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    Analysis

    Who should pay for long-term care? US costs and UK reform compared

    CareScout's 2025 survey put US median long-term care costs at $129,575 a year for a private nursing home room and $80,080 for 44 hours a week of home care, while Medicare generally does not pay for such care.[1][2] The US relies on means-tested Medicaid and families; the UK government has instead proposed a National Care Service with free personal care for older people.[3][4] The US also reversed course on nursing-home staffing minimums, which the Biden administration framed as a safety measure and the Trump administration as a one-size-fits-all mandate.[5][6]

    Editor reviewedStrict sourcingUpdated AnalysisSocial welfare, Health and medicine, Tech policy
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    Long-term care is one of the largest financial risks of old age, and neither the US nor the UK has settled how to pay for it.[1][7] This analysis separates the sourced facts from interpretation and forecasts and attributes each position to those who hold it. Costs and rules vary by place and person. It is not financial, legal or medical advice; check official sources and talk to a clinician about care needs.

    The facts: costs

    CareScout’s 2025 survey of about 16,000 providers put national median costs at $35 an hour for a non-medical home caregiver, or $80,080 a year at 44 hours a week. It found $74,400 a year for assisted living, $114,975 for a semi-private nursing home room and $129,575 for a private room.[1][8] Assisted living rose 5% in a year, home care 3% and private nursing home rooms 1%.[9] Total US spending on long-term services and supports was an estimated $563.7 billion in 2023. That total does not count unpaid family care.[10] In the UK, the government says one in seven older people face lifetime care costs above £100,000.[7]

    The facts: who pays and who provides care

    Medicare and Medigap generally do not pay for custodial long-term care.[2] Medicare’s skilled nursing benefit ends after 100 days per benefit period, and from day 21 patients pay $217 a day in 2026.[11] In 2023 Medicaid paid 45.6% of LTSS spending and Medicare 18.0%. Out-of-pocket spending made up 14.4% and private insurance 8.7%.[3] About 4.5 million people used Medicaid LTSS in fiscal 2022.[12]

    Home health and personal care aides held about 4.7 million jobs in 2025 at a median $17.21 an hour. The Bureau of Labor Statistics projects 18% growth by 2035.[13] A 2024 CMS rule set minimum nursing-home staffing levels.[14] Public Law 119-21 then barred enforcement until after September 2034, and CMS repealed the standards effective 2 February 2026.[15][16]

    The political positions

    When CMS issued the 2024 rule under the Biden administration, it framed the rule as a way to ensure safe, quality care. It attributed safety problems partly to chronic understaffing.[5] In repealing the rule, CMS under the Trump administration called the standards one-size-fits-all. It cited nursing shortages and warnings from rural and tribal facilities that they could close.[6] Two federal district courts had already vacated the provisions.[16]

    In the UK, Prime Minister Andy Burnham announced on 29 September 2026 that a National Care Service would provide free personal care for older people, based on need.[4] It would be funded by changing the State Pension triple lock from April 2030, which the government estimates would save £15 billion a year by the end of the 2030s.[17] Bed and board would stay means-tested.[18] Baroness Casey’s commission is to recommend how to deliver it by summer 2027.[19]

    Interpretation

    The two countries are debating different parts of the same problem. The US argument in 2025-26 has been about the supply side: how many staff nursing homes must employ. The UK argument has been about the demand side: who pays for personal care. Both run into the same constraint, which is the size and cost of the care workforce. BLS projects a large number of openings each year, which suggests that recruitment, rather than rules alone, will shape what care is available.[13]

    The cost figures also show why Medicaid is so central in the US. At a median $129,575 a year for a private nursing home room, long stays quickly become expensive.[1] Medicare’s benefit is time-limited, so people with long stays tend to spend down until they qualify for Medicaid, or rely on family.[11][3] This is an inference from the payer data, not a measured spend-down rate. The UK plan would remove personal care charges but not accommodation costs, so families could still face large bills for residential care.[18]

    Forecast

    The UK National Care Service is a proposal. It depends on legislation to change the triple lock and on the Casey commission’s recommendations in summer 2027. The government has said the service would be introduced in phases as savings and workforce capacity grow, so its scope in any given year is uncertain.[4][19] In the US, federal staffing minimums cannot be enforced before October 2034 under current law.[15] Changes to Medicaid under the 2025 law may affect long-term care funding, which is covered in the 2025 Medicaid changes. These are projections with considerable uncertainty.

    Context

    For the basics of long-term care and coverage, see the elderly care explainer and Medicare in 2027. For technology that some older people use to live independently, see the medical alert systems buyer’s guide.

    Competing views

    Means-tested safety net plus private funding (current US model)

    Medicare covers only short post-acute stays; Medicaid, which is means-tested and state-designed, is the largest payer, and private sources pay about 31%. Supporters of this model are not quoted in the sources reviewed; the facts describe how the system works.[2][11][3][20]

    Free personal care, funded by pension changes (UK government plan)

    Prime Minister Andy Burnham's government says a National Care Service should give older people free personal care based on need, paid for by adjusting the triple lock, with bed and board still means-tested.[4][18][17]

    Mandatory nursing-home staffing floors

    CMS under the Biden administration said minimum staffing standards were needed to ensure safe, quality care, attributing problems partly to chronic understaffing.[14][5]

    Flexibility over one-size-fits-all mandates

    Congress suspended the standards until 2034, and CMS under the Trump administration repealed them, citing local labour shortages and warnings from rural and tribal facilities about closures.[15][16][6]

    Next in the crash course

    Developing in World & Policy

    Questions readers ask

    How much does long-term care cost in the US?

    CareScout's 2025 national medians were $35 an hour for a home caregiver ($80,080 a year at 44 hours a week), $74,400 a year for assisted living and $129,575 a year for a private nursing home room.[1]

    Why doesn't Medicare cover nursing homes long-term?

    Medicare's skilled nursing benefit is limited to 100 days per benefit period after a qualifying hospital stay, with daily copays from day 21, and it does not pay for custodial care.[11][2]

    Why was the nursing home staffing rule repealed?

    The 2025 reconciliation law barred enforcement until after September 2034, two courts had vacated the provisions, and CMS said the standards were one-size-fits-all and could force rural and tribal facilities to close.[15][16][6]

    Will the UK make social care free?

    The government has proposed free personal care for older people through a National Care Service set up in the next Parliament. Bed and board would stay means-tested, and Baroness Casey is to recommend how and when the service is built up, reporting in summer 2027.[4][18][19]

    Sources

    · 20 claims from 6 publishers

    Each numbered claim is a statement we checked against the sources listed with it. Tap a number in the text to see its sources in place.

    1. [1]

      CareScout's 2025 Cost of Care Survey put US national median costs at $35 an hour for a non-medical home caregiver ($80,080 a year at 44 hours a week), $6,200 a month for assisted living ($74,400 a year), $315 a day for a semi-private nursing home room ($114,975 a year) and $355 a day for a private room ($129,575 a year). confirmedas of 2026-10-11

    2. [2]

      Long-term care, also called custodial care or long-term services and supports, is mostly help with everyday personal tasks such as dressing, bathing and using the bathroom. Medicare and Medigap generally do not pay for it, including care in a nursing home; people may get it through Medicaid if eligible or buy private long-term care insurance. confirmedas of 2026-10-11

      • Long-term care coverage · Medicare.gov (U.S. Centers for Medicare & Medicaid Services) · Description (retrieved 2026-10-11)
      • Long-term care coverage · Medicare.gov (U.S. Centers for Medicare & Medicaid Services) · Coverage details (retrieved 2026-10-11)
      • Long-term care coverage · Medicare.gov (U.S. Centers for Medicare & Medicaid Services) · Who's eligible (retrieved 2026-10-11)
    3. [3]

      In 2023 Medicaid paid 45.6% of US long-term services and supports spending ($257.0 billion) and Medicare 18.0% ($101.7 billion, mostly post-acute nursing and home health care). Public sources paid 69.4% in total, out-of-pocket spending 14.4% and private insurance 8.7%. confirmedas of 2025-08-28

    4. [4]

      On 29 September 2026 the Prime Minister announced that a National Care Service providing free personal care for older people, based on need, would be established in the next Parliament, introduced in phases and paid for by adjusting the State Pension triple lock from April 2030. confirmedas of 2026-09-29

    5. [5]

      When it issued the 2024 rule, CMS under the Biden administration said the standards were meant to ensure safe, quality care, and attributed safety and quality problems at least partly to chronic understaffing, particularly of registered nurses and nurse aides. confirmedas of 2024-05-10

    6. [6]

      In repealing the standards, CMS under the Trump administration said they imposed one-size-fits-all requirements that ignored local labour supply and resident needs, cited projected nursing shortages, and noted warnings from rural and tribal facilities that the rule could force closures. confirmedas of 2025-12-03

    7. [7]

      The UK government says around three in four adults over 65 are expected to need care and support in later life, and one in seven will face care costs above £100,000. confirmedas of 2026-09-29

    8. [8]

      CareScout ran its survey from July to November 2025, contacting 211,985 long-term care providers and completing about 16,000 surveys. It notes that individual providers' prices can differ widely from the medians. confirmedas of 2026-10-11

    9. [9]

      In CareScout's survey, the median monthly cost of assisted living rose 5% from 2024 to 2025, home caregiver rates rose 3%, private nursing home rooms rose 1%, and adult day health care fell 5% to $95 a day. confirmedas of 2026-10-11

    10. [10]

      An estimated $563.7 billion was spent on long-term services and supports in the US in 2023, 13.7% of personal health care spending. That figure leaves out unpaid care by family and friends. confirmedas of 2025-08-28

    11. [11]

      Medicare Part A covers skilled nursing facility care after a qualifying inpatient hospital stay of at least three days, for up to 100 days per benefit period. In 2026 patients pay nothing for days 1-20 after the Part A deductible, $217 a day for days 21-100, and all costs after day 100. confirmedas of 2026-10-11

    12. [12]

      About 4.5 million people, 4.8% of Medicaid enrollees, received Medicaid-covered long-term services and supports in fiscal 2022, while those services made up 33.2% of Medicaid personal health care spending in 2023. confirmedas of 2025-08-28

    13. [13]

      The Bureau of Labor Statistics counted 4,677,100 home health and personal care aide jobs in 2025, with median pay of $35,800 a year ($17.21 an hour). It projects employment to grow 18% from 2025 to 2035, adding 847,300 jobs, with about 760,500 openings a year. confirmedas of 2026-10-11

    14. [14]

      A 2024 CMS rule would have required nursing homes to have a registered nurse on site 24 hours a day, 7 days a week, and to provide at least 3.48 total nurse staffing hours per resident day, including 0.55 RN and 2.45 nurse aide hours. confirmedas of 2025-12-03

    15. [15]

      Section 71111 of the 2025 reconciliation law (Public Law 119-21, signed 4 July 2025) bars CMS from implementing or enforcing those minimum staffing standards until after 30 September 2034. confirmedas of 2025-12-03

    16. [16]

      CMS published an interim final rule on 3 December 2025, effective 2 February 2026, repealing the 2024 staffing minimums and restoring the earlier rule text. It noted that two federal district courts had already vacated the staffing provisions. confirmedas of 2025-12-03

    17. [17]

      The government estimates that adjusting the triple lock would cut State Pension spending by £15 billion a year by the end of the 2030s and £50 billion a year by 2050. confirmedas of 2026-09-29

    18. [18]

      Under the plan, the National Care Service would cover personal care such as eating, bathing and using the toilet, but not bed and board, which would stay subject to means-tested council contributions. confirmedas of 2026-09-29

    19. [19]

      On 29 July 2026 Prime Minister Andy Burnham brought forward the Casey commission's report on delivering a National Care Service from 2028 to summer 2027, and Baroness Casey launched a public "Big Conversation on Care". confirmedas of 2026-07-29

    20. [20]

      Medicaid is means-tested and jointly funded by federal and state governments. It pays for nursing facility care, home health, personal care and other home and community-based services, and each state designs its own programme within federal rules. confirmedas of 2025-08-28

    Revision history (1)
    1. Page created.

    Created Oct 11, 2026. Last reviewed by an editor on Oct 11, 2026. Next scheduled review: Jan 11, 2027.

    Cite this page

    "Who should pay for long-term care? US costs and UK reform compared." ContentLora, updated Oct 11, 2026. https://contentlora.com/analysis/long-term-care-costs-debate

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