Summary: Long-term care costs depend overwhelmingly on the setting: a private nursing home room runs a national median of $129,575 a year, assisted living $74,400, and 44 hours a week of in-home care $80,080. The table below compares all four settings side by side with a free CSV download, and the sections explain what drives each number, how costs vary by state, and how to project your own total.
The CareScout/Genworth Cost of Care Survey has tracked these numbers for over 20 years, and the 2025 edition is the freshest public dataset. Costs are reported as national medians, which means half of markets are cheaper and half are more expensive. Your state's number can differ from the median by 50 percent or more in either direction.
The four settings below are not interchangeable rungs on a ladder. Most people who need care use a mix: in-home help first, then assisted living or adult day care, then a nursing home only if needs become severe. Price the whole journey, not just the endpoint.
National medians from the CareScout/Genworth 2025 Cost of Care Survey. Your state and metro will differ; use the free CareScout cost-of-care tool for local figures.
| Care setting | National median cost |
|---|---|
| Nursing home, private room | $129,575 / year ($355 / day) |
| Nursing home, semi-private room | $114,975 / year ($315 / day) |
| Assisted living community | $74,400 / year ($6,200 / month) |
| In-home care, non-medical caregiver (44 hrs/week) | $80,080 / year ($35 / hour) |
| Adult day health care | $24,700 / year ($95 / day, 5 days/week) |
Almost nobody buys the table's headline numbers on day one. Care typically starts with a few hours of home help a week, grows to daily help, and only later becomes assisted living or a nursing home. The 44-hour week in the survey is a benchmark, not a prescription; many families start at 15 to 20 hours, which at $35 an hour is $27,000 to $36,000 a year, less than half the table figure.
Adult day health care, at $24,700 a year for five days a week, is the most underused option in the table. It gives working caregivers respite at a third of the assisted living cost and is often covered partially by state programs. When you project lifetime costs, model this staircase: a year or two of part-time home care, then fuller support, then facility care only if needed. The total is usually well below 'nursing home times average stay.'
A private room's $129,575 national median reflects 24-hour skilled staffing, the most regulated environment, and the highest acuity patients. Semi-private rooms save about $14,600 a year at $114,975, which is why most residents choose them. Cost growth here has actually moderated: the 2025 survey showed only 1 to 2 percent increases as pandemic-era staffing pressures eased.
Few people pay the nursing home rate for long. The average nursing home stay is under 3 years, and many residents arrive only after exhausting home and assisted living options. When you project costs, model the setting transitions rather than assuming nursing home from day one.
Assisted living at $74,400 a year bundles housing, meals, and help with daily activities, but not skilled nursing. The 5 percent increase in 2025 tracked closely with rental housing inflation, which makes sense given the room-and-board component. What the median hides is the level-of-care surcharge: base rates cover minimal assistance, and each additional level of help adds hundreds a month.
Ask for the full level schedule before comparing communities. Two places with the same base rate can differ by $2,000 a month once care levels are applied, and levels are reassessed as needs change.
Forty-four hours a week of non-medical home care at $35 an hour totals $80,080 a year, more than assisted living. In-home care wins on quality of life, not price: your home, your schedule, one-on-one attention. It is the right choice for moderate needs and the wrong choice when needs become round-the-clock, at which point 24-hour home care exceeds even nursing home costs.
The 2025 survey streamlined its categories: homemaker and home health aide services are now reported together as non-medical caregiver at the $35 hourly median. Skilled nursing at home, a separate clinical service, medians $90 an hour.
State medians vary enormously. High-cost states like Alaska, Massachusetts, and Connecticut can run double the national median for nursing homes; lower-cost states in the South and Midwest run well below it. The variation follows wages and real estate like everything else in care economics.
Do not plan from the national median alone. The CareScout cost-of-care tool publishes state and metro medians from the same survey; look up your market and your likely future market if relocation in retirement is on the table.
Multiply the relevant annual cost by your expected years of care, then add inflation. The federal Administration for Community Living puts the average at 3.7 years for women and 2.2 for men, with about 70 percent of 65-year-olds needing some care. At 3 percent inflation, a $130,000 nursing home year becomes $142,000 in year three.
The calculator on the home page does this arithmetic with the insurance offset included. The key insight from running it: even three years of care at today's prices exceeds $400,000, which is why this decision belongs in the financial plan, not after the diagnosis.
Medicaid is the largest payer of nursing home care nationally, but only after spend-down: generally $2,000 in countable assets for an individual. Medicare pays for short skilled-nursing stays after hospitalization, not custodial care. Private long-term care insurance covers a small fraction of total spending. The remainder, the majority for middle-class families, is out of pocket.
This payer mix is why the self-insure-versus-insure decision matters so much. There is no cavalry coming for the middle: too wealthy for Medicaid, too uninsured for the costs. The guides on insurance versus self-insuring and hybrid policies walk through the options.
2025 national medians: $129,575 for a private nursing home room, $114,975 semi-private, $74,400 assisted living, $80,080 for 44 hours a week of in-home care.
The 2025 survey showed 1 to 5 percent increases depending on setting, slower than the double-digit jumps of the pandemic years but still above general inflation for most settings.
Part-time home care is cheaper; full-time is not. Forty-four hours a week at $35 an hour costs $80,080 a year, and round-the-clock home care exceeds nursing home costs.
The CareScout/Genworth cost-of-care tool publishes state and metro medians from the same survey used for the national figures above.
Figures: CareScout/Genworth 2025 Cost of Care Survey (July-November 2025 fieldwork). Verify local costs with the survey tool. This guide is for planning only.