You may not foresee ever needing assistance with your day-to-day life. However, research shows that seven in 10 adults aged 65 and older will require long-term care at some point in their later years. Meanwhile, the U.S. population continues to age rapidly. Americans aged 65 or older are on track to total 82 million in the next 30 years, up from 58 million in 2022.

More older adults will therefore be likely to rely on long-term care services. These services include in-home care, adult day health care, assisted living, and residential nursing. Unfortunately, the workforce of professionals trained in caring for the senior population has been facing a critical shortage.

Knowing what you can expect to pay for long-term care services is important for older adults and their families. However, as you plan for the future, you may worry that budgeting and saving for long-term care will pose a serious challenge.

In the face of inflation, for example, the costs of essentials like groceries, housing, and care have steadily climbed. For elders and their family members, it’s crucial to understand and compare these kinds of costs over time. This way, they can strive to make informed decisions about their best options going forward, including how to pay for long-term care.

Genworth’s new 2023 Cost of Care Survey sheds light on the latest national and state median costs for in-home care, community and assisted living, and nursing homes. The survey highlights the rising costs of long-term care services, which reflect inflation and worker shortages.

Genworth’s Research

Since 2004, Genworth has investigated the cost of different types of long-term care services nationwide. The current survey reflects data from September through December of 2023. For the 2023 report, Genworth surveyed more than 11,000 elder care providers, including:

  • 13 percent of certified and licensed nursing homes,
  • 15 percent of licensed assisted living facilities,
  • 6 percent of adult day health care facilities, and
  • 14 percent of home health care providers.

Key Findings

The research revealed the following national median care costs for in-home care, community and assisted living, and nursing homes for 2023.

In-Home Care Costs Saw the Biggest Increases

In-home care involves hired caregivers helping an older adult in their private residence, allowing them to continue living on their own. Homemaker services may help with housekeeping, such as cleaning, cooking, and errands. Home health aides, meanwhile, supply more extensive personal care, such as assistance with medication management and activities of daily living (ADLs). ADLs comprise everyday tasks that reflect one’s ability to manage their own care, including bathing, dressing, and walking.

For a standard 44-hour week, the national monthly median costs for these types of care have seen the steepest increase this past year. In 2023, these monthly costs were $5,720 for homemaker services and $6,292 for a home health aide. These figures reflect price increases of 7 percent and 10 percent, respectively, compared with 2022.

Community and Assisted Living Services

Community and assisted living services support older adults who need some help but not round-the-clock nursing care. Adult day health care is a community-based service that offers seniors health and therapeutic services as well as social activities in a community setting. It may also serve to give caregivers some respite. The median monthly cost of adult day health care was $2,058 in 2023.

Unlike adult day health care, assisted living is a form of housing. Staff assist with ADLs in a residential setting, but do not provide nursing care. For assisted living, the monthly median cost was $5,350.

Nursing Home Costs

When an older adult requires round-the-clock care, nursing homes can provide a safer alternative to independent living. Nursing home residents receive skilled nursing care, therapeutic services, medication assistance, and supervision. Because of the level of care provided, nursing homes are the costliest long-term care service. The national median monthly fee in 2023 was $8,669 for a semi-private room in a nursing home and $9,733 for a private room.

Reasons for Increasing Costs

According to the survey data, costs increased across all long-term care domains, from 1 percent to 10 percent over the past year. The rising costs reflect inflation and the ongoing shortage of long-term care professionals. Inflation was the top driver for assisted living and adult day care. Among nursing homes and in-home care, it was lack of workers.

Person-Centered Care

In addition to examining the costs of long-term care, the survey revealed providers’ growing focus on person-centered care. This type of care recognizes patients’ preferences, needs, values, and autonomy.

Respondents across all care settings indicated that person-centered care was important to them but saw barriers to it. The most significant barriers were the lack of staff training and perceived higher cost.

Estimating Your Long-Term Care Costs

Along with the online survey data, Genworth offers a free Coverage Needs Estimator tool. It allows you to estimate your future costs adjusted for inflation and shows hourly, daily, monthly, and annual estimates. This can help you in planning for your future potential costs of long-term care, which are likely to continue increasing. By viewing costs for different states and types of service, individuals can also compare their options.

“Understanding long-term care options and the costs associated with care are critical first steps toward being prepared for whatever you want your aging journey to look like,” Jamala Arland, President and CEO of Genworth U.S. Life Insurance, said in a news release.

Why You Need to Plan Early for Long-Term Care

Thinking about a time when you will need help taking care of yourself is not fun. That is why most people put off discussing long-term care until it can’t be ignored. But it is better to start long-term care planning early.

Among other advantages, planning ahead may enable you to preserve more of your assets instead of using all or a significant portion of them for long-term care, particularly if public benefits will be a primary source of financing your long-term care.  Take for example, two families of similar means, one who plans early and the other who waits until long-term care is needed to plan.

AssetFamily 1Family 2
Bank Accounts$100,000$100,000
Retirement Accounts$100,000$100,000


Family 1

Family 1 plans well before the need for long-term care.  They place their house and a majority of the cash in their bank accounts in an Irrevocable Family Trust.  They also start to make more than their Required Minimum Distributions from their retirement accounts and place what they don’t need in a joint brokerage account.  As a result, when they need long-term care six years later, $250,000 (the house and bank accounts) are protected.  They can gift a portion of their remaining assets or invest in assets that are exempt under the Medicaid and Department of Veterans Affairs (VA) pension programs to meet eligibility criteria.  The end result is that they have protected at least $300,000 of their assets (if not more) and are eligible for long term care assistance from VA pension and/or Medicaid.

On the other hand…

Family 2

Family 2 waits until there is an immediate need for care before starting their long-term care planning.  Both VA pension and Medicaid have rules against making transfers to meet eligibility limits. Family 2 will have to wait a period of time before qualifying for public benefits (the penalty period).  Because Family 2 needs care while serving a penalty, they must use a portion of their assets to pay for care through the penalty period.  The end result is that Family 2 protects about $175,000 and has to wait 26 months for Medicaid assistance or 36 months for VA pension assistance.

While these are two very simplified examples, they illustrate a concept we often discuss with clients. While we can still protect assets in a crisis, delaying planning until an immediate need for long-term care can cost half of what you own.  But that is not all.  Planning early also ensures that those individuals you want handling your affairs in a crisis have the instruction and authority they need to plan for you.  You can also have more control over what type of care you receive-whether it’s compensated or uncompensated family caregivers, third party provided home care, adult day care, assisted living, or nursing home care.  You can also review alternatives to public benefits, such as long term care insurance.

Work With an Elder Law Attorney

For those planning long-term care options, Stinson Law Firm can provide essential support. Our Carmel, Indiana attorneys can assist you in determining which type of care is appropriate. They also can help with strategies such as applying for public assistance or purchasing long-term care insurance. Contact us or call (317) 622-8181 to schedule your consultation.

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