This article is part of the Biblically-Informed Framework for Retirement Stewardship (BIFRS). It was originally published in May of 2020 (in the midst of the COVID pandemic), but was updated in May of 2026.

This article is the first in a series of five about long-term care (LTC). In this article, we will look at the various types of care, why and when they might be needed, and how to approach the decision. Subsequent articles cover the role of Medicare and Medicaid in LTC, how to pay for care, traditional LTC insurance, and hybrid insurance products.

Why long-term care is a stewardship issue

From a biblical perspective, long-term care planning is part of the “stewardship of life”—whether our own or a loved one’s. Whether we are planning for ourselves, a spouse, or an aging parent, following biblical principles will be of significant benefit. “Commit your work to the Lord, and your plans will be established” (Prov. 16:3).

As with so much of later-life planning, there is considerable uncertainty about the factors that will drive our LTC decisions. Some people will never need it. Some will, but for a short time. Others may require it for a long time. An unexpected accident, illness, or injury can change your situation suddenly and dramatically. The best time to think about long-term care is therefore before it becomes an urgent need.

The most important questions we must answer are: How would I get the care I (or a loved one) may need if a debilitating illness, disability, or natural aging necessitated long-term care? Who would provide that care? How would it be funded?

What is long-term care?

Many people do not fully understand the world of long-term care. It’s diverse and complex. There are different kinds of care, a variety of programs, and federal, state, and local governments are all involved. The term “long-term care” can refer to a range of services—from a few hours of in-home assistance per week to around-the-clock nursing home care for years.

Long-term care is distinguished from acute medical care by its focus: rather than treating illness or injury, it addresses ongoing personal care needs that arise when someone can no longer perform basic Activities of Daily Living (ADLs) independently. The six ADLs are bathing, dressing, toileting, transferring (moving from bed to chair), maintaining continence, and eating. When someone cannot perform two or more of these independently, they typically qualify for LTC benefits under an insurance policy or Medicaid.

Beyond ADLs, there are also Instrumental Activities of Daily Living (IADLs)—tasks like meal preparation, managing medications, handling finances, housekeeping, using transportation, and shopping. Many people begin needing IADL assistance before they lose ADL capacity, and a realistic LTC plan accounts for this earlier, lighter phase of care as well.

The spectrum of care

As we will see, there is a broad spectrum of care, including where and how it’s provided and its cost.

In-home care

Many older people want to stay in their homes and age in place. For those who need additional assistance with simple tasks and personal care, home-based services can support continued independence. Home health aides visit for a few hours each week or daily to assist with bathing, dressing, meal preparation, and medication management. Care can also include homemaker services for housekeeping and errands.

In-home care works best when care needs are moderate and the home environment is suitable for aging—ideally on one level, with grab bars, walk-in shower access, and no major mobility hazards. In 2026, the national median hourly rate for home care is approximately $34. A 40-hour-per-week schedule runs roughly $70,000–$75,000 per year—a figure that surprises many families who had assumed in-home care was affordable.

The emotional advantage of remaining in familiar surroundings is real and significant. The limitation is that intensive in-home care requires substantial family oversight and supplemental help, and it becomes increasingly difficult to manage as care needs grow more complex.

Adult day care

Adult day care programs provide daytime supervision, structured activities, health monitoring, and social engagement outside the home, with the participant returning home each evening. They are particularly valuable for employed family caregivers because they provide supervised care during working hours without requiring full-time residential placement. Current costs range from about $75 to $100 per day nationally, or roughly $20,000 to $26,000 per year for a five-day-per-week schedule.

Assisted living facilities (ALFs)

A move to an assisted living environment is typically needed when a person can no longer live on their own safely, for physical or cognitive reasons, or both. Assisted living facilities provide apartment-style living with meals, housekeeping, and organized activities, while offering personal care assistance with bathing, dressing, and medication management as needed.

They are designed to feel more like a residential community than a medical facility, with a meaningful degree of independence preserved. The national median cost for assisted living in 2026 is approximately $5,419 per month, or around $65,000 per year, based on actual move-in data from A Place for Mom’s 2026 Cost of Long-Term Care Report. This is a significant increase from just a few years ago—LTC costs broadly have risen nearly 50 percent since 2019.

Memory care facilities

Memory care is a specialized form of assisted living designed for people with Alzheimer’s or other forms of dementia. These facilities feature secured environments to prevent wandering, higher staff-to-resident ratios, and staff specifically trained in dementia care. The national median for memory care runs approximately $6,690 per month in 2026—roughly 25 to 50 percent higher than standard assisted living, reflecting the intensive supervision and specialized staffing required.

Dementia care is among the most demanding and emotionally complex care situations families face. The combination of a long duration—Alzheimer’s can progress over five to fifteen years—and high monthly costs makes memory care one of the most financially significant LTC scenarios a family can encounter.

Skilled nursing facilities (nursing homes)

Skilled nursing facilities provide 24-hour medical care and supervision for individuals with complex medical needs or very high personal care requirements. Some nursing homes provide both long-term care and skilled nursing, enabling them to admit patients who need intensive rehabilitation after a hospital stay (typically covered by Medicare for a limited period) as well as those requiring ongoing custodial care.

The national median cost in 2026 is approximately $9,842 per month for a semi-private room ($118,000 annually) and $11,294 per month for a private room ($135,500 annually). These are medians—actual costs vary dramatically by geography, with rural areas in lower-cost states running considerably less and major metropolitan areas running considerably more.

Not all nursing homes accept Medicaid payments. Some are private-pay-only facilities; others have both private-pay and Medicaid-funded residents. As a general rule, private-pay residents pay 20 to 30 percent more than Medicaid reimbursement rates. Facilities that accept Medicaid must be licensed by their state and are subject to regular inspections to ensure they meet federal quality standards.

Continuing Care Retirement Communities (CCRCs)

Continuing Care Retirement Communities offer a campus model that spans independent living, assisted living, and skilled nursing care, allowing residents to move through levels of care as their needs change without leaving their community or familiar neighbors and staff. For couples in particular, CCRCs can be a powerful solution—both spouses can live on the same campus even if their care needs diverge significantly.

CCRCs typically require a large entrance fee (ranging from $100,000 to $500,000 or more depending on location and contract type) plus ongoing monthly fees of $3,000 to $6,000 or higher. The contract structure matters enormously: a “lifecare” contract essentially pre-pays for future care at a fixed cost, while a “fee-for-service” contract charges market rates for care as needed. CCRC entry decisions involve significant due diligence into the facility’s financial health and contract terms.

Sources: A Place for Mom 2026 Costs of Long-Term Care Report; CareScout 2025 Cost of Care Survey; SeniorLiving.org (2026). National medians; costs vary significantly by state and metro area.

How Do You Decide?

The decision about what kind of care is appropriate—and when—is rarely simple. It involves the person’s medical needs, personal preferences, cognitive state, financial resources, family capacity, and geography. There is no single right answer, and the answer usually changes over time as care needs evolve.

Several factors matter most. First, the nature and progression of the underlying condition: Is this a temporary recovery situation, a progressive disease, or the general frailty of advanced age? Second, the suitability of the home environment: Can modifications make it safe and functional for aging in place, or are there structural barriers? Third, family availability and capacity: Who can realistically provide or oversee care, and at what level of involvement? Fourth, financial resources: What can actually be afforded, and for how long?

The most important general principle is this: make decisions before they become urgent. A person who moves to an assisted living facility while still healthy and able to choose their own community, manage the logistics of moving, and build relationships there will have a vastly better experience than one who is moved in crisis, after a fall or hospital discharge, with no time for deliberate decision-making. The same is true for conversations about care preferences, legal documents, and financial arrangements. The time to plan is now, while everyone involved is still clear-headed and calm.

The biblical framework

Scripture does not give us a detailed LTC planning checklist. But it gives us more than enough wisdom to approach the subject with humility and wisdom. Proverbs 27:12 tells us that “the prudent see danger and take refuge, but the simple keep going and pay the penalty.” Planning for the possibility of future care needs is not pessimism—it is prudence.

1 Tim. 5:8 establishes that caring for one’s own family members is a fundamental obligation, not an optional generosity. But honoring your parents (Ex. 20:12) does not require adult children to personally provide all hands-on care at the cost of their own health, marriages, and finances. Arranging for appropriate professional care, paying for it, overseeing its quality, and providing regular emotional and spiritual support can be just as honoring as direct physical caregiving—often more so, because it is sustainable over the long duration that care frequently requires.

At the same time, the Caregiving Principle extends beyond biological family. Church community can provide remarkable practical and spiritual support to aging members, and those who have invested in their church community through years of service and presence tend to receive care and companionship in return. This is not transactional—it is simply the nature of genuine community. Those who are known and connected receive help; those who are isolated and anonymous do not.