76% Of Older Adult Households Cannot Afford Daily In-home Care

Less than one quarter of single and partner households aged 75 and older can afford a daily visit from a home health aide.

Certain populations, including renters, households of color and people with functional difficulties, are even less likely to be able to afford care, according to a new paper published by the Joint Center for Housing Studies of Harvard University.  

“A majority of older adults will need long-term care (LTC) services at some point in their lives, such as assistance with dressing, bathing, or managing complex medication regimens,” Jennifer Molinsky, the director of the housing an aging society program and one of the paper’s authors, said in a statement. “Most older adults prefer to receive such care in their own homes. Yet the cost of paid LTC services is out of reach for many households.”

The paper’s researchers analyzed data from the U.S. Census Bureau’s 2021 American Community Survey, along with other data sets, to determine the number of households with older adults who can afford housing plus daily care at home. Of the nearly 10 million households analyzed, only 24% had sufficient income to afford daily care from a home health aide, in addition to housing and basic living expenses.

Partner households were better able to afford in-home care, with 43% able to afford a daily visit serving both partners. Only 19% of those living alone could afford daily care. More households were able to afford in-home care if it was delivered fewer times per week, however.

“Practically, periodic paid care could provide respite to unpaid family caregivers,” Molinsky said. “However, even without considering the cost of a daily LTC visit, only 63% of the entire sample could afford their housing and basic costs of living. The remainder lacked sufficient income for any LTC care services.”

Households earning less than 50% of their area’s median income were unable to afford a daily home care visit, which Molinsky said was “unsurprising.” Middle-income earners also struggled to pay for daily in-home visits, however, because they were less likely to be eligible for Medicaid-covered LTC services but could not afford to pay for care out of pocket.

“Fully funding Medicaid [Home and Community Based Support] HCBS would help those with the greatest affordability needs, while coverage of LTC services by Medicare would help millions more,” Molinsky said in a statement. “Addressing housing needs can also help older households make ends meet, including through expanded rental subsidies as well as home repair and modification assistance that ensure the home is a suitable and comfortable place in which to receive care.”

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