Long-Term Care Statistics: A Portrait of Americans in Assisted Living, Nursing Homes, and Skilled Nursing Facilities

According to our research team’s analysis of the latest available data, the following can be determined:

• 70% of adults aged 65 years and older will require long-term care at some point.
• The average length of stay in long-term care is 3.2 years. Just over 20% of residents will require care for 5 years or longer.
• Americans spend $475.1 billion annually on long-term care.
• Medicaid only covers 54% of America’s long-term care costs.

Read further for breakdowns on age groups and other demographics.

Long-term care facilities include nursing homes, assisted living communities, and skilled nursing facilities. Each of these care types offers unique amenities and services.

Skilled nursing facilities (SNFs) provide the highest level of medical care of any long-term care facility. This care is executed by registered nurses under the supervision of doctors. It’s fairly equivalent to the level of nursing care a patient would receive in a hospital, but in a more comfortable, residential setting. SNFs often also offer rehabilitation services, physical and occupational therapy, and post-surgical care.

The goal of SNFs is to provide transitional care — in other words, they’re designed for short- and mid-length stays of several months rather than the duration of a resident’s lifetime. It’s important to note that this is different from transitional home care. In some situations, short stays in SNFs may be covered by Medicare.

Nursing homes also offer round-the-clock medical care and are generally staffed by licensed practical nurses and nurse aides under the supervision of a limited staff of doctors or registered nurses. While nursing homes offer medication management, wound care, and assistance with medical needs, they focus primarily on residential, custodial care and help with activities of daily living (ADLs).

While some nursing home residents stay only for short-term rehabilitation, others reside there for the duration of their lifetime.

Assisted living communities, unlike nursing homes and skilled nursing facilities, aren’t designed to provide comprehensive medical care. Assisted living residents are generally active but often need assistance with some ADLs, like dressing and bathing. They enjoy a maintenance-free lifestyle where meals, activities, and housekeeping services are provided, and they generally live in private rooms or apartments with access to community amenities. Some assisted living communities may have memory care wings or secured memory care units for those who have memory loss challenges. It’s important to ask about staff-to-resident ratios in assisted living, especially if your loved one has a higher need level.

Home health care agencies can also provide long-term care. This care takes place in a senior’s home and includes both ADL assistance and medical services, depending on a patient’s needs.

Hospice care is prescribed by doctors when a patient is expected to live for six or fewer months from the time of admission. Some agencies who provide data sets, like the National Center for Health Statistics (NCHS), include hospice care under the umbrella of long-term care, while others, like the Centers for Disease Control and Prevention (CDC), do not.

A breakdown of long-term care facts by type

Most long-term care facilities are either assisted living communities or nursing homes. According to the NCHS, long-term care in the U.S. is offered by the following:

• 28,900 assisted living and residential care facilities
• 15,600 nursing homes and skilled nursing facilities
• 12,200 home health agencies
• 4,300 hospice agencies

Read more:Nursing Home Requirements for Seniors

Let our care assessment guide you

Most long-term care community residents are non-Hispanic, white, and female. The majority are aged 85 or older.

Resident demographics by race

The majority of long-term care residents are white and non-Hispanic. Long-term care demographics differ significantly from demographic statistics throughout the U.S.

About 75.8% of U.S. residents are white and non-Hispanic, but over 89% of long-term care facility residents are, according to the CDC.

• 89% of long-term care facility residents are white and non-Hispanic
• 6% of residents are Black
• 5% of residents identify as another race or ethnicity

It’s worth noting that nursing homes and skilled nursing facilities have higher percentages of Black and other non-white residents than assisted living communities do. Demographic breakdowns also vary by location and type of facility.

Resident demographics by gender

Long-term care residents are mostly female, with 67 women for every 33 men in long-term care facilities.

Women in the U.S. have longer life expectancies than their male counterparts, at 79.1 versus of 73.2 years old, respectively.

As of 2020, women outnumbered men 178 to 100 in the over-85 age demographic, according to the Administration on Aging. In addition, women are more likely to care for their male spouses at home, while women are more likely to enter long-term care facilities for care.

Women stay in long-term care facilities for an average of 3.7 years, while men live in long-term care facilities for an average of 2.2 years.

Resident demographics by age

The majority of long-term care residents are over the age of 85. According to the CDC, ages breakdown as follows:

• 7% of residential care community residents are younger than 65
• 38% of residents are 65 to 84 years old
• 55% of residents are 85 and older

Many of the residents in the 65-84 demographic reside in assisted living communities, while older residents live in nursing homes or SNFs.

It’s worth noting that many under-65 residents of long-term care facilities live there as a result of developmental concerns, intellectual disabilities, and chronic conditions. Learn more below.

A portrait of younger long-term care residents

While many people equate long-term care with elderly populations, residents between the ages of 31 and 64 have been the fastest-growing nursing home demographic over the past 10 years. Though this age group still only represents about 7% of long-term care residents, it’s worth noting their impact on the status of long-term care facilities.

These “younger adults,” defined by the Society for Post-Acute and Long-Term Care Medicine as people between the ages of 18 and 64, generally face different health concerns than residents over 65.

Younger adults are more likely to have the following:

• More likely to have diagnoses related to developmental concerns and intellectual disabilities
• More frequently diagnosed with psychiatric concerns
• More likely to have chronic and neurological disorders, including Huntington’s Disease, Muscular Dystrophy, and Amyotrophic Lateral Sclerosis
• More likely to have prior histories of stays in inpatient psychiatric facilities
• More likely to have suffered traumatic injuries

This demographic often has different care needs than the seniors they live with, and long-term care facilities may have unique activities and amenities designed for younger residents.

Talk with a Senior Living Advisor

Because long-term care facilities encompass a broad range of care types, different residents have different needs. While seniors in assisted living communities may only require help with a few activities of daily living, older adults in skilled nursing facilities may need intensive medical care.

ADL assistance in long-term care facilities

Sixty-one percent of long-term care residents need assistance with three or more activities of daily living (ADLs), such as bathing, dressing, using the toilet, or personal grooming.

As shown in assisted living statistics, assisted living residents are less likely to need help with multiple ADLs and tend to be more independent. Among nursing home and SNF residents exclusively, over 80% require assistance with three or more ADLs, and over 90% of people who are able to walk need supervision or assistance.

Recent statistics regarding ADL assistance in nursing homes and skilled nursing facilities aren’t publicly available, with the last concrete dataset recorded in 2014. However, assisted living ADL assistance is tracked by the American Health Care Association.

• 77% of assisted living residents need help with bathing
• 69% need help with walking
• 62% require dressing assistance
• 49% need help using the toilet
• 26% require assistance eating

Medical conditions in long-term care facilities

According to the CDC, the following percentages of long-term care residents experience these common medical conditions:

• 55% have high blood pressure
• 27% struggle with depression
• 20% are affected by arthritis
• 17% have heart disease
• 12% are affected by osteoporosis
• 11% have been diagnosed with chronic obstructive pulmonary disease or related conditions
• 10% have had a stroke

In 2020, an estimated $3.4 trillion was spent on personal health care resources in the U.S. Of that, about 14%, or $475.1 billion, was spent on long-term care facilities and services.

Long-term care services and facilities are funded by both public and private sources. Public and government organizations, like Medicaid and Medicare, accounted for 60.4% of all nationwide spending in 2020, according to the Congressional Research Service.

Pandemic assistance also contributed to long-term care and service funding in 2020 and 2021, making up about 6.3% of spending. It’s unlikely that pandemic funding will continue long-term.

Private sources accounted for 27.7% of long-term care spending in 2020. Of those sources, out-of-pocket spending was the largest source of revenue, at 13.5% of total long-term care spending. Private insurance, philanthropic contributions, and other sources like bridge loans and life insurance policy buyouts made up the rest of long-term care facility spending.