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Got senior care? As elderly start to outnumber young, a talk about long-term health care is vital

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Have you had “the talk” with the older adults in your life?

No, not the one about the birds and the bees. The one about long-term health care plans.

If you haven’t gone there, you really need to or you’ll risk financial ruin and a poor end-of-life experience, experts warn.

In a decade, older adults are projected to outnumber kids for the first time in US history, according to the Census Bureau. There will be 77 million people aged 65 and older in 2034, compared to 76.5 million under 18, it says. By 2060, nearly one in four Americans will be 65 and older, the number of 85-plus will triple, and the country will add a half million centenarians.

With this expected surge, America will likely see greater demand for health care, in-home caregiving and assisted living facilities. But the cost of that care is staggering. The median price tag for assisted living is $54,000 a year, a private nursing home room costs $108,405, and basic home care aid for five days a week, eight hours a day runs $56,160, according to a Genworth Cost of Care Survey from 2021.

According to National Health Expenditure projections, home health care spending will increase by 83% from 2018 to 2027, while spending for nursing homes and other continuing care retirement communities will increase by 58%.

“This could be the next public health crisis,” said Michelle Griffith, senior wealth advisor at Citi Global Wealth.

What if I have health insurance?

Health insurance doesn’t normally cover long-term care.

Medicare and supplemental insurance, or Medigap, only pay for short-term acute care, typically for injuries, illnesses, urgent and emergency needs, and for recovery or rehabilitation after surgery.

They don’t cover long-term care because it isn’t considered medical care. Instead, it’s categorized as “a range of services and support for your personal care needs” to assist with everyday living, according to

Only Medicaid will pay for non-medical, long-term nursing home care, indefinitely as long as there’s a need. However, Medicaid is only for people with limited finances, which leaves a huge swath of Americans to fend for themselves.

If you’re rich, paying out of pocket might be okay, but most Americans aren’t so lucky. Half the population is middle-income, according to the Pew Research Center using 2021 data.

“The forgotten middle,” said Narda Ipakchi, vice president of policy at The SCAN Foundation, an independent public charity focused on caring for older adults. “They’re particularly at risk. They don’t qualify for Medicaid and are paying out of pocket, which is prohibitively expensive.”

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What’s being done to help?

Currently, friends and family are picking up the slack. More than 50 million US adults are unpaid caregivers to family, friends, and neighbors, The SCAN Foundation said. They’re the “invisible backbone” of US health care, each spending roughly $7,000 per year on out-of-pocket costs related to caregiving, such as household and medical expenses, it said. AARP also estimated their unpaid work was worth $600 billion a year.

“If we don’t keep these millions of people who do free care for loved ones at home, there’s no way our healthcare system can cover their absence,” said Randy Wolfe, one of those unpaid caregivers who took care of his aging parents and who himself is a senior, soon to be 70 years old.

By day, he’s also president of Lambert’s Health Care, a Knoxville, Tennessee-based home medical equipment company that helps transform homes to allow older adults to stay in them as long as possible.

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Nearly 9-in-10 Americans between the ages of 50 and 80 would like to “age in place,” or age in the comfort of their homes, according to an AARP-sponsored poll last year. Yet nearly half admit they haven’t taken any steps toward this goal.

If you want to age in place, it’s not outrageously expensive to modify your home to do so, experts say. It’s just that people don’t consider doing so until it’s too late.

“Many don’t have the opportunity to age in place because it comes upon them, and they’ve done no proper planning,” said Tom Ryan, president of the industry group American Association for Homecare. “Then it’s crisis mode.”

While you’re still healthy and able to get around your house, consider adding modifications in stages to spread out the costs over several years, Wolfe suggests. Items to consider installing or shoring up include:

  • Safety bath benches and grab bars in showers and baths, which cost around $100, and help older people avoid breaking hips or ribs by falling in a bathtub.

  • Old decks and railings need repair to prevent wiggling. That way, older adults with bad knees won’t fall.

  • Stairlifts, whose cost ranges from $2,900 to $3,500, can be installed for straight stairs, don’t require construction and can be added in a day.

  • Elevated toilets generally cost less than $500 to install in a couple of hours.

  • Lift chairs, which help a person sit and stand without assistance, cost about $700 for the most basic and $3,000 for the fanciest. They also allow people to take naps without walking to a bedroom or elevating their feet to reduce swelling.

What can I do to prepare financially?

When speaking to a qualified financial adviser, make sure long-term care is part of your plan. And don’t forget to speak to a tax adviser because parts of your plan, including home modifications, may be deductible, experts say.

Financially, people have at least two options, according to Denis Poljak, managing director at Poljak Group Wealth Management at Steward Partners Global Advisory:

  • Long-term care insurance helps cover costs when you have a chronic medical condition, disability or disorder such as Alzheimer’s disease. The key though is to buy this early enough (generally, in your 50s) when you’re healthy because as you age, premiums rise, and it can get prohibitively expensive. Note, women typically pay more because they outlive men and require an average of 3.7 years of care to men’s 2.2 years, government data show.

Since payouts are capped in dollars, ask for an inflation rider to protect that against rising prices over time, he said. Also, ask if the policy has a guaranteed renewal so it can’t get canceled if you have a healthcare issue; a waiting period for when your payouts begin that you might have to cover out of pocket; and a non-forfeiture benefit so you can still get a portion of the benefit even if the contract is terminated or lapsed, he said.

  • Universal life insurance with a long-term care rider or chronic illness rider allows you to tap into your life insurance policy’s death benefit while you’re still living if you’re diagnosed with a qualifying health issue. For example, if you have a $1 million life insurance policy and use $300,000 for long-term care expenses, your beneficiary will receive $700,000 from it.

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Can the government help?

President Joe Biden signed an executive order in April to boost compensation for care workers, support family caregivers, and expand affordable care options through 50 directives to federal agencies. However, it may be a while until we can see the results from that.

Meantime, some states are acting. On July 1, Washington state workers will pay up to $0.58 per $100 of earnings to fund a long-term care fund, WA Cares Fund, for eligible residents to begin tapping in July 2026. Each person will be able to access care costing up to $36,500 (adjusted annually for inflation) over their lifetime, the state said.

Medora Lee is a money, markets, and personal finance reporter at USA TODAY. You can reach her at [email protected] and subscribe to our free Daily Money newsletter for personal finance tips and business news every Monday through Friday morning.

This article originally appeared on USA TODAY: Senior health care to gain importance as older adults outnumber kids