The affordability of private pay services is an important component of long-term
services and supports system performance. This Insight on the Issues presents
data on private pay affordability for every state and more than 400 markets in the
United States. There is wide variation in affordability between states and markets.
Private pay nursing home care is not affordable for middle-income families
anywhere. While less costly than nursing homes, home health care is still
unaffordable for middle-income older people at typical levels of use.