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Paying for Long Term Care Using Your Home Equity

Page Reviewed / Updated - May 2016


Today, many elderly Americans who cannot afford the ongoing cost of home care, assisted living or nursing home care are faced with the decision of whether or not to use their homes as a source of funding to pay for care. As many seniors have significant equity in their homes and since Medicare does not pay for assisted living or personal care at home, using one's home to finance long-term care can be a good option and sometimes it is the only option.

While there is more than one way to generate revenue from a home to pay for care, not each approach is appropriate for everyone or necessarily a sound economic decision. This article explores four different ways a home can be used to pay for care, and when, and for whom, each method is appropriate.

The four relevant options are renting the home, selling the home, getting a reverse mortgage, and getting a home equity line of credit. However, not each of these options is available to all homeowners depending on their family situation and location in which they will receive care. The table below describes the different types of family situations and the options available to them.


Option Comparison Table

Options for Using a Home to Pay for Care

Marital Status / Type of Care Required

Rent Home

Sell Home

Reverse Mortgage


Single / Home Care N/A N/A Available Available
Single / Assisted Living Available Available N/A Available
Single / Nursing Home Care Available Available N/A Available
Married / 1 Spouse needs Home Care N/A N/A Available Available
Married / 1 Spouse in Assisted Living N/A N/A Available Available
Married / 1 Spouse in Nursing Home N/A N/A Available Available
Married / Both Spouses need Home Care N/A N/A Available Available
Married / Both Spouses in Assisted Living Available Available N/A Available
Married / Both Spouses in Nursing Home Available Available N/A Available


Selling the Home

Obviously selling a home to pay for care is not an option applicable to everyone.  Most notably, it is not relevant to those individuals who wish to continue living at home and receive home care.  However, for individuals or couples who are moving into assisted living or nursing homes and have no intention of returning to their home, this option can make financial sense.

The benefits of a home sale are numerous.  The proceeds of which can be used to cover the moving and move-in costs for assisted living.  Paying off any outstanding mortgage will reduce monthly expenses as will the lack of home maintenance costs.  Once the home is sold, the homeowners or their family members no longer have to manage the logistics of owning or renting a home.

The large sum of money generated by a home sale has both positive and negative consequences.  Obviously the money can be put in the bank and used to pay for assisted living or nursing home care for many years.  However, since life expectancies are unpredictable, this money may run out eventually.  One option to prevent running out of money is to purchase a lifetime annuity with the proceeds of a home sale.  A lifetime annuity guarantees a monthly income for one or both spouses for the remainder of their lives regardless of how long they live.

One potential negative consequence of selling the home is the impact on Medicaid eligibility.  If one is considering Medicaid as a possible source of funding for nursing home care in the long term, they need to carefully consider the implications before selling their home.  A home, when occupied by the homeowners, is considered an exempt asset by Medicaid.  However, if the home is sold, the resulting sum of cash is not considered exempt by Medicaid and the individual will be required to spend all of the proceeds on their care costs before they can become eligible for Medicaid.  Seniors and couples in this situation should strongly consider consulting with a Medicaid planning profession.

 Short-term loans are available to pay for care while waiting for a home to sell.

Another consideration when selling the home is how to pay for care in the time it takes to sell a home. As of early 2016, it takes on average 3 months to sell a home. While obviously this depends on the local real estate market, it is worth noting that homes that have not been modernized take even longer than average to sell. Most homes owned by seniors have not been modernized. Fortunately, there are eldercare loans designed specifically to help seniors fund residential care while they are waiting for their homes to sell. Learn more about eldercare loans here.

In summary, selling a home to pay for residential care is a good financial option, but not a good option for everyone. This is not a decision that should be made independent of having a lifetime financial plan for long-term care. We strongly suggest homeowners review their options for assistance in developing financial plans for care.


Renting the Home

 Renting a home to pay for care instead of selling it only makes sense if the house is paid off or the mortgage payments are very low.

Renting one's home and using the monthly income to help offset the cost of residential care is a very good option as it can provide cash on an ongoing basis but only if many other conditions are met.  Obviously, the individual(s) in need of care cannot reside in the home and therefore it is only appropriate for persons going into residential care, be that assisted living or a nursing home.  Furthermore, it only makes sense to rent the home instead of selling it if the mortgage is paid off or if the monthly payments are very low.  To make sense, the rent money will have to cover the mortgage, any home maintenance and still have enough left over where it can contribute significantly towards the cost of care.   It is also challenging for elderly individuals in residential care to play the role of landlord.  Usually there needs to be another family member willing to take on this responsibility or there is another added expense of a property management company.  Another consideration is whether the homeowner has sufficient savings to withstand the interrupted cash flow of an unexpected tenant vacancy.

Given all these conditions, there is a limited set for whom home rentals are a good way to pay for care.  It is usually a good option if one or both spouses intend to return to living in the home after some period of time.  For example, sometimes when one spouse is ill and the other in good health, both spouses may choose to move to an assisted living residence.  The ill spouse may eventually pass away or it may be medically necessary to move to a nursing home.  At which time, the healthy spouse may wish to return to living in their home.  Couples with higher value homes which can command a good deal of rent are better suited for this option as well because the income can make a significant contribution toward the cost of care and higher value homes tend to attract more stable tenants.  

 Renting a home is not an option for those considering Medicaid.

Renting a home is not an option for those who are considering Medicaid as a possible source of financial assistance for long-term care. This is because if the home is not lived in by the homeowners, then Medicaid does not consider the home to be an exempt asset. In order to qualify, they must either live in the home or sell the home and use the proceeds to pay for care.

In summary, renting a home is a good option for couples in mixed health or of mixed ages that will require residential care for some defined period of time and intend to return to the home in the future.


Reverse Mortgages

As with renting or selling one's home, using reverse mortgages as a source of funding for senior care can make economic sense in certain defined situations.  Before a more detailed discussion of these situations, it is helpful to state certain facts about reverse mortgages.

As with renting or selling one's home, using reverse mortgages as a source of funding for senior care can make economic sense in certain defined situations. Before a more detailed discussion of these situations, it is helpful to state certain facts about reverse mortgages.
Many individuals think of reverse mortgages as loans that never need to be re-paid since they are drawing against their home equity. However, this is not entirely accurate. Reverse mortgages become due when the last individual on the agreement passes away or moves away from their home for a period of more than one year or when the home is sold.

There is also more than one type of reverse mortgage. For the purposes of this article, when discussing reverse mortgages we are referring to the HECM, (also called Home Equity Conversion Mortgage) type of reverse mortgage as in the majority of cases, it makes the most economic sense for the homeowner(s) wishing to use the proceeds to pay for senior care related expenses.
Because of the legal requirement that at least one individual who co-signs a reverse mortgage agreement must reside in the home, reverse mortgages are not appropriate for couples in every situation. Single or widowed individuals or couples in which both spouses are in poor health and require (or may soon require) residential care in assisted living or a nursing home, are not good candidates for reverse mortgages.

Couples or individuals in good health and couples in which one spouse is in good health are strong candidates to receive the benefits of a reverse mortgage. This is because it is very likely families in these situations will remain living in their homes for many years to come, and therefore, their reverse mortgages will not become due.
For single individuals in moderate health who wish to pay for home care with the proceeds of a reverse mortgage, the decision is more difficult. One must estimate the number of months and years they can continue to live at home and receive care in that location. Should it be estimated the individual's health may make a permanent move to residential care necessary within 24 months, a reverse mortgage probably does not make economic sense. However, should it be estimated they can remain living at home for 3 or more years, it might well be a good decision.

Reverse mortgages can be paid out in a single lump sum, as a line of credit, or as guaranteed monthly income for life.


Home Equity Line of Credit or Home Equity Loan

Often abbreviated as HELOCs, home equity lines of credit give homeowners the option of borrowing to pay for care on an as needed basis.  A bank will approve the homeowner for a certain amount of money for a certain period of time.  The homeowner can borrow however much they require whenever they require it and the monthly payments are dependent on how much they have borrowed.

 There are certain advantages and disadvantages to HELOCs, especially when considered in comparison to a reverse mortgage.

The disadvantages include the fact that the homeowner must continue to make monthly payments which is not the case with reverse mortgages.  If they fail to make their payments, the home can be foreclosed.  HELOCs do not have the same level of consumer protection as do reverse mortgages.  Finally, as monthly payments are required, the borrower's credit score plays an important part in the approval process.  With reverse mortgages, credit scores are considered significantly less important.

The major advantages of a HELOC are 1) the fees are generally lower for short-term loans then they would be for a reverse mortgage and 2) there is no requirement that the homeowner remain living in their home.  This is, of course, a very important consideration for persons who may need to move to assisted living or nursing homes at some point in the future.

One must apply these advantages and disadvantages to their specific situation to determine if a home equity line of credit is a good source of funding to pay for elder care.  Generally speaking:

  • Single individuals and married couples in good health should probably avoid a HELOC as a means of paying for care as their need for care is undetermined at present. 
  • Individuals with immediate care needs or couples in which both spouses require care are candidates for HELOCs because there is no requirement that they remain living at home.  Should it be necessary for them to move into residential care, they can do so without concern that their reverse mortgage will become due.  A line of credit also gives them the flexibility to accommodate sudden increases in their monthly expenses due to the added cost of residential care.  The line of credit also gives the flexibility to return to living at home should one's health allow for it or provide a source of funding for care while determining if the home should be sold. 
  • For couples in which only one spouse requires care, both HELOCs and reverse mortgages can be good options.  One needs to consider the extent and duration of the care required.  However, reverse mortgages are not available to couples in which one spouse is under 62 years of age, while HELOCs can be.    


Other Options

Elder Care Loans
There are loans specifically designed to help pay for home care and assisted living.  These loans are intended to be used as a bridge until further financing can be secured.  For example, while waiting for a home to sell or while waiting to be approved for a veterans pension (which can take several years).  Read more about loans for elder care.

Equity Key and Rex Agreements
Equity Key and Rex Agreement are two organizations that provides homeowners with immediate cash in exchange for a percentage of the future appreciation of their homes.  At present, these programs are only available in California and a few other states with higher value homes.  Read more about Equity Key or Rex Agreements.

Financial Assistance for Elder Care
There are many federal, state and local programs that provide assistance.  Find those programs which are available to you by using our Resource Locator Tool.  

Choosing Affordable Care
The cost of the same care can vary by as much as 50% even in the same city or town.  Our organization has developed multiple partnerships that can help families find affordable care