How Much Does Long-Term Care Cost?

2025 national medians: home care runs $80,000/year at typical hours, assisted living $74,400/year, nursing home $115,000–130,000/year. But that's the national average. Where you live and what level of care you need can move those numbers by 300% in either direction. Here is the full breakdown — and what it means for your planning.

National median costs by care setting (2025)

The following figures come from the CareScout 2025 Cost of Care Survey, the most comprehensive annual study of long-term care pricing in the U.S., covering hundreds of metropolitan regions across all 50 states.¹

Source: CareScout 2025 Cost of Care Survey.¹ Memory care estimates reflect industry-wide premium over assisted living (20–30%) based on specialized staffing requirements; individual facilities vary. Annual home care figure assumes 44 hours/week of aide coverage.

Year-over-year changes: assisted living rose 5%, nursing home semi-private rose 2%, private room rose 1%, home care rose 3%. Adult day care declined 5%. The pattern tracks broader healthcare inflation, which has historically run 3–5% annually for long-term care services.

What each setting actually provides

Home health aide care

A home health aide (HHA) provides personal care — bathing, dressing, grooming, meal preparation, light housekeeping, companionship — in the person's own home. The $35/hour national median is for non-medical, custodial care. Skilled nursing visits (wound care, IV medications) are charged separately and are frequently covered by Medicare under specific conditions.

The catch with home care: the $35/hour rate assumes someone is available. In high-demand markets, aides are scarce and rates climb to $45–55/hour. Staffing agencies typically charge an agency fee of 20–40% above the aide's wage. A family that needs 8 hours/day, 7 days/week — common for moderate dementia — spends $102,200/year at the national median, $148,000/year at a high-cost rate.

Home care is often the first and most emotionally preferred choice. It's also often the most expensive on a per-need basis because you're paying for dedicated time rather than amortizing facility overhead across many residents.

Adult day health care

Adult day programs provide supervised care in a community setting during daytime hours — typically 6–8 hours, Monday through Friday. The $95/day national median works out to roughly $25,000/year for full-time participation. It's the most affordable structured care option and allows a family caregiver to maintain employment.

Adult day is well-suited for early-to-moderate cognitive decline or physical limitations that don't yet require 24-hour supervision. It's less appropriate when someone needs overnight care, round-the-clock supervision, or has behavioral symptoms that make group settings difficult.

Assisted living

Assisted living facilities provide 24-hour supportive housing — private or semi-private apartment, meals, housekeeping, medication management, help with ADLs, activities. The $6,200/month national median covers the base rate. Most facilities have a tiered care structure where additional services (higher assistance levels, medication administration, incontinence care) add $500–2,000/month above the base.

The move into assisted living typically occurs when someone can no longer safely manage at home — usually with 2+ ADL impairments or meaningful cognitive decline. The average resident enters at age 87 and stays approximately 2 years before either transitioning to skilled nursing or passing away.

Memory care

Memory care units are secured dementia-specific environments within or adjacent to assisted living facilities. They provide higher staff-to-resident ratios, wandering prevention, specialized programming, and staff trained in dementia care. The 20–30% premium over standard assisted living reflects staffing costs.

Memory care is medically necessary, not optional, for residents with moderate-to-severe dementia. Alzheimer's patients who survive to the late stage typically spend 2–3 years in memory care specifically — layered on top of any earlier assisted living stay. Long Alzheimer's trajectories are a meaningful cost tail risk: the average duration from diagnosis to death is 8–10 years, with the last 2–3 years typically requiring intensive care.

Nursing home / skilled nursing facility

Nursing homes (also called skilled nursing facilities or SNFs) provide 24-hour medical oversight, skilled nursing, physical/occupational/speech therapy, and custodial care. A semi-private room ($315/day national median) shares a room with one other resident. A private room ($355/day) provides solitary occupancy — important for quality of life but a $14,600/year premium.

The step from assisted living to skilled nursing is driven by medical complexity — serious falls, post-acute hospital recovery, advanced dementia, or physical dependence requiring nursing-level care. Not everyone progresses to skilled nursing, but the severity of care costs makes it the dominant financial risk scenario.

How much LTC costs vary by state

Geographic variation in LTC costs is extreme — more than 5-to-1 between the least and most expensive states. If you plan to age in place in a high-cost state, national averages significantly underestimate your exposure. If you're willing and able to relocate for care, geography becomes a meaningful financial lever.

Nursing home (semi-private room) — highest and lowest cost states

Source: SeniorLiving.org based on February 2026 facility survey data.² Semi-private room, median rate.

A 3-year nursing home stay costs roughly $210,000 in Texas and $565,000 in Oregon. Planning in New York and Connecticut should use numbers closer to $200,000/year, not $115,000. Regional variation of this magnitude changes the entire self-fund vs. insure calculation.

Similar geographic dispersion exists in assisted living costs, though it's somewhat narrower. Urban markets (New York City, San Francisco, Boston, Chicago) typically run 40–70% above their state median. Rural markets can be 20–30% below.

The inflation problem: what costs look like in 15–20 years

Long-term care cost inflation has historically run 3–5% annually, tracking a blend of healthcare services inflation and skilled labor costs. At 4% annual inflation, costs roughly double every 18 years.³

If you're 60 today and plan for care beginning around age 80, you're pricing care 20 years out. Here's what the national median nursing home rate looks like at different inflation rates:

A 3-year stay at those inflation-adjusted rates costs $622,000 to $916,000 — at the national average. Residents in high-cost states face 50–100% higher numbers.

This is why inflation protection on LTC insurance policies matters. A $300/day benefit today that doesn't inflate will buy perhaps $170/day in real purchasing power in 20 years. Compound inflation riders (3% or 5% annually) address this directly — and they're a major driver of premium cost.

Total exposure scenarios: what you might actually spend

The planning question isn't "what does a nursing home cost today" — it's "what's my realistic total LTC exposure over my lifetime, including inflation?" Below are three scenarios at the national median, adjusted for care beginning in 15 years at 4% inflation:

Inflation-adjusted estimates assume care begins in 15 years, 4% annual LTC inflation, national median costs, single person. Geographic location and actual care needs will shift these materially.

The extended Alzheimer's scenario isn't a tail case — it's realistic for the ~6 million Americans currently living with Alzheimer's, a disease that disproportionately affects women who outlive their spouses.⁴ Women's average LTC duration is 3.7 years; for Alzheimer's specifically, full-care stages often run 5–8 years.

How these costs inform the self-fund vs. insure decision

Once you have specific cost estimates for your likely state and care trajectory, the financial planning question becomes concrete: do you have enough liquid assets to self-fund the realistic range, or does the tail risk justify insurance?

General thresholds that emerge from advisor practice:

• Under $500K liquid assets: Self-fund is not viable for a meaningful LTC event. Traditional LTC insurance or a Medicaid-qualified asset strategy is likely necessary.
• $500K–$1.5M: Self-fund covers a moderate scenario but is severely stressed by a significant or extended one. LTC insurance or hybrid products reduce tail risk without depleting retirement assets.
• $1.5M–$3M (couple): Self-fund is viable for most scenarios for one spouse, but not two simultaneously. Couples in this range often pursue a hybrid approach — insurance for one spouse, self-fund for the other — or a shared-care rider strategy.
• Over $3M liquid: Self-fund is financially viable for most scenarios. The question shifts from "can I afford care" to "do I want to dedicate a reserve to this vs. stay fully invested." Many advisors in this range recommend a disciplined reserve structure rather than purchased insurance.

These thresholds are state-sensitive. The same $2M portfolio is comfortably sized for self-fund in Texas and barely adequate for a couple in New York with Alzheimer's exposure.

The crossover calculation — at what asset level does self-fund beat insurance premium cost — is highly specific to your premium quote, health status, state, and expected return on assets. Our self-fund vs. insure calculator runs this comparison with your actual inputs.

What a fee-only advisor does with these numbers

Most families encounter LTC cost data in a vacuum — a brochure in a doctor's waiting room, a generic online calculator, an insurance agent with a sales agenda. A fee-only advisor uses cost data differently:

• Models your specific state, not the national median
• Projects costs to your likely care-need age, not today's dollars
• Runs the full care sequence probability — not just "what if you need a nursing home" but "what's the probability-weighted expected cost across all scenarios"
• Benchmarks your liquid asset base against that projection, stress-tested at the 75th percentile exposure, not the median
• Evaluates whether insurance premiums, self-fund reserves, or a hybrid structure is the right fit given your actual balance sheet, estate goals, and health status
• Models how LTC reserve decisions interact with Roth conversions, Social Security timing, Medicare IRMAA brackets, and estate planning — because they all connect

LTC cost data without a balance sheet analysis doesn't tell you much. The same $130,000/year nursing home cost is irrelevant to a $5M portfolio and catastrophic to a $600K one.

Related guides

• Self-fund vs. insure calculator — run the crossover math with your own numbers
• Traditional LTC insurance analysis — what it costs, who it fits, how to evaluate carriers
• Hybrid LTC insurance — single-premium products that combine life insurance and LTC coverage
• LTC planning for couples — joint probability, spousal discounts, coverage asymmetry
• When to buy LTC insurance — premium timing and health underwriting windows
• Complete long-term care planning guide