What causes people to need long-term care?

Understanding why people end up needing long-term care helps explain why insurers underwrite the way they do — and why buying coverage while you're still healthy matters. A landmark Society of Actuaries study of individual long-term care insurance claims, widely cited by the American Association for Long-Term Care Insurance (AALTCI), found the following causes behind new claims:

• Alzheimer's disease and other dementias — about 25%. Roughly one in four claims traces back to a cognitive impairment. This is the single largest category by a wide margin, and it's why a dementia diagnosis is one of the few conditions that makes traditional coverage essentially unavailable.
• Stroke — about 9%.
• Arthritis — about 9%.
• Injury, including falls — about 9%. See our guide to preventing falls and making your home safer.
• Circulatory conditions, including heart disease — about 9%.
• Cancer — about 8%.
• Nervous system disorders, such as Parkinson's disease — about 6%.
• Respiratory conditions — about 5%.

The remainder is spread across other conditions. Nursing home care specifically accounted for roughly one in four new individual claims, with home care and assisted living making up much of the rest.

What this means for planning

Two things stand out. First, cognitive decline dominates the list — and unlike many physical conditions, it develops silently over years, often before a family notices. Second, none of these are conditions you can predict for yourself years in advance, which is exactly why coverage is priced on age and current health rather than a crystal ball: the healthier and younger you are when you apply, the more insurable you are against all of the causes above, not just the one that eventually affects you.

A note on the data. This breakdown comes from a widely referenced Society of Actuaries claims study; more recent, comprehensive claims-cause studies of this kind are not published annually, so treat the percentages as directional rather than exact for the current year. The dominant role of Alzheimer's and other dementias in long-term care claims is well established across more recent research as well.

General information only. This is educational and not insurance, legal, tax, or financial advice. Rules and products vary and change — confirm the specifics with a licensed professional.