Start with what your parents want, not with a building
It is tempting to jump straight to comparing facilities, but start with your parents. What makes daily life feel like theirs — the home or neighborhood they want to stay near, their routines, a pet, their faith, their privacy, and how much they want family involved? Write these things down as a guide, not a promise, because needs change and you don't want to be bound to a pledge you can't keep. If they do push you to a promise, know that many ethicists believe that a forced agreement is not binding. Try to commit to do what is best for them and not to particular steps or outcomes.
Care can happen in a lot of places: in their own home, at an adult day program, in assisted living, or in a nursing facility — and the right answer often changes over time. Plan to revisit it after any big event: a fall, a hospital stay, a new diagnosis, a move, the loss of a spouse or caregiver, or a real change in money or family capacity.
Map the help — and the people
Make two lists. The first is the help that might be needed: personal care, meals, housekeeping, medications, transportation, appointments, finances, home maintenance, supervision, and overnight help. The second is who could actually provide each one. This is where families get into trouble, so I will say it plainly: do not assume a spouse or an adult child can provide unlimited unpaid care. Ask honestly about time, jobs, health, training, and what the caregiving would do to that person's own finances and wellbeing. A plan that quietly depends on one person burning themselves out is not a plan. If that’s what is currently happening, check in at least twice per year to review.
Find your local paid and community options before you need them. The federal Eldercare Locator will connect you with your parents' Area Agency on Aging and the services nearby. If the situation is complicated, a geriatric care manager can assess needs and coordinate the pieces — just ask up front about their credentials, their fees, and whether they have any financial relationships with the providers they recommend.
What long-term care costs
Costs vary widely by the type of care and by where your parents live, so start from national medians and then get local quotes. The table below shows national median prices from the CareScout (Genworth) 2025 Cost of Care Survey, the most widely used source for these numbers.
A few things matter as much as the headline numbers. These are national medians, and local prices vary enormously — the Northeast (Massachusetts is right there in the table), California, and Alaska run well above these figures, so use local quotes when you actually sit down to plan. Keep in mind that the in-home figure assumes about 44 hours of help a week; around-the-clock care at home costs far more — at roughly $35 an hour, 24/7 coverage runs well over $250,000 a year, more than a private nursing-home room. Assisted-living base rates also usually don’t include everything, since the quoted price typically covers room, meals, and a baseline of help while added care levels, medication management, and memory care cost extra (memory care itself generally lands between assisted living and a nursing home). And costs have been rising roughly 1–5% a year lately, so build in annual increases.
Source: CareScout 2025 Cost of Care Survey.
Build a realistic funding plan
Once you have a feel for the costs, figure out where the money would come from. For most families it is some mix of your parents' income and savings, long-term care insurance if they bought it, veterans' benefits if they qualify, and — for those who meet the income and asset limits — Medicaid. Two things surprise people: regular health insurance and Medicare generally do not pay for ongoing, non-medical help with daily living, and Medicaid, which does cover a great deal of long-term care, only starts paying once someone has spent down to fairly low asset limits. If your parents have a long-term care insurance policy, dig it out and read it carefully now, before you need it, so you understand what it actually covers — the daily benefit, the waiting period before it starts paying, whether it has inflation protection, and what has to happen for a claim to be approved — because these policies vary enormously and those details decide how much help it will really provide. One warning: do not move money, tap home equity, buy an annuity, or change who owns what based on a website, because those moves can backfire on taxes, Medicaid eligibility, and housing — get professional advice first.
Put the decision-making documents in place
A care plan only works if someone can actually act on it. That usually means a financial power of attorney, a health-care power of attorney and advance directive, a way to see and pay the bills, and clear instructions your parents set while they can still fully take part. These documents are governed by state law, so they are worth getting right — the legal section of this site goes deeper, and an elder-law or estate-planning attorney can line them up with the benefit rules and the care plan. Keep the plan and the contact list somewhere trusted people can find them, while still protecting your parents' medical, financial, and identity information — they decide who gets copies.
Trusted resources
Next step
Start my long-term care plan.