Updated September 2026
Buy long-term care coverage while you can still qualify medically and while the benefit has time to grow. My wife and I bought in our 50s at about $6,000 a month of benefit; it has since grown to roughly $11,000 a month. Buying that same benefit in your 70s costs far more, if preexisting conditions let you buy it at all.
Why does almost nobody plan for caregiving?
We spend more time deciding how we want to be buried than deciding who will take care of us while we are still here. We spend more time choosing a vacation. We spend more time choosing a meal.
Part of it is that caregiving is not fun. Vacations are fun. Choosing a meal is fun. Buying insurance is not. And part of it is that nobody ever taught you. You will not learn this in high school, where you might get shop and possibly something about financial literacy. You will not get it in college. You learn it in life, usually from a financial advisor, or from family, or from watching a caregiving situation happen to someone close to you.
The other thing I have noticed is that people genuinely do not know how to talk about it. When I told people I had been very sick, almost all of them said some version of "well, I'm glad you're getting better." Very few asked what happened. It is a safe place to go. I understand why people go there. But the conversation you are avoiding is the one that protects your family.
What happened to me
I had a medication reaction that affected my liver, my kidneys and my muscles. Over three months I was in three hospitals, in the emergency room more times than I want to count, and in a care rehabilitation center, because I was paralyzed. I could not walk. I am the person out of the movie with the handlebars and the stairs. I still use a walker. I have a caregiver. I am learning to drive again.
Here is the part I did not expect, and I say this as somebody who does this for a living.
There are a handful of moments in a life where you feel genuinely vulnerable and afraid. Birth. Marriage. A job loss or a financial crisis. A divorce. Death. Needing care belongs on that list, and it does not get less intense than that.
Having a plan did not remove the fear. What it removed was the second catastrophe, the financial one, and the position it would have put my wife in.
When should you buy long-term care insurance?
Earlier than you think, and the reason is arithmetic rather than sales pressure.
My wife and I bought ours in our 50s. The benefit was about $6,000 a month then. It is about $11,000 a month now, because it had time to grow. If I tried to buy an $11,000 a month plan today, in my 70s, the cost would be outrageous, and that is the optimistic version, because with my preexisting conditions I could not get it at all.
The later you start, the less time the benefit has to grow, and the more benefit you need, because you are nearer the point of using it, and the more likely it is that your health has closed a door. Three things move against you at once. Buying early is buying time.
People ask when they should buy it. If you are in your 60s, it is better than your 70s. If you are in your 50s, better again. Think of it the way you think about retirement planning or career planning: the question is not whether the future arrives, it is whether you did anything about it while you had options.
And if you do not need it, and everyone in your family dies right on schedule, right on time, then fine. But people live longer than the previous generation did. I do not know how long you are going to live. Neither do you.
What does caregiving actually cost?
To give you one real benchmark: the care center cost $850 a day. For that I got a bed and meals. No masseuse, no gourmet meal.
People ask for a price sheet. There is no such thing as a price sheet. The honest name for it is a guess sheet. Unlike most medical billing, you will find out exactly what caregiving costs, and you will find out in real time, and it drains a reserve fund faster than people expect. If you want anxiety, look at the numbers without a plan in place.
None of it is free even when it looks free. If your spouse provides the care, or a friend, or a volunteer, there is still a cost. It is paid in careers interrupted and sleep lost, rather than in dollars, and it is paid by the people you love most.
What surprises people most when caregiving starts?
Not the bathing, dressing and eating. Everyone braces for that part. It is barely the half of it.
It is the administration. It is the phone calls at two in the afternoon from someone asking to visit at four, who never says who they are or what they do. It is the return calls to doctors' offices and the queue system, and the maybe they call you back. It is working out which appointments go in the calendar for October, November, December and January. It is the thirty pages of discharge paperwork. It is the support equipment: a chair in the bathtub, grab bars, ramps, the bed, and, in my case, a fleet of walkers my wife has opinions about.
And it does not land on one person. Everybody around you is affected, especially family and friends. That is the part people miss when they think of this as an individual purchase.
Why do you need an advocate?
If there is one thing to take from all of this, it is this one.
You will not be in a state to catch it. You are on medication. You are tired. Do you really think you are getting eight hours of quality sleep in a hospital or a care center? Every thirty-five minutes it is blood pressure, weight, we need to take your blood.
An advocate is someone calm enough to slow the conversation down and ask the questions you did not ask because you were not in a position to think of them. You can record the conversation, and you can run an AI summary of it afterwards. Do both if you like. But neither of them will interrupt a practiced explanation and say "wait, go back."
Does long-term care insurance pay for home modifications?
It will, on most plans. Home modification, not home improvement, and the distinction matters. Things for the bathroom. Grab bars. Ramps. The equipment that determines whether you can get into your own house and into your own bed.
That is one of several benefits people do not know they have. Another: if you retired from the federal government, there is a long-term care benefit available to you, and you have to go and buy it directly. A lot of retirees have no idea.
Who can I work with?
If you are a company looking at employee benefits, I can work with you anywhere. For individuals I am licensed in selected western states: Washington, Oregon, California, Arizona, Nevada, New Mexico and Colorado. If you are somewhere else, say New York, I will tell you so and refer you to someone who is licensed there. Being licensed in fifty states is expensive and it would not make me better at this.
The first step is always a health assessment, because until I know your health I cannot tell you what is available to you or what it costs. Anybody who gives you a number before that is guessing.
I have been in financial services a long time and specialized in extended care benefits for sixteen years. I am in webinars, continuing education and reading two, three, four times a week, because this is a moving target. What was true in 2010 is not true now.
If
I read a poem on podcasts now. Rudyard Kipling wrote If about responsibility and maturity. I rewrote it about caregiving, because it says the thing better than a brochure does.
"If you can sit beside the kitchen table and speak the words that no one wants to say. If you can plan today while you are able for caregiving seasons that may come some distant day."Raymond Lavine, after Kipling
It goes on for a while. The end of it is the part I care about: that you leave behind clarity and grace and dignity, a promise kept, a future gently known. The rarest gift is the gift of caregiving planned.
People do not want to feel invisible, and they do not want to feel vulnerable, and they do not want to feel afraid. That is every culture, everywhere. In the last few months I was all three. You can still live a life if you need care, a real one. But you have to have the support in place, and you have to have the funds.
As Jack Hawkins says in The Bridge on the River Kwai, there is always the unexpected. The unexpected is everything.
Raymond Lavine is an extended care benefits advisor at Lavine LTC Benefits in Gig Harbor, Washington, a US Army veteran, a contributing author of Empathy and Understanding in Business, and host of the podcast Planning with Purpose: The Caregiver's Blueprint. This article is adapted from a recorded interview with Jess Todtfeld of Success in Media.
The full conversation
Video coming shortly.
Raymond Lavine with Jess Todtfeld on caregiving, cost, and why timing decides everything.