Long-term care planning means deciding, before a health event, how extended care would be paid for, where it would happen, and who would make decisions. It matters because about 70% of Americans turning 65 will need some care, and Medicare covers only short skilled-nursing stays after a hospitalization, not ongoing help with daily living.
November is Long-Term Care Awareness Month, and it lands at a useful time of year. Families gather for Thanksgiving. Medicare open enrollment is wrapping up. Year-end tax decisions are on the table.
In our planning meetings, there is one question we put in front of nearly every couple: if one of you needed help bathing, dressing, and getting out of a chair every day for three years, starting next spring, which dollars would pay for it, and whose life would change to provide it?
Most people have thought about the first half of that question for about five minutes. Almost nobody has thought about the second half. This article walks through both, using current 2026 numbers, so the conversation at your table starts with facts instead of fear.
What Long-Term Care Is (and What It Isn’t)
Long-term care is help with everyday living, not treatment for an illness. Planners usually measure it by the activities of daily living: bathing, dressing, eating, using the toilet, moving from a bed to a chair, and continence. Supervision for someone with memory loss counts too.
That help can happen in a lot of places. Your own home, an adult day program, assisted living, a memory care unit, or a nursing home. Most people start at home and move only when they have to.
The odds are higher than most people expect. According to the U.S. Administration for Community Living, someone turning 65 today has almost a 70% chance of needing some type of long-term care. The average need lasts about three years. Women need care longer than men, about 3.7 years compared with 2.2, and 20% of people will need it for more than five years.
One-third of 65-year-olds may never need long-term care at all. That is the part that makes people put this off. Nobody knows which group they’ll land in, and that uncertainty is exactly why it belongs in the plan.
The Medicare Myth That Catches Families Off Guard
Ask a room of retirees who pays for a long nursing home stay, and a lot of hands go up for Medicare. Medicare’s own site says otherwise. Medicare does not cover long-term care when the only care you need is custodial, meaning help with daily living.
What Medicare does cover is short-term skilled nursing, and only with conditions attached. Under Medicare’s skilled nursing facility rules for 2026:
- You need a qualifying inpatient hospital stay of at least three days in a row. Time spent “under observation” or in the ER does not count.
- Days 1 through 20 are covered after the $1,736 Part A deductible. Days 21 through 100 cost you $217 per day.
- After day 100 in a benefit period, you pay everything.
Some Medicare Advantage plans now include small extras like meal delivery or rides to appointments. Those benefits are helpful, but they are not a funding source for years of care. Our VP of Care Planning, Greg Boling, reviews exactly this during Medicare planning / review your Medicare coverage, because the plan you choose at 65 shapes your options at 80.
Having wealth and having a long-term care plan are two different things, and only one of them protects the spouse who stays healthy.
What Long-Term Care Costs in 2026
The CareScout 2025 Cost of Care Survey, released in March 2026, gives the clearest national snapshot available right now. These are national medians, and prices in Knoxville, Loudon County, and Blount County can run higher or lower.
| Type of Care | National Median Cost | Annual Cost | Change From Prior Year |
| Nursing home, private room | $355 per day | $129,575 | Up 1% |
| Nursing home, semi-private room | $315 per day | $114,975 | Up 2% |
| Assisted living | $6,200 per month | $74,400 | Up 5% |
| In-home caregiver (44 hours/week) | $35 per hour | $80,080 | Up 3% |
| Adult day health care | $95 per day | $24,700 | Down 5% |
Run the math on the average three-year need in a private nursing home room and you land near $389,000, before any price increases. For a couple who built a retirement plan to support two people at home, that’s a number that can quietly hollow out the healthy spouse’s future.
In-home care is often assumed to be the cheaper path. At full-time hours, it costs more per year than assisted living. Many families start with part-time help, then watch the hours climb.
Why Medicaid Is a Safety Net, Not a Strategy
Medicaid does pay for long-term care. In Tennessee, that program is TennCare CHOICES, and its 2026 eligibility rules are strict:
- Countable assets can’t be more than $2,000. Your home is excluded while you live there.
- Monthly income can’t be more than $2,982 in 2026, though a Qualifying Income Trust may help those above it.
- Gifts or below-value sales made in the last five years can delay eligibility.
There are rules that protect a healthy spouse at home, but they are narrow, and the five-year lookback means last-minute moves rarely work. For most families we serve, Medicaid becomes the plan only after the savings meant for the surviving spouse, the grandchildren, or a church endowment are spent down.
That’s the “just in case” mindset at its most expensive: hoping it won’t happen, and paying full price when it does.
The Integrated Way to Plan for Long-Term Care
Here’s where long-term care planning usually breaks. The insurance agent sells a policy. The CPA files the return. The attorney drafts a power of attorney. The financial advisor manages the portfolio. Each person does good work, and no one checks whether the pieces fit.
Long-term care touches every one of those pieces at once, which is why we handle it as a team under one roof.
Funding. Greg Boling evaluates whether traditional long-term care insurance, a hybrid life and long-term care policy, an annuity with a care benefit, or a self-funded reserve fits your health, budget, and goals. Hybrid policies have grown popular because if care is never needed, a death benefit typically still passes to your beneficiaries.
Taxes. Where the care money comes from matters. Pulling large amounts from a traditional IRA to pay for care can push you into a higher bracket and raise your Medicare premiums two years later through IRMAA surcharges. Our in-house tax team models which accounts to draw from first so a care event doesn’t create a second, avoidable tax bill. See how this connects to our tax strategy / where your retirement income comes from.
Legal authority. If you can’t sign a check, someone else needs the legal right to. Jeanne Miser, attorney with Bowen Miser Law Group, our in-house legal team, makes sure your durable power of attorney” / “estate documents” gives the right people the right powers, including the ability to pay for care and manage accounts without going to court.
When those three conversations happen in the same room, the plan holds together. When they happen in three different offices over three different years, gaps show up at the worst possible moment.
Getting Started This November
You don’t need to solve everything this month. You need to start.
Name your preference. Decide, even loosely, where you’d want to receive care and what would make you willing to move. Write it down.
Check your documents. Pull out your durable power of attorney and healthcare directive. If they’re more than five years old or were signed in another state, have them reviewed.
Find your number. Look up local costs on CareScout for the type of care you’d most likely use, then compare it with what your current income and savings could absorb without hurting the healthy spouse.
Get a coordinated review. Bring the funding, tax, and legal questions to one table so the answers work together.
Ready to See Where Your Plan Stands?
A single conversation can show you whether a care event would be an inconvenience or a crisis for your family. Derek, Greg, Jeanne, and the team will review your situation together, at no cost and with no obligation.
schedule a complimentary consultation →
Call 865-281-1616 or visit us at our Tellico Village or Farragut office. Next week, we’ll cover how to bring your family into the plan / long-term care and estate planning.
Frequently Asked Questions (FAQ Schema)
Does Medicare pay for long-term care in a nursing home?
Medicare does not pay for custodial long-term care, which is help with daily activities like bathing and dressing. It covers short-term skilled nursing only after a qualifying hospital stay of at least three days, for up to 100 days per benefit period. In 2026, you pay $217 per day for days 21 through 100 and the full cost after that.
How likely is it that I will need long-term care?
According to the U.S. Administration for Community Living, someone turning 65 today has almost a 70% chance of needing some type of long-term care. The average need lasts about three years, and about 20% of people need care for more than five years. Women tend to need care longer than men.
How much does long-term care cost in 2026?
The CareScout 2025 Cost of Care Survey puts the national median for a private nursing home room at $129,575 per year and a semi-private room at $114,975. Assisted living runs about $74,400 per year, and a full-time in-home caregiver about $80,080. Local costs vary, so check rates where you plan to live.
What is Long-Term Care Awareness Month?
Long-Term Care Awareness Month is observed each November to encourage people to plan for extended care before they need it. It is a good time to review insurance options, update legal documents like a durable power of attorney, and talk with family about care preferences.
What is a hybrid long-term care policy?
A hybrid policy combines life insurance or an annuity with long-term care benefits. If care is needed, the policy helps pay for it, and if care is never needed, a death benefit typically passes to beneficiaries. Policies vary widely in cost, benefits, and limitations, so they should be reviewed with a licensed insurance professional.
Can I just rely on Medicaid for long-term care in Tennessee?
Tennessee’s Medicaid long-term care program, TennCare CHOICES, requires countable assets of no more than $2,000 and has a monthly income limit of $2,982 in 2026. It also reviews gifts and below-value transfers from the past five years. Relying on Medicaid generally means spending down most savings first, which can leave a healthy spouse with far less.
