Many Americans will need long-term care (LTC) at some point in their lives. Older adults, sick and disabled adults, as well as children with special needs—including those who are chronically or terminally ill—may all require long-term care services.

Despite this, long-term care remains a complex topic for many. This article provides an overview of long-term care statistics, including information on who receives long-term care services, how much it costs, and where those services are provided.

What is long-term care?

According to the National Institute on Aging, long-term care is a broad term used to describe a variety of services and supports for those who can no longer care for themselves due to age-related impairments. This care can be provided at home or in a facility designed to care for those who can no longer complete Activities of Daily Living (everyday tasks and responsibilities) on their own without risking their health and safety.

“Long-term care is care for an individual that helps with grooming, bathing, dressing, eating, and other tasks throughout the day,” says Mary McDonald Winners, BSBA, MSG, CPG, gerontologist and founder of About Seniors Solutions.

The term encompasses assisted living and nursing home care, as well as in-home care provided by a home health aide, family caregiver, or visiting nurse. Adult day care centers also fall under the long-term care umbrella.

Who needs long-term care?

Seniors aged 65 have a nearly 70% chance of requiring long-term care services in the future.
Women (3.7 years) stay in long-term care facilities longer than men (2.2 years).

Administration for Community Living, 2020

Long-term care statistics worldwide

Every day until 2030, 10,000 “Baby Boomers” will reach the age of 65. (Genworth, 2022)
Seven out of every 10 people will require long-term care. (Genworth, 2022)
Denmark, Norway, the Netherlands, and Sweden spend the most on long-term care. (Organisation for Economic Co-operation and Development, 2020)

Long-term care statistics in the U.S.

In 2016, roughly 8.3 million people received long-term care services in a regulated facility. (National Center for Health Statistics, 2019)
In the United States, there are nearly 1 million licensed beds with an average of 33 licensed beds per assisted living facility. (AHCA/NCAL, 2015)
The Western region of the U.S. has the most assisted living communities (41%) followed by the South (28%), Midwest (23%), and the Northeast (8%). (AHCA/NCAL, 2015)
There are more than 800,000 people in assisted living throughout the United States. (AHCA/NCAL, 2015)
Of 3.9 million Americans receiving care in a skilled nursing facility, 78% received long-term care for 100 days or more. (American Health Care Association, 2015)
There are only 1.7 million assisted living employees in the U.S. to care for the 3.9 million residents. (American Health Care Association, 2015)

Long-term care statistics by facility type

In 2016, there were approximately 65,600 regulated long-term care facilities in the United States. Long-term care services were provided by:

28,900 assisted living and similar residential care facilities
15,600 nursing home facilities
12,200 home health agencies
4,600 adult day care centers
4,300 hospice agencies

National Center for Health Statistics, 2019

Most assisted living communities offer 24-hour supervision and assistance, wellness programs, housekeeping, meals, medication management, transportation, and personal care services. The following are examples of personal care services:

64% of assisted living residents need help bathing
57% need help walking
48% need help dressing
40% need help with going to the bathroom
29% need help with bed transfer
19% need help eating

The following statistics are the percentage of assisted living communities that provide other healthcare services than those listed above:

84% provide pharmacy
83% provide dietary and nutritional services
71% provide therapy (including physical therapy, occupational therapy, or speech therapy)
68% provide hospice
66% provide skilled nursing
55% provide mental health or counseling services
51% provide social work services
14% have a dementia care unit, wing, or designated floor
9% only serve adults with dementia

AHCA/NCAL, 2015

Long-term care demographic statistics

In 2018:

7% of residential care community residents were younger than 65.
38% of residents were 65 to 84 years old.
55% of residents were 85 and older.
67% of residents were female; 33% were male.
89% of residents were non-Hispanic white, 6% were non-Hispanic Black, and 5% were of another race or ethnicity.

CDC, 2019

Long-term care and health outcomes

According to the CDC, the most common conditions affecting long-term care residents, in order of prevalence, are:

High blood pressure (55%)
Alzheimer’s disease or other dementias (34%)
Depression (27%)
Arthritis (20%)
Diabetes (20%)
Heart disease (17%)
Osteoporosis (12%)
Chronic obstructive pulmonary disease (COPD) and related conditions (11%)
Stroke (10%)

Coronavirus

Coronavirus cases and deaths are also prevalent in long-term care facilities. As of June 2021, 4% of coronavirus cases and 31% of COVID-related deaths occurred in long-term care facilities, according to The New York Times. More than half of COVID-related deaths were linked to nursing homes in five states: New Hampshire (66%), Rhode Island (61%), Minnesota (59%), North Dakota (58%), and Connecticut (53%).

Hospitalizations, ER visits, and deaths

An estimated 1 to 3 million serious infections occur in long-term care settings each year. (CDC, 2020)
Throughout a three-year study, the yearly mortality rate of nursing home residents was 32%. (PLOS One, 2018)
From 2011 to 2017, 56.1% of nursing home residents with advanced illnesses were transferred to a hospital for care. (JAMA Internal Medicine, 2019)
Falls, trauma, or fractures were the most frequent problems of nursing home residents treated in the emergency department from 2015 to 2016. (Journal of the American Geriatrics Society, 2020)

RELATED: Fall prevention for seniors

Elder abuse

Unfortunately, elder abuse sometimes occurs in nursing homes.

Globally, about 1 in 6 people aged 60 years or older have experienced some form of elder abuse in community settings. (World Health Organization, 2021)
Two-thirds of long-term care staff around the world reportedly committed elder abuse in the past year. (World Health Organization, 2021)
Before the COVID-19 pandemic, 1 in 10 older adults reported elder abuse per year. In a 2021 study, 1 in 5 older adults reported elder abuse. (The American Journal of Geriatric Psychiatry, 2021)
Rates of elder abuse have increased in the U.S. by 84% during the COVID-19 pandemic. (The American Journal of Geriatric Psychiatry, 2021)
Up to 5 million older Americans are abused each year. (National Council on Aging, 2021)
Half of seniors with dementia experience abuse or neglect. (National Council on Aging, 2021)

The cost of long-term care

The following table compares the national average long-term care costs in 2021 compared to costs of long-term care in 2020.

Long-term care costs are increasing
	Year	Daily cost	Monthly cost	Annual cost
Homemaker services	2021	$163 ($26/hour)	$4,957	$59,488 (10.64% change since 2020)
Homemaker services	2020	$147 ($23.50/hour)	$4,481	$53,768
Home health aide	2021	$169 ($27/hour)	$5,148	$61,776 (12.5% change since 2020)
Home health aide	2020	$150 ($24/hour)	$4,576	$54,912
Adult day health care	2021	$78	$1,690	$20,280 (5.41% change since 2020)
Adult day health care	2020	$74	$1,603	$19,240
Assisted living facility	2021	$148	$4,500	$54,00 (4.65% change since 2020)
Assisted living facility	2020	$141	$4,300	$51,600
Semi-private room in a nursing home facility	2021	$260	$7,908	$94,900 (1.96% change since 2020)
Semi-private room in a nursing home facility	2020	$255	$7,756	$93,075
Private room in a nursing home facility	2021	$297	$9,034	$108,405 (2.41% change since 2020)
Private room in a nursing home facility	2020	$290	$8,821	$105,850

Genworth, 2022

Who pays for long-term care? Is it covered by insurance, Medicare, or Medicaid? In 2019:

Medicaid spent $182.8 billion on long-term services and supports.
Medicare spent $87.5 billion on long-term services and supports.
Other public sources (including Veterans Health Administration) spent $25.7 billion on long-term services and supports.
Consumers spent $63.4 billion out-of-pocket on long-term services and supports.
Private insurance spent $35.5 billion on long-term services and supports.
Other private sources (philanthropic support from individuals and organizations such as the United Way) spent $28.2 billion on long-term services and supports.

Although private funding makes up just over 30% of the total spending for long-term care services and supports, this amount has decreased almost 8% in the past 20 years while public funding has increased from 62% in 1999 to nearly 70% in 2019.

Congressional Research Service, 2021

Preparing for long-term care

Being prepared for long-term care is important for all seniors. There are several ways to do this, but the reality is that most don’t plan for it. According to one survey, 40% of respondents had purchased long-term care insurance or were planning to. The same survey found that only 1 in 3 respondents were able to accurately predict the annual cost of long-term care insurance. Planning early allows for better insight into your options and could save you and your loved ones money in the long run.

Here are a few things to consider:

Develop a financial plan: Financial planning is a critical step in preparing for future long-term-care needs, but is often overlooked.
Consider what type of care you may need and the associated costs: This isn’t straightforward and requires research and discussion. It’s impossible to know what type of care you’ll require at some point in your future, but it’s important to research different care options, as well as the cost of each. Consider looking into the cost differences of different types of long-term care facilities. For example, how does the cost of residential care compare to the cost of home care?
Review the benefits available from Medicare and your current health insurance plan: Long-term care isn’t covered under Medicare, but there are several other benefits that may help. For example, it’s possible to be reimbursed for home health care through Medicare Part B.
Determine your method for paying for long-term care: Long-term care costs are steep. Most individuals pay for care services through private funds, long-term care insurance, or Medicaid.
Purchase long-term care insurance: This is an option that can help you financially if you need long-term care in the future. The premiums for this insurance vary depending on your age, health, and other factors—but it’s important to consider it as part of your overall plan.
Create an Advance Care Plan: This document allows you to outline your wishes for medical care if you’re unable to speak for yourself. This is an important document to have if you want to ensure your care is carried out the way you want. Advance Care Plans include advance directives, financial power of attorney, creating a living will, and a healthcare proxy.
Talk to your family member: Discussing long-term care with loved ones is important. They need to know what your plans are and may also be able to assist, both in terms of your care and with your financial situation.

Long-term care reform

The current long-term care system has many barriers to quality service. It’s often inaccessible for those who most need it.

Two organizations that are working to improve long-term care are The American Health Care Association and National Center For Assisted Living (AHCA/NCAL). They have a vision for senior living that includes providing seniors with access to services in all types of communities, one that promotes independence and wellness, and offers the opportunity to age with dignity.

Both organizations focus on improving the quality of care through the use of innovative technologies and evidence-based best practices. They also work to increase transparency and accountability in the long-term care system. This helps ensure that seniors receive the best possible care.

Long-term care questions and answers

How many people in the U.S. are in assisted living?

More than 800,000 Americans reside in assisted living facilities, and this number is only expected to grow.

What percentage of people receive long-term care?

Roughly 70% of people age 65 and older will need some type of long-term care during their lifetime.

How long does the average person receive long-term care services?

The average adult age 65 and older receives long-term care services of some kind for approximately three years. This includes unpaid caregivers, paid care, home care, and care provided in a nursing or assisted living facility.

What is the average life expectancy of someone in assisted living?

More than half (55%) of assisted living residents are 85 years of age or older. The yearly mortality rate of nursing home residents was 32% and the median survival rate was 2.2 years.

What is the leading cause of death in nursing homes?

The most common cause of death among nursing home residents is pneumonia and other lower respiratory tract infections.

How many assisted living facilities are there in 2021?

There were approximately 65,600 regulated long-term care facilities across the United States in 2016. Of those, 28,900 were assisted living facilities.

What state has the most assisted living?

California has the highest number of assisted living communities with 5,900, followed by Florida with 2,400 and Washington with 2,000. Wyoming has the least amount of assisted living communities with only 20.

Long-term care research

How much care will you need, Administration for Community Living
Cost of care survey, Genworth
Spending on long-term care, Organisation for Economic Co-operation and Development
Long-term care providers and services users in the United States, 2015–2016, National Center for Health Statistics
Facts and figures, AHCA/NCAL
Skilled nursing care centers fast facts, American Health Care Association
Residential care community resident characteristics: United States, 2018, CDC
Nearly one-third of U.S. coronavirus deaths are linked to nursing homes, The New York Times
Long-term care facilities, CDC
Mortality in nursing home residents: A longitudinal study over three years, PLOS One
Hospital transfer rates among U.S. nursing home residents with advanced illnesses before and after initiatives, JAMA Internal Medicine
Long-stay nursing facility resident transfers: Who gets admitted to the hospital? Journal of the American Geriatrics Society
Elder abuse, World Health Organization
High prevalence of elder abuse during the COVID-19 pandemic, The American Journal of Geriatric Psychiatry
Get the facts on elder abuse, National Council on Aging
Who pays for long-term services and supports? Congressional Research Service
Infections in nursing homes, Nursing Home Abuse Center
2021 assisted living statistics, Consumer Affairs

Lea este artículo en español aquí.