Long-term care is one of the most significant financial risks facing families, yet it is often overlooked. As life expectancies increase, and medical advances allow people to live longer with chronic conditions, the likelihood increases that an individual eventually will require some form of long-term care. A study by the US Dept. of Health and Human Services found that 70% of adults who survive to age 65 develop severe LTSS needs before they die and 48% receive some paid care over their lifetime.1
Now, more than ever, it is prudent to have a long-term care strategy that evaluates potential care needs, estimates costs, and weighs potential funding options.
What is Long-Term Care and How Much will it Cost?
Long-term care typically includes assistance with “activities of daily living” such as bathing, dressing, eating, and mobility, as well as supervision for cognitive conditions such as dementia. Care may be provided at home, in assisted living communities, or in skilled nursing facilities.
Cost is key because care services can be expensive and are generally not covered by traditional health insurance or Medicare. The cost of long-term care varies widely depending on the type of care and geographic location. In many parts of the United States, home health aides may cost $25 to $35 per hour, assisted living communities may cost $5,000 to $7,000 per month, and nursing home care can exceed $100,000 per year.2 As you plan ahead, it’s important to note that these costs tend to increase faster than general inflation due to rapidly rising labor and healthcare expenses.
Because care needs may last several years, the total financial exposure can be significant. Some individuals require only short-term care following a medical event, while others, particularly those with cognitive decline, may need care for many years. For those who enter assisted living, the average stay in a nursing home is about 485 days, or a little over a year, according to a report by the Department of Human Services and the National Center for Health Statistics.3
Timing is Everything
An important step in long-term care planning is addressing the issue well before care is needed. Waiting until retirement or until health conditions emerge can significantly limit available options. Insurance premiums rise with age, and pre-existing health issues may make individuals ineligible for coverage.
It’s recommended that family members begin evaluating long-term care planning options in their mid-50s to early 60s. At this stage of life, most people are still healthy enough to qualify for insurance, yet close enough to retirement to realistically evaluate their financial resources and goals.
Starting early also allows families to incorporate long-term care considerations into a broader financial plan that includes retirement income, investment strategy, estate planning, and tax planning. Think about how you want to age; do you want to stay at home, go into assisted living, or live in a community?
Is Long-Term Care Insurance the Right Choice?
Long-term care insurance was originally developed to help individuals protect their savings from the potentially high costs of extended care. Traditional policies typically pay a daily or monthly benefit toward qualifying care expenses once the policyholder meets certain conditions, such as needing assistance with multiple activities of daily living.
However, the long-term care insurance market has evolved over the past two decades. Premiums have increased for many policies due to higher-than-expected claims and lower investment returns for insurers. As a result, fewer companies offer traditional policies today, and consumers must evaluate coverage carefully.
Despite these changes, long-term care insurance remains an effective solution for many households, particularly those with moderate to substantial assets who wish to protect their retirement savings from a potentially large medical expense.
The Hybrid Option
In response to concerns about traditional long-term care insurance, many insurers now offer hybrid policies that combine long-term care coverage with life insurance or annuity products. These policies typically allow policyholders to access a portion of the death benefit to pay for long-term care expenses if needed. If care is never required, beneficiaries receive the remaining death benefit.
Hybrid policies address one of the most common objections to traditional long-term care insurance – the fear of paying premiums for something you may never use. While hybrid policies often require larger upfront premiums, they provide more certainty about the value of the benefits.
For individuals who have accumulated significant savings and want both asset protection and estate planning flexibility, hybrid policies can be an attractive option.
When Does Self-Funding Make Sense?
Long-term care insurance is not necessarily appropriate for every family. Some households may be better served by self-funding potential care expenses. This approach involves intentionally setting aside a portion of retirement assets to cover possible care costs.
Self-funding may be appropriate for individuals with substantial wealth who can comfortably absorb several years of care expenses without jeopardizing their lifestyle or legacy goals. In these situations, insurance premiums may represent an unnecessary cost.
However, self-funding requires discipline and realistic planning. Families should estimate potential care costs, consider inflation, and ensure that sufficient resources remain available even if care expenses occur late in retirement.
Staying Flexible
One of the challenges of long-term care planning is the uncertainty surrounding future needs. It is impossible to predict whether care will be required, what type of care will be necessary, or how long it may last. For this reason, flexibility is key.
Some families combine strategies. For example, purchasing a modest insurance policy to cover potential expenses while reserving personal assets for additional costs. Others may rely on investment income and home equity as part of their care funding strategy.
Whatever the care strategy, regularly reviewing long-term care plans is important. As financial circumstances change, families may adjust their coverage levels, asset allocation, or care preferences.
Legislative Changes
Some states have begun considering statewide payroll taxes to help fund long‑term care and other state‑run programs. Washington was the first to implement such a measure, introducing a mandatory 0.58% payroll tax on all W‑2 employees with no income cap to support its program. The only way to be exempt from this tax was to purchase private long‑term care insurance before November 1, 2021. California, New York, Minnesota, and Illinois are actively developing or evaluating similar legislation, with several other states exploring related initiatives.
Integrating Long-Term Care into a Comprehensive Financial Plan
Whether individuals choose insurance, self-funding, or a combination of both, long-term care planning should be integrated into a broader financial strategy. Retirement income projections should incorporate potential healthcare costs, and investment portfolios may need to include liquid assets that can be accessed if care becomes necessary.
Estate planning also plays an important role. Legal documents such as durable powers of attorney, healthcare proxies, and advance directives help ensure that trusted individuals can make decisions if a person becomes unable to manage their affairs. These documents can also clarify preferences regarding the type of care and living arrangements desired.
Keeping the Goal in Mind
Long-term care planning is ultimately about maintaining independence, dignity, and financial stability in later life. By considering potential care needs early and evaluating the available funding strategies, families can avoid making difficult decisions during a time of crisis.
A proactive plan, whether through insurance, self-funding, or a combination of both, provides peace of mind that resources will be available if care becomes necessary. It also allows families to focus on enjoying retirement, knowing that an important financial risk has been addressed.
If you are not yet a Crestwood client, we welcome the opportunity to connect and support you, contact us.
Sources:
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US. Department of Health and Human Services, ASPE, What Is the Lifetime Risk of Needing and Receiving Long-Term Services and Supports? April 2019.
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Carescout.com,“Calculate the cost of long-term care near you,” updated March 3, 2026 (carescout.com). Actual costs may vary by location, provider, and level of care required.
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Care.com, Wendy Wisner, “How Long Is the Average Nursing Home Stay?” updated August 19, 2025 (care.com).













