Long-term care covers help with everyday personal tasks you can no longer do on your own, like bathing, dressing, eating, and getting in and out of bed. It is not the same as medical care. Most long-term care involves non-medical assistance provided over weeks, months, or years, either at home, in an assisted living facility, or in a nursing home. The cost is significant: a private nursing home room now runs a median of $129,575 per year, and even a home health aide averages about $80,080 annually for 44 hours a week of care.
The Core Services: Activities of Daily Living
Long-term care is built around six basic personal tasks known as activities of daily living (ADLs). These are the specific functions that insurance companies, Medicaid, and other programs use to decide whether you qualify for benefits:
- Bathing
- Dressing
- Using the toilet
- Transferring (moving to or from a bed or chair)
- Caring for incontinence
- Eating
Beyond these six, long-term care also covers what are called instrumental activities of daily living, which are the slightly more complex tasks that keep a household running. These include managing money, preparing meals, doing housework, shopping for groceries, taking medication on schedule, and using a phone. Someone who can still feed and dress themselves but can no longer safely cook, manage bills, or remember to take their prescriptions may still need long-term care support.
Where Long-Term Care Happens
Long-term care is not limited to nursing homes. In fact, most people receive it at home or in community settings. The main options include:
- In-home care: A caregiver comes to your home to help with personal care, meal preparation, housework, and transportation. This can range from a few hours a week to round-the-clock assistance.
- Adult day care: Structured daytime programs that provide supervision, social activities, and meals, often used by families who need daytime support while a primary caregiver works.
- Assisted living facilities: Residential communities where you live in your own apartment but have access to help with ADLs, meals, and medication management.
- Nursing homes: Facilities that provide 24-hour supervised care, including skilled nursing when needed alongside long-term custodial care.
The level of care you need, along with how you’re paying for it, determines which setting makes sense. Many people start with in-home care and transition to a facility as their needs increase.
What Medicare Does and Does Not Cover
Medicare does not pay for long-term care. This catches many people off guard. Medicare covers short-term skilled nursing stays after a hospitalization, but that is fundamentally different from long-term custodial care.
Specifically, Medicare Part A covers up to 100 days in a skilled nursing facility per benefit period. Days 1 through 20 are fully covered after you pay the $1,736 deductible (2026 figures). Days 21 through 100 cost you $217 per day. After day 100, Medicare pays nothing. And this coverage only applies when you need skilled medical care like physical therapy or wound care following a qualifying hospital stay. It does not apply to ongoing help with bathing, dressing, or other daily tasks.
Home-delivered meals, personal care assistance, and adult day programs are all considered long-term care services. Medicare does not cover them. You pay 100% of the cost for non-covered services, and most long-term care falls into that category.
How Medicaid Covers Long-Term Care
Medicaid is the largest payer of long-term care in the United States, but it is a means-tested program. You have to meet strict income and asset limits to qualify. These limits vary by state, but they are uniformly low. In Pennsylvania, for example, the individual income limit for nursing home Medicaid is $2,901 per month, and the resource limit is $2,000 (with an additional $6,000 disregard in some cases).
If you’re married and one spouse needs nursing home care, special spousal impoverishment rules prevent the healthy spouse from losing everything. In 2025, the community spouse can keep between $31,584 and $157,920 in countable resources, depending on the couple’s total assets. The exact rules and figures differ by state, and many families work with an elder law attorney to navigate the process.
Once you qualify, Medicaid covers nursing home care, and many states also cover home and community-based services through waiver programs. The tradeoff is that you must spend down nearly all of your savings to become eligible.
What Private Long-Term Care Insurance Covers
Private long-term care insurance is designed to fill the gap that Medicare leaves open. Most policies cover in-home care, assisted living, adult day care, and nursing home stays. Some also cover respite care, which gives a family caregiver a temporary break, and modifications to your home like grab bars or wheelchair ramps.
To start receiving benefits, you have to meet what the industry calls “benefit triggers.” Most policies require that you need help with at least two of the six ADLs, or that you have a cognitive impairment such as dementia. An insurance company will send a nurse or social worker to assess your condition before approving a claim.
Policies typically have a waiting period (often 30 to 90 days) before benefits kick in, a daily or monthly benefit cap, and a maximum lifetime payout. The specifics depend entirely on the policy you purchased.
Common Exclusions
Long-term care insurance does not cover everything. Standard exclusions include care provided outside the United States, care delivered by immediate family members (unless they work for an agency providing your services), treatment at Veterans Administration or federal government facilities when no charge is made to you, and conditions arising from attempted suicide, self-inflicted injuries, or participation in a felony. Policies also exclude care directly related to untreated alcoholism or drug addiction, except for addiction to a prescribed medication taken as directed.
VA Benefits for Veterans
Veterans who already receive a VA pension may qualify for an additional monthly benefit called Aid and Attendance. This provides extra money specifically to help cover long-term care costs. To qualify, you need to meet at least one of these criteria: you need another person to help you with daily activities like bathing, feeding, or dressing; you’re confined to bed for a large portion of the day due to illness; you’re in a nursing home because of a disability-related loss of mental or physical ability; or your eyesight is severely limited (5/200 or worse in both eyes, even with correction).
The Aid and Attendance benefit is added on top of your existing pension amount. The VA sets specific rate tables that change annually, so the exact monthly figure depends on your situation, whether you have dependents, and whether your spouse also needs care.
How Most People Actually Pay
The reality is that most long-term care costs are paid through some combination of personal savings, family support, Medicaid (after spending down assets), and private insurance if you have it. At $80,080 a year for a home health aide or $129,575 for a private nursing home room, costs can deplete savings quickly. The median need for long-term care services lasts several years, which is why planning ahead matters so much.
If you do not have private long-term care insurance and your income and assets are too high for Medicaid, you will pay out of pocket until your resources are low enough to qualify. This is the path a large number of Americans end up on, and it is the primary reason financial advisors recommend addressing long-term care planning well before the need arises.