Who Will Care for Us?

At age 74, I like to think our retirement is pretty much set in stone. Most of the big health and financial decisions—Medicare, Social Security, Roth conversions—have already been made. But there’s one concern I’ve been thinking about a lot lately: how will Rachel and I get the help we need if we can no longer take care of ourselves?

Our family is spread out across the country, and we have no plans to move closer to them. Even if we did, we wouldn’t want to burden them with caring for us.

The odds are that one of us will need care as we age. According to the Center for Retirement Research at Boston College, about 80% of retirees will require some level of long-term care—ranging from minimal help to extensive support.

Many seniors face this health care challenge. The U.S. Census Bureau estimates that the number of elderly people aged 85 and older will nearly double by 2035 (from 6.5 million to 11.8 million) and almost triple by 2060 (to 19 million).

At the same time, The New York Times reports a shortage of workers in the care industry, largely driven by low wages. This issue could be worsened by the current administration’s immigration crackdown, which affects a workforce where 28% of long-term care workers are immigrants.

According to CareScout, the price of some long-term care services—such as assisted living communities and nursing home care—rose as much as 10% in 2024, while the general inflation rate rose by 2.9%. A CareScout survey found that the national median monthly cost in 2024 was $6,483 for a home health aide, $5,900 for an assisted living community, and $10,646 for a private nursing home room.

Facing a future with both a shortage of long-term care aides and rising costs makes getting the help you need a difficult task.

We’ve looked into Continuing Care Retirement Communities, or CCRCs, which offer a range of care—from independent living to skilled nursing—all in one location. At first, we thought it was a smart solution, and it still might be. However, most CCRCs require large entry fees—sometimes hundreds of thousands of dollars—which we feel is a significant financial gamble.

Yes, some contracts offer refundable fees, but they usually come at an even higher cost. Our biggest concern is whether a CCRC can uphold the terms of a Type A contract, which states that they will not evict you if you run out of money or significantly raise your fees—except for cost-of-living adjustments—even when you require a higher level of care, such as assisted living or skilled nursing.

Will this type of model be sustainable when we’re facing a future with a shortage of workers and rising costs? Or will it resemble the long-term care insurance industry, where we’ve seen significantly higher premium increases and reduced coverage over time?

There are other types of CCRC contracts, but we would only be interested in one that guarantees lifetime care with predictable costs.

Instead of a CCRC, we’re considering another option: avoiding entry fees and paying a monthly fee for an assisted living and memory care community. There’s one not far from where we currently live, and if we needed more care, there’s a skilled nursing facility and a hospital nearby.

This type of care also presents its own set of problems. Will there be room when we need it? And when is the right time to move—especially if we’re still mostly independent? There’s also the risk that we could run out of money under this arrangement.

There’s always the option of staying in our home and hiring a home health aide. To plan for that possibility, we would follow the financial guidelines recommended by Carolyn McClanahan, a physician and certified financial planner who was interviewed for The New York Times article.

She suggests “planning for two to three years of long-term care needs, and up to five years for those at higher risk of dementia or with good health and longevity prospects.” We would probably fall into the latter category, which would require us to set aside five years of funds for care for each of us.

To reduce the amount of money that needs to be set aside, Dr. McClanahan advises married couples that one spouse should apply for long-term care insurance. That’s something we’re considering. Rachel is still in her 60s and has no preexisting conditions, so she would likely qualify for coverage.

Our current healthcare system doesn’t seem to offer a perfect solution. There are uncertainties no matter which direction we go.

Over lunch recently, a close friend shared how difficult it has been to care for his wife, who has dementia. After our conversation, I realized his journey is about more than just finding long-term care—it’s also about seeking peace of mind and preserving dignity.

Whatever we decide, we want to make the choice on our terms—while we still can.