The affordability of private pay services is an important component of long-term services and supports (LTSS) system performance. When private pay services are relatively more affordable (or less unaffordable), people with moderate to high incomes are more able to access the services they need. As well, those with low incomes are more able to afford additional or noncovered services to supplement those that may be available through public programs.

This Insight on the Issues, produced by the AARP Public Policy Institute with support from The SCAN Foundation and The Commonwealth Fund as a follow-on piece to Raising Expectations: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers, presents data on private pay affordability for every state and more than 400 markets in the United States. There is wide variation in affordability between states and markets. Private pay nursing home care is not affordable for middle-income families anywhere. While less costly than nursing homes, home health care is still unaffordable for middle-income older people at typical levels of use.