Briefing from Bruce – November 2025

As the U.S. population continues to age, the demand for long-term healthcare is expected to rise steadily. Yet, it’s a topic many prefer to avoid, and in some cases, neglect to plan for, despite its growing importance.

While statistics vary, anywhere between 60% and 70% of us will one day need assistance with long-term care, according to the U.S. Department of Health and Human Services.

What does long-term care include? How might long-term care be described?

Costs may include assistance with daily activities such as driving to appointments, bathing, meal preparation, dressing, and eating. Such assistance can be provided in various settings, including assisted living facilities, nursing homes, or at home.

Yet, as many of us are aware, there is a substantial cost to paying for long-term care, and in many cases, we tend to underestimate these costs.

The cost of long-term care

The costs can vary significantly and depend on the duration, type of care required, and your location.

According to the Genworth Cost of Care Survey Results for 2024,

• The cost of a home health aide, which includes hands-on personal assistance with activities such as bathing, dressing, and eating, rose 3% to an annual median cost of $77,792.
• Homemaker services, which include assistance with hands-off tasks such as cooking, cleaning, and running errands, rose 10% to an annual median cost of $75,504.
• The annual national median cost for adult day care was $26,000, up 5% from 2023.
• Assisted living community costs jumped 10% to $70,800 per year, with rising occupancy rates likely pressuring prices.
• The annual median cost of a semi-private room in a nursing home rose to $111,325, an increase of 7%; the cost of a private room in a nursing home rose 9% to $127,750.

The survey, one of the most comprehensive studies of its kind, reached out to more than 140,000 long-term care providers nationwide to complete more than 15,000 surveys for nursing homes, assisted living communities, adult day health facilities, and home care providers.

The numbers are daunting and underscore the importance of proactive planning, especially since most traditional health insurance policies and Medicare do not cover long-term care.

Who pays for long-term care?

Medicare and Medicaid

In general, Medicare (Parts A & B) does not pay for most long-term-care services or for personal care services such as custodial care. Medicare is health insurance. It covers the costs related to illnesses and injuries. To some extent, it also covers prevention.

But there are limited exceptions.

Medicare Part A will help pay a portion of the costs for a short stay (up to 100 days per benefit period) in a skilled nursing facility if you meet the following conditions:

1. You were admitted to the hospital with an inpatient stay of three days or more.
2. You need skilled care, such as physical therapy or skilled nursing services.
3. The nursing facility you will be admitted to is Medicare-certified.
4. You are admitted to the Medicare-certified nursing facility within 30 days of your inpatient hospital stay.

Medicare may also assist with some long-term services if they’re medically necessary to treat an illness or injury.

Medicaid, on the other hand, is the largest public payer for long-term care. It covers nursing home care and some home and community-based services for individuals who meet strict income and asset requirements. Eligibility varies by state, and applicants often must “spend down” their assets to qualify.

However, when a senior applies for long-term care Medicaid, there is an asset limit. To be eligible for Medicaid, one cannot have assets greater than the limit. Medicaid’s Look-Back Period is meant to discourage Medicaid applicants from gifting assets, including selling them under fair market value, to meet Medicaid’s asset limit, according to the American Council on Aging.

Generally speaking, the “look back” is 60 months, with two exceptions: California and New York. In California, the look-back period is 30 months. By July of 2026, there will be no look-back period. California’s “look back” only applies to Nursing Home Medicaid.

While New York has a 60-month “look back” for Nursing Home Medicaid, there is currently no “look back” for Community Medicaid, the program through which state residents receive long-term home and community-based services. The state, however, plans to implement a 30-month look-back period for this program sometime in 2025.

Explore insurance options

Long-term care insurance (LTCI) is designed to cover services not paid for by Medicare or standard health insurance. Policies vary but typically cover care in nursing homes, assisted living facilities, adult day care centers, and at home.

However, LTCI can be expensive and may be difficult to obtain, especially for those who have pre-existing conditions. Hybrid policies that combine life insurance with LTC benefits are becoming more popular, offering more flexibility and value.

Personal funds and family support

Many individuals rely on personal savings, pensions, and investment income to cover the costs of care. Family members often provide unpaid care, which, while cost-saving, can lead to emotional and financial strain.

Other considerations

1. Consider a Health Savings Account (HSA)if you have a high-deductible health plan. Contributions are tax-deductible, with a maximum of $4,300 in 2025. At 55, you may contribute up to $5,300. Realized capital gains, dividends, and interest are tax-free in an HSA, and withdrawals are not taxed if used for qualified medical expenses, including long-term care.
2. You may also tap into your home equity or take out a reverse mortgage.
3. Do you have excess cash from RMDs? Consider placing them in a taxable brokerage account, which can be used if long-term care needs arise.

Financial planning and long-term care

Given the high costs and limited public support, financial planning is essential. Experts recommend the following steps:

1. Assess your risk: Consider family health history, lifestyle, and age. Women and single individuals are statistically more likely to need long-term care.
2. Consider legal preparations: Establish powers of attorney, advance directives, and wills to ensure your wishes are followed.
3. Consult us as your resource: We can integrate healthcare cost planning into your retirement strategy and your goals.

Final thoughts

Paying for long-term healthcare requires proactive planning. We want to emphasize that we are here to assist you in navigating life’s important financial decisions.

A thoughtful strategy can help ensure you and your loved ones receive the quality care you deserve, without unnecessary financial stress.

If you’d like to discuss how this fits into your overall financial plan, we are just a phone call or email away.

Factoring healthcare into your retirement plan is critical.  It’s not about buying something…it’s about having a plan.  And the worst time to have to come up with a plan is at the moment you need it.

Perhaps you will move in with one of your children, or live with some friends in a shared home.  The moral of the story: plan now.

October delivers further stock market gains

October has a curious reputation rooted in market history.

The Crash of 1929 (a 13% selloff on Black Monday and 12% on Black Tuesday, according to Federal Reserve History), the Crash of 1987 (a 22% selloff in October per MarketWatch data), and the financial crisis of 2008 (a 17% decline in October) have all contributed to the month’s spooky reputation.

But does perception match reality? Since 1970, October averages a 0.91% return for the S&P 500 Index (dividends not reinvested), according to S&P 500 data from the St. Louis Federal Reserve. Between 2010 and 2024, October sports an average monthly advance of 2.13%, which is eclipsed only by November and July.

Last month’s action was generally in line with the long-term averages.

Key Index Returns
	MTD %	YTD %
Dow Jones Industrial Average	2.5	11.8
Nasdaq Composite	4.7	22.9
S&P 500 Index	2.3	16.3
Russell 2000 Index	1.8	11.2
MSCI World ex-USA**	1.0	23.9
MSCI Emerging Markets**	4.1	30.3
Bloomberg US Agg Total Return	0.6	6.8

Source: Wall Street Journal, MSCI.com, Bloomberg, MarketWatch
MTD returns: September 30, 2025–October 31, 2025
YTD returns: December 31, 2024–October 31, 2025
**in US dollars

More impressively, the major market averages—the Dow, the S&P 500 Index, and the Nasdaq Composite—have all been up in each month—six straight monthly gains—since May.

As we briefly noted last month, government shutdowns typically have little impact on equities, and last month was no exception. Broadly speaking, the absence of all but essential government services does not have a lasting impact on the economy.

We did, however, experience a brief bout of volatility during the month when the president threatened punitive tariffs against China, which was primarily in response to China’s decision to tighten export controls on rare earth minerals and related technologies.

Rare earth minerals are crucial for manufacturing various high-tech products and military equipment, and China dominates the global supply chain.

However, cooler heads prevailed. As part of the truce, China agreed to delay its new export restrictions, and the president lowered some tariffs.

What were the major catalysts behind last month’s rally?

1. The government shutdown has delayed key economic data, but investors aren’t flying blind. In addition to private sources of data, investors are carefully combing through Q3 corporate profits, which have been quite strong overall, according to LSEG.
2. The ongoing boom in AIcontinues unabated and has been fueling investor enthusiasm.
3. The Federal Reserve delivered a widely expected quarter-point rate cut.
4. While Fed Chief Jay Powell tempered market enthusiasm by signaling that a December cut is far from certain, investors chose to focus on the generally favorable economic fundamentals, including solid corporate profits and the expanding economy

Overall, October continued the upward momentum that began in May, driven by a combination of solid economic fundamentals, a stable interest rate environment, and the ongoing AI revolution, which remained a key catalyst for gains among large-cap tech firms.

I trust you have found this review informative and helpful. If you have any questions or would like to discuss any other topics, please don’t hesitate to reach out to me or any member of our team.

Thank you for choosing us as your financial advisor. We are truly honored by your trust and remain committed to serving you with integrity and care.

Bruce Elfenbein

Certified Financial Fiduciary ®️