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    Elderly care explained: long-term care costs, who pays, US and UK

    Long-term care is mostly help with everyday tasks such as bathing and dressing. Medicare generally does not pay for it, so in the US it is funded mainly by Medicaid, which paid 45.6% of long-term care spending in 2023, and by families.[1][2] CareScout's 2025 survey put the median cost of a private nursing home room at $129,575 a year.[3] In the UK, Prime Minister Andy Burnham announced in September 2026 a plan for a National Care Service with free personal care for older people, to be set up in the next Parliament.[4]

    Editor reviewedStrict sourcingUpdated ExplainerSocial welfare, Health and medicine, Tech policy

    Many people need help with daily life in old age. The UK government, for example, estimates that around three in four adults over 65 will need care and support.[5] This explainer covers what long-term care is, what it costs, who pays, and how the US and UK systems are changing. It is the first page in a short course. Costs and coverage rules vary by state, country and person, so check Medicare.gov, your state Medicaid agency or your local council. This page is general information, not medical, legal or financial advice. Talk to a clinician about care needs.

    What long-term care is

    Long-term care, sometimes called custodial care, is mostly help with everyday personal tasks. Examples are dressing, bathing and using the bathroom.[1] It can be given at home, in an assisted living community or in a nursing home.[3] It is different from short-term skilled nursing care after a hospital stay. Medicare covers that kind of care for a limited time.[6]

    US data sources call it long-term services and supports (LTSS). It covers nursing facility care, home health, personal care and other home and community-based services.[7] In 2023, LTSS spending was an estimated $563.7 billion, 13.7% of personal health care spending. That figure excludes unpaid care by family and friends.[8] It is based on an expanded definition that includes Medicare post-acute skilled nursing and home health spending.[2]

    What it costs in the US

    CareScout’s 2025 Cost of Care Survey gives these national medians.[3]

    Setting2025 national medianAnnual
    Non-medical home caregiver$35 an hour$80,080 (44 hours a week)[3]
    Assisted living$6,200 a month$74,400[3]
    Nursing home, semi-private room$315 a day$114,975[3]
    Nursing home, private room$355 a day$129,575[3]

    Assisted living costs rose 5% from 2024 and home caregiver rates 3%.[9] The survey covered about 16,000 providers. CareScout notes that individual prices can differ widely from the medians.[10] The long-term care costs analysis looks at what these numbers mean for families and policy.

    Who pays

    Medicare, the health programme for people 65 and over, generally doesn’t pay for long-term care.[1] It pays for a short nursing home stay after at least three days in hospital. Even then, from day 21 you pay $217 a day in 2026, and after day 100 you pay everything.[6] Medicaid, which is for people with low income and few assets, is the biggest payer of long-term care. Families pay much of the rest themselves.[7][2] See Medicare in 2027 and the 2025 Medicaid changes.

    In 2023 Medicaid spent $257.0 billion on LTSS, 45.6% of the total. Medicare spent $101.7 billion (18.0%) on skilled nursing and home health. Public payers covered 69.4% overall, out-of-pocket spending 14.4% and private insurance 8.7%.[2] About 4.5 million people, 4.8% of Medicaid enrollees, used Medicaid LTSS in fiscal 2022, yet LTSS made up 33.2% of Medicaid personal health spending.[11] Each state designs its own Medicaid programme within federal rules.[7] People who qualify for SSI get Medicaid in most states.[12]

    The care workforce

    The Bureau of Labor Statistics counted about 4.7 million home health and personal care aide jobs in 2025, with median pay of $35,800 a year. It projects 18% growth to 2035 and about 760,500 openings a year.[13] In nursing homes, a 2024 CMS rule would have required a registered nurse on site around the clock and at least 3.48 nurse staffing hours per resident per day.[14] The 2025 reconciliation law blocked enforcement until after September 2034.[15] CMS repealed the standards with effect from 2 February 2026.[16]

    The UK: social care reform

    In England, adult social care is the subject of an independent commission chaired by Baroness Louise Casey. It was set up in January 2025.[17] On 29 July 2026 Prime Minister Andy Burnham brought its report on delivering a National Care Service forward from 2028 to summer 2027.[18] On 29 September 2026 he announced that the service would provide free personal care for older people, based on need, and would be set up in the next Parliament. It would be funded by adjusting the State Pension triple lock from April 2030.[4] Bed and board would remain means-tested.[19] The government says one in seven older people face lifetime care costs above £100,000.[5]

    Next in this course

    Read the long-term care costs analysis for the competing policy views, then the medical alert systems buyer’s guide. For coverage details, continue with Medicare in 2027 and the 2025 Medicaid changes. Younger disabled adults should also see the disability benefits explainer.

    Next in the crash course

    Developing in World & Policy

    Questions readers ask

    Does Medicare pay for long-term care?

    Generally no. Medicare and Medigap do not pay for long-term (custodial) care, including care in a nursing home. Medicare Part A covers short skilled nursing facility stays after a qualifying hospital stay of at least three days, up to 100 days per benefit period.[1][6]

    How much does a nursing home cost in 2025?

    CareScout's 2025 survey put national medians at $315 a day ($114,975 a year) for a semi-private room and $355 a day ($129,575 a year) for a private room. Prices vary widely by location and provider.[3][10]

    Who pays for long-term care in the US?

    In 2023 Medicaid paid 45.6% of long-term services and supports spending and Medicare 18.0%, mostly for post-acute care. Out-of-pocket spending was 14.4% and private insurance 8.7%.[2]

    How much does home care cost?

    CareScout's 2025 national median for a non-medical home caregiver was $35 an hour, or $80,080 a year at 44 hours a week.[3]

    What happened to the nursing home staffing rule?

    The 2025 reconciliation law barred CMS from enforcing the 2024 minimum staffing standards until after 30 September 2034, and CMS repealed them in an interim final rule effective 2 February 2026.[15][16]

    What is the UK's National Care Service plan?

    The government says a National Care Service providing free personal care for older people, based on need, will be established in the next Parliament, funded by adjusting the State Pension triple lock from April 2030. Bed and board would remain means-tested.[4][19]

    Sources

    · 19 claims from 7 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]

      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)
    2. [2]

      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

    3. [3]

      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

    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]

      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

    6. [6]

      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

    7. [7]

      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

    8. [8]

      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

    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]

      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

    11. [11]

      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

    12. [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

    13. [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

    14. [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

    15. [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

    16. [17]

      In January 2025 the UK government announced an independent commission into adult social care in England, chaired by Baroness Louise Casey, with a first phase reporting in 2026 and a second by 2028, as a step towards a national care service. confirmedas of 2025-01-03

    17. [18]

      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

    18. [19]

      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

    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

    "Elderly care explained: long-term care costs, who pays, US and UK." ContentLora, updated Oct 11, 2026. https://contentlora.com/explain/elderly-care-explained

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