Disclaimer: General educational research only — not legal, tax or financial advice. Figures are survey-based estimates with the limits explained in the methodology. Verify with official sources and a qualified professional before making decisions.
Estate Planning Data & Research → Can You Afford Long-Term Care on Your State’s Median Retirement Income?
Most people want to stay in their own home as they get older, even if they need help with bathing, dressing, meals or getting around. The question families run into is whether the money will stretch.
We put two government numbers side by side for every state and Washington, D.C.:
- What it costs to pay a home health or personal care aide for 44 hours a week (a little more than a full-time job), using the typical (median) aide wage in each state.
- The typical income of households headed by someone 65 or older in that state.
The short answer: in a typical older household, paying an aide’s wage for 44 hours a week would take about two-thirds of the household’s income nationwide, and more than 80% in three states. And that is the low estimate. It counts only the aide’s wage, not agency fees.
While you plan for care, make sure the legal papers are in place too: a will, a power of attorney and a health care directive. See whether you need a will, a living trust or both.
Downloads
Cite this page URL when reusing findings. Not a substitute for official sources or professional advice.
Key findings
- Nationally, 44 hours a week of aide care costs about $39,400 a year at the median aide wage of $17.21 an hour. The median household headed by someone 65+ brings in $59,648 a year. The care alone would take 66% of that income, leaving roughly $1,700 a month for everything else.
- Heaviest burden: Kentucky (86% of the typical 65+ household’s income), Rhode Island (81%), Oregon (81%), Maine (76%) and Washington (76%). In Kentucky, the household would have about $550 a month left after paying the aide.
- Lightest burden: Texas (45%), Hawaii (46%), Virginia (50%), Louisiana (52%) and California (53%). Texas and Louisiana rank here mainly because aide pay is low there, not because older households are especially well off.
- In 14 states, the 44-hour cost tops 70% of the typical older household’s income.
- Round-the-clock care is out of reach on income alone everywhere. At 168 hours a week, the aide’s wages come to more than the median 65+ household income in every state, from 173% in Texas to 328% in Kentucky. Nationally it is about $150,300 a year, 252% of median income.
- Part-time help is more manageable. At 20 hours a week, the cost drops to about 30% of the typical older household’s income nationally (21% in Texas, 39% in Kentucky).
Full state table
Sorted from heaviest to lightest burden at 44 hours a week. Costs use the state’s median aide wage × hours × 52 weeks, with no overtime, agency markup or payroll taxes. The “likely range” column shows how the percentage moves if the true income figure is at the high or low end of the Census margin of error.
| Rank (heaviest burden first) | State | Aide median pay (hourly) | Yearly cost, 44 hrs/week | Median income, 65+ households | Share of income, 44 hrs/week | Likely range (income ± margin of error) | Share of income, 20 hrs/week | Around-the-clock (168 hrs/week) |
|---|---|---|---|---|---|---|---|---|
| 1 | Kentucky | $17.52 | $40,086 | $46,685 (±$1,115) | 86% | 84%–88% | 39% | $153,055 (328%) |
| 2 | Rhode Island | $21.00 | $48,048 | $59,258 (±$4,037) | 81% | 76%–87% | 37% | $183,456 (310%) |
| 3 | Oregon | $21.35 | $48,849 | $60,405 (±$1,767) | 81% | 79%–83% | 37% | $186,514 (309%) |
| 4 | Maine | $18.55 | $42,442 | $55,568 (±$2,193) | 76% | 73%–80% | 35% | $162,053 (292%) |
| 5 | Washington | $22.95 | $52,510 | $69,010 (±$1,520) | 76% | 74%–78% | 35% | $200,491 (291%) |
| 6 | Vermont | $20.00 | $45,760 | $60,814 (±$2,917) | 75% | 72%–79% | 34% | $174,720 (287%) |
| 7 | North Dakota | $18.96 | $43,380 | $57,708 (±$3,447) | 75% | 71%–80% | 34% | $165,635 (287%) |
| 8 | Indiana | $16.86 | $38,576 | $52,592 (±$1,025) | 73% | 72%–75% | 33% | $147,289 (280%) |
| 9 | New York | $19.05 | $43,586 | $59,909 (±$1,067) | 73% | 71%–74% | 33% | $166,421 (278%) |
| 10 | Wisconsin | $17.47 | $39,971 | $55,336 (±$921) | 72% | 71%–73% | 33% | $152,618 (276%) |
| 11 | Ohio | $16.57 | $37,912 | $53,095 (±$909) | 71% | 70%–73% | 32% | $144,756 (273%) |
| 12 | Nebraska | $17.38 | $39,765 | $56,008 (±$2,052) | 71% | 68%–74% | 32% | $151,832 (271%) |
| 13 | Michigan | $16.83 | $38,507 | $54,599 (±$808) | 71% | 69%–72% | 32% | $147,027 (269%) |
| 14 | Iowa | $17.34 | $39,674 | $56,419 (±$1,319) | 70% | 69%–72% | 32% | $151,482 (268%) |
| 15 | Minnesota | $18.45 | $42,214 | $61,129 (±$1,194) | 69% | 68%–70% | 31% | $161,179 (264%) |
| 16 | South Dakota | $18.15 | $41,527 | $60,166 (±$2,357) | 69% | 66%–72% | 31% | $158,558 (264%) |
| 17 | Montana | $17.61 | $40,292 | $58,390 (±$2,981) | 69% | 66%–73% | 31% | $153,841 (263%) |
| 18 | Illinois | $18.30 | $41,870 | $60,697 (±$873) | 69% | 68%–70% | 31% | $159,869 (263%) |
| 19 | Missouri | $15.90 | $36,379 | $53,027 (±$1,076) | 69% | 67%–70% | 31% | $138,902 (262%) |
| 20 | West Virginia | $13.47 | $30,819 | $45,778 (±$1,348) | 67% | 65%–69% | 31% | $117,674 (257%) |
| 21 | District of Columbia | $20.53 | $46,973 | $70,668 (±$7,561) | 66% | 60%–74% | 30% | $179,350 (254%) |
| 22 | Tennessee | $15.45 | $35,350 | $53,889 (±$1,295) | 66% | 64%–67% | 30% | $134,971 (250%) |
| 23 | Massachusetts | $19.67 | $45,005 | $69,095 (±$1,608) | 65% | 64%–67% | 30% | $171,837 (249%) |
| 24 | Idaho | $16.72 | $38,255 | $59,657 (±$2,170) | 64% | 62%–67% | 29% | $146,066 (245%) |
| 25 | Arizona | $17.51 | $40,063 | $62,575 (±$1,327) | 64% | 63%–65% | 29% | $152,967 (244%) |
| 26 | Arkansas | $13.30 | $30,430 | $48,078 (±$1,130) | 63% | 62%–65% | 29% | $116,189 (242%) |
| 27 | New Hampshire | $18.64 | $42,648 | $67,530 (±$1,975) | 63% | 61%–65% | 29% | $162,839 (241%) |
| 28 | Colorado | $18.53 | $42,397 | $67,322 (±$1,711) | 63% | 61%–65% | 29% | $161,878 (240%) |
| 29 | North Carolina | $15.02 | $34,366 | $55,235 (±$1,117) | 62% | 61%–64% | 28% | $131,215 (238%) |
| 30 | Florida | $16.25 | $37,180 | $60,005 (±$576) | 62% | 61%–63% | 28% | $141,960 (237%) |
| 31 | Connecticut | $18.75 | $42,900 | $69,395 (±$1,898) | 62% | 60%–64% | 28% | $163,800 (236%) |
| 32 | Alabama | $13.39 | $30,636 | $50,483 (±$1,062) | 61% | 59%–62% | 28% | $116,975 (232%) |
| 33 | Wyoming | $15.96 | $36,516 | $60,674 (±$4,038) | 60% | 56%–64% | 27% | $139,427 (230%) |
| 34 | Kansas | $15.03 | $34,389 | $57,155 (±$1,361) | 60% | 59%–62% | 27% | $131,302 (230%) |
| 35 | South Carolina | $14.48 | $33,130 | $55,385 (±$1,128) | 60% | 59%–61% | 27% | $126,497 (228%) |
| 36 | Mississippi | $11.47 | $26,243 | $44,031 (±$1,947) | 60% | 57%–62% | 27% | $100,202 (228%) |
| 37 | Oklahoma | $13.32 | $30,476 | $51,209 (±$1,245) | 60% | 58%–61% | 27% | $116,364 (227%) |
| 38 | Alaska | $19.11 | $43,724 | $74,308 (±$3,959) | 59% | 56%–62% | 27% | $166,945 (225%) |
| 39 | Nevada | $16.19 | $37,043 | $63,688 (±$1,539) | 58% | 57%–60% | 26% | $141,436 (222%) |
| 40 | Pennsylvania | $14.14 | $32,352 | $55,938 (±$837) | 58% | 57%–59% | 26% | $123,527 (221%) |
| 41 | New Mexico | $13.71 | $31,368 | $54,478 (±$1,790) | 58% | 56%–60% | 26% | $119,771 (220%) |
| 42 | Georgia | $14.07 | $32,192 | $56,010 (±$1,098) | 57% | 56%–59% | 26% | $122,916 (219%) |
| 43 | Delaware | $16.50 | $37,752 | $66,859 (±$2,584) | 56% | 54%–59% | 26% | $144,144 (216%) |
| 44 | New Jersey | $17.83 | $40,795 | $72,905 (±$1,165) | 56% | 55%–57% | 25% | $155,763 (214%) |
| 45 | Utah | $17.25 | $39,468 | $70,712 (±$2,298) | 56% | 54%–58% | 25% | $150,696 (213%) |
| 46 | Maryland | $18.29 | $41,848 | $75,539 (±$2,330) | 55% | 54%–57% | 25% | $159,781 (212%) |
| 47 | California | $16.50 | $37,752 | $71,673 (±$726) | 53% | 52%–53% | 24% | $144,144 (201%) |
| 48 | Louisiana | $10.83 | $24,779 | $47,263 (±$1,173) | 52% | 51%–54% | 24% | $94,611 (200%) |
| 49 | Virginia | $14.57 | $33,336 | $66,450 (±$1,179) | 50% | 49%–51% | 23% | $127,284 (192%) |
| 50 | Hawaii | $18.32 | $41,916 | $91,390 (±$3,895) | 46% | 44%–48% | 21% | $160,044 (175%) |
| 51 | Texas | $11.65 | $26,655 | $58,739 (±$932) | 45% | 45%–46% | 21% | $101,774 (173%) |
| — | United States | $17.21 | $39,376 | $59,648 (±$207) | 66% | 66%–66% | 30% | $150,347 (252%) |
Source: Family Estate Guide analysis of BLS Occupational Employment and Wage Statistics, May 2025 (SOC 31-1120, Home Health and Personal Care Aides), and U.S. Census Bureau American Community Survey 2024 1-year estimates, table B19049 (median household income, householder 65 years and over).
How to read this
This is a floor, not a quote. The cost here is what an aide is typically paid. If you hire through a home care agency, the hourly rate you pay also covers the agency’s costs, so it will be higher. If you hire someone directly, you may become a household employer, with payroll tax and paperwork duties (see IRS Publication 926). Also, federal rules generally require home care workers to get overtime for hours over 40 a week. Paying 4 overtime hours at time-and-a-half would raise the national share from 66% to 69% (our CSV includes this column for every state).
“Median income” is the middle household, not your household. Half of older households earn more and half earn less. The figure is total household income before taxes: Social Security, pensions, retirement account withdrawals, wages and so on. It does not count savings, home equity or long-term care insurance, which is how many families actually pay for care.
Close rankings are not exact. The Census numbers come from a survey. For example, Rhode Island’s likely range (76%–87%) overlaps with Oregon’s, Maine’s and several others, so the order near the top should be read as “these states are all in the highest group.”
What this means for your family
Have the money talk before the care talk. Once you know what care costs where your parent lives, the next questions are: What income is coming in? What savings are there? Who can sign checks if Mom or Dad can’t? Our guide to the family conversation and My Parents Are Getting Older: Where Do I Start? walk through how to begin.
Get the legal papers in place first. A durable power of attorney and a healthcare directive let a trusted person pay the aide, deal with the bank and talk with doctors. Without them, a family may need a court-appointed guardian, which costs time and money when care can’t wait. If a crisis is already here, see We Need a Plan Now.
Know how Medicaid fits in. When income and savings run out, Medicaid is the main public payer for long-term care, including home and community-based care in many states. Eligibility rules on income, assets and gifts are strict and vary by state. After death, Medicaid may try to recover what it paid from the estate. See our Medicaid estate recovery scorecard by state, and talk with an elder law attorney before moving assets around.
Think about how the house and savings are titled. For many older households the home is the biggest asset. Whether you use a will or a trust, and whether a trust is revocable or irrevocable, can affect what heirs receive and how Medicaid treats things. These choices are worth making with a professional, not in a hurry.
Compare with other care settings. If home care is out of reach, see nursing home costs by state, nursing home capacity by state, and our care cost and income calculator, which lets you plug in your own quote.
Related research: home health quality by state compares Medicare star ratings for home health agencies in every state.
Methodology
Aide wages. U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics (OEWS), May 2025 (published May 2026). State file state_M2025_dl.xlsx from oesm25st.zip; national file from oesm25nat.zip. Occupation SOC 31-1120, Home Health and Personal Care Aides (BLS publishes 31-1121 and 31-1122 only as this combined code). Measure: median hourly wage (H_MEDIAN). All 51 values published, none suppressed. OEWS excludes self-employed workers and workers employed directly by private households.
- https://www.bls.gov/oes/special-requests/oesm25st.zip
- https://www.bls.gov/oes/special-requests/oesm25nat.zip
Older-household income. U.S. Census Bureau, American Community Survey 2024 1-year estimates, table B19049, variable B19049_005E (median household income in the past 12 months, in 2024 inflation-adjusted dollars, householder 65 years and over) and its 90% margin of error B19049_005M. Pulled from the Census Data API (https://api.census.gov/data/2024/acs/acs1). The 2025 ACS 1-year release, normally out in mid-September, has been postponed by the Census Bureau (see https://www.census.gov/programs-surveys/acs/news/updates/2026.html), so 2024 is the latest single-year data available. For comparison, the CSV also includes the 2020–2024 5-year estimate, which our care cost calculator uses; the two are close in most states.
- Table info: https://data.census.gov/table/ACSDT1Y2024.B19049
Hours assumptions.
- Main scenario: 44 hours a week × 52 weeks = 2,288 hours a year, paid at the straight median wage.
- Part-time: 20 hours a week (1,040 hours a year).
- Around-the-clock: 168 hours a week (8,736 hours a year), straight time. Real 24-hour care usually involves several workers, overtime or live-in arrangements, so treat this as a rough lower bound.
- Overtime sensitivity (CSV only): 40 hours at the median wage plus 4 hours at 1.5×.
Calculations. Share of income = annual aide cost ÷ median 65+ household income × 100. Likely range = annual cost ÷ (income ± margin of error). Wages are May 2025; income is 2024 dollars. We did not adjust for inflation between the two, which makes the shares slightly higher than a same-year comparison would.
The full CSV is available in the Downloads section above.
Frequently asked questions
Does Medicare pay for an in-home aide?
Generally not for ongoing help with daily activities. Medicare covers short-term home health care when certain medical conditions are met. Long-term help with bathing, dressing and meals is usually paid by the family, by long-term care insurance, or by Medicaid for people who qualify.
Why 44 hours a week?
It is a common level of help for someone who needs a person around during the day but not overnight, roughly a full-time shift plus a little extra. We also show 20 hours and around-the-clock so you can see the range.
My state looks “cheap.” Is home care easy to afford there?
Not necessarily. A lower share often means aides are paid less, which can make it harder to find and keep workers. Our Caregiver Shortage Index looks at how many seniors there are for each aide in your state.
Why use household income instead of Social Security?
Census measures income for the whole household, which is what usually pays the bills. It includes Social Security plus pensions, retirement withdrawals, earnings and other income. It does not include savings or home equity.
Cite this data
Family Estate Guide, “Can You Afford Long-Term Care on Your State’s Median Retirement Income?” October 2026. Analysis of BLS Occupational Employment and Wage Statistics (May 2025, SOC 31-1120) and U.S. Census Bureau ACS 2024 1-year table B19049. https://familyestateguide.com/estate-planning-data/home-care-cost-vs-retirement-income/
Feel free to use these numbers with a link back to this page. The complete CSV is free to download.
Published October 1, 2026. Data vintage: BLS OEWS May 2025 (released May 2026); Census ACS 2024 1-year, table B19049 (released Sept 2025). The 2025 ACS 1-year release has been postponed by the Census Bureau.. Editorial standards.