Long-Term Care (LTC)

Long-term care (LTC) refers to the range of services and support a person may need when they are no longer able to independently manage daily activities due to age, chronic illness, injury, or cognitive impairment. While nursing homes and assisted living facilities are often the first settings that come to mind, long-term care can also include in-home assistance, adult day care programs, and other community-based services.

The need for long-term care is generally defined by difficulty performing Activities of Daily Living (ADLs), which include:

• Bathing and personal hygiene
• Dressing and grooming
• Eating
• Using the restroom
• Transferring and mobility (such as moving from a bed to a chair)
• Medication management

Unlike short-term medical care aimed at recovery, long-term care often extends over months or years. It is important to note that the costs of long-term care are not fully covered by Medicare or traditional health insurance, making proactive planning a critical step in financial and personal well-being.

The need for long-term care can arise for many reasons, including:

• Aging: As people grow older, physical strength, balance, and overall health may decline, increasing the likelihood of needing assistance.
• Chronic conditions: Illnesses such as heart disease, diabetes, arthritis, or respiratory issues may gradually reduce independence.
• Cognitive impairment: Alzheimer’s disease, dementia, or other neurological conditions often require specialized care and support.
• Injury or disability: Accidents, falls, or strokes can result in a sudden and lasting need for assistance with daily living.

Understanding these potential scenarios highlights why it is important to learn about long-term care options and prepare in advance for both the personal and financial aspects.

It is more than just occasional forgetfulness, it’s a measurable and ongoing decline in mental function.

It often includes problems with:

• Memory — forgetting names, places, life’s milestones, or recent events
• Reasoning and judgment — trouble making safe choices or solving problems
• Orientation — confusion about time, place, or identity
• Communication — difficulty understanding or expressing thoughts

If someone can physically take care of themselves but their memory, judgment, or awareness is impaired to the point they aren’t safe alone, that’s considered cognitive impairment and it can trigger long-term care coverage.

Alzheimer’s disease is the most common form of dementia, a progressive brain disorder that slowly destroys memory, thinking skills, and the ability to carry out everyday tasks.

Dementia is a general term used to describe a decline in mental ability that is severe enough to interfere with daily life. It’s not a single disease, but rather a group of symptoms that affect memory, thinking, communication, and behavior.

Parkinson’s disease is a progressive disorder of the nervous system that primarily affects movement, but it can also impact thinking, mood, and overall quality of life.

A stroke happens when blood flow to part of the brain is interrupted or reduced, depriving brain cells of oxygen. Within minutes, those brain cells begin to die. The result is often permanent brain damage that can affect how a person moves, thinks, speaks, or even behaves.

A traumatic brain injury (TBI) occurs when an external force, such as a blow, bump, or jolt to the head, or a penetrating injury like a skull fracture, disrupts normal brain function. TBIs can range from mild (like a concussion) to severe, with lasting effects on physical and cognitive abilities.

Long-term care (LTC) impacts far more than just the individual requiring assistance—it significantly affects family members, friends, and caregivers. In the United States, approximately 63 million individuals serve as unpaid family caregivers, providing essential support to loved ones with chronic illnesses, disabilities, or aging-related conditions (AARP, 2025).

These caregivers often face considerable physical, emotional, and financial challenges. On average, family caregivers dedicate about 27 hours per week to caregiving tasks, and 24% of caregivers report spending over 40 hours per week on these responsibilities (National Alliance for Caregiving, 2025). This commitment can lead to significant personal sacrifices, including:

• Physical and mental health strain: Caregivers frequently experience stress, fatigue, and burnout, which can negatively affect their own well-being.
• Employment disruptions: Many caregivers reduce their working hours, take leaves of absence, or even quit their jobs to fulfill caregiving duties, leading to lost income and career advancement opportunities.
• Financial burdens: Out-of-pocket expenses for caregiving can be substantial, and the inability to contribute to retirement savings can have long-term financial implications.

Moreover, the financial value of unpaid caregiving is immense. In 2023, the estimated worth of unpaid caregiving in the U.S. was approximately $873.5 billion, highlighting the critical role caregivers play in the healthcare system (McKnight’s Senior Living, 2023).

Understanding the multifaceted impact of long-term care on families and caregivers is crucial. Proactive planning and support can help mitigate these challenges, ensuring that both care recipients and their families receive the assistance they need.

References:
1. AARP. New Report Reveals Crisis Point for America’s 63 Million Family Caregivers. 2025. press.aarp.org
2. National Alliance for Caregiving. Caregiving in the U.S., 2025 Report. johnahartford.org
3. McKnight’s Senior Living. Family Caregivers Provide $873.5 Billion in Unpaid Labor Annually. 2023. mcknightsseniorliving.com

Most people prefer to receive long-term care in the comfort of their own home, but that is not always possible. Understanding the full range of care options now can help you make informed decisions and maintain as much independence and choice as possible later in life.

Choosing where to receive care begins with knowing what settings are available.

No, Medicare does not pay for the majority of long-term care costs, as it is designed for acute care, not ongoing support for chronic illnesses or disabilities. Medicare is not nursing home insurance, not adult day care and not assisted living insurance. Medicare may cover short-term, skilled nursing care in a nursing home or home health services, but only after a qualifying hospital stay and when skilled care is medically necessary. Most long-term care, which is often custodial care (assistance with daily living), is not covered by Medicare.

A long-term care insurance policy makes it easy for you to access the best type of care for your situation, and it can help to give your family peace-of-mind and the ability to focus on your well-being. In our experience, when there is no long-term care policy to rely on, the plan of care chosen is typically the most inexpensive which may not provide you with the level of care that you need. Often, the healthy spouse has concerns of running out of money and there may be a need or desire to protect assets for future generations.

You have options. Long-term care policies come in all shapes and sizes and we can help you identify the one that is right for you. There are also ways to access long-term care protection with a life insurance or an annuity product, also known as hybrid policies, which may better fit your needs than a stand-alone long-term care policy. These strategies ensure your money is never “use it or lose it,” since any unused benefits can be passed on to your chosen beneficiaries.

1. By 2030, an estimated 20% of the US population will be over the age of 65. (Source: US Census Bureau)
2. Over 70% of people over the age of 65 will require some form of long-term care in their lifetime. (Source: Department of Health and Human Services)
3. In 2020, the national median cost of a private room in a nursing home was $8,821 per month. (Source: Genworth)
4. A semi-private room in a nursing home costs an average of $7,756 per month. (Source: Genworth)
5. In 2019, the national median cost of in-home care was $4,385 per month. (Source: Genworth)
6. Women are more likely than men to require long-term care, with 79% of nursing home residents being female. (Source: AARP)
7. Over 60% of nursing home residents have some form of cognitive impairment. (Source: Department of Health and Human Services)
8. The average length of stay in a nursing home is 835 days, or just over two years. (Source: National Care Planning Council)
9. In 2018, there were 4.5 million Medicaid beneficiaries receiving long-term care. (Source: Kaiser Family Foundation)
10. The number of people using home health care services is expected to increase by 47% by 2026. (Source: Bureau of Labor Statistics)

Staying healthy and active can help you delay—or even avoid—the need for long-term care. Start by consulting your doctor to review your medical and family history, as well as your daily habits. Your doctor can offer personalized guidance to help you improve and maintain your health.

Key ways to support your wellbeing include:

• Regular physical activity and maintaining a balanced diet
• Avoiding tobacco and limiting alcohol consumption
• Managing stress to protect both your mental and physical health
• Staying socially engaged and fostering meaningful connections
• Living in a safe environment and minimizing financial strain
• Keeping up with healthcare and dental checkups

By taking these steps, you can strengthen your overall health and enhance your quality of life.

Long-term care claims often occur 20–30 years after purchase. Strong, stable insurers and good service histories reduce your risk of unpleasant surprises later.