United States – Elderly Care

How are elderly people regarded and treated in the United States?

American attitudes toward growing older are layered and sometimes contradictory. The culture prizes personal independence and self-reliance above most other values, and this shapes the entire architecture of care — the majority of older adults express a strong preference for remaining in their own homes for as long as their health permits, a concept widely known as “ageing in place.” This preference has generated robust demand for home-based support services and has accelerated the adoption of telehealth platforms and remote monitoring tools intended to extend care delivery beyond institutional walls.

According to the US Bureau of Labor Statistics, fourteen percent of the civilian noninstitutional population aged 15 and over — roughly 38.2 million people — provided unpaid care to an elderly person during the 2023–2024 period. On any given day, approximately 28 percent of those caregivers were engaged in this unpaid work, devoting an average of 3.9 hours to it. These figures highlight how central informal family caregiving remains to the American eldercare landscape, especially for those who have not yet reached the point of requiring professional residential support or who cannot afford it.

The US model stands in sharp contrast to the universal, publicly financed frameworks found in countries such as Germany or the Nordic nations, where long-term care insurance or state provision covers a wide range of needs for most residents. The existing eldercare infrastructure in the United States is widely considered ill-equipped to meet the rising tide of demand, with a shortage of quality, affordable options leaving many older Americans unable to spend their final years in dignity. This gap is increasingly recognised in public discourse and is a critical consideration for anyone contemplating ageing in the country.

As of 2024, approximately 61 million Americans were aged 65 or older, accounting for around 18% of the total US population. Projections indicate that by 2060, this figure will climb to 95 million, representing nearly a quarter of the country’s population. This demographic transformation is placing mounting pressure on an already stretched system and is fuelling policy debate at both state and federal levels.

What state or publicly funded elderly care is available in the United States?

The United States has no single national elderly care system comparable to the NHS in the United Kingdom or the publicly managed long-term care insurance programmes found in Japan or Germany. Public support is instead channelled through an overlapping patchwork of federal and state programmes, the most consequential of which are Medicare and Medicaid.

Medicare is the federal health insurance scheme designed primarily for people aged 65 and over. The Social Security Administration (SSA) determines who qualifies and manages enrolment for the two foundational Medicare components: Part A, which covers hospitalisation, and Part B, which covers physician services and most outpatient care. Those enrolled in both Parts A and B may elect to receive their benefits via a managed care arrangement known as Medicare Advantage. A crucial limitation to understand is that Medicare does not generally pay for extended nursing home stays, nor does it cover activities of daily living such as meal provision, room and board, or housekeeping. Medicare will fund a nursing home placement for a maximum of 100 days — and only where the individual was admitted to the skilled nursing facility within 30 days of a qualifying hospital discharge.

Medicaid is the joint federal–state programme providing coverage for people with low incomes and modest assets. Unlike Medicare, Medicaid does cover long-term residential nursing home care for those who meet its eligibility criteria. The programme extends health coverage to 7.2 million low-income seniors who are also enrolled in Medicare. Medicaid also funds services not included under Medicare, among them nursing facility care beyond the 100-day Medicare ceiling, prescription medications, eyeglasses, and hearing aids.

Medicaid eligibility is assessed across multiple dimensions, and each state applies its own rules, with income thresholds revised annually. As a general guide for 2026, a single senior aged 65 or older must have income no greater than $2,982 per month to qualify for Nursing Home Medicaid or a Home and Community-Based Services (HCBS) Waiver. Thresholds should always be confirmed with your state’s Medicaid office or via medicaid.gov, as they are subject to change.

The Older Americans Act (OAA) is another significant piece of federal legislation that supports older residents. According to the US Department of Health and Human Services, programmes funded by the OAA assist one in six older adults annually. These services include home-delivered meals, transportation assistance, caregiver support, and the Long-Term Care Ombudsman programme. OAA reauthorisation has been subject to ongoing Congressional debate; readers should verify the programme’s current status through acl.gov or its successor agency.

What residential, care home, and nursing home options exist in the United States?

The US eldercare market encompasses a wide spectrum of residential arrangements, ranging from independent retirement communities at one end to intensive skilled nursing facilities at the other. The most suitable option in any given case will depend on the individual’s health requirements, degree of independence, and financial situation.

• Independent Living Communities: Sometimes referred to as retirement communities or senior apartments, these settings are intended for active older adults who need little or no daily help. Residents typically occupy private apartments and enjoy access to communal facilities, organised activities, and in some cases dining services. These communities are not generally covered by Medicare or Medicaid.
• Assisted Living Facilities (ALFs): These provide assistance with activities of daily living (ADLs) — including bathing, dressing, and medication management — while permitting residents to retain a meaningful degree of independence. Assisted living occupies the middle ground between independent living and nursing home care, combining personal care, meals, and social programming with a greater degree of autonomy than a nursing home setting.
• Memory Care Units: These are specialist secured environments — sometimes embedded within an assisted living community and sometimes operating as standalone facilities — for individuals living with Alzheimer’s disease or other dementias. Although costly, memory care units offer structured activities, a safe physical environment, and much-needed relief for family caregivers.
• Skilled Nursing Facilities (SNFs) / Nursing Homes: These settings provide round-the-clock medical supervision and nursing care. Staffing typically includes registered nurses, licensed practical nurses, and therapists. Some facilities also offer short-term rehabilitation following surgery or acute illness.
• Continuing Care Retirement Communities (CCRCs): These campus-style developments offer a graduated spectrum of care — from independent living through to assisted living and skilled nursing — enabling residents to remain within the same community as their care needs evolve. They typically require a significant entrance payment in addition to ongoing monthly charges.

Oversight of nursing homes and assisted living facilities is largely a state responsibility, but federal regulation is exercised through the Centers for Medicare & Medicaid Services (CMS). CMS certifies facilities that participate in Medicare and Medicaid and makes inspection results, staffing data, and quality ratings publicly available through its Care Compare tool, which enables individuals to compare nursing homes, home health agencies, and other care providers side by side. This is an indispensable resource when evaluating specific facilities.

Assisted living facilities are licensed and regulated at the state level, and the standards applied vary considerably. Some states mandate minimum staffing ratios and rigorous inspection cycles; others adopt a lighter-touch approach. Always review a facility’s most recent inspection report and, wherever possible, conduct an in-person visit before reaching a decision.

How much does elderly care cost in the United States?

Elderly care in the United States ranks among the most expensive in the world, and costs have been climbing at a rate that substantially outpaces general inflation for several decades. Since 1997, the prices for nursing homes and adult daycare measured in the Consumer Price Index have risen at nearly twice the pace of overall inflation; as of December 2024, nursing home prices had increased by 193% compared with an overall inflation increase of 100%. Realistic financial planning is therefore not optional — it should begin well before care becomes necessary.

Nursing Homes (Skilled Nursing Facilities): In 2024, the national annual median cost of a semi-private room in a skilled nursing centre reached $111,325 — a 7% rise from the previous year — while the median cost of a private room climbed 9% to $127,750 annually. Expressed monthly, this equates to approximately $9,277 for a semi-private room and $10,646 for a private room. Regional variation is considerable: Texas offers some of the most affordable nursing home rates, at $5,639 per month for a semi-private room, while Alaska, New York, and Massachusetts sit at the opposite end of the pricing spectrum.

Assisted Living: The national median monthly cost for assisted living rose 5% to $6,200 per month, or $74,400 annually, based on survey data collected between July and November 2025. Assisted living prices vary considerably across the country, reflecting differences in availability and local cost of living, with Washington, D.C. recording the highest costs and Louisiana the lowest.

Memory Care: Analysis conducted in late 2025 found that assisted living memory care units nationally average approximately $7,000–$8,500 per month, reflecting the specialist staffing and secure environments these units require.

Home Care: Home health aide services cost an average of $214 per day ($77,792 per year), based on an eight-hour day provided five days per week — more intensive or round-the-clock care will cost considerably more. Many families begin with part-time home support and move to a residential setting as the individual’s needs intensify.

Always request a fully itemised schedule of fees from any facility you are considering, and probe specifically what is and is not included in the headline rate. The Federal Long Term Care Insurance Program’s Cost of Care Tool also allows you to look up regional cost data broken down by care type.

Can expats access elderly care in the United States, and are there any restrictions?

Access to publicly funded elderly care for foreign nationals in the US is substantially restricted and depends on a combination of immigration status, US work history, and duration of residency. This represents a significant departure from certain European systems, where long-term residency alone may be sufficient to unlock care entitlements.

Medicare eligibility for non-citizens: Prior to legislation enacted in 2025, US residents — including citizens, permanent residents, and lawfully present immigrants — were eligible for premium-free Medicare Part A if they or their spouses had worked at least 40 quarters (10 years) in positions where Medicare payroll taxes were paid, and if they were at least 65 years old. From July 2025, Medicare eligibility was restricted to US citizens, permanent residents (green card holders), Cuban-Haitian entrants, and individuals residing under the Compacts of Free Association. This means that lawfully present immigrants who fall outside these categories — including refugees, asylees, and holders of Temporary Protected Status — are no longer eligible for Medicare. This represents a major policy shift, and anyone in a non-citizen immigration category should verify their current eligibility without delay at cms.gov.

Medicaid eligibility for non-citizens: A 1996 welfare reform statute requires immigrants to have completed five years of lawful US residency before becoming eligible for federal benefits including Medicaid. Many immigrants must serve out this five-year waiting period after obtaining qualified noncitizen status before they can enrol. States may waive this requirement for children and pregnant individuals, but this waiver does not generally extend to elderly immigrants. Some states deploy their own funds to broaden coverage; California is a prominent example where more expansive eligibility criteria have been applied.

An older immigrant’s length of US residency and work history also influence Medicare premiums and, in some instances, eligibility. Part A premiums — which are tied directly to work history — can pose a particular challenge for older immigrants who arrived later in life and have accumulated little or no US employment history.

No bilateral agreement or EU-citizen exemption confers preferential access to US public elderly care programmes — all non-citizens are subject to the same federal rules regardless of their country of origin. Private insurance and personal savings are therefore essential for the majority of expats in the US, particularly in the early years of residency. Always confirm your current eligibility directly with the relevant state Medicaid office and with the Social Security Administration.

What private elderly care and international options are available in the United States?

The private elderly care sector in the United States is expansive, well-established, and diverse. Because public provision is limited in scope, the overwhelming majority of care — particularly assisted living and residential nursing — is delivered by private operators. This creates a broad range of choices in terms of quality, amenities, and specialist services, but it also concentrates a substantial financial burden on the individual and their family.

Prominent national operators include chains such as Sunrise Senior Living, Brookdale Senior Living, Five Star Senior Living, and Atria Senior Living, all of which maintain facilities across multiple states offering varying levels of care and amenity. Continuing Care Retirement Communities offered by organisations such as Life Care Services or Erickson Senior Living represent a premium, all-inclusive option, typically demanding a considerable upfront entrance deposit — which may range from $100,000 to $500,000 or beyond — in addition to monthly fees.

For expats from particular cultural or linguistic backgrounds, specialist communities and facilities can be found in many major metropolitan areas. Cities with substantial immigrant populations — including New York, Los Angeles, Miami, Chicago, and Houston — commonly have care settings with multilingual staff, culturally appropriate food, and programming tailored to specific communities. It is worth searching local directories such as Medicare’s Care Compare and enquiring directly about language support during facility visits.

A number of religious organisations operate non-profit care facilities — including Catholic Charities, Jewish Family Services, and various Protestant church-affiliated networks — which may offer more affordable rates and culturally sensitive environments. These facilities are subject to the same state licensing requirements and CMS oversight as any other provider.

Quality across the private market is highly variable. Premium facilities can deliver hotel-standard surroundings, rich recreational programming, and specialist medical teams. Budget facilities or those in under-resourced regions, however, may face staffing difficulties and inconsistent quality. Always review a facility’s CMS Care Compare rating and most recent inspection report before committing to a placement.

What role does health insurance play in covering elderly care in the United States?

Health insurance occupies a central position in the US elderly care system, but it is vital to have a clear understanding of what different types of coverage do and do not include — especially with regard to long-term residential care.

Medicare covers acute medical treatment, inpatient hospital stays, short-term skilled nursing rehabilitation, and certain home health services. As noted, it does not fund custodial long-term care such as permanent nursing home residency or ongoing assisted living. Medicare operates through four basic coverage categories: Part A (hospitalisation), Part B (physician and outpatient services), Part C (Medicare Advantage plans marketed by private insurers), and Part D (prescription drug coverage).

Long-term care (LTC) insurance is a private insurance product engineered specifically to cover the costs that Medicare excludes — among them assisted living, nursing home care, and home health aides. Policies differ widely in their scope of coverage, benefit duration, elimination periods (the waiting time before payments commence), and the daily or monthly benefit amounts they provide. Premiums are considerably lower when a policy is taken out at a younger age and in good health, which is why financial advisers typically recommend exploring LTC insurance during one’s 50s or early 60s. Certain supplemental insurance plans can also help close the gap between what Medicare provides and what individuals actually need.

Expats without Medicare eligibility must fund their care either through private health and LTC insurance or from personal savings. Many expats in the US carry international health insurance policies while awaiting Medicare eligibility. These can be adequate for acute medical needs but rarely offer sufficient coverage for long-term residential care — policy wording should be examined carefully, with particular attention to provisions relating to long-term or custodial care.

When assessing any insurance product for elderly care purposes, pay close attention to: the daily benefit amount and whether it is indexed to inflation; whether the policy covers home care in addition to residential settings; the elimination period before benefits are triggered; and whether the policy is guaranteed renewable. Seeking advice from an independent insurance broker experienced in both expat and senior care markets is strongly advisable.

What should expats consider when planning for elderly care in the United States?

Forward planning is especially important for expats in the US, given the predominantly market-based nature of the care system and the eligibility barriers that govern access to public programmes. The practical steps below can help ensure that you or a family member are well positioned when care needs arise.

1. Understand your immigration status and its care implications. Your visa category, duration of US residency, and employment history in the country will determine whether you qualify for Medicare or Medicaid. Review your eligibility periodically, as legislative changes can alter your position — the 2025 Medicare eligibility restrictions are a recent illustration of this. Seek advice from an immigration attorney if your status is uncertain.
2. Research long-term care insurance early. If you intend to remain in the US permanently, investigate LTC insurance while you are still in good health. Premiums escalate steeply with age, and pre-existing conditions can trigger exclusions or outright denial of coverage.
3. Establish legal documents valid in the US. Ensure you hold a US-recognised Durable Power of Attorney (DPOA) and an advance healthcare directive (sometimes called a living will or healthcare proxy). These instruments authorise a nominated individual to take financial and medical decisions on your behalf should you lose capacity. Documents executed in another country are not automatically recognised by US healthcare providers or financial institutions.
4. Understand next-of-kin rights for foreign nationals. If your nearest family members reside outside the US, ensure they have been formally empowered to act on your behalf. A healthcare proxy designation is particularly important. Without one in place, medical decisions may default to institutional protocols that may not reflect your personal wishes.
5. Build a local support network. Social engagement and community connection are well recognised as beneficial to the mental health and overall wellbeing of older adults. Cultivating relationships with local community organisations, faith groups, or expat networks can be valuable both now and in future years.
6. Consult local legal and financial professionals. An elder law attorney and a financial planner with expertise in the US system — and ideally in expat situations — can provide personalised guidance on Medicaid planning, asset protection, estate planning, and insurance. This is particularly important given that Medicaid eligibility rules are complex and differ state by state.
7. Research facility options well in advance. Statistically, seven out of ten people will require long-term care at some point in their lives. Waiting until a care crisis strikes leaves little room for thorough research. Visiting facilities, reviewing inspection records on Care Compare, and familiarising yourself with the local care market in your region is best done long before care becomes urgent.

What are the best official sources of information on elderly care in the United States?

Given how frequently eligibility criteria, fee thresholds, and programme structures change in the US, it is vital to consult official, current sources rather than relying solely on secondary summaries. The following are the most authoritative resources for elderly care information in the United States:

• Centers for Medicare & Medicaid Services (CMS): The principal federal regulatory authority for Medicare, Medicaid, and care facility certification. Publishes eligibility information, facility inspection data, and quality ratings. cms.gov
• Medicare Care Compare: CMS’s official comparison tool for nursing homes, home health agencies, hospices, and other care providers. Includes inspection results and staffing information. medicare.gov/care-compare
• Medicaid.gov: Official information on Medicaid eligibility, state-level programmes, and long-term care coverage, with links to individual state Medicaid agencies. medicaid.gov
• Social Security Administration (SSA): For Medicare enrolment, work credit eligibility, and information on Social Security benefits for older residents, including non-citizens. ssa.gov
• Administration for Community Living (ACL) / Administration for Children, Families, and Communities (ACFC): Administers Older Americans Act programmes. Note that ACL is undergoing restructuring in 2025–2026; verify the current status at acl.gov.
• Long-Term Care Ombudsman Programme: A federally mandated programme that champions the rights of residents in nursing homes and assisted living facilities. Each state maintains its own Ombudsman office — find your state’s contact via acl.gov.
• Federal Long Term Care Insurance Program (FLTCIP): Provides cost of care data and information on long-term care insurance options. ltcfeds.gov
• State Health Insurance Assistance Programs (SHIPs): SHIPs deliver free, impartial, one-on-one counselling to Medicare beneficiaries and their families. There are 54 SHIPs organised at the state and territory level, offering unbiased guidance on Medicare benefits, coverage options, and low-income assistance programmes. SHIP services are provided at no charge and are not subject to any income or demographic restrictions. Locate your local SHIP at shiphelp.org.

All specific fees, eligibility thresholds, and facility listings should be verified directly through these official channels. The information in this article reflects data available as of early 2026, but rules and figures are subject to regular revision.

Frequently Asked Questions About Elderly Care in the United States

Does Medicare cover nursing home care long-term?

Medicare funds nursing home care for a maximum of 100 days, and only where the individual was admitted to the skilled nursing facility within 30 days of leaving hospital. It does not cover open-ended residential or custodial nursing home stays. Medicaid — for those who satisfy its financial eligibility criteria — and private long-term care insurance are the primary mechanisms for funding extended nursing home care.

Can I access US public elderly care if I am a permanent resident (green card holder)?

Permanent residents holding a green card may qualify for Medicare provided they meet the age and work history requirements, and may become eligible for Medicaid after completing five years of lawful permanent residency. Both Medicare costs and eligibility are influenced by the length of US residency and employment history — Part A premiums, which are linked to work history, can present a challenge for those who arrived in the US later in life with limited domestic employment. Always confirm your current eligibility with the SSA and your state’s Medicaid agency.

What happens if a family member in the US suddenly needs emergency residential care?

In an emergency situation, a hospital social worker will normally take the lead in coordinating a discharge plan, which may involve short-term placement in a skilled nursing facility. Medicare covers up to 100 days of skilled nursing care following a qualifying hospital stay. Where the individual does not meet Medicare or Medicaid eligibility requirements, private-pay admission to a nursing home or assisted living facility will be necessary. Having legal documents — including power of attorney and healthcare proxy — prepared before any emergency arises is essential to allow family members, particularly those living abroad, to respond swiftly and effectively.

Are there language support services in US care facilities?

Care facilities in major cities with large immigrant communities frequently employ multilingual staff and offer culturally relevant programming. Federally funded providers are generally obligated under civil rights law to make language access services available to individuals with limited English proficiency. When visiting potential facilities, ask directly which languages are spoken by care staff and whether interpreter services are available for medical appointments and consultations.

How do I find and compare nursing homes in the United States?

The most reliable starting point is the CMS Care Compare tool, which allows you to search for nursing homes and other care settings by location and review inspection outcomes, staffing levels, and quality star ratings. Your local Long-Term Care Ombudsman office can also provide independent guidance and advocacy support throughout the evaluation process.

Is long-term care insurance worth buying as an expat in the US?

For expats who plan to remain in the US long term and are unlikely to qualify for Medicaid, long-term care insurance can offer meaningful financial protection. With seven out of ten people projected to need long-term care at some point, and national nursing home costs now surpassing $100,000 per year, LTC insurance can significantly slow the depletion of personal savings. Policies are most cost-effective when purchased in your 50s or early 60s. An independent financial adviser with knowledge of the US insurance market and expat financial planning can help you identify a suitable policy.

What is a Continuing Care Retirement Community (CCRC), and is it a good option for expats?

A CCRC — also referred to as a Life Plan Community — brings together independent living, assisted living, and skilled nursing care on a single campus, enabling residents to move between levels of care without changing provider or location. This continuity can be particularly appealing to expats seeking long-term stability. CCRCs typically require a substantial upfront entrance fee, which may or may not be partially refundable, as well as ongoing monthly charges. Contract structures vary considerably — some follow an all-inclusive model (Type A), others operate on a fee-for-service basis (Type C) — so having the contract reviewed by a legal professional before signing is strongly recommended.

What legal documents should expats prepare before needing elderly care in the US?

All adult residents of the US, regardless of nationality, should hold a US-recognised Durable Power of Attorney (DPOA) covering financial affairs, a healthcare proxy or medical power of attorney naming someone to make medical decisions on their behalf, and an advance directive or living will recording their care preferences. These documents must comply with the legal requirements of the state where you reside. An elder law attorney can prepare documents that are valid in your state and that reflect the particular circumstances of your situation as a foreign national. Without these instruments in place, medical providers may be legally unable to involve overseas family members during a health crisis.