Free Retirement Classes. What You Need To Know To Retire Successfully

What is Long-Term Care?

Who Needs Care?

How Much Care Will You Need?

Who Will Provide Your Care?

Where Can You Receive Care?

Who Pays for Long-Term Care?

Questions about long-term care?

When most people think of longterm care for the elderly, they think of nursing homes. But it can involve much more than that.

Where Can You Receive Long-Term Care?

Most long-term care is provided at home. Other kinds of long-term care services and supports are provided by community service organizations and in long-term care facilities.

Examples of home care services include:

  • An unpaid caregiver who may be a family member or friend
  • A nurse, home health or home care aide, and/or therapist who comes to the home

Community support services include:

  • Adult day care service centers
  • Transportation services
  • Home care agencies that provide services on a daily basis or as needed

Often these services supplement the care you receive at home or provide time off for your family caregivers.

Outside the home, a variety of facility-based programs offer more options:

  • Nursing homes provide the most comprehensive range of services, including nursing care and 24-hour supervision
  • Other facility-based choices include assisted living, board and care homes, and continuing care retirement communities. With these providers, the level of choice over who delivers your care varies by the type of facility.  You may not get to choose who will deliver services, and you may have limited say in when they arrive.


For many, a blended approach to long-term care works best. Most consumers want to remain in their homes for as long as possible and delay facility care until they need it.  Plan early and look for flexible options that give you more say.


Participant Directed Services are a way to provide services that lets you control what services you receive, who provides them, and how and when those services are delivered. They provide you with information and assistance to choose and plan for the services and supports that work best for you including:

  • Who you want to provide your services (can include family and friends)
  • Whether you want to use a home care service agency

In facility-based services you generally don’t have the option to hire someone independently, but you should have choices about:

  • Which staff members provide your care
  • The schedule you keep
  • The meals you eat

In home and community-based settings, you should have the ability to participate or direct the development of a service plan, provide feedback on services and activities, and request changes as needed.



Many publicly funded programs that provide home and community services, such as Medicaid, are using this approach because it is more what people want.

The opportunity this combination creates

If your health forces you to make a permanent move to a nursing home, the rest of your major assets (like your house, car, or even any savings you may have) become far less useful to you. So if you’re living alone or if your spouse also needs care, then these assets can be sold to help cover the costs of the care.

Once your assets become nearly completely depleted, Medicaid will step in to cover your remaining long term care costs. Not all nursing home facilities accept Medicaid, however, so you should make sure that yours does if you may need the help of Medicaid.

Additionally, if you’re married and only one spouse needs nursing-home care, then Medicaid provides some protections for the remaining spouse. It generally allows the spouse who doesn’t need care to keep a reasonable place to live and enough assets and income not to force that remaining spouse into abject poverty. Once both you and your spouse pass away, your state may have a Medicaid-related claim against your estate, but that would be an issue for your heirs. 

Put those factors together, and the net result is that long term care insurance generally isn’t needed to protect you or your spouse from abject poverty should the need for nursing-home care arise. It can be a useful tool to protect some of your estate for your heirs if leaving an inheritance is important to you.


Long-Term Care Planning

You can never know for sure if you will need long-term care. Maybe you will never need it. But an unexpected accident, illness, or injury can change your needs, sometimes suddenly. The best time to think about long-term care is before you need it.

Planning for the possibility of long-term care gives you time to learn about services in your community and what they cost. It also allows you to make important decisions while you are still able.

People with Alzheimer’s disease or other cognitive impairment should begin planning for long-term care as soon as possible.

Learn more about advance care planning.

Making Decisions About Long-Term Care

Begin by thinking about what would happen if you became seriously ill or disabled. Talk with your family, friends, and lawyer about who would provide care if you needed help for a long time. Read about how to prepare healthcare advance directives.

You might delay or prevent the need for long-term care by staying healthy and independent. Talk to your doctor about your medical and family history and lifestyle. He or she may suggest actions you can take to improve your health.

Healthy eating, regular physical activity, not smoking, and limited drinking of alcohol can help you stay healthy. So can an active social life, a safe home, and regular health care.

Making Financial Decisions for Long-Term Care

Long-term care can be expensive. Americans spend billions of dollars a year on various services. How people pay for long-term care depends on their financial situation and the kinds of services they use. Often, they rely on a variety of payment sources, including:

  • Personal funds, including pensions, savings, and income from stocks
  • Government health insurance programs, such as Medicaid (Medicare does not cover long-term care but may cover some costs of short-term care in a nursing home after a hospital stay.)
  • Private financing options, such as long-term care insurance
  • Veterans’ benefits
  • Services through the Older Americans Act