GENWORTH FINANCIAL 2008 COST OF CARE SURVEYGENWORTH FINANCIAL 2008 COST OF CARE SURVEY APRIL 2008...

G E N W O R T H F I N A N C I A L 2 0 0 8 C O S T O F C A R E S U R V E Y

A P R I L 2 0 0 8

Home Care Providers, Adult Day Health Care Facilities,

Assisted Living Facilities and Nursing Homes

37522 04/30/08

I N T R O D U C T I O N

With the aging Baby Boomer generation 77 million strong and people living longer than in decades past, one of the biggest issues seniors and their families face is the prospect of needing, and potentially providing, long-term care at some point in their lives. Most Americans, though, have yet to seriously consider and plan for the emotional and financial consequences of aging, and many are not familiar with the care options available today or the associated costs.

Each year, Genworth Financial – a leading global financial services provider – conducts its benchmark Cost of Care survey to bring you an in-depth look at the cost of long-term care across the country, along with corresponding market trends. We do this to help consumers and financial professionals prepare for the future by arming you with the knowledge required to make long-term care decisions. Our report also informs policymakers, caregivers, advocates, the private business sector and media as they talk about issues critical to long-term care.

We have analyzed data from more than 10,000 nursing homes, assisted living facilities, home care providers and adult day health care facilities in all 50 states and the District of Columbia, including a comparative evaluation of 90 urban and rural regions in the United States. Also this year we include several new features. Tapping into our exclusive five years of Cost of Care survey data, we provide a five-year historical view of trends not available in any other industry report. We also offer for the first time adult day health care costs as well as a primer on long-term care options so that you may more fully benefit from the information presented in this report. And we encourage you to visit our easy-to-use, interactive Web site, including our popular U.S. Cost of Care map at genworth.com/CostofCare.

You will find a one page summary of data as well as a thorough review of findings in this report. In brief, we found that the average cost of care for nursing homes and assisted living facilities has steadily increased over the past five years, while the cost of non-skilled care delivered in a home setting has remained relatively flat. In addition, adult day health care – designed to meet the needs of and help adults who are functionally and/or cognitively impaired live more independently – is becoming more popular and more available across the country.

We are often asked what is influencing the cost of care. Long-term care is a complex issue and there is no simple answer. One key factor to note is that the U.S. is facing a critical long-term care labor shortage that will have significant implications on the quality and drastically increase the cost of care. With the enormous wave of Baby Boomers heading into their senior years, our health care system faces an increased demand for long-term care and qualified paraprofessional healthcare workers to administer this care. It is imperative that this workforce issue be positioned at the forefront of public policy discussions and that, as a nation, we recruit, cultivate and retain a highly trained workforce – an effort critical to bridging this gap and meeting the increased need for long-term care over the next few decades.

As the nation’s largest provider of long-term care insurance with more than 34 years in the industry, Genworth Financial has a unique view of the issues surrounding long-term care and is actively engaged in elevating awareness about the need to plan ahead. We designed this report to educate you about long-term care options and their costs by region and type of care. We hope this tool helps you make informed decisions and encourages you to proactively prepare for the future.

LIMRA International, U.S. Individual Long-Term Care Insurance Sales Survey, Fourth Quarter YTD 2007 and U. S. Group Long-Term Care Insurance Sales Survey, Fourth Quarter YTD 2007 in force results.

C O N T E N T S

Understanding Long-Term Care

Summary of 2008 Survey Findings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Long-Term Care Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

The Categories of Long-Term Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Emerging Trends and Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Cost of Care Maps and Tables

Homemaker Services (Non-Medicare Certified, Licensed) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Home Health Aide Services (Non-Medicare Certified, Licensed) . . . . . . . . . . . . . . . . . . . . . . . . . 13

Home Health Aide Services (Medicare Certified) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Home Health Aide Services (Both Provider Types) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Adult Day Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Assisted Living Facility (Private One Bedroom) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Nursing Home (Semi-Private Room) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Nursing Home (Private Room) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Appendix

State Regions With Counties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

1 Represents the compound annual growth rate based on Genworth Cost of Care survey data from 2004-2008.2 Represents the compound annual growth rate based on Genworth Cost of Care survey data from 2005-2008.

S U M M A R Y O F 2 0 0 8 S U R V E Y F I N D I N G S

Homemaker Services (Non-Medicare Certified, Licensed)

Provide “hands-off” care such as helping with cooking and running errands. Often referred to as “Personal Care Assistants” or “Companions.” This is the rate charged by a non-Medicare certified, licensed agency.• National average hourly rate of $18• 4% increase over 2007• Five-year annual growth of 2%1

Home Health Aide Services (Non-Medicare Certified, Licensed)

Provide “hands-on” personal care, but not medical care in the home with activities such as bathing, dressing, and transferring. This is the rate charged by a non-Medicare certified, licensed agency.• National average hourly rate of $19• 3% increase over 2007 • Five-year annual growth of 1%1

Home Health Aide Services (Medicare Certified)

Provide “hands-on” personal care and sometimes skilled care associated with a nurse visit in the home. Assist with activities such as bathing, dressing, and transferring. This is the rate charged by a Medicare certified agency.• National average hourly rate of $38• 18% increase over 2007• Four-year annual growth of 7%2

Adult Day Health Care

Provides social and other related support services in a community-based, protective setting during any part of a day, but less than 24-hour care.

• National average daily rate of $59

Assisted Living Facility (Private One Bedroom)

Provides “hands-on” personal care as well as medical care for those who are not able to live by themselves, but do not require constant care provided by a nursing home.• National average monthly rate of $3,008• 11% increase over 2007• Five-year annual growth of 6%1

Nursing Home (Semi-Private Room)

Provides skilled nursing care 24-hours/day.• National average daily rate $187• 4% increase over 2007• Five-year annual growth of 4%1

Nursing Home (Private Room)

Provides skilled nursing care 24-hours/day. • National average daily rate $209• 2% increase over 2007• Five-year annual growth of 4%1

Home

Community

Facility

1

2

L O N G T E R M C A R E O V E R V I E W

With all the talk today about the state of the economy, you can’t help but think about your financial future. By now, you may have saved a significant amount for retirement, and also may be well on your way to making progress to paying down your mortgage. Or perhaps you may be years away from retirement and are just starting to plan for your financial future.

But have you given much thought to what you would do if you needed long-term care? Long-term care is the kind of help you may need if you have a prolonged physical illness, disability, or cognitive impairment (such as Alzheimer’s disease) that keeps you from living an independent lifestyle. These limitations may prevent you from carrying out basic self-care tasks, called Activities of Daily Living (ADLs). ADLs may include things such as bathing, dressing or eating.

Review the OptionsInformation is power: the more you know about long-term care, the better decisions you can make about your future. For example, people who are thinking of relying on Medicare or Medicaid to provide long-term care services should be well informed about these programs.

Medicare Generally, Medicare is the federal program providing hospital and medical insurance to people aged 65 or older and to certain ill or disabled persons. Benefits may be available for home health care, but only if certain conditions are met. Additionally, Medicare may pay for up to 100 days of care in a skilled nursing facility per benefit period – 100% for the first 20 days (after a three-day hospital stay provided skilled care is needed). Then beginning on day 21-100, Medicare requires a co-payment. To help cover the co-payment, many seniors may also have a Medicare supplement insurance policy. In general, once Medicare stops paying for care, the supplement payment will end as well.

Medicaid Medicaid (in California referred to as Medi-Cal) generally pays for certain health services and nursing home care for those with low incomes and limited resources. Medicaid may also pay for some long-term care services at home and in the community. Medicaid has limitations on the amount of assets you can own and the amount of income you may receive each month before you are eligible for benefits. Who is eligible and what services are covered vary from state to state. There are also restrictions on transferring assets in order to qualify for Medicaid.

Learn the LevelsAlso, when talking about long-term care, people may not think about the type or level of care they may need. Long-term care can be therapeutic, rehabilitative or personal care delivered at home, in a community-based setting or in a facility. Here’s how each level of care differs:

• Custodial Care (Personal Care) is for those who need help with activities of daily living, and often involves non-medical personnel. An example would be having a helper come into your house to help with bathing, dressing, or eating and other ADLs.

• Intermediate Care is for those who need occasional nursing and rehabilitative care under the supervision of skilled medical personnel. It is less specialized and less comprehensive than skilled nursing care. Intermediate care is similar to skilled care except it is provided on a periodic basis. The caring for a wound every eight hours, for example, is considered intermittent treatment.

• Skilled Care is for those who have medical conditions that require care by medical professionals such as a registered nurse or professional therapist. This higher level of care can include physical therapy or supervising the administration of intravenous medication.

2

3

T H E C A T E G O R I E S O F L O N G T E R M C A R E

The good news is that today consumers have options when planning for a long-term care need. Here is a brief review of the categories of long-term care options available.

Homemaker ServicesThis service makes it possible for people to live in their own homes or to return to their homes by helping them complete household tasks that they can’t manage alone. Homemaker services aides may clean clients’ houses, cook meals or run errands.

Home Health AidesPersonal and home health aides help those who are elderly, disabled, or ill to live in their own homes or in residential care facilities instead of in nursing homes. Home health aides may offer care to people who need more extensive personal care than family or friends are able to or have the time or resources to provide. Home health aide agencies are broken up into two categories; Medicare certified and non-Medicare certified, licensed. Medicare certified agencies are certified to accept Medicare reimbursements while non-Medicare certified, licensed agencies are not certified by Medicare to receive Medicare reimbursements.

Adult Day Health CareAdult Day Health Care (ADH) centers can offer a much-needed break to caregivers. This type of care provides service at a community-based center for adults who need assistance or supervision during the day but who do not need round the clock care. The centers may provide health services, therapeutic services and social activities.

Assisted Living FacilitiesAssisted living facilities (in California referred to as Residential Care Facilities) are living arrangements that provide personal care and health services for people who may need assistance with ADLs, but who wish to live as independently as possible and who do not need the level of care provided by a nursing home. It’s important to note that assisted living is not an alternative to a nursing home, but an intermediate level of long-term care.

Nursing Home CareA nursing home is for those people who may need a higher level of supervision and care than in an assisted living facility. They offer residents personal care, room and board, supervision, medication, therapies and rehabilitation, as well as skilled nursing care 24 hours a day.

Review the CostsAs you page through this brochure, you can look up the costs of various types of care in your state – homemaker services, home health aides, adult day health care, assisted living and nursing home. These costs can give you a good idea of how much money you or your family would need if you or a loved one required long-term care.

3

4

E M E R G I N G T R E N D S A N D F I N D I N G S

This is the 5th consecutive year Genworth has used a consistent methodology to survey long-term care service providers across the country within 90 Regions.3

Based on these survey results, Genworth recognizes some emerging trends across the long-term care services landscape.

Overall, the cost of care within facility-based providers has steadily increased while non-skilled related home care costs have remained relatively flat. For example, in 2008 the average annual rate for a private nursing home room was $76,460 compared with the 2004 average annual rate of $65,185. This increase represents a 4% compound annual growth rate over that period and means Americans can expect to pay over $10,000 more per year than five years ago.

Similarly, the monthly rate for a one-bedroom unit within a licensed assisted living facility has increased almost 6% annually over five years,4

excluding any one-time community fees that are typically charged by approximately one-third of all assisted living facilities surveyed.

In contrast to facility-based care, rates charged by home care providers for non-skilled related services have remained relatively flat over five years. For example, in 2004 the national, hourly private pay rate charged by a non-Medicare certified, licensed home health agency for a home health aide was $18. In 2008 the hourly rate has only increased to $19. Despite a slight spike in these rates in 2006, the historical compound annual growth rate for this type of care has been a mere 1% over five years of survey results. Potential reasons for this trend include the possibility that home care rates have remained flat due to increased competition among agencies, availability of unskilled labor, and because agencies can avoid, for the most part, the costs associated with maintaining stand-alone health care facilities.

3 The 2007 Genworth Cost of Care survey included 90 regions as well; however, prior to 2007, Genworth Cost of Care surveys

included 88 regions. The two newest regions are Richmond, Virginia and Nashville, Tennessee.4 Percentage increase represents the compound annual growth rate for surveys conducted by Genworth from 2004 to 2008.

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

$80,000

2004 2005 2006

Year

2007 2008

Nursing Home(Private Room)

Nursing Home (Semi-Private Room)

Assisted Living Facility (Private One Bedroom)

4.07%

4.36%

5.84%

% Compound Annual Growth Rate from 2004 to 2008

ANNUAL COSTS OF FACILITY-BASED CARE – NATIONAL FINDINGS

5

Another industry trend is the increase in Adult Day Health Care (ADH) facilities and programs. ADH is becoming more popular and more available across the country and is designed to meet the needs of adults who are functionally and/or cognitively impaired. Programs are structured and comprehensive, and take place in a protective setting that promotes well-being through a variety of health, social, and other support services. These services are intended to help enable individuals to live more independently in the community. They also may be intended to provide some relief for family caregivers.

There are at least three different models of adult day health care programs: social, medical, and combined.

Social Model: This model provides social activities, meals, recreation, and some health related services. The primary focus is on providing non-medical interventions such as basic care, supervision, social activities, transportation, meals, and recreation. Five

percent of ADH facilities surveyed offered this model.

Medical Model: This model is typically for individuals who have health care problems. Generally, the medical model provides nursing supervision and medical monitoring for each participant. Medical model programs may also offer physical, occupational, and speech therapy. Thirty-eight percent of ADH facilities surveyed offered this model.

Combined Model: Providers offering this model may provide both social and medical services. Usually a Registered Nurse (RN) or Licensed Practical Nurse (LPN) on staff oversees general health while participants take part in a variety of activities designed to stimulate cognition and movement. Fifty-seven percent of ADH facilities surveyed offered this model.

Nationally, the average daily rate charged by an ADH provider is $59/day.

2004 2005 2006

Year

2007 2008

Home Health Aide Services (Non-Medicare Certified, Licensed)

Homemaker Services (Non-Medicare Certified, Licensed)

$0

$5

$10

$15

$20

$25

1.00%

2.27%

% Compound Annual Growth Rate from 2004 to 2008

HOURLY COSTS OF HOME-BASED CARE – NATIONAL FINDINGS

C O S T O F C A R E M A P S A N D T A B L E S

HOMEMAKER SERVICES (NON-MEDICARE CERTIFIED, LICENSED) HOURLY RATESNational Average $18

AL

AZAR

CACO

CT DE

FL

GA

ID

ILIN

IA

KSKY

LA

ME

MDM

AM

I

MN

MS

MO

MT

NE

NV

NH

NJ

NM

NY

NC

ND

OH

OK

OR

PARI

SC

SD

TN

TX

UT AK

HI

VT

VA

WA

WV

WI

WY

$19

$17

$19 $1

9

$19

$19

$18

$17

$17 $1

5

$13

$14

$15

$15$1

6

$16

$16

$18

$24

$18

$17

$16

$14

$17

$17

$18

$17

$19

$19

$19

$19

$18

$19

$20

$20 $2

1

$20

$19

$16

$16 $1

7

$16

$17

$20

$20

$20

$18

$18

$18

$19Sea

ttle

$23

Port

land

$20

San

Fr

anci

sco

$24

Sac

ram

ento

$21

Oak

land

$22

San

Jos

e$2

3 Los

Ang

eles

$19

Las

Veg

as$1

9

Den

ver

$19

Dal

las

$17

San

Ant

onio

$16A

usti

n$1

7H

oust

on$1

8

Chi

cago

$19

Atl

anta

$17

Jack

sonv

ille

$17 Orl

ando

$17

Mia

mi

$15

Tam

pa$1

9

Cha

rlot

te$1

6

Det

riot

$18

Syr

acus

eB

uffa

loR

oche

ster

$18

Indp

ls.

$18

Ric

hmon

d$1

7

Bos

ton

$22

Bri

dgep

ort

$19

New

ark/

Edis

on $

19N

ew Y

ork

$18

Bal

tim

ore

$18

Bet

hesd

a $1

7W

ashi

ngto

n D

C $

18

Phila

delp

hia

New

Yor

k C

ity

$18

Min

neap

olis

$22

$19

Kan

sas

Cit

y$1

8

Sai

nt L

ouis

$19

Nas

hvill

e$1

8S

anta

Ann

a$1

9

San

Die

go$2

1Ph

oeni

x$1

9

9

Minimum Maximum Average Five-YearState or Region Hourly Rate Hourly Rate Hourly Rate Annual Growth*

AKALARAZ - PhoenixAZ - Rest of StateCA - Los AngelesCA - OaklandCA - Rest of StateCA - SacramentoCA - Santa AnaCA - San DiegoCA - San FranciscoCA - San JoseCO - DenverCO - Rest of StateCT - BridgeportCT - Rest of StateDC - BethesdaDC - WashingtonDEFL - JacksonvilleFL - MiamiFL - OrlandoFL - Rest of StateFL - TampaGA - AtlantaGA - Rest of StateHIIAIDIL - ChicagoIL - Rest of StateIN - IndianapolisIN - Rest of StateKSKYLAMA - BostonMA - Rest of StateMD - BaltimoreMD - Rest of StateMEMI - DetroitMI - Rest of StateMN - Minneapolis

10


HOMEMAKER SERVICES (NON-MEDICARE CERTIFIED, LICENSED) HOURLY RATES


$231112171611171518181820161412151613161515111415161412141615141217131314

92018161016151418

$253018222026262724222226302222222224202318202323221920222820252420221918172523222423262127

$241515191819222021192124231918191917181917151718191716181917191718171616132221181820181822

9%3%1%4%0%3%3%

-2%1%2%7%2%3%4%3%

-2%-1%2%2%5%1%3%5%5%4%3%3%1%

-1%6%2%4%

-3%3%1%

-2%3%4%1%5%

-1%2%5%2%4%

10 *Represents the compound annual growth rate based on Genworth Cost of Care survey data from 2004-2008.

MN - Rest of StateMO - Kansas CityMO - Rest of StateMO - St. LouisMSMTNC - CharlotteNC - Rest of StateNDNENHNJ - New YorkNJ - Rest of StateNMNV - Las VegasNV - Rest of StateNYCNY - Buffalo, Rochester, SyracuseNY - New York, Newark, Edison (Not NYC)NY - Rest of StateOHOKOR - PortlandOR - Rest of StatePA - PhiladelphiaPA - Rest of StateRISCSDTN - NashvilleTN - Rest of StateTX - AustinTX - DallasTX - HoustonTX - Rest of StateTX - San AntonioUTVA - RichmondVA - Rest of StateVTWA - Rest of StateWA - SeattleWIWVWYNational

11


$161615171117151214151414161217171212111514141715151316121615121414121211151311161719151217$9

$272221211820172119182821222822222221252625252528242422252022172023242719242022222228251620

$30

$191817191419161717162018191819201818191917172019191719161918151717181616201716201923181419

$18

-4%2%6%0%1%5%2%2%1%4%5%2%

-4%8%4%5%3%2%5%4%3%1%3%4%2%

-2%2%4%

-2%-1%-1%1%5%2%2%4%3%2%2%2%2%4%3%1%5%2%

11


HOMEMAKER SERVICES (NON-MEDICARE CERTIFIED, LICENSED) HOURLY RATES

**Represents state-wide growth as city-specific data was added in 2007.

**

**

AL

AZAR

CACO

CT DE

FL

GA

ID

ILIN

IA

KSKY

LA

ME

MDM

AM

I

MN

MS

MO

MT

NE

NV

NH

NJ

NM

NY

NC

ND

OH

OK

OR

PARI

SC

SD

TN

TX

UT AK

HI

VT

VA

WA

WV

WI

WY

$19

$17

$20 $1

9

$19

$22

$18

$19

$18 $1

6

$14

$14

$15

$16$1

6

$17

$17

$19

$24

$20

$18

$17

$14

$18

$19

$20

$18

$20

$22

$19

$20

$19

$22

$22

$24 $2

2

$21

$20

$19

$17 $1

7

$16

$19

$21

$20

$21

$19

$18

$19

$20Sea

ttle

$23

Port

land

$21

San

Fr

anci

sco

$24

Sac

ram

ento

$21

Oak

land

$22

San

Jos

e$2

4 Los

Ang

eles

$19

Las

Veg

as$2

0

Den

ver

$21

Dal

las

$18

San

Ant

onio

$16A

usti

n$1

9H

oust

on$1

8

Chi

cago

$20

Atl

anta

$17

Jack

sonv

ille

$18 Orl

ando

$18

Mia

mi

$16

Tam

pa$2

0

Cha

rlot

te$1

7

Det

riot

$19

Syr

acus

eB

uffa

loR

oche

ster

$21

Indp

ls.

$19

Ric

hmon

d$1

7

Bos

ton

$23

Bri

dgep

ort

$20

New

ark/

Edis

on $

19N

ew Y

ork

$19

Bal

tim

ore

$19

Bet

hesd

a $1

8W

ashi

ngto

n D

C $

19

Phila

delp

hia

New

Yor

k C

ity

$18

Min

neap

olis

$25

$20

Kan

sas

Cit

y$1

9

Sai

nt L

ouis

$19

Nas

hvill

e$1

9S

anta

Ann

a$2

0

San

Die

go$2

1Ph

oeni

x$2

0

HOME HEALTH AIDE SERVICES (NON-MEDICARE CERTIFIED, LICENSED) HOURLY RATESNational Average $19

13



HOME HEALTH AIDE SERVICES (NON-MEDICARE CERTIFIED, LICENSED) HOURLY RATES

$231312181713171518181920161412151914161516131515161412141615151217131515

92219181416161520

$253018222128262724242226302622252526232321202325251929252820252423241918172727222425262327

$241516201919222121202124242119202218192018161819201717202017201919191716142322191921191825

1%2%1%2%

-3%0%2%0%2%

-4%3%2%1%5%3%

-1%-1%1%3%

-1%1%

-2%5%2%2%0%0%8%

-6%2%2%3%

-1%-2%2%

-4%-2%2%1%5%

-1%2%1%2%5%

14 *Represents the compound annual growth rate based on Genworth Cost of Care survey data from 2004-2008.


$181615171117151414152214171518181217111714141915151320121815121614141213151514181719161217$9

$272421211828182322282822222825232226252625252528252430282022182123242719251922272328251620

$30

$221918191420171819192419191820201821192018172120201822171919161918181616211717221923201419

$19

-4%1%

-1%-5%0%4%1%1%3%4%0%0%

-3%3%5%0%3%1%2%5%2%1%3%4%1%

-2%0%3%0%

-1%-1%2%3%2%0%3%3%1%1%3%

-1%2%

-2%1%5%1%

15


HOME HEALTH AIDE SERVICES (NON-MEDICARE CERTIFIED, LICENSED) HOURLY RATES


**

**

17

AL

AZAR

CACO

CT DE

FL

GA

ID

ILIN

IA

KSKY

LA

ME

MDM

AM

I

MN

MS

MO

MT

NE

NV

NH

NJ

NM

NY

NC

ND

OH

OK

OR

PARI

SC

SD

TN

TX

UT AK

HI

VT

VA

WA

WV

WI

WY

$83

$33

$27 $2

9

$21

$28

$35

$44

$23 $2

6

$69

$74

$76

$48$6

2

$41

$63

$22

$74

$45

$41

$31

$49

$18

$24

$30

$25

$37

$30

$36

$43

$35

$22

$26

$39 $3

6

$54

$36

$26

$27 $4

1

$40

$29

$27

$72

$38

$33

$28

$36

$47Sea

ttle

$52

Port

land

$45

San

Fr

anci

sco

$45

Sac

ram

ento

$49

Oak

land

$72

San

Jos

e$7

7 Los

Ang

eles

$38

Las

Veg

as$3

3

Den

ver

$36

Dal

las

$51

San

Ant

onio

$36A

usti

n$4

0H

oust

on$3

1

Chi

cago

$33

Atl

anta

$69

Jack

sonv

ille

$32 Orl

ando

$18

Mia

mi

$18

Tam

pa$2

2

Cha

rlot

te$3

7

Det

riot

$29

Syr

acus

eB

uffa

loR

oche

ster

$27

Indp

ls.

$24

Ric

hmon

d$3

2

Bos

ton

$29

Bri

dgep

ort

$26

New

ark/

Edis

on $

34N

ew Y

ork

$28

Bal

tim

ore

$30

Bet

hesd

a $2

1W

ashi

ngto

n D

C $

22

Phila

delp

hia

New

Yor

k C

ity

$22

Min

neap

olis

$28

$32

Kan

sas

Cit

y$4

1

Sai

nt L

ouis

$29

Nas

hvill

e$3

5S

anta

Ann

a$4

4

San

Die

go$4

6Ph

oeni

x$3

8

HOME HEALTH AIDE SERVICES (MEDICARE CERTIFIED) HOURLY RATESNational Average $38


Minimum Maximum AverageState or Region Hourly Rate Hourly Rate Hourly Rate

HOME HEALTH AIDE SERVICES (MEDICARE CERTIFIED) HOURLY RATES

$211413151916231719211823262020172317152315131513181714181815121717151220121818181720121418

$11513069

15092

1751851059490

140106119707035383040

11010063256435

12011311099

1251279938759090

150557675858490

10035

$747626383638723849444645773633263021224332181822226963453633334424242762692936303554293528

18

Annual growth rates are not provided

for this category. Because Medicare

certified rates include rates associated

with skilled service visits in the home

(along with rates for non-skilled

visits), the wide variety of ranges in

the skilled rates skew the average

rates from year to year. Given this

fluctuation and the random sampling

methodology employed by the survey,

compound annual growth rates do

not provide a true indication of

annual growth on a regional basis

for this category.


$171215155015161518142219171318231619141712141818191418141817151712101012201613172022151420

$10

$451246585

1496360

110100507588659075

1753537906045

104157102939027752465

1301001751251258535

1209045

11714667

10078

$185

$284123297427374129263928362833722227343718414547322522412135484051314036273231268352304929

$38

19


HOME HEALTH AIDE SERVICES (MEDICARE CERTIFIED) HOURLY RATES

21

AL

AZAR

CACO

CT DE

FL

GA

ID

ILIN

IA

KSKY

LA

ME

MDM

AM

I

MN

MS

MO

MT

NE

NV

NH

NJ

NM

NY

NC

ND

OH

OK

OR

PARI

SC

SD

TN

TX

UT AK

HI

VT

VA

WA

WV

WI

WY

$51

$25

$23 $2

4

$20

$25

$27

$32

$20 $2

1

$41

$44

$46

$32$3

9

$29

$43

$20

$49

$32

$29

$24

$32

$18

$21

$25

$24

$28

$26

$28

$31

$27

$22

$24

$32 $2

9

$38

$28

$23

$22 $2

9

$28

$24

$24

$46

$29

$26

$23

$28

$33Sea

ttle

$38

Port

land

$33

San

Fr

anci

sco

$34

Sac

ram

ento

$35

Oak

land

$47

San

Jos

e$5

0 Los

Ang

eles

$29

Las

Veg

as$2

7

Den

ver

$28

Dal

las

$34

San

Ant

onio

$26A

usti

n$2

9H

oust

on$2

4

Chi

cago

$27

Atl

anta

$43

Jack

sonv

ille

$25 Orl

ando

$18

Mia

mi

$17

Tam

pa$2

1

Cha

rlot

te$2

7

Det

riot

$24

Syr

acus

eB

uffa

loR

oche

ster

$24

Indp

ls.

$21

Ric

hmon

d$2

5

Bos

ton

$26

Bri

dgep

ort

$23

New

ark/

Edis

on $

27N

ew Y

ork

$24

Bal

tim

ore

$25

Bet

hesd

a $1

9W

ashi

ngto

n D

C $

20

Phila

delp

hia

New

Yor

k C

ity

$20

Min

neap

olis

$26

$26

Kan

sas

Cit

y$3

0

Sai

nt L

ouis

$24

Nas

hvill

e$2

7S

anta

Ann

a$3

2

San

Die

go$3

3Ph

oeni

x$2

9

HOME HEALTH AIDE SERVICES (BOTH PROVIDER TYPES) HOURLY RATESNational Average $29



HOME HEALTH AIDE SERVICES (BOTH PROVIDER TYPES) HOURLY RATES

$211312151713171518181820161412151914151515131513161412141615121217131215

91818181416121418

$11513069

15092

1751851059490

140106119707035383040

11010063256435

12011311099

1251279938759090

150557675858490

10035

$494621292829472935323334502826232619203125171820214340322825273221212239412629252738242726

22

Annual growth rates are not provided

for this category. Because Medicare

certified rates include rates associated

with skilled service visits in the home

(along with rates for non-skilled

visits), the wide variety of ranges in

the skilled rates skew the average

rates from year to year. Given this

fluctuation and the random sampling

methodology employed by the survey,

compound annual growth rates do

not provide a true indication of

annual growth on a regional basis

for this category.


$171215151115151414142214171318181217111712141815151318121815121612101012151513171719151417$9

$451246585

1496360

110100507588659075

1753537906045

104157102939030752465

1301001751251258535

1209045

11714667

10078

$185

$253020244423272924233224282327462024272818293333262222292027322934242826242524245138253224

$29

23


HOME HEALTH AIDE SERVICES (BOTH PROVIDER TYPES) HOURLY RATES

25

AL

AZAR

CACO

CT DE

FL

GA

ID

ILIN

IA

KSKY

LA

ME

MDM

AM

I

MN

MS

MO

MT

NE

NV

NH

NJ

NM

NY

NC

ND

OH

OK

OR

PARI

SC

SD

TN

TX

UT AK

HI

VT

VA

WA

WV

WI

WY

$58

$66

$67 $6

0

$15

$49

$47

$61

$61 $4

3

$52

$43

$32

$49$5

6

$50

$56

$57

$99

$59

$45

$55

$42

$47

$49

$53

$46

$54

$71

$81

$67

$68

$64

$59

$58 $5

4

$44

$66

$55

$72 $4

8

$29

$73

$37

$69

$73

$63

$23

$50

$102S

eatt

le$5

2

Port

land

$63

San

Fr

anci

sco

$73

Sac

ram

ento

$73

Oak

land

$97

San

Jos

e$6

5 Los

Ang

eles

$77

Las

Veg

as$7

7

Den

ver

$50

Dal

las

$34

San

Ant

onio

$29A

usti

n$5

5H

oust

on$4

0

Chi

cago

$51

Atl

anta

$43

Jack

sonv

ille

$52 Orl

ando

$57

Mia

mi

$52

Tam

pa$4

2

Cha

rlot

te$4

5

Det

riot

$53

Syr

acus

eB

uffa

loR

oche

ster

$64

Indp

ls.

$52

Ric

hmon

d$4

9

Bos

ton

$59

Bri

dgep

ort

$70

New

ark/

Edis

on $

75N

ew Y

ork

$82

Bal

tim

ore

$70

Bet

hesd

a $7

0W

ashi

ngto

n D

C $

62

Phila

delp

hia

New

Yor

k C

ity

$95

Min

neap

olis

$67

$81

Kan

sas

Cit

y$6

3

Sai

nt L

ouis

$56

Nas

hvill

e$4

6S

anta

Ann

a$7

8

San

Die

go$7

9Ph

oeni

x$4

1

ADULT DAY HEALTH CARE DAILY RATESNational Average $59


Minimum Maximum Average AverageState or Region Daily Rate Daily Rate Daily Rate Annual Rate◊

ADULT DAY HEALTH CARE DAILY RATES

$701626

n/a10505048307072485541306262554030324050491230204444304049463055283554514436

n/a353054

$1257552

n/a67

10016484

1008685

1058066

11380809070996360608159558087

12510072736080

100729565568375

n/a756383

$993243415077977373787973655063707170626752525757424356596666516152497256525954706844534767

$25,6758,377

11,05010,54613,00019,95025,31418,92319,00620,23820,54519,10016,83513,00516,28918,07318,47618,13516,01917,32113,59313,64014,84614,74210,87611,05014,68715,24917,12917,16013,15615,95913,42412,84418,75414,43313,55915,33714,00918,07817,68511,55013,72512,18417,529

26

‡ ‡

‡ ‡

◊ Assumes five days a week. ‡Represents an imputed daily rate calculated by multiplying the average hourly rate within the region by eight hours and applying a 49.7% discount.


$43563036133230273817505577

56058403540202745257658305745

814355030271325253045

n/a5045442060$5

$6365757078

1255561

1659568918450

10585

1751221511056259

101150845580823080806570608035486596

n/a6657646360

$175

$4963615643674545735558828123776995647554474863

102814664501546495543402929374955595852534260

$59

$12,80016,27315,83714,66711,29217,45611,66111,81718,99014,22515,02021,23421,0785,923

20,02018,02624,63516,67419,52913,94612,09012,44116,44826,63221,16411,84316,58812,9903,986

12,00412,77914,30011,09410,3357,5567,5459,646

12,77614,21915,27515,16613,64213,72810,96915,600

$15,236

27

Minimum Maximum Average AverageState or Region Daily Rate Daily Rate Daily Rate Annual Rate◊

ADULT DAY HEALTH CARE DAILY RATES

‡ ‡

29

AL

AZAR

CACO

CT DE

FL

GA

ID

ILIN

IA

KSKY

LA

ME

MD

MA

MI

MN

MS

MO

MT

NE

NV

NH

NJ

NM

NY

NC

ND

OH

OK

OR

PARI

SC

SD

TN

TX

UT AK

HI

VT

VA

WA

WV

WI

WY

$2,5

98

$2,7

49

$2,8

26 $2,4

49

$2,1

91

$2,7

31

$2,5

33

$2,9

56

$2,0

48

$1,9

81

$2,5

28

$2,2

77$2

,440

$2,7

29$2,7

93

$2,6

69

$2,1

84

$2,4

80

$4,5

67

$3,4

43

$2,3

95

$2,8

86$2

,717

$2,9

32$2

,979

$3,1

70

$2,6

63

$2,9

55

$3,51

1

$3,7

74$2

,827

$3,1

36

$2,5

69 $3,42

6$3

,870$4

,103

$2,6

14$2

,335 $2

,468 $2

,138

$2,4

79

$2,2

36

$2,4

33

$2,9

33

$2,9

89$3

,105

$2,9

81$2

,761

$3,4

30

$4,92

1

Sea

ttle

$3,4

67

Port

land

$2,7

97

San

Fr

anci

sco

$3,6

68

Sac

ram

ento

$2,7

16

Oak

land

$3,1

97

San

Jos

e$2

,599 Lo

s A

ngel

es$3

,318

Las

Veg

as$2

,076

Den

ver

$3,3

92

Dal

las

$2,7

63

San

Ant

onio

$3,0

19Aus

tin

$2,9

98H

oust

on$2

,562

Chi

cago

$4,5

07

Atl

anta

$2,4

95

Jack

sonv

ille

$2,4

90 Orl

ando

$2,7

26

Mia

mi

$2,7

53

Tam

pa$2

,760

Cha

rlot

te$3

,066

Det

riot

$3,1

17

Syr

acus

eB

uffa

loR

oche

ster

$2,9

69

Indp

ls.

$2,4

84R

ichm

ond

$3,1

40

Bos

ton

$4,5

04

Bri

dgep

ort

$4,3

46

New

ark/

Edis

on $

3,93

8N

ew Y

ork

$4,4

42

Bal

tim

ore

$2,9

12B

ethe

sda

$3,6

93W

ashi

ngto

n D

C $

4,02

7

Phila

delp

hia

New

Yor

k C

ity

$3,3

19

Min

neap

olis

$3,6

77

$3,7

08

Kan

sas

Cit

y$3

,521

Sai

nt L

ouis

$2,8

48

Nas

hvill

e$2

,984

San

ta A

nna

$3,3

79

San

Die

go$2

,922

Phoe

nix

$2,4

73

ASSISTED LIVING FACILITY (PRIVATE ONE BEDROOM) MONTHLY RATESNational Average $3,008


$2,1001,5131,200

5501,300

920950

1,0001,6501,6001,0002,0001,3001,7501,5002,4001,6002,0003,3501,0001,5001,1501,5001,020

9251,000

8501,2001,6251,5002,0001,6801,0951,6751,9001,5252,0002,8703,0001,0001,2002,0001,200

7512,000

$6,5003,9152,8005,2504,5008,7006,0005,8005,6006,8006,2006,0004,8005,1255,9706,2005,0606,1004,8606,3903,8004,8954,5005,6004,2986,0004,0006,1164,6274,0006,6006,3005,5204,2503,9185,7004,2006,9004,6505,3504,8507,1705,5004,8008,850

$4,5672,4401,9812,4732,7613,3183,1972,9892,7163,3792,9223,6682,5993,3923,1054,3463,5113,6934,0273,7742,4902,7532,7262,4802,7602,4952,1843,4432,6142,7494,5072,9562,4842,9792,4682,7932,5284,5043,8702,9122,8274,1033,1172,5333,677

$54,80929,28023,77429,67633,13439,81538,35835,87032,59140,54335,06144,01131,18340,70337,26152,15142,12644,32048,32845,28229,88033,03232,71829,76533,12429,94326,21441,31031,36332,98554,08935,47229,80735,74929,61433,51330,33654,05246,44034,93833,92749,24037,40830,39344,125

30

9%5%4%2%4%7%3%4%4%7%7%6%

-1%6%7%2%4%4%7%5%4%6%6%

12%9%4%5%

10%7%

10%12%1%5%9%

-2%2%8%6%1%2%8%6%0%5%9%

Minimum Maximum Average Average Five-YearState or Region Monthly Rate Monthly Rate Monthly Rate Annual Rate Annual Growth*

ASSISTED LIVING FACILITY (PRIVATE ONE BEDROOM) MONTHLY RATES

*Represents the compound annual growth rate based on Genworth Cost of Care survey data from 2004-2008.


$1,3062,0351,1251,3001,2501,6621,7001,1181,7251,0091,2002,5963,7501,800

9001,9601,1252,2871,6501,500

750616

1,9501,100

9251,1251,1281,2001,6001,9001,6001,5001,4401,100

5581,8501,5251,2001,0751,2001,2301,880

7701,1551,541$550

$4,8306,5004,6205,2652,9653,9104,8005,0003,1283,8957,1706,3507,8004,9504,0004,8505,5004,2607,9805,9705,7003,7203,9954,1756,4505,3104,9503,9013,2805,8754,4284,6004,4005,6004,4004,3503,7204,2005,8504,4184,2007,5936,7715,5503,525

$8,850

$2,7313,5212,0482,8482,2772,8263,0662,3952,2362,3353,4264,4424,9212,9812,0762,9333,3192,9693,9382,9552,9322,1382,7973,4303,7082,6633,1362,6692,1912,9842,7292,9982,7632,5622,4793,0192,4333,1402,8862,5692,5983,4673,1702,7172,449

$3,008

$32,77142,24724,57434,17827,32933,90736,79528,73426,82928,01641,11753,30759,05035,77224,91135,19539,82535,63247,26035,46335,18025,65333,56941,15544,49831,95537,62632,02726,29635,81432,74435,97333,15530,74729,75136,22729,19337,67634,63330,82231,18041,60738,04332,60129,388

$36,090

31

3%15%1%9%3%8%4%4%5%2%3%5%

11%6%1%7%

-2%6%8%

11%5%1%3%9%5%7%9%8%3%8%8%3%2%3%4%9%4%7%7%1%2%4%9%7%6%6%

Minimum Maximum Average Average Five-YearState or Region Monthly Rate Monthly Rate Monthly Rate Annual Rate Annual Growth*

ASSISTED LIVING FACILITY (PRIVATE ONE BEDROOM) MONTHLY RATES


**

**

33

AL

AZAR

CACO

CT DE

FL

GA

ID

ILIN

IA

KSKY

LA

ME

MDMA

MI

MN

MS

MO

MT

NE

NV

NH

NJ

NM

NY

NC

ND

OH

OK

OR

PARI

SC

SD

TN

TX

UT AK

HI

VT

VA

WA

WV

WI

WY

$193

$172

$157 $1

67

$142

$121

$187

$132

$119 $1

25

$118

$169

$149

$150$1

55

$149

$135

$183

$515

$267

$170

$159

$176

$173

$154

$183

$205

$241

$240

$197 $186

$224

$220

$238 $2

76

$208

$125

$142

$124 $1

20

$109

$125

$143

$186

$176

$176

$149

$163

$179

$306

Sea

ttle

$213

Port

land

$201

San

Fr

anci

sco

$212

Sac

ram

ento

$196

Oak

land

$202

San

Jos

e$2

03 Los

Ang

eles

$166

Las

Veg

as$1

80

Den

ver

$182

Dal

las

$118

San

Ant

onio

$127

Aus

tin

$123

Hou

ston

$120

Chi

cago

$171

Atl

anta

$162

Jack

sonv

ille

$177 O

rlan

do$1

87

Mia

mi

$213

Tam

pa$1

92

Cha

rlot

te$1

71

Det

riot

$195

Syr

acus

eB

uffa

loR

oche

ster

$263

Indp

ls.

$157

Ric

hmon

d$1

63

Bos

ton

$281

Bri

dgep

ort

$336

New

ark/

Edis

on $

332

New

Yor

k $2

64

Bal

tim

ore

$215

Bet

hesd

a $2

16W

ashi

ngto

n D

C $

203

Phila

delp

hia

New

Yor

k C

ity

$380

Min

neap

olis

$146

$241

Kan

sas

Cit

y$1

54

Sai

nt L

ouis

$146

Nas

hvill

e$1

45S

anta

Ann

a$1

91

San

Die

go$1

89Ph

oeni

x$1

60

NURSING HOME (SEMI-PRIVATE ROOM) DAILY RATESNational Average $187


$385124100128133125164135158155135123125150144235165177163170155135168150155130105195102154120

88110108

90134

96220242174153155158

99115

$850198151200210215240242235300225267250214254392358238245220199300215249239190187375183198228220194201163201137365325256278247248240199

$515149125160163166202176196191189212203182176336306216203197177213187183192162135267125172171132157154124155118281276215186208195187146

$187,81354,25845,58058,43759,32960,66073,82864,06871,38069,69268,88277,48574,02166,52764,058

122,501111,78078,71274,27271,83264,60777,90968,14766,88370,06959,06349,25697,60145,55062,60562,37448,35257,45156,12045,09656,75442,903

102,691100,57478,55067,80975,92871,20968,43753,229

34

0%3%3%2%3%3%4%5%6%6%4%1%4%6%3%6%4%5%4%

-1%4%6%4%5%5%2%0%7%4%4%7%5%3%5%4%

-1%3%4%4%5%3%4%5%4%

-1%

Minimum Maximum Average Average Five-YearState or Region Daily Rate Daily Rate Daily Rate Annual Rate Annual Growth*

NURSING HOME (SEMI-PRIVATE ROOM) DAILY RATES



$100133

99110150135149136110100195187208135147142290201225171109

85179122175140180115117116125

8585966595

115139135185140198113130150$65

$148200141180210198187217140236295310275184201233454325485361234150220202293274279170170160180183175168152162165199187260255236263214187

$850

$121154119146169157171170125142238264240149180186380263332241173120201179241205224149142145150123118120109127143163159220193213183176167

$187

$44,06256,37743,38053,21561,52357,17262,42361,91345,75851,93186,92096,46787,48854,54165,65867,767

138,63495,892

121,04188,14562,98843,79573,27465,33587,96274,83081,74654,53351,93053,10654,70245,06742,99543,85939,79146,38452,05359,62358,19480,25870,33377,67266,72664,20660,951

$68,408

35

-1%5%3%8%7%5%3%3%2%6%2%3%2%3%5%

-2%3%4%4%3%5%4%7%5%4%5%5%5%4%4%4%5%2%4%5%5%5%4%4%4%4%3%3%0%5%4%


NURSING HOME (SEMI-PRIVATE ROOM) DAILY RATES


**

**

37

AL

AZAR

CACO

CT DE

FL

GA

ID

ILIN

IA

KSKY

LA

ME

MDMA

MI

MN

MS

MO

MT

NE

NV

NH

NJ

NM

NY

NC

ND

OH

OK

OR

PARI

SC

SD

TN

TX

UT AK

HI

VT

VA

WA

WV

WI

WY

$211

$185

$163 $1

76

$157

$141

$201

$157

$126 $1

37

$125

$174

$158

$159$1

77

$158

$143

$202

$515

$295

$183

$170

$185

$191

$188

$198

$221

$251

$210

$195

$248

$232

$259 $2

91

$233

$137

$156

$133 $1

41

$144

$139

$157

$209

$200

$206

$162

$197

$193

$328

$263

Sea

ttle

$230

Port

land

$222

San

Fr

anci

sco

$274

Sac

ram

ento

$252

Oak

land

$254

San

Jos

e$2

47 Los

Ang

eles

$209

Las

Veg

as$2

13

Den

ver

$198

Dal

las

$166

San

Ant

onio

$185

Aus

tin

$150

Hou

ston

$155

Chi

cago

$199

Atl

anta

$173

Jack

sonv

ille

$193 O

rlan

do$2

07

Mia

mi

$249

Tam

pa$2

12

Cha

rlot

te$1

84

Det

riot

$217

Syr

acus

eB

uffa

loR

oche

ster

$272

Indp

ls.

$193

Ric

hmon

d$1

89

Bos

ton

$300

Bri

dgep

ort

$362

New

ark/

Edis

on $

355

New

Yor

k $2

90

Bal

tim

ore

$230

Bet

hesd

a $2

38W

ashi

ngto

n D

C $

216

Phila

delp

hia

New

Yor

k C

ity

$398

Min

neap

olis

$171

$274

Kan

sas

Cit

y$1

75

Sai

nt L

ouis

$184

Nas

hvill

e$1

64S

anta

Ann

a$2

38

San

Die

go$2

26Ph

oeni

x$2

09

NURSING HOME (PRIVATE ROOM) DAILY RATESNational Average $209


$385130100155148130180145194185165165190160169245170187163175158150175160170135105210108157120

95163126103145104240260200160175164106132

$850203185300321360335345450360262365345230340433380280292235227350250289289207202375225218279341235338182340144375335263278326334274239

$515158137209197209254200252238226274247198206362328238216210193249207202212173143295137185199157193188133177125300291230195233217201171

$187,90257,59149,97676,20272,08476,45992,74072,91992,09486,93482,560

100,10189,97372,35975,259

131,958119,67887,00378,88776,65070,37391,02275,38773,83377,21263,17652,139

107,57549,91867,67572,56757,36270,28368,65548,65664,74045,539

109,396106,32183,80471,27385,11279,02773,48162,355

38

0%3%3%2%1%4%5%6%

10%4%2%3%2%3%5%5%4%4%2%0%4%6%4%4%5%3%0%6%4%5%7%6%2%5%2%

-1%1%2%4%4%3%5%4%3%

-2%


NURSING HOME (PRIVATE ROOM) DAILY RATES



$116137104127153145157148114110200198224146178162290215250177109

89191135185147195129125131130118

90115

95135130149142200145200145135158$89

$180229151255210207206237162243315450302202360277476342500377259215250221488286287175214176186240240218220250225212192284302265281227200

$850

$141175126184174163184183139156259290263162213209398272355251191141222193274221248158157164159150166155144185157189170232211230198185176

$209

$51,34263,98046,01867,24263,62359,39567,25966,83050,60356,84694,641

105,77996,00958,96577,78776,429

145,39299,378

129,57091,58869,61151,60780,84870,39599,84080,70490,64057,54557,25059,77858,13954,89060,64056,59252,59067,62457,33269,04162,09684,80276,94983,84672,27267,54964,058

$76,460

39

2%4%3%

12%6%4%3%3%1%6%2%2%2%2%5%0%3%4%4%1%3%5%7%4%4%6%6%5%5%6%6%5%3%0%5%8%3%3%3%4%4%3%2%2%3%4%


NURSING HOME (PRIVATE ROOM) DAILY RATES


**

**

A P P E N D I X

STATE REGIONS WITH COUNTIESListed alphabetically by state abbreviation

42

State Name State or Region CountiesAlaska AK All countiesAlabama AL All countiesArkansas AR All countiesArizona AZ - Phoenix Maricopa, Pinal

AZ - Rest-of-State All remaining countiesCalifornia CA - Los Angeles Los Angeles

CA - Oakland Alameda, Contra CostaCA - Rest-of-State All remaining countiesCA - Sacramento El Dorado, Yolo, Placer, SacramentoCA - Santa Ana OrangeCA - San Diego San DiegoCA - San Francisco Marin, San Mateo, San FranciscoCA - San Jose Santa Clara, San Benito

Colorado CO - Denver Adams, Arapahoe, Broomfield, Clear Creek, Elbert, Denver, Douglas, Gilpin, Jefferson, Park

CO - Rest-of-State All remaining countiesConnecticut CT - Bridgeport Fairfield

CT - Rest-of-State All remaining countiesDistrict of Columbia DC - Bethesda Frederick, Montgomery

DC - Washington Charles County, Prince Georges and Calvert County in MD; All remaining counties in DC; Manassas City, Warren, Stafford, Spotsylvania, Fairfax, Manassas Park City, Fairfax City, Prince William, Clarke, Fredricksburg City, Falls Church City, Loudoun, Fauquier, Alexandria City Counties in VA

Delaware DE All countiesFlorida FL - Jacksonville Baker, Clay, St Johns, Nassau, Duval

FL - Miami Miami-Dade, Broward, Palm BeachFL - Orlando Osceola, Seminole, Orange, LakeFL - Rest-of-State All remaining countiesFL - Tampa Hillsborough, Pasco, Hernando, Pinellas

Georgia GA - Atlanta Haralson, Newton, Walton, Lamar, Fulton, Barrow, Pickens, DeKalb, Bartow, Gwinnett, Butts, Coweta, Paulding, Cherokee, Jasper, Clayton, Meriwether, Cobb, Douglas, Spalding, Forsyth, Carroll, Henry, Dawson, Rockdale, Pike, Fayette, and Heard

GA - Rest-of-State All remaining countiesHawaii HI All countiesIowa IA All countiesIdaho ID All counties

43

STATE REGIONS WITH COUNTIES (CONT.)

Listed alphabetically by state abbreviation

State Name State or Region CountiesIllinois IL - Chicago Kenosha, McHenry, Lake, DeKalb, Kane, Kendall, DuPage, Cook, Will,

Grundy, Lake (IN), Porter, Newton, JasperIL - Rest-of-State All remaining counties

Indiana IN - Indianapolis Brown, Shelby, Hendricks, Marion, Johnson, Hamilton, Hancock, Morgan, Boone, Putnam

IN - Rest-of-State All remaining countiesKansas KS All counties (excluding portions of state within MO-Kansas City region)Kentucky KY All countiesLouisiana LA All countiesMassachusetts MA - Boston Essex, Norfolk, Suffolk, Middlesex, Plymouth

MA - Rest-of-State All remaining countiesMaryland MD - Baltimore Harford, Anne Arundel, Queen Annes, Baltimore, Howard, Carroll

MD - Rest-of-State All remaining countiesMaine ME All countiesMichigan MI - Detroit Livingston, Lapeer, Oakland, St Clair, Wayne, Macomb

MI - Rest-of-State All remaining countiesMinnesota MN - Minneapolis Washington, Carver, Ramsey, Isanti, Hennepin, Scott, Wright, Anoka,

Sherburne, Dakota, ChisagoMN - Rest-of-State All remaining counties

Missouri MO - Kansas City Wyandotte, Miami, Johnson, Franklin, Leavenworth, Linn Counties in KS; Bates, Cass, Lafayette, Clinton, Jackson, Ray, Clay, Platte, and Caldwell Counties in MO

MO - Rest-of-State All remaining countiesMO - St. Louis St Charles, Crawford, Washington, Warren, Lincoln, Jefferson,

St Louis, FranklinMississippi MS All countiesMontana MT All countiesNorth Carolina NC - Charlotte Anson, Cabarrus, Mecklenburg, Gaston, Union

NC - Rest-of-State All remaining countiesNorth Dakota ND All countiesNebraska NE All countiesNew Hampshire NH All countiesNew Jersey NJ - New York Bergen, Union, Hunterdon, Monmouth, Somerset, Morris, Sussex,

Middlesex, Passaic, Hudson, Ocean, EssexNJ - Rest-of-State All remaining counties

New Mexico NM All countiesNevada NV - Las Vegas Clark

NV - Rest-of-State All remaining counties

STATE REGIONS WITH COUNTIES (CONT.)

Listed alphabetically by state abbreviation

New York NYC New YorkNY - Buffalo-

Rochester- Syracuse

Oswego, Niagara, Onondaga, Orleans, Monroe, Erie, Wayne, Livingston, Ontario, Madison

NY - Newark- Edison (not NYC)

Kings, Westchester, Rockland, Putnam, Queens, Bronx, Richmond, Nassau, Suffolk

NY - Rest-of-State All remaining countiesOhio OH All countiesOklahoma OK All countiesOregon OR - Portland Columbia, Washington, Multnomah, Clackamas, Yamhill Counties in OR;

Clark, Skamania Counties in WAOR - Rest-of-State All remaining counties

Pennsylvania PA - Philadelphia New Castle County in DE; Cecil County in MD; Gloucester, Salem, Burlington, Camden Counties in NJ; Philadelphia, Delaware, Bucks, Montgomery, Chester Counties in PA

PA - Rest-of-State All remaining countiesRhode Island RI All countiesSouth Carolina SC All countiesSouth Dakota SD All countiesTennessee TN - Nashville Robertson, Sumner, Trousdale, Macon, Dickson, Cheatham, Davidson,

Wilson, Smith, Hickman, Williamson, Rutherford, CannonTN - Rest-of-State All remaining counties

Texas TX - Austin Bastrop, Caldwell, Williamson, Hays, TravisTX - Dallas Ellis, Tarrant, Wise, Delta, Kaufman, Collin, Dallas, Rockwall, Johnson,

Parker, Hunt, DentonTX - Houston Liberty, Austin, San Jacinto, Montgomery, Chambers, Waller, Brazoria,

Harris, Galveston, Fort BendTX - Rest-of-State All remaining countiesTX - San Antonio Wilson, Atascosa, Bandera, Bexar, Medina, Comal, Kendall, Guadalupe

Utah UT All countiesVirginia VA - Richmond Amelia, Caroline, Charles City, Chesterfield, Cumberland, Dinwiddie,

Goochland, Hanover, Henrico, King and Queen, King William, Louisa, New Kent, Powhatan, Prince George, Sussex, Colonial Heights, Hopewell, Petersburg, Richmond

VA - Rest-of-State All remaining countiesVermont VT All countiesWashington WA - Rest-of-State All remaining counties

WA - Seattle Snohomish, Pierce, KingWisconsin WI All countiesWest Virginia WV All countiesWyoming WY All counties

44

4545

M E T H O D O L O G Y

CareScout conducted the 2008 Cost of Care survey for Genworth. CareScout, located in Wellesley, Massachusetts, has specialized in developing eldercare provider databases and helping families select appropriate providers nationwide since 1997. CareScout contacted over 40,000 providers in order to complete over 10,000 surveys of nursing homes, assisted living facilities, adult day health care, and home care providers in all 50 states and the District of Columbia between December 2007 and February 2008.

CareScout researchers conducted telephone interviews with long-term care providers within 90 regions5 across the U.S. The 90 regions cover every state including the District of Columbia. In some states more than one region was surveyed to account for more heavily populated areas. The heavily populated regions correspond geographically with their Metropolitan Statistical Areas as defined by the U.S. Census Bureau.

To determine historical trends, CareScout used Genworth Financial Cost of Care survey results dating back to 2004 to calculate compound annual growth rates.6

Home Care ProvidersAcross 90 individual regions, researchers polled, on average, at least 13% of home care providers across both Medicare certified and non-Medicare certified, licensed provider types to determine the hourly private pay rates charged for the services of a “home health aide.” Researchers also surveyed non-Medicare certified, licensed home care providers to determine the hourly private pay rates charged for the services of a “homemaker.”

On rare occasions where an area had a small sample size, a minimum of 10 providers completed surveys for each region. In many areas, the sample size was significantly larger. Researchers completed over 3,000 surveys.

Where a rate range was provided by an agency, the midpoint was used. Some agencies charge a higher hourly rate when the patient uses less than four hours of services in a week; where such a practice was employed, surveyors used the hourly rate associated with four or more hours of service in a week (that is, the rate more closely aligned with typical long-term care services utilization). All rates are weekday (Monday – Friday) rates.

Adult Day Health Care Across 90 individual regions, researchers polled more than 25% of Adult Day Health Care (ADH) facilities, and in no region did less than 10% of providers complete the survey. With limited exception, at least 10 facilities completed the survey in all regions. More than 980 providers completed the survey. The survey evaluated the daily private pay rates for sending an individual to an ADH provider for services.

NUMBER OF REGIONS AND PROVIDERS SURVEYED

Provider Type Geographic Regions

Providers Surveyed

Home Care Providers 90 > 3,000

Adult Day Health Care 90 > 980

Assisted Living Facilities

90 > 4,500

Nursing Homes 90 > 2,000

5 The 2007 Genworth Cost of Care survey included 90 regions as well; however, prior to 2007, Genworth Cost of Care surveys

included 88 regions. The two newest regions are Richmond, Virginia and Nashville, Tennessee.6 Compound annual growth rate = [(Ending Value ÷ Beginning Value)1/n] – 1; where “n” is the number of time periods.

46

There are at least three different models of ADH programs: social, medical, and combined. All models are intended to offer socialization, supervision, and structured activities designed for the individual needs of the participants at the center. Some programs may provide personal care, transportation, medication management, health-related services, intergenerational programming, social services, meals, personal assistance, and therapeutic activities.

In interpreting the survey results, where a daily range was provided that included a low-end rate range of less than $25, the high-end rate within the range was used. For example, where the ADH provider charged between zero and $40 “depending upon income level,” CareScout used the $40/day rate. Where the ADH provider charged between $25 and $40, for example, CareScout used the midpoint of the range. This method proves conservative in that it avoids underestimating the private pay cost of ADH due to the “$0.0” rates for people who cannot afford the care. Where three rates were provided for three levels of care, CareScout used the middle care level rate. Where an hourly range was provided, CareScout used the average of the range. All rates exclude transportation fees.

This is the first Genworth-published ADH survey and therefore a historical trend analysis is not available.

Assisted Living FacilitiesAcross 90 individual regions, researchers polled approximately 11% of the licensed facilities and, with limited exception completed surveys with at least 10 facilities per region. In many areas, the sample size was significantly larger. More than 4,500 providers completed the survey.

Unlike nursing homes, there is no national, uniform regulatory protocol for assisted living facilities. As a consequence, states

have instituted licensing standards that vary from state to state. CareScout’s researchers interviewed assisted living facilities, which go by a number of different names including “Residential Care Facility” which were licensed according to the licensure requirements of the state in which the assisted living facility was located.

The survey evaluated the monthly base private pay rate for a one-bedroom unit in an assisted living facility. Where a rate range was provided, CareScout calculated and used the average of the high and low range rates. Researchers also determined whether a non-refundable community or entrance fee was typically charged by a facility. While community and entrance fee rates are not included in the average monthly assisted living rate calculations, 33% of the assisted living facilities surveyed charged a one-time, non-refundable fee ranging from $35 to $118,180 with a national average one-time fee of $2,316.

Nursing HomesAcross 90 individual regions, researchers polled at least 13% of all certified and licensed nursing homes and in no region did less than 10% of providers complete the survey. With limited exception, at least 10 facilities completed the survey in all regions. In many areas, the sample size was significantly larger. More than 2,000 providers completed the survey.

The survey evaluated the daily rate for a private room (single occupant) and a semi-private room (double occupancy) in Medicare certified nursing facilities. Medicare certified nursing homes represent more than 90% of all nursing homes in the U.S. Rates for transitional care units (typically hospital-based certified nursing homes) were not included. The daily room charge usually includes services beyond rent such as three meals a day, laundry, sundries, basic nurse supervision, and generic-brand, non-prescription pharmaceuticals.

ABOUT CARESCOUTHeadquartered in Wellesley, Massachusetts, CareScout helps Americans in every state find quality care providers at preferred rates. Large employers, insurance companies, risk underwriters and families rely on CareScout’s proprietary quality of care ratings systems, discount network and database of more than 90,000 nursing homes, assisted living facilities and home care agencies.

ABOUT GENWORTH FINANCIALGenworth Financial (NYSE: GNW) is a leading insurance holding company, serving the lifestyle protection, retirement income, investment and mortgage insurance needs of more than 15 million customers, with operations in 24 countries, including the U.S., Canada, Australia, the U.K. and more than a dozen other European countries. The Long Term Care Insurance business of Genworth Financial is a leading provider of long term care insurance in the United States. For more information, visit genworth.com/CostofCare.

Insurance and annuity products:• Are not deposits. • Are not insured by the FDIC or any other federal government agency.• May decrease in value. • Are not guaranteed by the bank or its affiliates.

©2005-2008 Genworth Financial, Inc. and National Eldercare Referral Systems, Inc. (CareScout). All rights reserved. Genworth, Genworth Financial and the Genworth logo are registered service marks of Genworth Financial, Inc.

Alzheimer’s Association and Genworth Financial, Inc. have entered into a strategic relationship that permits Genworth’s use of the Association’s trademarks and/or logos. The use of the Alzheimer’s Association logo does not constitute an endorsement of the Company’s products and services.

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