Most older adults will need long-term care — services that help people with daily activities like bathing, dressing, eating, and getting around — at some point in their lives. Yet long-term care remains unaffordable for many people, with nursing home and home care costs often far exceeding monthly Social Security income and retirement savings. Many families are surprised to learn that Medicare generally does not cover ongoing long-term care, leaving people to rely on Medicaid, limited private insurance options, or out-of-pocket spending.

In a West Health Mosaic blog post, CHCS program officer Valerie Flores, MPH, examines who pays for long-term care in the United States and why the current financing system creates significant financial strain for older adults and families. The article explains the roles of Medicaid, Medicare, the Program of All-Inclusive Care for the Elderly (PACE), Older Americans Act programs, private insurance, and out-of-pocket spending. It also highlights state and local financing approaches, including Washington State’s public long-term care insurance program and local tax levies that support aging-related services.