What is Long-Term Care?
Long-term care encompasses personal and medical assistance for people who cannot independently perform daily activities due to chronic illness, disability, or aging.
Services range from in-home help with bathing and medication to comprehensive nursing home care, typically lasting months or years rather than short recovery periods.
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Get GuidanceTable of Contents
- What is Long-Term Care?
- Does Medicare Cover Long-Term Care?
- What Medicare Doesn’t Cover
- Who Needs Long-Term Care?
- How Many People Need Long-Term Care?
- Long-Term Care Settings
- Compare Options
Estimated reading time: 4 minutes
Does Medicare Cover Long-Term Care?
Most Americans mistakenly believe Medicare will cover their long-term care needs in retirement. This critical misunderstanding can lead to devastating financial consequences when care is eventually needed.
Medicare Does Not Cover Custodial Care
Medicare provides restricted coverage for long-term care services:
- Skilled nursing facility care: Up to 100 days maximum
- Requires a qualifying 3-day hospital stay first
- Days 21-100 require a daily copayment ($200+ per day in 2025)
- Must show continuous improvement to maintain coverage
- Home health services: Limited coverage
- Requires doctor certification of medical necessity
- Must be skilled nursing care (not custodial)
- Care must be part-time or intermittent only
The Custodial Care Gap: What Medicare Won’t Cover
Over 90% of long-term care services fall under “custodial care”, the assistance with activities of daily living that Medicare doesn’t cover 
:
- Bathing and personal hygiene
- Dressing and grooming
- Mobility assistance and transfers
- Eating and meal preparation
- Toileting and incontinence care
- Medication management
These services become essential following:
- Stroke or physical impairments
- Dementia or Alzheimer’s disease
- Chronic progressive conditions
- General age-related decline
Who Needs Long-Term Care?
The need for care generally falls into these two categories:
Physical Impairment
When someone requires assistance with their Activities of Daily Living (ADLs) such as: walking, bathing, continence, dressing, eating, toileting and transferring.
Cognitive Impairment
May be caused by Dementia or Alzheimer’s disease. An individual may be able to physically take care of their Activities of Daily Living, but forget to turn off the stove or cannot remember where they live.
How Many People Need Long-Term Care?
Key Statistics
Key long-term care numbers, summarized.
- Those turning age 65 today have about a 70 percent chance of needing some type of long-term care in their lifetime.
- Women need care longer (3.7 years) than men (2.2 years). The average length of time people need long-term care services is 3 years.
- One-third of people may never need long-term care, but 20 percent will need it for longer than 5 years.1
- Long-term care needs aren’t limited to seniors. About 35% of people receiving long-term care services are age 64 or younger.2
Risk Factors
Factors that increase long-term care risk.
- Age: The older you are, the more likely it is you will need assistance.
- Living Alone: If you live alone it is more likely you will need paid care. It is less likely if you live with a spouse or partner.
- Gender: Women are more likely to need long term care than men. Mostly because women live 5 years longer than men on average.
- Lifestyle: Poor diet and exercise habits increase the chance of needing care.
- Personal History: Health and family history can increase the chances of needing long term care.
Long-Term Care Settings
- Nursing Homes: Provide 24-hour skilled nursing and personal care in a facility setting. Rooms may be private or semi-private, depending on availability and cost.
- Assisted Living: Designed for people who need help with daily activities but do not require 24-hour nursing care. Residents typically have a private apartment and access to meals, medication support, and social activities.
- Home Health Care: A caregiver or nurse comes to your home to provide help for a few hours per day, or in some cases, around-the-clock support.
- Adult Day Care: Community-based programs that provide supervision, meals, and activities during the day. This can support family caregivers who work or need daytime relief and may help delay nursing home placement.
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Last updated: December 16, 2025
Written by: Craig Matesky, President, ACACIA Insurance
Reviewed by: Mike Berger, National Sales Manager
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