How Much Care Will You Need? (2023)

The duration and level of long-term care will vary from person to person and often change over time. Here are some statistics (all are "on average") you should consider:

  • Someone turning age 65 today has almost a 70% chance of needing some type of long-term care services and supports in their remaining years
  • Women need care longer (3.7 years) than men (2.2 years)
  • One-third of today's 65 year-olds may never need long-term care support, but 20 percent will need it for longer than 5 years

The table below shows that, overall, more people use long-term care services at home (and for longer) than in facilities.

Distribution and duration of long-term care services

Type of careAverage number of years people use
this type of care
Percent of people who use
this type of care (%)
Any Services3 years69
At Home
Unpaid care only1 year59
Paid careLess than 1 year42
Any care at home2 years65
In Facilities
Nursing facilities1 year35
Assisted livingLess than 1 year13
Any care in facilities1 year37


How Much Care Will You Need? ›

To qualify for these benefits, you must demonstrate that you need assistance with at least two activities of daily living (ADLs), such as bathing, eating, dressing, toileting, transferring (moving in and out of bed), or continence.

How do you qualify for benefits under the ADL trigger? ›

To qualify for these benefits, you must demonstrate that you need assistance with at least two activities of daily living (ADLs), such as bathing, eating, dressing, toileting, transferring (moving in and out of bed), or continence.

How many Americans will need long-term care? ›

Roughly 70% of people age 65 and older will need some type of long-term care during their lifetime.

What is the average length of a long-term care claim? ›

Why? The average length of claim is 2.8 years and more than 90% of the time a claim doesn't last more than 5 years. Should a person find they need more than 3 years of help, they have bought a lot of time to financially prepare for more care.

What should the daily benefit amount of a long-term care insurance policy be? ›

Benefit Amount - Monthly or Daily

A monthly benefit allows you to receive benefits for expenses on specific days that are greater than an equivalent daily benefit but only up to the monthly benefit limit. The benefit choices may range from $50 to $500 per day ($1500 to $15,000 per month) depending on the carrier.

What triggers to receive long-term care benefits? ›

The six standard ADLs are generally recognized as bathing, dressing, toileting, transferring (getting in and out of bed or chair), eating, and continence. ADLs are the most common triggers used by insurance companies to determine eligibility for long-term care insurance benefits.

What is a benefit trigger of medical necessity? ›

A medical necessity benefit trigger permits an insured to qualify for long-term care insurance benefits even though he or she suffers no cognitive impairment and is able to perform the usual activities of daily living.

Who is more likely to need long-term care? ›

Basic Needs

Someone turning age 65 today has almost a 70% chance of needing some type of long-term care services and supports in their remaining years. Women need care longer (3.7 years) than men (2.2 years)

What is the most common long-term care? ›

The most common type of long-term care is personal care—help with everyday activities, also called "activities of daily living." These activities include bathing, dressing, grooming, using the toilet, eating, and moving around—for example, getting out of bed and into a chair.

How long do most people live in assisted living? ›

The average length of stay in assisted living is about 28 months according to a report that was published jointly by the American Health Care Association and the National Center for Assisted Living.

How long do most people live in a nursing home? ›

Once in a nursing home, about half of residents stay for at least a year, while 21 percent live there for almost five years, according to the Health in Aging Foundation.

Can you deduct long-term care? ›

Qualified long-term care premiums, up to the amounts shown below, can be included as medical expenses on Form 1040, Schedule A, Itemized Deductions or in calculating the self-employed health insurance deduction: Age 40 or under: $450. Age 41 to 50: $850. Age 51 to 60: $1,690.

How many people actually use long-term care insurance? ›

Key Long Term Care Statistics

Only 7.5 million Americans, or about 3.3% of the population, has long term care insurance. On average, a female will need 3.7 years of long-term care services while a male will need 2.2 years. 20% of Americans over 65 will need long-term-care for more than 5 years.

What is the biggest drawback of long-term care insurance? ›

Long-term care insurance has the significant drawback of increasing premiums over time, which may become unaffordable for some seniors. Additionally, traditional LTCI does not offer a return of premium, meaning if you never require long-term care, the money you paid into the policy is lost.

Does long-term care insurance count as income? ›

The Internal Revenue Service (IRS) generally treats long-term care insurance benefits as tax-free. However, this is subject to certain conditions and limits. If your received benefits exceed a specific limit or your insurance policy doesn't qualify under IRS guidelines, you could pay taxes on some or all benefits.

Why would you be denied long-term care insurance? ›

One of the most common reasons a long-term care insurance claim is denied is insufficient evidence or documentation. Insurance companies are entitled to adequate records and documentation for them to determine claim eligibility. Poor or insufficient records will result in a claim denial.

What are the 5 activities of daily living? ›

The basic ADLs (BADL) or physical ADLs are those skills required to manage one's basic physical needs, including personal hygiene or grooming, dressing, toileting, transferring or ambulating, and eating.

What would be a condition that may prevent you from getting long-term care coverage? ›

Conditions such as Alzheimer's disease, certain types of cancer, or chronic illnesses like Multiple Sclerosis could disqualify an applicant in the long-term care insurance eligibility assessment, regardless of their Medicare enrollment.

How do you prove medical necessity? ›

How is “medical necessity” determined? A doctor's attestation that a service is medically necessary is an important consideration. Your doctor or other provider may be asked to provide a “Letter of Medical Necessity” to your health plan as part of a “certification” or “utilization review” process.

What is an example of a medical necessity? ›

The most common example is a cosmetic procedure, such as the injection of medications, such as Botox, to decrease facial wrinkles or tummy-tuck surgery. Many health insurance companies also will not cover procedures that they determine to be experimental or not proven to work.

How do you explain medical necessity? ›

"Medically Necessary" or "Medical Necessity" means health care services that a physician, exercising prudent clinical judgment, would provide to a patient. The service must be: For the purpose of evaluating, diagnosing, or treating an illness, injury, disease, or its symptoms.

What is the best age to get long-term care? ›

The Best Age to Buy

The American Association for Long-Term Care Insurance (AALTCI) recommends that individuals take out a policy in their mid-50s. That may seem early, considering the vast majority of claims occur when people are in their 70s or 80s.

Who needs health care the most? ›

High-need adults are disproportionately:
  • Older. More than half were age 65 and older; of these, most were 75 and older. ...
  • Female. ...
  • White. ...
  • Less educated. ...
  • Low income. ...
  • Publicly insured. ...
  • Fair or poor self-reported health.
Aug 29, 2016

What patients have long-term conditions? ›

A long-term condition is an illness that cannot be cured. It can usually be controlled with medicines or other treatments. Examples of long-term conditions include diabetes, arthritis, high blood pressure, epilepsy, asthma and some mental health conditions.

What is the lowest level of long-term care? ›

The 3 Different Levels of Assisted Living Care
  • Level 1 Assisted Living Care. Level 1 residents require a low level of care and need occasional help with their ADLs. ...
  • Level 2 Assisted Living Care. ...
  • Level 3 Assisted Living Care. ...
  • Skilled Nursing Care.
Sep 2, 2022

What type of patients would use a long-term care facility? ›

Long-term care is designed for individuals of any age, not just seniors. Anyone who is injured, sick, or who has diminished physical/mental capabilities can benefit from long-term care facilities.

What is a primary purpose of long-term care? ›

While the primary goal of acute care is to return an individual to a previous functioning level, long-term care aims to prevent deterioration and promote social adjustment to stages of decline.

What are examples long-term care? ›

Many different services fall under the definition of long-term care. These services include institutional care such as nursing facilities, or non-institutional care such as home health care, personal care, adult day care, long-term home health care, respite care and hospice care.

What are names for long-term care? ›

Residential Facilities, Assisted Living, and Nursing Homes.

What is the largest source of payment for long-term care? ›

Medicaid. Medicaid, the primary funder for LTSS, is a joint federal and state program that helps with medical costs for some people who have limited resources. It also covers things that are not usually covered by Medicare, like personal care services.

What is the lowest level of assisted living? ›

Level One — Low level of care.

This resident is mostly independent but may need reminders to perform ADLs. Some may require a low level of supervision or assistance to ensure that tasks are performed correctly and safely.

What is the youngest age for assisted living? ›

Some have programs for people as young as 55, while others require residents to be at least 62-years-old.

What is the best age to move to assisted living? ›

The truth of the matter is there is no one right age to transition to assisted living. Every person and every situation is different. There are some adults who choose to transition at a younger age around the time when they retire, while others may wait until they are in their 80s or 90s.

What is the average length of stay in a care home? ›

Main points. Life expectancy for care home residents between 2021 and 2022 ranged from 7.0 years at age group 65 to 69 years, to 2.9 years at age 90 years and over for females, and from 6.3 years at age group 65 to 69 years, to 2.2 years at age 90 years and over for males.

What are the odds of ending up in a nursing home? ›

Misconception No. 1: Very few people end up using long-term care. This study by researchers from the National Bureau of Economic Research estimates that a 50-year-old has a 53 to 59% chance of entering a nursing home during his or her lifetime.

Do dementia patients do better at home? ›

Research shows that with the right supports, people with dementia can live at home longer and with higher quality of life compared to those living at home without coordinated support, and that this support may be most impactful when introduced early.

What type of care is excluded in a long-term care policy? ›

Some of the more common exclusions in policies covering long term care services are: Mental illness, however, the policy may NOT exclude or limit benefits for Alzheimer's Disease, senile dementia, or demonstrable organic brain disease. Intentionally self-inflicted injuries. Alcoholism and drug addiction.

Can I claim my mother as a dependent if she receives Social Security? ›

Your parent must not have earned or received more than the gross income test limit for the tax year. This amount is determined by the IRS and may change from year to year. The gross income limit for 2022 is $4,400. Generally, you do not count Social Security income, but there are exceptions.

Is dementia a disability for tax purposes? ›

Qualifying for SSDI

In order to qualify for SSDI, patients must meet the requirements of a disability listing. For patients with Alzheimer's or other forms of dementia, neurocognitive disorders are the most common disability listing that they qualify for.

What is considered a tax qualified benefit trigger? ›

For an LTCI policy to be deemed “tax-qualified” under HIPAA, the policy must meet certain requirements in relation to benefit triggers: Standardized Activities of Daily Living (ADLs). HIPAA establishes six standard ADLs (bathing, dressing, toileting, transferring, continence, and eating) and defines them in detail.

What is a benefit trigger? ›

Benefit triggers are the criteria that an insurance company will use to determine if you are eligible for benefits. Most companies use a specific assessment form that will be filled out by a nurse/social worker team.

What is an ADL disability? ›

ADL is used as an indicator of a person's functional status. The inability to perform ADLs results in the dependence of other individuals and/or mechanical devices. The inability to accomplish essential activities of daily living may lead to unsafe conditions and poor quality of life.

What is disability for ADL? ›

The ADL assessment identifies the individual's ability to perform competencies considered essential for personal self-maintenance. Older adults self-report their degree of difficulty with bathing, dressing, personal grooming, transfer, continence, and use of the toilet.

Does cognitive impairment trigger LTC? ›

Even though cognitive impairment is a benefits trigger by itself, it can often impact one's ability to perform various ADLs – eating, dressing, bathing, personal hygiene, walking, getting in and out of bed – which are also used to determine one's eligibility for long term care benefits.

What do most insurers use to assess ADLs and cognitive abilities? ›

The Mini-Mental State Examination (MMSE) is the most commonly used quantitative instrument in screening for moderate or severe cognitive impairment.

How much income triggers a tax return? ›

Tax Year 2022 Filing Thresholds by Filing Status
Filing StatusTaxpayer age at the end of 2022A taxpayer must file a return if their gross income was at least:
singleunder 65$12,950
single65 or older$14,700
head of householdunder 65$19,400
head of household65 or older$21,150
6 more rows

What triggers an accelerated living benefit? ›

You qualify for accelerated benefits if you contract a terminal illness and are expected to die within 6 months to two years. You also qualify if you've been diagnosed with an illness that will reduce your expected lifespan, if you need an organ transplant because of illness or if you are in hospice long-term care.

What is benefit payouts? ›

a payment of money by the government to people who are ill, unemployed, poor or who have children.

What is a trigger claim? ›

A claims-made coverage trigger obligates an insurer to defend and/or pay a claim on an insured's behalf if the claim is first made against the insured during the period in which the policy is in force.

What not to say in a disability interview? ›

5 Things Not to Say in a Disability Interview
  • No one will hire me; I can't find work. ...
  • I am not under medical treatment for my disability. ...
  • I have a history of drug abuse or criminal activity. ...
  • I do household chores and go for walks. ...
  • My pain is severe and unbearable. ...
  • Legal Guidance When SSDI Benefits Are Denied.

How do you answer SSI disability questions? ›

How to Answer Disability Questionnaires
  1. Write clearly and legibly. Avoid erasures as much as possible. ...
  2. Do not leave any section of the form blank (unless otherwise specified). ...
  3. Give consistent answers. ...
  4. Answer the questions truthfully. ...
  5. Follow the instructions on the form.
Feb 27, 2022

What are the 10 Activities of Daily Living? ›

The Barthel Index for Activities of Daily Living takes 10 activities into account. These include feeding, bathing, grooming, dressing, bowel control, bladder control, toilet use, transfers (bed to chair and back), mobility on level surfaces, and stairs.

What to say and not to say at a disability doctor? ›

Never Be Deceptive About Your Condition

You need to explain everything you feel and be clear about how it limits your activity. Conversely, don't be tempted to exaggerate your condition. Disability doctors are well trained at ferreting out false symptoms or exaggerated conditions.

What are the 11 categories of ADL? ›

There are eleven ADLs that are listed on the Minimum Data Set or MDS. They are bed mobility, transfers, walk in room, walk in corridor, locomotion on unit, locomotion off unit, dressing, eating, toilet use, personal hygiene and bathing.

Can you have hobbies on disability? ›

Some popular hobbies well suit disabled people, such as reading books, learning languages, board games, crafting, and playing musical instruments. By reading this article, you may be able to understand why disabled people need hobbies and what hobbies can a disabled person do.

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