An Introduction to Long-Term Care

What is Long-Term Care?

Long-term care (LTC) is a number of healthcare and personal care services and other supports that an individual with a chronic illness or disability may need for long periods of time. Although people of all ages may need long-term care, most of of those who receive it are senior citizens.

More often than not, LTC means assistance with the activities of daily living (ADLs), which include:

  • Eating
  • Bathing
  • Toileting
  • Dressing
  • Help transferring to/from the bed or chair
  • Care for those who are incontinent

Long-term care can also help with other tasks that are referred to as Instrumental Activities of Daily Living (IADLs), which include:

  • Housekeeping – cleaning, laundry, etc.
  • Meal preparation
  • Financial management
  • Grocery shopping

Who Will Need LTC?

The United States Department of Health and Human Services estimates that around 70% of all Americans will need long-term care at some point and that nearly 40% of those who reach age 65 will enter a nursing home. It is more likely that you will need LTC than not. Of course, there are individual factors that help determine your need for care. These include: age, gender, family history, your lifestyle, and your marital status.

The main factors that determine whether you will need long-term care are:


The older you are, the more likely that you will need some form of LTC.


Women are more likely to need long-term care than men; in fact, about 75% of LTC insurance claims are filed by women, who live five years longer than men on average and are more likely to live alone at older ages.


Your health is also a big factor in whether you will need LTC. If you have a poor diet and/or do not exercise often, you are at higher risk. Also at higher risk: those with chronic conditions such as diabetes, or those with a family history of chronic conditions such as Alzheimer’s.


If you are disabled, either through illness or injury, you have a higher chance of needing LTC. Around 70% of individuals aged 90 or older have a disability.

Marital Status

Those who live alone are more likely to need long-term care than those who are married or living with a partner.

The Types of Long-Term Care

There are two main kinds of long-term care – formal care and informal care. Formal care refers to LTC that is provided by paid professionals in a facility or at home. Informal care refers to unpaid LTC provided in the home by family, friends, or other volunteers. Of course, long-term care is not an “either/or” proposition, and there are many individuals who utilize a blended approach of formal and informal care to meet their needs.

Formal Long-Term Care

Formal long-term care can be provided in a specialized facility or at home. The facilities that offer LTC go by many names, including nursing homes, assisted living, personal care facilities, continuing care communities, and more. In general, nursing homes offer the most comprehensive service, which includes around-the-clock supervision and care from professional nurses. As a rule of thumb, a LTC facility is the right option for those who require constant, 24 hour care.

However, most do not require constant care, and the majority of formal long-term care is provided in the home. Formal care at home is referred to as home heath care or simply home care.  Home care can be provided by professionals such as registered nurses, home care aides, therapists, and more.

Informal Long-Term Care

As the American population ages and life expectancies increase, more and more family members are providing informal, unpaid long-term care to loved ones. Around 80% of home care is provided by an unpaid caregiver. As of 2009, around 25% of adults in the United States were providing unpaid care to an adult or child. Informal caregivers tend to be older, female, and well educated individuals. Many are married to the care receivers. For seniors, formal and informal care are not substitutes but are generally provided together. Paid caregivers often assist unpaid caregivers, often for large amounts of time each week.

A study by the US Department of Health found that around 70% of informal caregivers provided care for somewhere between two and four years and helped the care receiver with around 2.5 activities of daily living. The average informal caregiver provides around 40 hours of help per week, which drops to 19 hours per week if the caregiver is working full time.

The Costs of LTC

The costs of long-term care are substantial and rising, so it’s important to understand how much you may need to spend and why. Of course, the cost of your care will depend on the type of care, amount of care, and where you are receiving it. According to a 2013 study by the LTC insurance company Genworth Financial, the median costs are:

  • Home Care provided by a home health aide, $19/hr, up 2.32% from 2012
  • Assisted Living, $3450/month, up 4.55% from 2012
  • Nursing Home, private room, $230/day, up 3.60% from 2012
  • Adult Day Health Care, $65/day, up 6.56% from 2012

You should understand that most estimates out there the base rates for care. There are other factors that can drive the costs higher or lower which are not usually included in these estimates.  For home care, time of day can greatly impact cost – care on weekends, holidays, and in the evening tend to be more expensive. At LTC facilities, there may be extra charges for specialized services such as Alzheimer’s care, along with variable rates for extra activities or events.

Click here for more information about the costs of long-term care and our LTC calculator.

When is the Right Time to Plan for Long-Term Care?

The sooner you can begin planning for long-term care, the better. If you begin early, you will have plenty of time to prepare, and you can dramatically lower your costs. For long-term care insurance, premiums are lower for younger individuals. For those who decide to self-insure through savings, the early you begin the easier this process becomes. We realize that this is a difficult process whether you’re planning for yourself or a loved one. However, aging and the potential need for care are an inevitability, and you will be far better off facing these issues now.

More Resources

Informal Caregivers of Disabled Elders with Long-Term Care Insurance