What Long-Term Care Actually Costs
National benchmarks, portfolio depletion math, geographic variation, and the home-care cost myth
Most people know that long-term care is expensive. What most people lack is a concrete number — the kind that converts a vague awareness of risk into a specific financial problem.
"Expensive" is not a planning figure. $114,975 per year for a semi-private nursing home room is. The difference matters because planning requires a target, and a vague sense of expense does not produce one.
This page presents 2025 national median costs for each level of long-term care, explains how costs escalate as care needs intensify, shows how quickly different care levels can deplete a retirement portfolio, documents the geographic variation in costs, and names the trade-off between home-based and facility-based care that most families encounter when planning.
2025 National Median Costs by Care Level
The following figures are national medians from CareScout 2025 Cost of Care data (supplemented by A Place for Mom 2026 data for memory care). Medians represent the midpoint of the national distribution — half of care settings cost more, half cost less. Individual costs will vary significantly by geography, staffing model, facility quality, and care level within the category.
SOURCE NOTE
Figures reflect 2025 national medians. The non-medical in-home figure uses the conventional 44-hours-per-week benchmark. Memory care lacks a single federal cost-reporting standard; the figure shown is a national median from A Place for Mom 2025/2026 data with a documented range of $4,000–$11,000+ per month depending on geography, staffing, and dementia acuity. Skilled nursing at home is extrapolated and typically provided on an episodic rather than ongoing basis.
The Cost Ladder: How Expenses Escalate with Need
Long-term care costs are not flat — they rise with the intensity and complexity of the care needed. A person who begins with part-time companion care may progress through personal care, assisted living, and memory care before reaching skilled nursing. Each step carries a higher monthly cost, and the transitions are not always predictable in timing.
Understanding the ladder matters because retirement plans often prepare for a single cost assumption — the average monthly cost of "care" — without accounting for the fact that costs may increase substantially over the course of a care episode.
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Adult day services ($2,167/mo) serve people who can safely be home nights and weekends but need structured daytime supervision or programming
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Non-medical home care ($6,673/mo at 44 hrs/week) covers companion and personal care but no medical services. Cost scales directly with hours needed
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Assisted living ($6,200/mo) bundles personal care, meals, and activities in a residential setting. Level-of-care fees — typically $500–$2,000/mo — add to the base rate as needs increase
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Memory care ($6,450/mo median) adds secured environments and dementia-specific staffing. The $4,000–$11,000+ range reflects significant geographic and acuity variation
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Skilled nursing facility — semi-private ($9,581/mo) and private room ($10,798/mo) — provides 24-hour clinical oversight for complex medical or functional needs
The practical implication: a plan funded for the cost of home care may face a significant gap if the care episode progresses to assisted living or nursing facility level. The cost ladder is not a worst-case scenario — it is the normal trajectory for people with degenerative conditions.
Why Home Care Is Not Always the Low-Cost Option
COMMON ASSUMPTION
"Staying home will be cheaper than going to a facility." This is often true at low care intensities. It is frequently false at high care intensities — and families often discover this only after care needs have already escalated.
At low levels of need — a few hours of companion care or personal care per day — home-based care is typically less expensive than assisted living or nursing facility placement. This is accurate and often the appropriate initial approach.
The math changes as the hours of needed care increase. At near-round-the-clock intensity — which is often required for people with advanced dementia, significant fall risk, or complex personal care needs — in-home care can cost $15,000 to $20,000 per month or more. At that level, home care routinely exceeds the cost of assisted living and approaches or exceeds nursing facility rates.
The complicating factor is that the preference to remain home is strong and legitimate. Most people prefer their own environment, and most families want to honor that preference. The financial reality is that "staying home" and "lower cost" are only reliably paired at lower care intensities. As needs increase, the cost advantage of home care narrows and can reverse entirely.
The relevant planning question is not simply "do you want to stay home?" but "at what point does the cost of staying home exceed what the plan can sustain, and what happens then?"
Portfolio Depletion: How Long Does the Money Last?
The following table shows how long $500,000 and $1,000,000 in assets would fund each care level at current national median costs. These are gross figures — they assume no investment return on remaining assets, no Social Security or pension income offsetting care costs, and no inflation in care costs over time. They represent a simplified worst-case depletion scenario, not a projection.
Figures in red indicate care scenarios where $500,000 is depleted within the typical long-tail care window (5–10 years for dementia-related episodes). These are not hypothetical edge cases — they are the financial consequence of the most common catastrophic care scenario.
THE PLANNING INSIGHT FROM THIS TABLE
The consumer error is focusing on monthly cost while underweighting duration. A family can often absorb one year of care. What depletes portfolios is a multi-year episode with rising acuity — particularly Alzheimer's/dementia episodes that run 8–10 years. At nursing home rates, $500,000 funds roughly 4 years of care. At assisted living rates in an extended dementia case, $1,000,000 funds approximately 13 years — but 8–10 of those years at escalating acuity may exhaust more than the table suggests once memory care premiums and level-of-care fees are included.
The depletion table is a frame, not a prediction. Individual outcomes depend on: actual care costs in the person's geographic market, the mix of care types over the episode, any income (Social Security, pension, rental income) that offsets care costs, and the investment return on assets during the care period. The table isolates the cost variable to make the structure of the problem visible.
Geographic Variation: Where You Live Determines What You Pay
National median figures are a useful planning reference, but long-term care costs vary dramatically by geography. The difference between the highest- and lowest-cost states is not marginal — it is a multiple of two to five times for the same type of care. Where a person lives, and where they plan to receive care, is one of the largest variables in long-term care financial planning.
The drivers of geographic variation include local labor costs and wage floors, real estate and facility operating costs, state regulatory requirements and staffing ratios, provider supply and competition, and the local mix of care settings available.
Three observations from the data:
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The range for nursing home semi-private room is striking — Alaska's $27,831/month is nearly five times Texas's $5,627/month. Both are national data points for the same care category.
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High-cost states for one care type are not always high-cost for others. Oregon is among the highest for private nursing home rooms; it is not the outlier for home care.
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National medians understate the planning requirement for people in high-cost markets. A person planning in Hawaii, Alaska, or the Northeast should not use the national median as a primary cost assumption.
Care cost data should be verified against current local market data before use in financial planning. National benchmarks provide a structural frame; local data provides the planning figure.
The Core Trade-Off: Home-Based vs. Facility-Based Care
For most families, the practical decision about care setting involves a genuine trade-off between emotional preference and financial structure. Neither home-based nor facility-based care is the correct answer across all circumstances. Each involves costs and benefits that depend on the person's condition, the available family support, and the financial plan.
The trade-off is not resolvable in advance for most people. What can be structured in advance is a plan that acknowledges both scenarios — one that funds the preferred option (home) while establishing thresholds and resources for the alternative (facility) if and when the preferred option becomes inadequate or financially unsustainable.
Why These Numbers Are Hard to Use
EMOTIONAL ACKNOWLEDGMENT
Encountering specific long-term care cost figures for the first time is often jarring. The numbers are large relative to what most people expect, and they arrive in the context of a scenario that is already emotionally difficult to engage. The instinct is to discount the figures — to assume costs will be lower, the episode shorter, the family more capable of managing informally than the data suggests. This is a normal response. The figures on this page are presented not to alarm but to replace a vague sense of expense with a concrete and accurate one. Planning against a real number is more productive than planning against a feeling.
Summary
The 2025 national median cost of long-term care ranges from approximately $26,000 per year for adult day services to $129,575 for a private nursing home room. Memory care and assisted living sit in the $74,000–$77,000 range nationally. Skilled nursing at home, extrapolated to ongoing use, exceeds $200,000 annually.
Costs escalate with care intensity — from companion care through personal care, assisted living, memory care, and skilled nursing. Home-based care is typically the lower-cost option at low care intensities, but can equal or exceed facility costs when round-the-clock coverage is required.
Geographic variation is substantial. The same care type can cost five times more in the highest-cost state than the lowest. National medians are planning references; local market data should inform actual planning figures.
Portfolio depletion at nursing facility rates is a real and near-term risk for many retirees. At $9,581/month (semi-private), $500,000 funds approximately 4.35 years of care — within the window of a typical dementia care episode.
Frequently Asked Questions
How much does long-term care cost per month?
The 2025 national medians vary widely by care type: adult day services run approximately $2,167/month; non-medical home care (at 44 hours/week) runs approximately $6,673/month; assisted living is approximately $6,200/month; memory care is approximately $6,450/month (with a range of $4,000–$11,000+); a semi-private nursing home room runs $9,581/month; and a private room runs $10,798/month. These are national medians — actual costs vary significantly by geography, facility quality, and level of care within the category.
How much does a nursing home cost per year?
At 2025 national median rates, a semi-private nursing home room costs approximately $114,975 per year. A private room costs approximately $129,575 per year. These figures do not include ancillary costs such as personal items, medications not covered by insurance, therapy beyond covered limits, or specialized programming. In high-cost markets, annual nursing home costs can substantially exceed these figures.
How long will $500,000 last paying for long-term care?
At 2025 national median rates, $500,000 lasts approximately: 6.72 years for assisted living, 6.46 years for memory care, 4.35 years for a semi-private nursing home room, and 3.86 years for a private nursing home room. These are gross figures assuming no investment return on remaining assets and no income (Social Security, pension) offsetting care costs. They represent a simplified worst-case depletion scenario. A dementia care episode that begins with home care, transitions to memory care, and ends in skilled nursing would likely combine costs from multiple tiers.
How long will $1 million last paying for long-term care?
At 2025 national median rates, $1,000,000 lasts approximately: 13.44 years for assisted living, 12.92 years for memory care, 8.70 years for a semi-private nursing home room, and 7.72 years for a private room. The same gross assumptions apply — no investment return on remaining assets, no income offset. For context, a typical dementia care episode runs 8–10 years or more. $1M at nursing home rates covers that window; $1M at assisted living rates covers it with room to spare — but the actual episode will likely involve escalating acuity and increasing costs over time.
Is it cheaper to stay at home than go to a nursing home?
At low care intensities — a few hours of help per day — yes, home care is typically less expensive than assisted living or nursing facility placement. At high care intensities — near-round-the-clock support — home care can cost as much or more than facility-based care. Extrapolated to 44 hours/week, non-medical home care already exceeds the cost of assisted living. When skilled nursing at home is required on a near-continuous basis, the annual cost can exceed $200,000 — more than a private nursing home room. "Staying home is cheaper" is accurate at low need levels and increasingly inaccurate as care needs intensify.
Why does long-term care cost so much more in some states than others?
Geographic variation reflects local labor costs and wage floors, real estate and facility operating costs, state regulatory requirements and minimum staffing ratios, and the local supply of care providers. The extremes are substantial: nursing home semi-private room costs range from approximately $5,627/month in Texas to $27,831/month in Alaska — a nearly five-fold difference. Planning based on national medians can significantly understate costs for people in high-cost markets such as Alaska, Hawaii, the Northeast, and parts of the Pacific Coast.
What is the cost of memory care vs. assisted living?
The 2025 national median for assisted living is approximately $6,200/month for a standard unit. Memory care — which provides secured environments, dementia-trained staff, and structured programming — runs approximately $6,450/month nationally, though the range ($4,000–$11,000+) reflects significant variation by geography, staffing model, and dementia acuity. Memory care often costs $500–$2,000/month more than the base assisted living rate in the same market. There is no single federal cost-reporting standard for memory care comparable to the nursing home data collected by CMS.
What is the cost of in-home care for someone with dementia?
In-home care for a person with dementia spans a wide range depending on the level of supervision needed. Early-stage dementia may require several hours of companion care daily — perhaps $2,000–$4,000/month. As dementia progresses and continuous supervision becomes necessary, home care costs escalate significantly. Near-round-the-clock in-home support — two caregivers covering day and night shifts — can run $15,000 to $20,000 or more per month, exceeding the cost of memory care facility placement. This is the point at which many families transition to facility-based care for practical as well as financial reasons.
Do long-term care costs go up over time?
Yes. Long-term care costs have historically increased faster than general inflation, driven by rising labor costs, increasing demand, and the growing complexity of care needs in an aging population. Planning models that use current cost figures without any inflation adjustment will understate future costs. Genworth and CareScout cost-of-care surveys have documented consistent annual increases across care categories. Long-term care insurance policies with inflation protection riders are specifically designed to address this dynamic.
What costs are not included in assisted living or nursing home monthly rates?
Base rates for assisted living typically cover a standard unit, meals, activities, and basic personal care. They often do not include: level-of-care fees that increase as care needs intensify ($500–$2,000/month or more at many facilities); medications and medication management beyond basic administration; specialized therapy (physical, occupational, speech) beyond covered limits; personal items, clothing, and incidentals; cable, phone, and internet; beauty and barber services; and transportation for non-medical purposes. In nursing facilities, Medicare covers certain costs during covered stays, but ancillary costs and non-covered items accumulate. Understanding the full cost structure — not just the base rate — is essential for accurate planning.
This page does not predict the cost of care for any individual, recommend a care setting, or advise on how to fund long-term care. Geographic market figures should be verified with current local data before use in financial planning.
The portfolio depletion table is a simplified illustration — it does not account for investment return, income offset, or cost inflation. It isolates the cost variable to make the structural problem visible.
Funding mechanisms — how to pay for long-term care through insurance, assets, Medicaid, and hybrid structures — are addressed in following articles.
This page is part of the WSN Reference Library, a first-principles financial education resource. It explains — it does not advise.