One of the most common questions I get asked is “How can I get care for my aging parent and how much will it cost?”
The answer generally depends on these factors:
What kind of elder care does the older person need or want?
What are the available options for providing the needed elder care?
How much do the different options cost?
What are the options for paying for the desired type of elder care?
These are important questions to consider. If your aging parent seems to need help, it’s imperative to find out what are your options for providing the needed support. And finances do often determine how a family proceeds with arranging elder care.
And even if your aging parent doesn’t need help now, they very well might in the future. So it’s also reasonable to plan ahead, and consider how elder care might be provided, if/when it becomes needed in the future.
Now, the truth is that most older adults don’t need much assistance from others. But research shows about 70% of older adults do end up needing some form of “senior care,” for a time ranging from a few months to several years.
So in this article, I’ll share the key things to know, about options for elder care and how to pay for it. Specifically, I’ll cover:
What is “elder care”?
What are the options for elder care?
How much do the most common types of elder care cost?
How do we pay for elder care?
What to know about Medicare & Medicaid for elder care
Options for aging in place
You can also watch a subtitled video version of this information below.
What is elder care?
I personally define elder care as “whatever assistance or support an older adult needs from someone else, to maintain their independence, quality of life, or wellbeing.”
In health services lingo, if this type of assistance lasts for more than a short while, it’s commonly referred to as “long-term care” (LTC) or “long-term care supports and services” (LTCSS).
What exactly are we talking about? In my experience, elder care most commonly means some form of assistance with Activities of Daily Living or Instrumental Activities of Daily Living (ADLs and IADLs).
Many older adults need help with IADLs first.
Examples include: transport, finances, shopping & meal preparation, medications, home maintenance, communication.
Some older adults need assistance with ADLs.
These can include: walking, feeding, dressing & grooming, toileting, bathing, transferring into a wheelchair.
However, elder care can also mean things like:
Supervision and safety monitoring
This is especially common if the older person has developed a condition such as Alzheimer’s or another form of dementia.
Companionship
Support in managing ongoing health conditions
Support in accessing preferred activities
This last item is important: supporting an older person should not just be about helping them survive; we also want older adults to thrive.
Especially if an older person has developed physical or cognitive limitations, it’s essential to help them continue to access activities that bring them enjoyment and meaning, such as attending church, visiting friends, gardening, etc.
What are the options for elder care?
So if an older person needs some form of care or assistance, what are the options for providing that? Here’s an overview of the most common types/providers of elder care:
1.Family care
Generally when an older person needs assistance, it’s family that is the first source of elder care. Spouses, partners, adult children and daughters-in-law are the most common sources of elder care. In many cases, there are also other members of the extended family who step up, or can be recruited to assist. “Chosen family” or friends are another option.
2. In-Home Care
This includes private duty caregivers or certified nursing assistants providing assistance in the older adult’s home. They are also sometimes referred to as home aides or home care aides. They often work as part of a home care agency, but sometimes they can be hired independently.
Note: People often confuse home care with home health care, but they aren’t the same thing! Home health care is a medical benefit covered by Medicare, and it means that under certain circumstances, an older person can get skilled medical services (the most common ones are physical therapy and nursing care) at home. Home healthcare is great, but it’s temporary and doesn’t cover the routine help with ADLs and IADLs that many older adults end up needing.
3. Adult Day Care Programs
Unlike senior centers, which are usually designed to provide activities and resources to relatively independent older adults, adult day programs are designed for older adults with cognitive or physical limitations, and higher levels of caregiving needs. They usually provide structured activities, a meal, and lots of hands-on assistance for participants. They can also usually support older adults who have mobility limitations, or need medications administered. They may include door-to-door transportation.
Adult day programs are regulated by state laws, and can include:
Social day programs for people with Alzheimer’s and other forms dementia
Adult day health care programs, for people with higher levels of medical needs (these programs are more likely to have a nurse or other skilled medical staff on site)
Adult day programs are often a great option for older adults with Alzheimer’s, since they provide a routine with lots of social stimulation and appropriate activities.
I am a big fan of adult day programs and often recommend them to families I am working with. It can be really hard for a spouse or other family caregiver to provide enough activity and stimulation to someone with Alzheimer’s; they are often very tired. Once a person with dementia gets used to the day program, they tend to really enjoy it and it provides much-needed respite to the family caregiver.
Note: a twist on the adult day program model is PACE (Program of All-Inclusive Care for the Elderly). PACE is a model of integrated medical care and long-term care, and includes day programs.
4. Assisted Living
Assisted living facilities are larger residential facilities that also provide housing, group meals, and some additional forms of elder care support, such as medication management and some personal care. Residents are often in a small apartment, which may have a kitchenette. Assisted living facilities usually offer activities and other resort-like amenities.
Assisted living facilities are regulated by state laws.
One thing I’ve noticed about assisted living: it’s often less assistance than families realize. In particular, although some help with personal care is generally available (often for an extra fee), most assisted living facilities cannot provide constant supervision or assistance to an older adult.
So if an older person needs help to stand, or to walk safely, or to ensure they don’t wander off if they have Alzheimer’s, then they often will need additional elder care beyond what the assisted living can provide.
This additional care is often provided by a healthier spouse if a couple moves into assisted living. It can also be provided by hiring an additional personal care aide, or by moving to a residential option with a higher level of care.
I think assisted living is often a good option if it’s financially feasible…unless the older person has Alzheimer’s and is moving in alone; that tends to not work out long-term, unless the family also hires an additional companion or personal care aide to provide supervision and help.
5. Memory care units
These are often located within an assisted living community, and are designed to provide care to residents who have Alzheimer’s or other forms of dementia. The units often feature locked doors, to keep residents from wandering, and the activities are adapted for people with dementia.
Memory care units are regulated by states, as a special form of residential care for elders. They are usually required to have a higher level of staffing and may require workers to have special training in managing Alzheimer’s and other forms of dementia.
6. Board and Care Homes
These are homes in residential neighborhoods that have been equipped to care for a smaller group of older adults. They are often run by a family, and the residential experience is more akin to being in a group home, with each older resident in a private room or semi-private room.
Many board and care homes are able to provide a fairly high level of personal care, at a price comparable to assisted living, and some are able to provide care for people with Alzheimer’s and other forms of dementia.
Board and care facilities are regulated by state laws, and are usually licensed as a type of small residential care facility. They are sometimes known as adult foster homes, personal care homes, or adult group homes.
7. Nursing Homes ( Skilled Nursing Facilities)
For those requiring daily help with multiple ADLs (activities of daily living), or those with significant ongoing medical needs, a long-term nursing home bed might be needed, as these facilities provide a much higher level of care than assisted living. Nursing homes have medical staff on-site and are also supposed to be staffed so they can provide a high level of personal care.
Unlike most residential elder care facilities, nursing homes are federally regulated.
Most nursing homes combine long-term beds with short-term rehab beds, which are used for shorter stays post-hospitalization.
8. Continuing Care Retirement Communities (CCRCs)
These are a particular type of residential community offering a range of care levels, from independent living to nursing home care. The idea is that residents can transition between the care levels as their needs change, without having to relocate to a completely new facility.
CCRCs are regulated by states. The contract with a CCRC is usually much more complicated than for other forms of residential elder care, as CCRCs are supposed to provide care for a resident’s lifetime, and often require paying a large up-front fee, along with monthly fees.
Less common forms of elder care:
Here are a few additional options that can also provide some forms of elder care under certain circumstances:
Technology: A wide variety of technologies have been used to help older adults remain in their homes, or otherwise compensate for declines in physical or cognitive ability. Technology can especially be used for certain forms of supervision, but usually can’t really provide companionship or hands-on personal care.
Villages: These are community-based organizations designed to help older adults access support services and stay connected as they age. They often involve neighbors and volunteers being available to provide lighter forms of assistance, and a vetted pool of service providers.
Local volunteer or non-profit services for older adults: Many cities and communities have non-profits or other groups available to provide some services to older adults. Churches also often make some support services available to older adults.
Your local Area Agency on Aging should be able to point you to local resources and community groups.
How much does elder care cost?
The cost of care varies based on the type of service. It’s also very dependent on the location and related costs of living and of labor. Here’s what you might expect to pay for the most common forms of elder care.
1. The cost of family care
This is often “free” for the older adult. But ongoing care often takes time and is also emotionally taxing, so this can end up costing the family member a fair bit in terms of lost wages and the impact on their life.
You should know that although family caregivers often don’t charge for their care, it IS possible to create a family personal care contract so that family caregivers get paid for their efforts. Personally, I think this can be a good idea for significant ongoing care, and it’s also a way for older adults to legitimately spend down assets.
2. The cost of in-home care
Hiring a private home care aide through an agency often ranges from $30 to $50 per hour, varying based on location and specific needs.
You certainly can hire someone outside an agency at a lower rate, but then you will be responsible for management and also for paying taxes.
Learn more here: Hiring In-Home Caregivers for Aging in Place: What to Know.
3. The cost of adult day programs
As described above, these are day programs designed for older adults with cognitive or physical limitations, and higher levels of caregiving needs.
These are often run by non-profits and can be very good value for the care provided. The cost can be anywhere between $40 to $100 per day.
4. The cost of assisted living and memory care
Assisted living facilities provide a living environment with various levels of support, typically costing $3,000 to over $10,000 per month.
Memory care units, designed for individuals with cognitive impairments, often have higher costs due to specialized staffing and security measures.
Many assisted living facilities and memory care units are run by for-profit companies.
5. The cost of board and care homes (personal care homes)
These smaller, residential-style homes usually provide a lot of hands-on care to a small group of residents. They are often able to provide care to residents who need help with Activities of Daily Living (ADLs) or have Alzheimer’s or a related dementia.
These personal care homes typically start at $3000-$5000/month, but costs can be higher depending on the level of attention provided and the local cost of living.
Board and care homes can be good value, especially for an older person who needs a lot of hands-on care.
6. The cost of nursing homes (skilled nursing facilities)
For those requiring a high level of care (such as help with two or more ADLs), nursing homes offer round-the-clock medical and personal care, albeit in a fairly institutional setting.
A semi-private room often costs $9,000-$10,000/month.
How do we pay for elder care?
Older adults and families often assume that Medicare — or another government program — covers most elder care. But this is not true; it’s actually Medicaid that is the primary government payor of long-term care services, and only under certain circumstances as explained below.
If you are considering elder care that is not free labor or provided by volunteers, then there are basically four common ways to cover the cost.
1.Pay with your family’s own funds.
This is where most people have to start: by paying for elder care out of their own income and assets.
Some expenses may be tax-deductible, especially if they qualify as medical expenses. So, it can be a good idea to itemize expenses and keep documentation as you or a family member pays for elder care.
2. Use long-term care insurance (if the older person has it).
Long-term care insurance (LTCI) is a type of insurance that people can buy earlier in their life, to cover certain elder care expenses later in life. If you or your parent has a valid LTCI policy, check the terms and conditions to find out what type of care is covered and under what circumstances (the “benefit trigger”).
To start paying benefits, most policies require the beneficiary to need help with at least two ADLs (Activities of Daily Living) or to be diagnosed with cognitive impairment (e.g. Alzheimer’s or a related dementia) of a certain severity.
You can learn more about receiving LTCI benefits here: Receiving Long-Term Care Insurance Benefits.
Note: if you’re wondering whether YOU should buy long-term care insurance for yourself, you should know that insurance companies got financially clobbered by trying to service the policies they sold to previous generations, and many of them have left the LTCI market. So, it’s often no longer possible to get an affordable policy with benefits similar to those your older relative may be entitled to. Some insurers are still offering LTCI, often as a “hybrid” product that combines the LTCI with life insurance or an annuity.
For more on the state of LTCI, I recommend this Congressional Research Service brief, which includes a section on “market stability”: Long-Term Care Insurance: Overview.
3. Apply for assistance from the Veterans Affairs Administration (VA)
If you or your loved one served in the military — especially during an active war period — it’s worthwhile to find out whether you might be eligible for the VA’s Aid and Attendance benefit.
This benefit provides a monthly payment that can be used to pay for elder care services.
Learn more about eligibility and the benefit here: VA Aid and Attendance Benefits.
4. Apply for Medicaid (find out if you’re eligible)
Medicaid is the federally-funded and state-administered program that pays for medical care for eligible low-income adults and children.
Unlike Medicare, which limits coverage to medical services, Medicaid can and does cover non-medical long-term care services under certain circumstances. So it is Medicaid (not Medicare!) that is the largest public funder of long-term care services for older adults.
Medicaid covers long-term nursing home care for eligible older adults, and in most states also covers some form of home care or community-based care.
One key thing to know about Medicaid is that because it is state-administered, different states can have different eligibility requirements. They can also cover different forms of elder care.
For more on Medicaid and long-term care, see Medicaid and Home Health Care & Non-Medical, In-Home Care.
Middle-class families often cannot imagine that they would ever qualify for Medicaid. However, because elder care can become quite expensive, many older adults can and do spend down their assets until they qualify.
Even if you think your family doesn’t qualify for Medicaid now, it can be a good idea to learn more about this option, so that you can more easily become eligible later, if it becomes necessary.
Applying for Medicaid can be a complicated process. You can learn more by talking to a social worker or your local Area Agency on Aging.
You can also consider working with a Certified Medicaid Planner, or a professional service that specializes in helping people apply for Medicaid.
What to know about Medicare and Medicaid for elder care
The main thing to know is what I wrote above: Medicare does NOT cover most forms of elder care.
Medicaid DOES cover elder care for eligible older adults. However, in most states, it’s only available to those with limited income or assets, and even if you’re eligible, it may not be easy to access the type of elder care you’d prefer for yourself or your family member.
Now you may be wondering: why don’t we have better public funding for elder care?
I certainly wish we did. However, as a society, we tend to leave it to individuals and families and the market to work out a variety of services that are publicly funded in other developed countries. So the current situation is not surprising to me, even though I don’t like it.
Medicaid for long-term care is not ideal in its current format, but it is better than having nothing.
You can potentially improve things by supporting policy efforts to strengthen our public long-term care system.
Note, however, that if we want to do more to publicly provide or subsidize elder care, we’ll have to be willing to collectively pay in some way. (Or we’d have to pull back on something we’re currently spending on.) All good elder care requires time, effort and the labor of others.
Elder care options for aging in place
And what if you’re hoping to age in place, or trying to arrange this for your aging parent or other relative?
This is a very common goal: Americans overwhelmingly say that this is their preference.
Is it feasible for most people? It really depends on the circumstances. For this to work out, people generally will lean on these elder care options:
Family
Paid home aides (usually paid out of pocket, sometimes covered by long-term care insurance, a VA benefit, or Medicaid)
Adult day programs
PACE (Program of All-Inclusive Care for the Elderly), which provides integrated medical care and long-term care, and includes day programs.
This is doable, but I do see some common problems come up when people attempt this. They are:
Family caregivers can become quite stressed and burned out, especially if they are coping with Alzheimers and related dementias, or if the care goes on for years.
The cost of paid home care can really add up, especially when families attempt to provide all day care or 24/7 care.
Older adults can become very isolated and understimulated, if they are spending most of the day at home.
An older person who is mostly alone often suffers from loneliness or boredom.
Those at home with a caregiver can still end up bored, because the caregiver may not have the bandwidth or the resources to provide activities and be upbeat.
For these reasons, if an older person is developing more significant care needs, I think it’s important that older adults and families consider the alternatives to aging in place, namely: some form of residential care.
Although it’s usually hard to leave “home,” residential care can be more affordable than 24/7 paid home care, and often provides more socialization and activities for the older person.
Of course, good affordable residential care for elders can be hard to find. But hopefully, that will change, if we choose to advocate for better residential care options, such as Green Houses.
Taking your next steps
I hope this article has helped you better understand your options for elder care, whether for your aging parent or for yourself.
Good luck!
