I want to tell you about a moment that happened in a client meeting a few years back. We were going through a comprehensive retirement review — income, taxes, investments, the whole picture, when I brought up long-term care planning. The client got quiet for a moment.
Then he told me about his aunt.
She had dementia. She'd driven herself to a rehabilitation facility one afternoon, apparently thinking it was a pharmacy. She didn't know where she was. She didn't know how she'd gotten there. She was, by every measure, no longer capable of living independently.
He was managing her care. He was watching what that process looked like, the decisions, the costs, the emotional weight of it, in real time. And he was sitting across from me thinking: I don't want my kids to go through this.
That's the conversation long-term care planning is actually about. Not asset protection. Not insurance products. Not Medicaid eligibility rules. It's about maintaining your dignity and your independence, and making sure the people you love don't have to carry a burden you could have planned for.
The Numbers Are Harder Than You Think
The average cost of a private room in a skilled nursing facility in North Carolina is currently around $8,000–$9,000 per month. Memory care, specialized care for dementia and Alzheimer's, runs higher, often $10,000–$12,000 per month or more. Home health aide services typically run $4,000–$6,000 per month for full-time care.
The average length of a long-term care event is 2–4 years. But "average" is doing a lot of work in that sentence. Alzheimer's disease, which affects roughly 1 in 9 Americans over 65, has an average duration of 8–10 years from diagnosis.
One of my clients had a mother in memory care at $8,000 per month. "God forbid something happens like that to me," she told me. "I don't want my children burdened. It's $8,000 a month at that dang place."
That's $96,000 per year. For a couple where both spouses require care, not uncommon, you're looking at nearly $200,000 per year in care costs. For multiple years.
Even a well-funded retirement can be significantly impaired by an unplanned long-term care event. And the impact isn't just financial. It's the family dynamics, the caregiver burden, the decisions that have to be made under stress without a plan in place.
Why Most People Don't Plan for This
I've had this conversation hundreds of times, and the reasons people haven't planned for long-term care are remarkably consistent.
"It won't happen to me." The statistics don't support this. Roughly 70% of people over 65 will need some form of long-term care during their lifetime. The question isn't really whether, it's when, for how long, and what kind.
"My family will take care of me." This is the most common assumption, and the most unfair one to make unilaterally. Informal family caregiving is enormously demanding, physically, emotionally, financially, and professionally. Planning for long-term care is, in part, an act of love for the people who would otherwise have to carry that weight.
"I'll just self-fund it." For some people with significant assets, self-funding is a legitimate strategy. But it requires actually setting aside the money, not just assuming the portfolio will cover it.
"Long-term care insurance is too expensive." Traditional long-term care insurance has become significantly more expensive over the past decade, and many carriers have exited the market. This is a real concern. But it's not the only option.
The Three Approaches
Long-term care planning isn't a product decision, it's a strategy decision. There are three broad approaches, and the right one depends on your assets, your health, your family situation, and your priorities.
Approach 1: Self-Funding If you have substantial assets, generally $3 million or more in investable assets, self-funding may be appropriate. The key is intentionality: you're not just assuming the portfolio will cover it, you're explicitly earmarking a portion of your assets for this purpose.
Approach 2: Traditional Long-Term Care Insurance Traditional LTC insurance pays a daily or monthly benefit if you need care, typically triggered when you can no longer perform two of six Activities of Daily Living (ADLs) or when you have a cognitive impairment. The advantages: it's designed specifically for this risk, benefits are typically inflation-adjusted. The disadvantages: it's expensive, premiums can increase over time, and if you never need care, you've paid for something you didn't use.
Approach 3: Asset-Based Hybrid Policies Hybrid policies combine life insurance or annuity features with long-term care benefits. If you need care, the policy pays for it. If you don't, your beneficiaries receive a death benefit. You don't "lose" the premium if you never need care. This is the approach that has gained the most traction in recent years, and for good reason.
The Conversation You Need to Have
Beyond the financial mechanics, long-term care planning requires a different kind of conversation, one about values and preferences and family dynamics.
Where do you want to receive care if you need it? Most people say "at home, as long as possible." That's a legitimate preference, but it has implications for the type of coverage you need and the modifications your home may require.
Who would be involved in your care? If you have children, have you talked to them about what you'd want? Do they know where your documents are? Do they know your wishes?
What does dignity mean to you in the context of care? Some people prioritize staying in their own home above all else. Others prioritize access to specialized memory care. Others prioritize not burdening their children, even if that means a facility. There's no right answer, but having the answer before the crisis is infinitely better than trying to find it during one.
The Best Time to Plan Is Before You Need To
Long-term care insurance and hybrid policies are health-underwritten. The best time to apply is when you're healthy enough to qualify, typically in your 50s or early 60s. Waiting until you have a health condition that makes care more likely also makes coverage harder to obtain and more expensive.
This is one of the few areas of retirement planning where procrastination has a direct, measurable cost. Every year you wait, premiums increase. Every health event that occurs before you apply potentially affects your eligibility.
I'm not saying this to create urgency for its own sake. I'm saying it because I've watched too many families have this conversation after it was too late to do anything about it.
The Bottom Line
Long-term care planning is not a pleasant topic. I understand why people avoid it. But the families who've gone through a long-term care event without a plan will tell you unanimously that the conversation they wish they'd had was the one they kept putting off.
Your goal isn't to protect your assets from Medicaid. Your goal is to maintain your independence, preserve your dignity, and make sure the people you love aren't left to figure it out alone under the worst possible circumstances.
That's a goal worth planning for.
Jason Rindskopf is the founder of Two Waters Wealth Management and creator of the SMART Retirement Blueprint®. He works with high-achieving professionals and couples in the Charlotte, NC area who are within 10 years of retirement or recently retired. If you'd like to talk through your long-term care strategy, book a complimentary consultation here.