This means someone who owns a $200,000 home may be pay up to $6,000 in upkeep each year. Costs may include home repairs and seasonal expenses, like snow removal and lawn maintenance, in addition to property taxes, home insurance, and home association fees.
• Cost of making a home safe. As your family member ages, they may need to make home modifications to help prevent injuries, reduce the risk of falls, and accommodate potential mobility issues. Some of these modifications, such as adding grab bars or improving lighting, can be relatively inexpensive, while others may be more costly, such as installing ramps or chair lifts.
• Cost of utilities. If your loved one lives at home, they have monthly costs associated with electricity, water, gas, trash services, and more. But the cost of utilities is typically included in the monthly fee of many senior living communities.
• Food. Depending on your loved one’s lifestyle and preferences, they may spend anywhere from $400 to $800 on food and meals each month. However, meals are often included in the cost of senior living. While meal services and packages may vary, many communities offer three nutritious meals each day, and some may also include snacks throughout the day.
• Transportation. From car payments to gas, insurance, or public transportation, your family member likely needs to budget for costs associated with getting to and from appointments, outings, and visits to friends and family. In some cases, complimentary transportation to appointments and outings is offered at senior living communities.
• Entertainment.Social engagement is a key benefit of senior living, and many opportunities for entertainment may be included in a community’s monthly fee. This means seniors who enjoy staying active may not spend as much on entertainment once they move to a senior living facility.

Paying for long-term care: private pay options

Many families struggle with planning and paying for senior care. This is why it’s important to do your research to understand your options. Typically, families will finance senior care through a combination of options — from savings and retirement income to long-term care insurance and proceeds from the sale of a home or other alternatives.

Personal and retirement funds

Your loved one’s retirement income, pension funds, and savings may help cover the cost of senior care. If your parent has individual retirement accounts (IRAs), stocks, bonds, or other investments, they may be able to sell their assets or use dividends to pay for long-term care.

Long-term care insurance

Long-term care insurance policies may cover some or all costs associated with long-term care. Coverage varies based on each specific policy, but long-term care insurance typically includes care for cognitive decline for seniors who have Alzheimer’s disease or another form of dementia, and care that provides help with ADLs, such as bathing, dressing, and toileting. This means long-term care insurance may help pay for the cost of an in-home caregiver for seniors aging in place or care provided at an assisted living facility, memory care community, nursing home, adult day care center, or hospice facility. Some policies may also cover the cost of having someone help with cooking, running errands, or doing chores.

If your family member has a long-term care insurance policy, it’s important to discuss exactly what it covers and how it can be used to pay for senior care with their insurance provider before hiring an in-home caregiver or moving to a senior living facility. If your loved one is relocating to another state to be close to family, check if the policy covers the types of services and facility in the new location before moving.

Long-term care insurance benefits may be paid in different ways depending on your family member’s policy:

• Paying for senior care-related expenses incurred
• Paying a set dollar amount regardless of costs incurred
• Paying for the full benefit whether or not your loved one is receiving senior care

Life insurance

While life insurance is typically a benefit for surviving family members, it may be possible to use your aging relative’s life insurance policy to help pay for long-term care. Your options will depend on the type of life insurance policy your loved one has.

Below are some options for using a life insurance policy for paying for senior care:

• Selling your loved one’s life insurance policy to a third party so you can use the proceeds to fund care.
• Surrendering your family member’s life insurance policy to the insurance provider. This means your loved one is giving up their ownership and death benefit. If the policy has accumulated cash value, the insurance provider may be able to write you a check for the amount, which may help fund long-term care. However, it’s important to note that your loved one will likely need to pay taxes on the amount received.
• Taking a loan against cash accumulation. Your aging family member may be able to get a loan against most of the cash value on the policy. This means a portion of the amount of death benefit would still be payable to beneficiaries.
• Converting your policy into long-term care payments. While this type of conversion may pay less than selling your policy to a third party, it may help provide an alternative for families considering how to pay for senior care.

If your loved one is planning to use a life insurance policy to help pay for long-term care, it may be a good idea to consult with a financial advisor before making a decision. The choices your family makes may affect your loved one’s taxes or access to public assistance.

Home equity

If your senior family member owns a home or property, there are many ways to use it to generate funds to pay for senior care.

• Sell a home to pay for senior care. If your loved one is moving to a senior living community, it may make sense to sell their home and free up resources to help fund long-term care.
• Use a home as an investment by renting it out. If your family wishes to keep your loved one’s home while generating income to help pay for senior care, renting it out for short-term or long-term stays may be worth considering. If you’re interested in exploring this option, A Place for Mom has selected Knox Financial as a trusted partner that can offer expert advice on how to rent a family home to help finance senior care. As a part of our partnership with Knox Financial, we may be compensated for marketing their services to you.
• Take a reverse mortgage loan. A reverse mortgage loan takes part of the equity accumulated on a home and converts it into cash to help pay for senior care. There are different types of reverse mortgage loans, so it’s important to do your research before making a decision. There are also some eligibility requirements, so this type of loan may not be for everyone.
• Taking a bridge loan. This short-term loan can help fund senior care while you’re waiting for your loved one’s home to sell or while you’re liquidating other assets to cover the care expenses.

Health savings account (HSA)

A health savings account (HSA) allows you to set aside money to pay for medical expenses that aren’t covered by a health insurance plan. Those who have an HSA can contribute pre-tax dollars to save for health care costs. Withdrawals are also tax-free as long as the money is used for qualified health care expenses.

If your loved one has an HSA, it’s also possible to use HSA assets to help pay for long-term care.

• HSA assets to pay for long-term care insurance premiums. In some cases, it’s possible to withdraw money from an HSA account without tax penalties to pay for long-term care insurance premiums. However, there are some restrictions based on the type of long-term care insurance policy. It’s important to check with your loved one’s insurance provider if their policy is tax-qualified. There are also limits to the amount of HSA assets that can be used to pay for long-term care insurance premiums based on age, so it’s important to do your research. You can find information on the limits on long-term care insurance you can deduct on the IRS website.
• HSA assets to pay for health care costs in senior living. Many of the services offered in long-term care facilities may be considered health care expenses. For example, your loved one may use their HSA balance to cover the cost of in-home nursing care or care at a nursing home facility, including the cost of meals and housing while receiving medical care away from home.

Paying for long-term care: public pay options

For seniors with few or no assets who don’t have long-term care coverage, options are more limited. Medicare doesn’t cover long-term care and Medicaid has strict limits on income and assets. However, certain veterans benefits may provide financial assistance to eligible seniors and their surviving spouses who need long-term care.

Medicare

All Americans who are 65 years old are eligible for Medicare, a national, government-funded health insurance program. In some cases, people who have a disability may be able to enroll in Medicare even if they’re under 65.

Medicare pays for short-term care at nursing home facilities for seniors who need rehabilitation or nursing care after an illness or injury that requires hospitalization. In some cases, Medicare may also cover rehabilitation services and therapies at home or at a senior living community. However, it won’t cover long-term care.

Short-term care expenses covered by Medicare may include the following:

• 100% of the first 20 days in a Medicare-approved skilled nursing facility after a three-night minimum inpatient hospitalization
• 80% of days 21-100 in a Medicare-approved skilled nursing facility for those who have a qualifying diagnosis
• Short-term rehabilitation care at a nursing home after a hospitalization
• Short-term rehabilitation care and in-home therapy in some cases

Medicaid

Medicaid is the leading government assistance program for long-term care, providing financial support to seniors who can’t afford the care they need without it.

In most states, Medicaid will provide financial assistance to seniors who need help with personal care. However, Medicaid programs and eligibility requirements vary from state to state, and so do covered services. For this reason, if your family member is planning to apply for Medicaid, it’s a good idea to contact your state medical assistance office for more details. Depending on where you live, Medicaid programs may be referred to as auxiliary grant, elderly waiver, or frail elderly waiver programs.

Some long-term care expenses Medicaid covers in most states include the following:

• Assistance with personal care, such a bathing or dressing, which can be provided at home, at an assisted living community, or at a nursing home facility
• Inpatient and outpatient hospital services that aren’t covered by Medicare
• Home health services, which provides clinical or medical care from a licensed health care professional, often after an injury or hospitalization
• Rehabilitation services, which can be offered at a skilled nursing facility, at home, or at a senior living community
• Respite care for a limited period of time at an approved inpatient facility
• Hospice care, which can be provided at home, at an assisted living community, or at a nursing home facility

Veterans benefits

Two types of benefits can help eligible veterans and their surviving spouses pay for long-term care: the VA Aid and Attendance and Housebound benefits. Both of these benefits for senior care provide supplemental income to seniors who are eligible to receive VA pension to help cover costs associated with long-term care.

To qualify for VA benefits for long-term care, your loved one must meet eligibility requirements, which vary depending on each specific benefit. However, to be eligible for either Aid and Attendance or Housebound benefits, seniors must meet certain basic requirements:

• Service requirements. Veterans must have had at least 90 days of active duty, with one of those days being during wartime.
• Financial requirements. Your loved one’s net worth — which includes their annual household income plus assets, such as property, investments, and land — must fall below $130,773, which is the limit set by Congress until November 30, 2021.
• Clinical requirements. The clinical requirements for Aid and Attendance and Housebound benefits differ, but the highest amount is awarded to seniors who need assistance with ADLs, like bathing and dressing.

If your family member qualifies for VA benefits, their payment rate will be calculated based on their household income and the Maximum Annual Pension Rate (MAPR), which is set by Congress. Amounts will also vary based on factors such as number of dependents, whether they’re married to another veteran who qualifies for pension, and whether they qualify for Aid and Attendance or Housebound benefits.

How to save when paying for senior care

When looking for senior care at a senior living facility, these tips may help you save:

• Ask about discounts. Many communities offer discounts to fill vacant rooms depending on location and move-in date. Don’t hesitate to ask whether move-in specials are available.
• Be upfront about your budget. Be candid about your budget when talking with your community representative. They may be able to work with you to find options that match your finances.
• Compare a la carte vs. all-inclusive options. Some communities allow residents to select an all-inclusive rent fee or to pay for services based on need. Consider which option best fits your loved one’s needs and budget.
• Consider shared room options. If your loved one is willing to share a space, finding a roommate can provide companionship while helping them save on costs.
• Save on moving expenses. In some cases, a senior move manager can help your family member downsize and determine the least expensive time to move. They may also help you sell possessions to help cover the cost of care.

Planning for long-term care

Most aging adults will need some level of support or care at some point in their lives. In fact, approximately 70% of adults who live to be 65 or older will need long-term care, according to the U.S. Department of Health and Human Services (HHS).

With Americans living so much longer these days and with the record number of aging baby boomers reaching retirement age, the younger generations have to do more thinking about how they might care for parents who have either exhausted or lost their savings. The aging workforce is also straining Social Security and Medicare benefits, according to the Congressional Budget Office, leaving more of the financial burden on the individual families. So planning for your family and being cognizant of elder care costs is crucial.

Yet, many families often struggle with talking about senior care with aging loved ones. Planning ahead will give you and your family time to think about options and discuss what you need to do to prepare.

Talking to elderly parents about senior care

Set aside dedicated time, without distractions, to discuss your loved one’s wishes, needs, and potential solutions for care when they need more support. Be prepared to have a series of conversations before your family agrees on senior care plans that match everyone’s needs.

Some topics to cover may include the following:

• Ideal scenarios and other options. Most seniors prefer to age in place, according to a 2018 AARP survey. Unfortunately, this isn’t always possible. In some cases, elderly adults need more care than what can be provided at home. Finances may also be an issue as home care can be costly, depending on the frequency and level of care needed. It’s important to listen to and acknowledge your family member’s wishes for the future, but it may also be a good idea to discuss options. Let your loved one know you’re bringing up different scenarios so you understand what they would want in these situations.
• Location. If your parents don’t live nearby, do they want to remain where they are? Would they prefer to move to be close to you or other family members? The cost of care varies significantly based on location, so it’s important to think about options as you plan for how to pay for long-term care.
• Costs. Many families don’t have a good grasp of the cost of long-term care. Do your research and share your findings with your family members. This can help them make plans to save for care.

Talking to aging relatives about finances

For many people, money is a private topic. However, when it comes to paying for senior care, it’s vital to understand your aging parents’ financial resources. Talking to your loved one about finances doesn’t have to be awkward.

• Set aside time to get a clear picture of what resources and assets are available. Don’t start the discussion when you’re rushed. If appropriate, invite siblings or other close family members to join the conversation and help you keep track of details.
• Be upfront about why you’re bringing up finances. Let them know you want to understand their wishes and what resources are available to help find the best care to match their needs.
• Ask specific questions to learn what monthly income is available, whether your loved one has plans for care, such as a long-term care insurance policy, or whether they have investments that may help pay for care. The more you know, the better equipped you’ll be to help your family member make financial decisions about how to pay for long-term care.

Gathering essential information and documents

As you discuss future plans for senior care with your parent, organizing and understanding how to quickly locate important documents is an important step. This may help prevent a lot of stress for families in case your aging loved one becomes ill or needs to move to a long-term care facility unexpectedly.

Set aside time to help your family member organize or locate the following documents:

• Financial documents, such as bank account information, tax returns, deeds to properties, and power of attorney
• Health care documents, such as long-term care insurance policy or a health care power of attorney
• Estate planning documents, such as will, trust documents, or life insurance policies

Getting professional advice

With so much to consider, many families feel overwhelmed when it’s time to look for long-term care. If you need help understanding senior care options and how to pay for long-term care, connect with one of our local Senior Living Advisors. They can help you find care that matches your loved one’s needs and budget in their desired location