Planning for the Cost of Aging
What Every Family Should Know About Long-Term Care
Long-term care is one of the largest and least predictable expenses a family will face in retirement, and it's a conversation we have often with the households we serve. It is also becoming a more pressing one: today's retirees are living meaningfully longer than previous generations, which means more years of exposure to the kind of extended care needs this blog describes. We have seen aging care costs deplete large estates; and while not common, it is a realistic potential outcome that some of our clients will navigate significant care needs. What tends to be harder to pin down is when the expense might arrive, how long it might last, and which family member ends up carrying it. We will walk you through the data behind long-term care: the odds of needing it, how long it typically lasts, what it costs across different settings, and the often-invisible cost of unpaid family caregiving. Our goal is to bring the evidence behind these conversations into one place, so that if a long-term care need arrives, it meets a plan already in place.
THE ODDS, AND WHY THEY VARY BY HOUSEHOLD
When we talk about “needing long-term care” in this piece, the technical definition is an individual that is having difficulty with two or more of six activities of daily living (getting in and out of bed, dressing, bathing, eating, walking across a room, and using the toilet) that is expected to last 90 days or longer, or having a severe cognitive impairment such as dementia. This definition mirrors the standard used across the long-term care industry, including in federal tax law governing qualified long-term care insurance, and eligibility is typically certified by a physician or other licensed health care practitioner rather than self-reported. That cognitive impairment trigger is becoming more common as Americans live longer, and it matters because a diagnosis alone can qualify someone as needing care even while they remain physically capable. Research from the U.S. Department of Health and Human Services and the Urban Institute finds that 70 percent of adults who survive to age 65 will develop this level of need before they die, while 30 percent never will.²
The statistics below show just how difficult it is to build one specific long-term care expense plan, because outcomes vary so widely from person to person. Averages can also be deceiving here: some people will spend almost nothing on long-term care over their lifetime, while others will face substantial expenses. Even so, this data is useful for understanding the range of outcomes you could face.
- Longevity. The odds of needing long-term care rise the longer someone lives: adults who die between ages 65 and 74 have only a 51 percent chance of ever developing severe care needs, compared with 63 percent for those who die between 75 and 84, and 75 percent for those who live past 85.² Since life expectancy keeps climbing, this is one of the more important factors working against today's retirees.
- Gender. Women are considerably more likely to need long-term care than men: 75 percent of women who survive to 65 will develop severe care needs, compared with 64 percent of men, and women are also more likely to ever pay for care directly (55 percent versus 38 percent).²
- Financial resources. Having more money does not meaningfully change the odds of ever needing paid care. In a related analysis from the same research team, which followed a group of adults from their early 70s until death, those with more than $200,000 in non-housing wealth were about as likely to ever pay for long-term care (47 percent) as those with minimal savings (49 percent). What resources do change is severity: care spells lasting more than four years were notably less common among wealthier adults (25 percent) than among those with the fewest resources (35 percent).²
None of these factors make a long-term care event certain for any one client, but together they explain why we can't attach high confidence to any single long-term care expense projection: some clients will spend nothing on care in their lifetime, while others will need to fund years of six-figure annual expenses and coordinate care across multiple settings and providers. Because a point estimate can't capture that range, one of the most useful things we can do in your plan is stress-test it against a scenario where extensive long-term care expenses are projected based on your household factors, rather than build around a national average that may not describe your household at all.
WHEN CARE IS NEEDED, IT TENDS TO LAST LONGER FOR WOMEN
On average, women who need long-term care require it for about 3.7 years, compared with 2.2 years for men.¹ The reasons are straightforward: women live longer on average and are more likely to be the surviving spouse. For a married couple, this asymmetry deserves direct attention in the plan: if the husband's care event draws down the couple's reserve first, the wife may later face a longer, more expensive need with a thinner cushion behind it, at an age when she is also more likely to be managing it alone.
Looking specifically at nursing home stays, actuarial data shows a similar pattern by marital status: married individuals average about 1.6 years in a facility, compared with 3.8 years for those single or never married, 2.7 years for those divorced or separated, and 2.3 years for those widowed.³ The distribution is also uneven rather than centered on the average: roughly 20 percent of nursing home stays end within three months, while about 24 percent extend beyond three years.³
This gap is largely a function of unpaid spousal caregiving rather than a lower total need for care: research on nursing home admissions finds that residents with a spouse at home tend to enter a facility later and closer to the end of life, while those without that support enter sooner and stay longer.⁸ The 1.6-year figure for married individuals therefore understates their total care exposure, since a meaningful stretch of it happens earlier, at home, and off the books.
THE TYPES OF CARE, AND WHAT THEY COST IN THE SEATTLE AREA
Most people do not move directly into extensive paid aging care. Aging care typically begins informally at home, and then progresses to paid in-home care help as needs grow, and only moves to a higher-acuity setting, such as assisted living or skilled nursing, when the level of need requires it. The table below shows current costs for the Seattle metro area, where most of our clients live, based on the CareScout 2025 Cost of Care Survey.⁴ Seattle-area costs run meaningfully above the national medians in nearly every category, particularly for facility-based care; costs will still vary further by specific neighborhood and provider.
Memory care, a specialized setting for residents with dementia or related cognitive decline, is not separately tracked in the survey but typically runs 20 to 30 percent above the standard assisted living pricing noted above. It is also worth noting that healthcare costs, including long-term care, have historically risen faster than general inflation; we tell clients they should plan for something closer to 4 to 6 percent annual growth on these figures rather than a standard inflation assumption in their plan.
Some of the families we work with also consider Continuing Care Retirement Communities (CCRCs), which package independent living together with guaranteed access to assisted living and skilled nursing on the same campus as needs change. These communities typically require a substantial upfront entrance fee, commonly ranging from $300,000 to well over $1 million depending on the community, contract type, and unit size, plus an ongoing monthly fee that typically runs $4,000 to $10,000 per month, again depending on the community, service level, and unit size. Pricing structures for long-term care vary from there: some communities guarantee you'll pay roughly the same rate you paid under the independent living agreement, while others simply add the cost of care at market rate as it's needed. Again its important to identify which to properly map out these potential expenses within the plan.
THE HIDDEN EXPENSE: UNPAID FAMILY CARE
Before, and often alongside, any paid care, families absorb an enormous amount of uncompensated caregiving. In 2024, an estimated 59 million Americans provided 49 billion hours of unpaid care to an adult family member, valued at $1.01 trillion nationally, more than the country spent on Medicaid that year and nearly double total out-of-pocket health care spending.⁵ In Washington State alone, family caregivers are estimated to provide about $25 billion in unpaid care annually, averaging 27 hours a week on top of their own jobs and households.⁶ For many families, this cost rarely shows up as a line item. It shows up as an adult child's reduced work hours, a spouse's own health decline from caregiving strain, or holidays reorganized around a parent's care schedule. It is real, it is unevenly distributed within a family, and it belongs in the planning conversation even when the checkbook is not the constraint.
OTHER CONSIDERATIONS WORTH NAMING DIRECTLY
- Medicare and Medicaid are not funding sources here. Medicare covers only short-term, post-hospital skilled nursing, typically up to 100 days, and does not pay for the ongoing custodial care described in this paper, a point that surprises many clients who assume their existing coverage will apply. Medicaid eligibility depends on asset and income thresholds that make it largely irrelevant to affluent households, so the full cost of extended care sits with the family or with an insurance contract, not with a public program.
- Liquidity matters more than net worth. A large balance sheet concentrated in a closely held business, real estate, or restricted stock does not pay a monthly facility invoice. The useful question is which specific assets are earmarked to fund care, not whether total assets are theoretically sufficient.
- The tax treatment is worth coordinating. Qualified long-term care expenses can be deductible as medical expenses above 7.5 percent of AGI, tax-qualified LTC insurance premiums carry age-based deduction limits, and HSA balances can be applied to qualified long-term care costs and premiums.
- The insurance market has contracted, and perception hasn't caught up. Roughly 29 percent of consumers believe they own some form of long-term care coverage, whether a standalone policy or a life insurance policy with LTC benefits built in, but the actual figure across all of those product types combined is only about 3 to 4 percent of adults over 50.⁷ For most of our clients, some degree of self-funding is already the default, whether or not it was ever a deliberate choice.
OUR ROLE: MAPPING THE EXPENSE, NOT PREDICTING THE EVENT
The data above points to one consistent conclusion: most of our clients will fund long-term care from their own balance sheet, whether by deliberate choice or simply by not addressing the alternative. For a well-resourced family, that is often the right outcome. What matters is that it be a decision rather than a default. Our role is to help map this potential expense explicitly into your plan: sizing a dedicated reserve, identifying which specific assets are earmarked to fund it, coordinating the tax treatment, and stress-testing the plan against the potential scenarios in this paper. A long-term care need, if it comes, should meet a plan that already exists, not one drawn up under pressure. Funding is only part of that plan, though: knowing who coordinates care, which providers and settings you would actually choose, and how the family stays informed along the way matters just as much as having the dollars in place.
One trusted local resource on the logistics side: Lisa Mayfield at Aging Wisdom, a Seattle-based aging life care practice, regularly helps the families we work with translate a care plan into action, coordinating providers, evaluating care options, and managing the day-to-day decisions as needs change. She's a great resource to continue this conversation once you're ready to talk through the practical side of care. We hosted a webinar with her on exactly this topic: The Power of Proactive Planning with Lisa Mayfield of Aging Wisdom.
Also make sure to read out recent blog post, When Your Parents Need You to Be the Adult, which provides logistical insights into when aging care becomes a reality for families, and best practices to navigate those moments.
As always, we hope this information helps you make informed decisions about your future and the potential aging care scenarios you and your family may encounter. No two families face this the same way, and that's exactly why these conversations matter. We're always happy to talk through what any of this means for your own personal financial life plan.
SOURCES
- Administration for Community Living, U.S. Department of Health and Human Services, “How Much Care Will You Need?” acl.gov.
- Johnson, R., “What Is the Lifetime Risk of Needing and Receiving Long-Term Services and Supports?” Office of the Assistant Secretary for Planning and Evaluation (ASPE), U.S. Department of Health and Human Services, and the Urban Institute, 2019.
- American Association for Long-Term Care Insurance (AALTCI), “What Is the Probability You’ll Need Long-Term Care?” aaltci.org. Nursing home duration and policy-utilization figures reflect actuarial data cited on that page (2008 LTCi Sourcebook duration data; 2012 actuarial utilization study).
- CareScout (a Genworth company), 2025 Cost of Care Survey, data collected July through November 2025. Seattle-area figures reflect CareScout/Genworth metro-level survey data (as reported March 2026); the Washington statewide median hourly rate for private duty nursing ($73/hour) is used for the skilled in-home care figure. Continuing Care Retirement Community entrance fee and monthly fee figures are national averages from the National Investment Center for Seniors Housing & Care (NIC), 2025.
- AARP Public Policy Institute, “Valuing the Invaluable 2026: Family Caregivers’ Contribution Reaches $1 Trillion,” March 2026.
- AARP, “Economic Value of Family Caregiving in Washington,” 2026.
- LIMRA consumer and industry research on long-term care insurance ownership versus consumer perception (2024–2025); American Association for Long-Term Care Insurance / Milliman analysis of NAIC Long-Term Care Experience Reporting data, as summarized in industry market reviews, 2025–2026. Kelly, A., Conell-Price, J., Covinsky, K.E., et al., “Length of Stay for Older Adults Residing in Nursing Homes at the End of Life,” Journal of the American Geriatrics Society, 2010.
Mirus Planning is an independent wealth management firm. Securities offered through Osaic Wealth, Inc., member FINRA/SIPC. This material is for informational and educational purposes only and does not constitute financial, tax, legal, or insurance advice. Cost and utilization figures are national medians drawn from the third-party sources cited on the final page and will vary by state and individual circumstance. Please consult your financial, tax, and legal professionals before acting on this information.