Long-Term Care

Long-Term Care


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. This research culminated in a Financial Innovations Lab® that brought together a curated group of cross-sector stakeholders to develop solutions that can improve access to quality affordable long-term care for middle-income households.

(Program Initiative) Statistics Header

The percentage of adults aged 65 and older who will require a high level of LTC.


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. In 2019, the median 401(k) account balance for those 65 and older was $64,548.

  • 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.