Long-Term Care Affordability is Worsening for Middle-Class Americans

The private-pay cost of long-term services and supports (LTSS) has long been unaffordable for most Americans. Although these services became more affordable during the 2010s with the cost of care rising more slowly than income, over the past five years (2019–2024), the affordability trend has sharply reversed for home and community services, which older people and adults with disabilities overwhelmingly prefer over nursing facility care. This report explores the trends of increasing LTSS costs and decreasing affordability of home care, as well as variation in costs among different types of services and among states. Read the full report. 

Key Takeaways: 

• 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. The cost of adult day services increased by 33 percent, compared to a 23 percent to 25 percent increase in the cost of nursing home care and a 22 percent increase in the median income of older households headed by someone 65 or older. 
• 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.