What Long-Term Care Actually Costs a Family

Attorney Greg Robinson

Picture this. You're parked outside a facility with three brochures on the passenger seat. Glossy photos, a courtyard, a smiling resident holding a watercolor. And not one of them printed a price. That's not an accident. Facilities generally want you to tour and sit for an assessment before anyone says a number, and by then the decision already feels urgent. So let's put the numbers on the table now, before you walk back in.

Attorney Greg Robinson

These come from the 2024 Cost of Care Survey by Genworth and CareScout. They're medians, which means half of providers charge less and half charge more, and the survey itself warns that your actual cost can differ by location. Treat them as a starting point, not a quote.

Attorney Greg Robinson

Alabama first. A private room in a nursing home runs about $102,200 a year. That's roughly $8,500 a month. A semi private room is $97,820 a year. Assisted living is lower, about $54,870 a year, so roughly $4,600 a month. And in home care, a home health aide at forty four hours a week, runs $57,200 a year, about $4,800 a month.

Attorney Greg Robinson

Now Texas. A private nursing home room is $85,045 a year, roughly $7,100 a month. Semi private is $65,700. Assisted living is $63,000 a year, about $5,250 a month. A home health aide is $68,640 a year, and homemaker services, which is help with meals and housekeeping, came in at $64,064. That homemaker figure jumped twenty four percent in a single year. Alabama and Texas both come in under the national numbers, but look at what's happening: prices are rising in both states.

Attorney Greg Robinson

For comparison, the 2025 national medians are about $9,581 a month for a semi private room and $10,798 for a private room. Assisted living is $6,200 a month. And a nonmedical caregiver is thirty five dollars an hour. Here's the part families rarely price out. That forty four hours a week is not full time supervision. If your parent needs someone around the clock, a hundred and sixty eight hours a week, the monthly figure can climb past $25,000. That's often what turns home care from the cheap option into the expensive one.

Attorney Greg Robinson

So who pays? There are five sources, and each one covers a different stage of care. The mistake families make is expecting one source to cover every stage. Let's walk them in order.

Attorney Greg Robinson

Medicare first, because everyone assumes it's the answer. Medicare Part A covers skilled nursing facility care on a short term basis, for rehabilitation after a hospital stay. You need an inpatient hospital stay of at least three days in a row. Time under observation status does not count, so ask the hospital which one you're in. You generally need to enter the facility within thirty days. Then, days one through twenty, you pay nothing. Days twenty one through one hundred, you pay $217 a day in 2026. That's more than $6,500 a month unless a supplement picks it up. Day one hundred and one, Medicare pays nothing. And it does not pay for custodial care, the help with bathing, dressing, and eating. One more thing: a facility can't cut you off just because you've plateaued.

Attorney Greg Robinson

Second, private pay. This is the default when someone enters assisted living, which runs almost entirely on private money. At roughly $8,000 a month, a hundred thousand dollars in savings lasts about a year. That's why the next two sources matter.

Attorney Greg Robinson

Third, long term care insurance. A traditional policy can help with home care, assisted living, and nursing homes once you can't perform two of six activities of daily living, or you have a severe cognitive impairment. Read for the friction. There's usually an elimination period, often thirty, sixty, or ninety days, where your family pays everything. There's a daily cap, and a total pool, commonly two to five years. Hybrid life insurance policies with a long term care rider let you accelerate the death benefit, and if care is never needed, your heirs keep the benefit. But this is a decision you make years before the parking lot.

Attorney Greg Robinson

Fourth, and this is the one almost nobody asks about: the Veterans Aid and Attendance pension. It's a tax free monthly benefit for wartime veterans and their surviving spouses who need help with daily living. Families assume the veteran had to see combat, serve overseas, or be injured. That's not true. The veteran generally needs at least ninety days of active duty, with at least one day during a recognized wartime period, and a discharge other than dishonorable. Surviving spouses can qualify too, if they were married to the veteran at least a year and at the time of death, and they haven't remarried. There's a financial test. The net worth limit is about $163,699, though your home and car don't count, and ongoing unreimbursed care costs can reduce your countable income. Amounts vary, but the 2024 rate for a single veteran with Aid and Attendance works out to roughly $2,300 a month, and a surviving spouse's benefit is lower, around $1,478. That won't cover a nursing home bill alone. But it can pay for a caregiver at home, or serve as a bridge. And be careful: the VA has its own thirty six month lookback on assets given away for less than fair market value, with a penalty of up to five years.

Attorney Greg Robinson

Fifth, Medicaid. It's the largest payer of nursing home care in this country, and it's the safety net, not the plan. It generally requires you to be down to $2,000 in countable assets, it has income limits, and it has a sixty month lookback on gifts and transfers. That's the territory we covered in the last episode on the house and estate recovery.

Attorney Greg Robinson

So here's the map. Short rehab after a hospital stay: Medicare, for a limited time. Early custodial care at home or in assisted living: private pay, insurance if you have it, and Aid and Attendance if you qualify. Long term nursing home care: those same sources, and Medicaid. Don't wait for a crisis. The earlier you plan, the more you can protect.