After many years of handling daily tasks, such as bathing, dressing, and cooking, we tend to take for granted that we can do these tasks without help. However, as we age, many of us will need help with some of these tasks, as well as other daily activities. In fact, nearly 70 percent of people age 65 and older will develop difficulty performing certain daily tasks, requiring some form of long-term care support in their remaining years. According to a recently released paper from Harvard University’s Joint Center for Housing Studies (JCHS) titled Older Adults Struggle to Meet the Dual Burden of Housing and Care, many older adults will have trouble paying for these long‑term care services, particularly after covering their housing costs. This struggle to afford the costs of both housing and long-term care services creates the dual burden cited in the title of the paper.
Long-Term Care Services
Long-term care (LTC) services can include assistance with activities of daily living (ADLs) such as bathing and dressing and help with medical-related tasks, such as managing complex daily health care regimens. Older adults may also use LTC services for housekeeping tasks, such as doing laundry, cooking, and shopping. LTC services are often essential for many older adults who want to continue living independently by delaying or avoiding institutionalization in a nursing home.
Paid professionals or unpaid family members or friends may provide LTC services for seniors, with most older adults relying heavily, or exclusively, on unpaid support. The JCHS paper states that less than half of adults receive paid care. In fact, family members and friends provide 70 percent of all care given to people who have significant needs.
Although some people need LTC services only for a short time, such as when recovering from an injury or illness, many older adults rely on them for an average of three years, with 20 percent needing them for more than five years.
Core Findings of the Dual Burden Study
The JCHS found that in single or partnered households with at least one person aged 75 or older, just 24 percent were able to pay for a single daily visit from a paid home health aide after paying for housing and basic living costs. Only about 63 percent of households can afford basic housing and living costs without the additional cost of LTC services.
The study found a discrepancy between homeowners and renters. Less than 9 percent of older adults who rent their homes can afford the costs of housing, basic expenses, and paid daily care compared with 30 percent of those who own their homes.
Reasons Why Older Adults Struggle With Dual Burden Costs
Older adults are struggling to meet the dual burden costs of housing and long-term care for several reasons.
Rising Housing Costs
In 2021, nearly 11.2 million older adults spent more than 30 percent of their income on housing, the highest amount ever. This is about a third of older households. This issue of affordability is expected to grow as the number of households headed by a person aged 80 or older more than doubles between 2021 and 2040.
High Costs of Long-Term Care
The study found that in 2021 the annual cost of a daily care visit of four hours was just under $41,000. The annual median cost in 2024, according to Genworth, was up to about $48,000. The annual median cost of living in an assisted living community was about $70,800 and a private room in a nursing home was nearly $128,000. With these costs tacked onto ever-increasing living costs, it is little wonder why so many seniors struggle to make ends meet.
Limited Insurance and Financial Safety Nets
Most medical insurance plans, including Medicare, don’t cover most LTC needs and relatively few older adults have private long-term care insurance. Medicaid home- and community-based services (HCBS) exist but aren’t universally available and have limited capacity in some states.
Growing Care Needs With Age
Nearly 70 percent of adults who reach age 65 will need LTC services for an average of three years. Functional difficulties, such as mobility and self-care issues, increase dramatically for those who are over 80, making independent living more difficult.
Why This Matters
When older households can’t afford adequate care, unpaid family caregivers — often themselves older or working — bear substantial financial and emotional burdens. Many older adults must choose between staying in their homes and maintaining independence but possibly sacrificing care and well-being or living in an institutionalized setting, such as a nursing home.
In New York, Medicaid can provide financial assistance for home care services. However, there are eligibility rules and often planning is required. With the help of an elder lawyer, seniors can navigate the Medicaid application process and more easily realize the benefits that will help them live more comfortable, independent lives.
Medicaid covers various long-term care services, including home health care, caregiver support, and personal care services for such activities as dressing, bathing, and meal preparation. However, qualifying for Medicaid home care involves meeting stringent financial and functional eligibility criteria. Many seniors are over these limits, but with the proper planning and the help of and elder law attorney, they can often become eligible.
Meeting the dual burden of care costs and housing can be difficult for seniors. Medicaid may be available, but navigating Medicaid’s complex requirements can be overwhelming for seniors and their families. Speak with the experienced elder lawyers at Kurre Schneps to discuss your specific situation and potential options.
