Long-Term Care

Long-Term Care

A Landscape Analysis


The Milken Institute Center for the Future of Aging and Innovative Finance teams have joined together to tackle one of the nation's most pressing challenges: financing and delivering long-term care (LTC). Based on extensive market research, the teams analyzed the greatest barriers to meeting the LTC needs of Americans and developed recommendations on improving LTC funding and delivery throughout the United States.

(Program Initiative) Statistics Header

The percentage of adults aged 65 and older who will require LTC at some point in their lives.


Twice the annual income of the average older (65+) middle-income family is needed to pay for one year of nursing home care.


The number of private insurers offering long-term care insurance today, compared with slightly more than 100 in 2002.

What is Long-Term Care?

LTC is the continuum of long-term services and supports (LTSS) designed to meet an individual's health or personal care needs when they can no longer perform everyday activities on their own. LTSS includes: 

• Assistance with activities of daily living (ADLs, such as eating, bathing, and dressing).
• Instrumental activities of daily living (IADLs, such as housekeeping and managing money) over an extended period.

How is Long-Term Care Currently Funded?

• Individuals and families pay 52 percent of LTC costs out-of-pocket.
• Medicaid pays for nearly 34 percent of LTC costs, primarily for low-income people or those who have spent down their financial assets to qualify for coverage.
• Private LTC insurance pays less than 3 percent. Most Americans are under-prepared to self-fund the very high costs of care, and the private LTC insurance market has suffered severe constriction in recent years.

How Prepared Are Americans to Meet Their LTC Needs?

• Today, pensions aren't available to most Americans, and very few have saved sufficiently for retirement. A typical American with savings and home equity, aged 65–74, has median financial assets of just $109,750 and only $86,800 in home equity.
• Most Americans are unaware that Medicare does not cover long-term services and supports (LTSS) and therefore have not adequately assessed care costs, insurance options, and the income/asset limits associated with Medicaid.
• On average, an American turning 65 today will incur $138,000 in future LTSS costs.