America’s Quiet Crisis: The Soaring Cost and Strain of Caring for an Aging Nation

The challenge of caring for older Americans is growing more urgent — and more expensive.

Roughly one in four people age 65 and older needs help with daily activities such as bathing, dressing, eating, or managing medications. By age 85, the need rises sharply. Nearly 60 percent report difficulty with routine tasks, and 41 percent receive some form of long-term care.

Most of that care happens at home. About 69 percent of seniors who receive assistance rely solely on unpaid help from family or friends. Smaller shares use paid home health aides or move into nursing homes. Yet about a quarter of older adults with long-term care needs receive no help at all, increasing their risk of serious medical complications.

Shift Away From Nursing Homes

Over the past decade, institutional care has declined. In 2023, the U.S. had 29 long-term care beds per 1,000 adults age 65 and older, down from nearly 40 a decade earlier. Public policy and personal preference have both pushed care toward home and community settings.

Still, quality and oversight concerns remain. The COVID-19 pandemic exposed vulnerabilities in nursing homes, where death rates were especially high.

Workforce Under Pressure

The paid care workforce is stretched thin. About 1.9 million formal caregivers assisted seniors in 2018, but employment in the sector remains below pre-pandemic levels. All states report shortages, driven in part by low wages. Immigrants make up a significant share of home health aides and nursing assistants, meaning tighter immigration policies could worsen staffing gaps.

Meanwhile, an estimated 10.6 million Americans — mostly women over age 50 — provide unpaid care. Many reduce work hours or retire early, adding hidden economic costs.

Limited Public Support

Public spending on long-term care equals about 1.1 percent of GDP, lower than in many peer nations. Medicaid is the primary payer but is limited to low-income seniors, often after they exhaust their savings. Private long-term care insurance remains rare, covering just 15 percent of older adults.

Out-of-pocket costs can consume up to 80 percent of median income for those with severe needs, pushing many into poverty.

With the share of Americans over 65 projected to reach 22 percent by 2050, the financial and emotional strain on families is likely to intensify. Without reforms, experts warn, the burden will only grow heavier.