Intro
Skilled nursing becomes essential when you need 24/7 medical care and additional support that assisted living cannot provide.
This level of care costs an average of $116,800/year, making it the most expensive form of long-term care.
This is higher than attending the most expensive colleges in the U.S.
Parents spend decades saving for college, but planning for a nursing home usually isn't part of their conversations.
While you can’t predict if or when you’ll need nursing care, it’s wise to include it in your long-term plan because of its significant cost.
Post jargon
ADLs (activities of daily living): basic tasks like bathing, dressing, eating, transferring, toileting, and continence
assisted living: a type of residential care that assists with ADLs
CNA: certified nursing assistant; entry-level help in nursing homes
LTC: long-term care
LTCi: long-term care insurance
Medicare: health insurance for 65+ adults and disabled
MedicAID: healthcare public assistance
skilled care: continuous care by a nurse, such as administering IV antibiotics
➡️ Explore all the LTC jargon
What is it?
When you move on from assisted living and require more care, your options are often limited to skilled nursing. This can take place in:
To help understand what defines nursing homes, a comparison to other care options is helpful.
| Features | Independent living | Assisted living | Nursing home |
|---|---|---|---|
| Independence | ✅ | ✅ | |
| Home-like | ✅ | ✅ | ❓ |
| ADLs help | ✅ | ✅ | |
| 24/7 care staff | ✅ | ✅ | |
| Skilled care | ✅ |
Nursing homes offer:
- 24/7 medical care
- skilled nursing (wound care, IVs, vital sign monitoring, medications)
- personal care (bathing, dressing, and other ADLs)
- social activities and meals
Odds
28% percent of adults over 65 will require long-term nursing home care at some point, with most staying less than four years. In contrast, memory care often lasts 8 to 10 years.
Why these stats matter
- A quarter of us will use a nursing home, but usually not for very long.
- Nursing home care is crazy expensive (see below). To save on costs, many people delay entering a nursing home until it's absolutely necessary.
Costs
The average cost is currently $117,000 per year and has increased by about 3% annually over the past two decades.
Use an online calculator to see local nursing home costs. For example, the median cost in Denver, Colorado, in 20 years is forecast to be $226k/year.
- Costs vary widely from state to state, often due to supply and demand. For example, a private room in a nursing home varies from $71k (Missouri) to $182k (Connecticut).
Payment options
Self-pay or long-term care insurance are your best options to pay for long-term nursing care.
- 🔴 Private health insurance doesn't cover long-term nursing home care (only short-term).
- 🔴 Medicare only pays for stays under 100 days (only short-term).
- 🟡 MedicAID only helps if you have a severe financial hardship or a disability.
- 🟢 Long-term care insurance covers nursing home care.
Facilities
Nursing homes are usually more like a hospital than a home. They're not your typical vacation spot.
Many facilities have been criticized for poor infection protection, inadequate staffing, and low pay for CNAs (certified nursing assistants).
Dropping our hourly pay
by u/Ok-Zebra8702 in cna
The Department of Health and Human Services introduced new minimum staffing requirements for nursing homes, aiming to improve care by increasing the number of nurses and aides.
....but the nursing home industry is working to overturn these new rules.
That said, a history of challenges in nursing homes doesn’t mean you're without options. Many facilities provide excellent care—you just need to take the time to research and find the right one for you.
Find a place
Nursing home quality varies considerably, so research your options before choosing a place.
Watch this 2-minute video or skip ahead to some helpful online resources.
Good sources
Start with some incredible resources from ProPublica and NursingHome411.
Use the official Medicare website to search for nursing homes near you with facility ratings. Unfortunately, 2 of the 3 ratings are self-reported.
That's dumb. Imagine if restaurant owners could rate themselves on Yelp.
Watch this 8-minute NY Times investigative video about the problems of nursing homes rating themselves.
To compensate for this rating problem, cross-reference these ratings with other online options.
Other options
After you review the above options, move on to these.
- Review sites: US News, Caring.com, Yelp, and Google (reviews can be limited, so compare across multiple platforms)
- Directories: Community Resource Finder and Senior's Blue Book
- Employer reviews: Glassdoor and Indeed
- Senior placement agencies: Search for local options and check chains like Care Patrol and Caring.com. They offer free advice and can guide you through the process. However, keep in mind that advisors are compensated by the facilities, so it’s important to do your own research as well.
In-person research
Online research is a good start, but nothing replaces in-person visits.
- Visit day and night to see care during busy and quiet periods.
- Talk to current residents, family members of residents, and staff.
- Check the menu and try the food.
- Review their medical capabilities and the proximity to a hospital.
- Watch some of the activities.
Wrap up
Planning for a nursing home can feel overwhelming, but it’s a lot like saving for college—just something that’s often off our financial radar.
As we’ve seen, nursing care can cost more than the most expensive universities. By including nursing care in your long-term plan, you ensure you’re ready for whatever comes next. A little planning today brings peace of mind for tomorrow.
