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“Mom is getting older,” my brother said to me as we chatted on the phone. “We need to prepare.”

He started offering ideas.


“Should we make a fund for her care? There’s insurance, right?”

“You mean long-term care insurance?” I responded. “That’s a joke.”

“OK. Let’s save up. You, me, my wife, and our two siblings could contribute $100 per month. That’s $6,000 a year, a realistic start.”


But is it?

The median cost of living in a semi-private room in a nursing home for one year is $93,000. Hiring a home health aide for 40 hours a week costs $55,000. Assisted living costs $52,000.

Our mom was 70 years old. How much time would we have to save before she needed long-term care? Five years? Ten? At that point we’d only have $30,000 to $60,000 in savings.

What about our dad, who will be turning 70 in three years? What about my future spouse’s parents?

We were ahead of most families that fail to have these conversations before the need for care arises, yet we were nowhere near a solution.

To have banked enough money for our parents’ care, we should have started more than 30 years ago — but we were barely out of our mother’s womb.

Plan for long-term care, they say. But how? Even as a gerontological nurse practitioner and a researcher focused on improving delivery of this essential service for older adults, I was lost.

Nearly 70% of adults 65 years and over will need long-term care. That means assistance with activities of daily living like getting dressed, preparing and eating meals, bathing, and more. Nursing homes, adult day services, assisted living, home health aides, and informal caregivers can provide this help. Yet one-quarter of adults fail to believe they will need extended care and so don’t plan for it.

When long-term care is needed, many older adults and their families are hit with the realization that Medicare does not cover it. Anything beyond rehabilitation or 100 days of nursing home care is the older adult’s responsibility. A long-term care system exists only for the impoverished (Medicaid) and the wealthy (self-pay). There is no robust system for the middle-income people who make up half of the U.S. population, and there are threats to the sustainability of Medicaid, which currently covers 62% of all nursing home residents.

These issues are framed as a failure to plan, but there is little support for planning, and planning doesn’t solve many of the problems. Without a long-term care infrastructure, most Americans face exorbitant costs, undue burdens, and threats to their well-being in older adulthood.

Concerns about long-term care have been complicated by the Covid-19 pandemic, which has disproportionately affected older adults, especially in long-term care facilities. Families have weighed their options: Should mom be in a nursing home, with increased risks for isolation, infection with SARS-CoV-2, the virus that causes Covid-19, and death? (Long-term care facilities currently face decreased occupancy and insufficient funding.) Or should she be at home with the accompanying family, work, health, and safety challenges?

Government funding is the most obvious solution to building a long-term care system and reshaping and supporting planning for long-term care, but efforts in this area have failed. For example, Maine proposed a universal home care initiative in 2018 to provide no-cost home care, but it was voted down due to fears that taxing those who made more than $128,000 a year (especially physicians) would cause people to relocate to other states. In 2011, the federal Community Living Assistance Services and Supports Act proposed to provide up to $50 a day in cash benefits to help families pay for in-home assistance or nursing home care, but it was plagued with unreasonable premiums and uncertain sustainability.

The first state social insurance program for long-term care was recently initiated in Washington. Beginning in 2022, all of the state’s residents will pay into a long-term care trust fund $5.80 for every $1,000 of their income. This program provides a glimpse of hope, although the first payout for an individual’s long-term care won’t occur for 10 years after paying into the trust — three years after a catastrophic disabling event — and has a lifetime cap of $36,500.

Long-term care needs to be on the new administration’s agenda. Efforts that increase access to long-term care financing, resources, services, and supports are needed at all levels: local, state, federal and for all socioeconomic groups. No family should shoulder the burden of long-term care planning alone.

My brother and I will work together to make a plan, and we are fortunate to be having these conversations earlier and with more resources than some families. But for all families, long-term care needs long-term solutions.

Jasmine Travers is a gerontological nurse practitioner and an assistant professor of nursing at New York University Rory Meyers College of Nursing.

  • It is unreal what the people that work there make an hour. In michigan the minimum wage is $9;45,. These people take care of our parents and grandparents. They can make more working at walmart. I found this out when someone I knew started working at one of these places. They ought to be making a lot more,. How much do these places rake in a year? I don’t know how they do it day after day. These people soil themselves, they have dementia and need so much care. My hats off to them

    • This is Oh sooo true, l make 14.00an hr doing exactly this n more, can b overwhelming n overworked due to many issues that r beyond our control, nursing shortage everywhere it seems ,thx for ur statement it speaks volumes to me lol.This to shall pass we/l will receive our reward n heaven thus is why he hired Angel’s, we r the extension of God’s hands 👩‍⚕️👨‍⚕️☝️👑💞👣👣🚶‍♀️🗣♿🙇‍♂️👩‍⚕️💞🙏🏠🏩💒🏥🏥😇👩‍🔬🧚‍♀️🧚‍♀️🧚‍♀️🧚‍♀️🧚‍♀️

  • Coming from a large family who seemed to live long, often needing help from a care center & having a husband with multiple health concerns I felt it possible I would need care at some point. In my late 50’s I purchased a long term care policy & have been paying a substantial premium each year. This was my choice. Because of this I receive a $100 deduction from taxes each year. I feel if the government would work with people, with more of an incentive it would encourage more people to make the effort to be prepared.

    • I sympathize with you, definitely a hard decision I know all too well, lve been n the medical profession for 30 years n a CNA 22 of them, it was hard wen my mom had to place my grandfather n a nursing home Believe me l cried didn’t want to make that choice but sometimes its inevitable, MayGod b with You/Us as we endure to move forward n the future with our decisions 🙏♿👣👣👣👣💞💞☝️👑📖

  • With the current situation with the Coronavirus, insurance provides more money to stay at home for care and avoid the high-risk nursing home care.
    * The Federal Deficit Reduction Act provided for every state to have a Partnership program to provide asset protection for those who buy qualified long term care insurance policies.
    * An alternative are linked products, Life Insurance or Annuities with long term care riders, popular with people that have high net worth. In most states you can also use your qualified money (IRA/401k) to fund your plan.
    Some companies have a cash option you can pay family and friends for care.

  • First off…your immediate remark that Long Term Care Insurance is a joke is flippant, irresponsible, and ignorant! Many states have introduced Partnership Programs! These Tax Qualified Insurance programs partner states/federal government and insurance companies! They are specifically designed to protect the policy owners personal assets at a reasonable rate! The real solution is comprehensive public awareness while individuals are in their 40’s and 50’s. These people are more likely to qualify at reduced rates and are, themselves, often faced with caring for an elderly loved one. The problem is that it’s never stressed to the children, of the affected loved one, that they need to be seeking protection! While your article addresses an elderly loved one I’m afraid it may be too late at that time to reach a reasonable and equitable solution. You’ve already run the proverbial red light and are now stopped in the middle of the intersection! Government sponsored awareness and education is the only true way to address this dilemma. A national awareness campaign could be the start to an equitable solution! You start with families and relatives of people that are currently receiving government assistance in a Nursing Home or Long Term Care facility! This is a complicated issue with many factors and variables. These factors and variables can only be simplified by early awareness citing reasonable options!

  • I think if there was more resources for family’s willing to personally take care of there parents, it would be better for the parents and for family. I know if my mom was poor I was told I would actually be paid to take care of her. I was appalled to find that out.

  • Nursing homes are a rip off. You have to share a small room with no privacy and have to share a bathroom with 3 other people who leave urine and feces on the seat and floor. You have no choice of toothpaste (Avamere won’t even provide toothpaste made for dentures, regular toothpaste damages dentures), no choice of deodorant, shampoo and the body lotion is a joke. It is not made for elderly skin especially for daily use etc. If you are a woman forget about any make up or hair color etc. The state takes all but $30 of your social security monies and gives it to the home who serves food that can be compared to concentration camp food. If your roommate is incontinent it has yeast infection you are forced to smell it because of understaffing and lack of care… neglect. God forbid you need help at night because the nurses are outside smoking at the same time leaving the floor with no nurse on duty. Or they are on their phones sharing family videos with each other, or nurse too busy with her dog rescue business to help residents and nursing aides on their cell phone with earbuds in and can’t hear residents yelling for help and nurses ignore their screams because it is not in the job description to respond. God forbid family complains about neglect etc, the facilities will attack them to in ways you cannot image. Find a way to keep your loved ones at home. Broken ribs, broken shoulders due to aides dropping residents and to cover up their incompetence they say it’s the residents fault bfir one reason another. Read the two stories in the Eugene Weekly about the neglect, falsification of records and cover ups.

    • Sir u r 10000% correct unfortunately lve had the pleasure n experience to see this first hand, facts unfortunately, some people are not cut out for this, for many reasons as u speak here.It is so unfair to the ones who care n r trying, SMH that’s all l have to say, l also pray for better times ahead, cause n all my 30 yrs experience things haven’t improved all that much, n u cant always blame it on the training all things aren’t always learned n a book, it takes integrity n grit to pull it through 👩‍🔬🗣🚶‍♀️👣👣👣👣♿👩‍⚕️🙇‍♂️👩‍⚕️📖☝️💫👴🏼👵💫😷🏥

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