The Costs Of Long Term Care By State

None of us will get out of here alive.  Sorry for the unfortunate truth bomb.  And although lifespan in general in America has gone up over the years with some recent declines, healthspan, or the number of years a person can expect to live free of chronic disease and in relatively good health, has not. 

So Americans are increasingly in need of long term care or nursing home care at earlier ages due to the epidemics of lifestyle related chronic disease.  If you haven’t faced these issues yet, you’re likely to in the future for either yourself or a loved one.  And that means long term care.

What is long term care?  Healthcare.gov defines it thusly:

Services that include medical and non-medical care provided to people who are unable to perform basic activities of daily living such as dressing or bathing. Long-term supports and services can be provided at home, in the community, in assisted living or in nursing homes.  Individuals may need long-term supports and services at any age. 

Long term care is expensive.  Most importantly, long term care is not healthcare and thus is not paid for by health insurance.  Medicare in some cases will cover short stays in a nursing home under strict conditions, but in general your health insurance will not help you with long term care. 

Medicaid will cover long term care but only if the patient has a very low income and $2,000 of assets or less beyond their primary home. 

How expensive is long term care and how much does it vary across the nation?  I haven’t done a mapping post in a while, but I’m here at your service to show the goods.

 

Different Types

There are different types of long term care and the lines between them can be easily blurred.  I have good and recent cost data broken down by state from the American Council On Aging and Long Term Care Insurance Partner and they break long term care into 4 main categories:

• Home Care Providers
• Adult Day Health Care Facilities
• Assisted Living Facilities
• Nursing Homes

There are others out there such as independent living facilities and hospice care.  But let’s look at the cost data for the 4 categories defined above.

 

Home Health Care

Medicare.gov defines home health care thusly:

Home health care is a wide range of health care services that can be given in your home for an illness or injury. Home health care is usually less expensive, more convenient, and just as effective as care you get in a hospital or skilled nursing facility (SNF). 

Here is the breakdown of the monthly costs of home health care by state (click on map for larger version):

 

The three most expensive states are: 

• Minnesota $6,292
• Washington $6,031
• Rhode Island $5,911

The three least expensive states are:

• Louisiana $3,241
• Alabama $3,432
• Mississippi & West Virginia (tied) $3,537

 

Adult Day Care

Eldercare.acl.gov defines adult day care as:

Adult Day Care Centers are designed to provide care and companionship for older adults who need assistance or supervision during the day. Programs offer relief to family members and caregivers, allowing them to go to work, handle personal business, or just relax while knowing their relative is well cared for and safe. 

You may see adult day care referred to as “adult day health care”, or “adult day services”, or “senior day care” among other terms.

Here is the breakdown of the monthly costs of adult day care by state (click on map for larger version):

 

The three most expensive states are: 

• Maine $3,467
• Wyoming $3,250
• Alaska $3,055

The three least expensive states are:

• Alabama $655
• Texas $698
• North Carolina $1,278

 

Assisted Living

WebMD defines assisted living as:

Assisted living is a type of housing designed for people who need various levels of medical and personal care. Living spaces can be individual rooms, apartments, or shared quarters. The facilities generally provide a home-like setting and are physically designed to promote the resident’s independence. Services are offered to assist residents with daily living.

Here is the breakdown of the monthly costs of assisted living by state (click on map for larger version):

 

The three most expensive states are: 

• Delaware $6,690
• New Jersey & New Hampshire (tied) $6,650
• Alaska $6,633

The three least expensive states are:

• Missouri $3,000
• Alabama $3,150
• Utah $3,400

 

Nursing Home

The first thing to know about nursing homes is that there is something called NHLOC, which stands for “Nursing Home Level Of Care”.  Sounds like a good thing and that there seems to be a standard. 

Nope.  As Medicaid’s help section says:

Because the federal government doesn’t universally define the criteria for a nursing home level of care, each state must set its own definition. Specific rules and approved assessment tools vary depending on where you live, and states may use different ranking systems for determining the appropriate level of care for an individual. 

One would think that since Medicaid is often used to pay for a nursing home and that Medicaid is one of the Federal Government’s welfare programs that the Feds would come to a universal criteria for NHLOC.  But maybe that makes too much sense.  Regardless a more general definition of a nursing home is this provided by Medcine.Net.

A residential facility for people with chronic illness or disability, particularly older people who have mobility and eating problems. Also known as a convalescent home and long-term care facility.

Here is the breakdown of the monthly costs of a nursing home with a semi-private room (click on map for larger version):

 

The three most expensive states are: 

• Alaska $37,413 (yes that’s monthly, and yes I checked other sources to verify)
• Connecticut $12,927
• Massachusetts $12,623

The three least expensive states are:

• Texas $5,019
• Missouri $5,080
• Oklahoma $5,323

 

And here is the breakdown of the monthly costs of a nursing home with a private room (click on map for larger version):

The three most expensive states are: 

• Alaska $36,378
• Connecticut $13,992
• Hawaii $13,802

The three least expensive states are:

• Missouri $5,749
• Oklahoma $5,779
• Louisiana $5,840

 

Geography matters.  The yearly cost difference of a nursing home with a private room between Alaska ($436,536) and Missouri ($68,988) is $367,548. 

Like me you might be wondering why nursing homes in Alaska cost such an exorbitant amount.  I found this slightly dated article about the issue but it doesn’t provide much insight except to state that Alaska is an expensive state.  Since this blog reaches literally dozens of people (numerous dozens!) please chime in below if you have specific knowledge of the issue.

 

Geoarbitrage

So there you have it financial warriors, some super-duper maps that show the average monthly costs of different kinds of long term care in America.

I do lots of posts like this that show various aspects of money and finance from a location perspective.  So you’re considering Geoarbitrage in the United States be sure to check out my Geoarbitrage Resources Page which has tons of great tools to help you find your perfect location.

I hope you find these resources handy and I will continue to expose valuable tools that can help when deciding on a geoarbitrage strategy.