AARP issued a report in March 2026 entitled “Long-Term Services and Supports Are Becoming Even More Unaffordable for Middle-Class Americans stated: “A recent analysis for the US Department of Health and Human Services estimates that 56 percent of people turning 65 between 2021 and 2025 will need LTSS [long-term services and supports] in their lifetime; 45 percent will receive paid care (including both private pay and public programs such as Medicaid); 35 percent will have some out-of-pocket cost; and 14 percent, or one in seven, will incur out-of-pocket costs of more than $100,000 in 2020 inflation-adjusted dollar.”
The key findings of the report are:
- The private pay cost of long-term services and supports (LTSS) increased dramatically between 2019 and 2024. Cost inflation was particularly high for the most frequently used home and community services (home health and assisted living), increasing by almost 50 percent over those five years.
- LTSS affordability (income divided by cost) improved throughout the 2010s, as the cost of care rose more slowly than the income of older households, but the affordability of home and community services plummeted between 2019 and 2024.
- There is considerable variation in private pay LTSS costs among states; for every type of service, the cost in the most expensive state is at least twice the cost of the least expensive state.
The report concluded:
“For most Americans who are not eligible for Medicaid, private pay is the main (and often only) way to receive long-term services and supports. The current cost of services in any setting is unaffordable for older people with moderate incomes. A year of homemaker or home health care services would consume almost the entire gross income of an older household, and a year of assisted living or nursing home care exceeds the median age 65+ household income. The typical savings of an older household are similarly insufficient to pay for an extended period of long-term care. The result is that many middle-income Americans must deplete their savings, go without needed care because of cost, and put additional pressure on family caregivers.
Against this background of private-pay unaffordability, the considerable variation in LTSS costs and affordability over time and among states can be overlooked. Importantly, the past five years reflect a worsening trend in affordability, particularly in certain areas of LTSS. Over the five-year period from 2019 to 2024, the cost of most home and community services (homemaker, home health, assisted living) increased by 46 percent to 48 percent, or an annual average rate of increase of 8 percent per year. Costs for adult day services and nursing homes also increased faster than income.
State variation in private pay LTSS costs is significant. Care in the highest-cost states is twice as expensive (or more) as in the lowest-cost states, for every type of service. Affordability is nearly as variable across states. In general, home care is more affordable in higher-income states, whereas the affordability of nursing home care is unrelated to state income. Costs, income, and affordability may vary considerably within states as well as among states.”
If you or a loved one suffered injuries (or worse) while a resident of an assisted living facility in the United States due to assisted living neglect, assisted living negligence, assisted living abuse, assisted living understaffing, or the assisted living facility failing to properly care for a vulnerable adult, you should promptly find an assisted living claim lawyer in your state who may investigate your assisted living claim for you and file an assisted living claim on your behalf or behalf of your loved one, if appropriate.
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