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Long-Term Care Planning

Updated June 02, 2020

Leacey Brown

SDSU Extension Gerontology Field Specialist

Written by Paige Madsen, former SDSU Extension Gerontology AmeriCorps VISTA Member, under the direction and review of Leacey E. Brown.

Long-term care is a continuum of medical, personal, and social services designed to support the needs of people who have chronic illnesses or disabilities that affect their ability to perform everyday activities at home, in the community, or at a facility. Long-term care (LTC) can be very expensive and can be a burden to your finances that can impact your quality of life as well as the lives of those who care for you. This can be prevented by preparing as your age.


  • One in five adults turning 65 will need five or more years of long-term care.
  • Someone turning 65 has nearly a 70 percent chance of needing some type of long-term care.
  • Women need care longer
  • A third of today’s 65-year-olds may never need LTC, but 20 percent will need it for longer than five years.

Types of Formal Long-Term Care

Home-based care

  • Allows people with special needs to stay in their homes
  • Home-health care usually involves helping someone recover from illness or injury
  • Home care provides assistance with activities like shopping, meal preparation, laundry, etc.

Community-based care

  • Adult day-care centers provide care and companionship for older adults who need assistance or supervision during the day
  • Community-living homes are family-style residences whose owner/operator provides individualized and independent residential community living supports for compensation to at least one unrelated adult, but no more than four adults, and provides one or more regularly scheduled health-related services.

Assisted living

  • Congregate residential setting with private apartments and contracted services
  • Residents choose services which are written into a contract. Monthly rent is based on the number and costs of services provided by the contract and square footage of the apartment unit rented
  • A basic rental package generally includes meals, housekeeping, activities, transportation, cable TV, and laundry.
  • Other services are included for an additional fee

Nursing facilities

  • Residents’ needs are complex
  • Residents need 24-hour care
  • Residents are admitted from a hospital or directly from their home
  • Reasons for admissions are the need for care throughout the day, help with daily living activities, continuous supervision, and care for complex needs.

Costs of Long-Term Care

Monthly costs depend on the type of provider, the type of care, and the duration of care needed.

National Median (2018) Provided by Genworth Cost of Care Survey

Category of Care Median
Nursing Home (semi-private room) $7,441
Nursing Home (private room) $8,365
Assisted Living $4,000
Home Health* $4,195
Home Care* $4,004
Adult Day Center $1,560

*Assumes 44 hours per week

How can you pay for long-term care?

Public Programs

Public Programs are funded by taxpayer dollars, the two public programs are:

  • Medicare: pays for LTC if you require skilled services or rehabilitative care, however, it does not pay for non-skilled assistance (e.g., bathing), which is the majority of LTC. You are responsible of paying for any LTC services that are not covered by a public or private insurance program. It is important to remember that medicare only pays for nursing home care in an extremely limited capacity.
  • Medicaid: pays for the largest share of LTC services, but you must meet financial and service need eligibility requirements. Such requirements are based on the amount of assistance you need with assistance you need with activities of daily living (ADL’s). Other federal programs, such as the Older Americans Act and the Department of Veterans Affairs pay for LTC services in certain circumstances and for specific populations.

Personal Finances

Personal Finances are funds to pay privately for LTC costs can come from sources such as pensions, savings, or income from investments.

  • Paying for LTC may be one of the largest financial investments a person or the person’s family will make
  • Other private financing options for paying for LTC costs include life insurance, annuities, reverse mortgages, trusts, and hybrid or combination products. You should contact your financial or legal consultant to discuss the advantages and disadvantages of private financing options for LTC

Long-Term Care (LTC) Insurance

  • Understanding that services your LTC insurance policy covers and how it covers the types of service you might need to use is important. LTC insurance policies may cover nursing home care, home health care, respite care, hospice care, personal home care, services in assisted living or basic care facilities, services in adult day-care facilities, and other services in other community facilities.
  • Premiums vary based on age, health, level of coverage, benefits, and options you choose. LTC insurance premiums can and often do go up after retirement. A tax credit may be available to individuals who purchase LTC insurance policies that meet certain requirements. The South Dakota Long-Term Care Partnership Program provides incentive for individuals to purchase.

When deciding on a nursing home facility

  • Consider what is important to you
  • Talk to others about what places they suggest
  • Call and ask question about each place on your list
  • Make plans to visit and meet with the directors
  • Ask questions of the staff and about the staff
  • Make a second visit without calling ahead
  • Once you have selected a nursing home, read the admission agreement/ contact carefully

Planning ahead for the need for long-term care and how you will pay for these costs is important. Long-term care can be provided in a variety of settings, including one’s own home. Many misconceptions exist about public programs covering long-term care costs. Resources for payment of long-term care services may include Medicare, Medicaid, personal funds and long-term care insurance. Resources are available to help people choose the best long-term care option when needed.

A variety of services are available, whether in your home, the community or a residential setting. Please contact Dakota at Home to see what services are available to support you or a loved one: Call 1-833-663-9673 or visit the Dakota at Home website.

Related Topics

Life Planning