Charleston Senior AdvisorHow do most Charleston families pay for assisted living?
Privately, from a mix of the resident's monthly income, savings and investments, proceeds from the family home, and sometimes help from adult children, because Medicare does not pay for assisted living and South Carolina's public help is limited to low-income residents in participating CRCFs.
At the 2025 South Carolina median of about $5,350 a month, a year costs about $64,200. Subtract Social Security and any pension from the monthly fee to see how fast savings will shrink, then allow for yearly increases and higher care charges as needs grow. Lowcountry home values often make the house the largest asset in the plan.
Will long-term care insurance pay for a CRCF?
Most policies pay for care in a licensed CRCF once the insured person needs help with at least two activities of daily living or has a cognitive impairment, after an elimination period and up to a daily or monthly limit.
Find the policy and call the insurer before choosing a building. Ask about the elimination period and whether it has started, the daily benefit, whether the facility must be licensed (a CRCF is), and what paperwork the insurer wants. Many policies also cover home care and adult day care.
Can we use the house to pay for care?
Yes. Selling the home is the most common way families fund a long stay; others rent it out, draw on a home equity line or, when a spouse still lives there, consider a reverse mortgage, each with trade-offs to discuss with a financial adviser.
If Medicaid could be needed later, how the house is handled matters. It is often an exempt asset while a spouse lives there or the owner intends to return, but sale proceeds count as resources. Talk with an elder law attorney before selling or retitling. In coastal neighborhoods, insurance and flood costs can also change the math of keeping an empty house.
What if a parent's money will last only a few years?
Plan the transition now by choosing a building that takes Optional State Supplementation or Community Choices Residential Personal Care, or one on a campus with a Medicaid-certified nursing home, so the move is not forced when savings are gone.
Ask each community, in writing, what happens when a private-pay resident's money runs out. Many larger communities around Charleston do not accept OSS. A two- to three-year budget that ends in a realistic public-program plan is better than a longer plan that ends in a crisis.
Are there tax benefits for paying for care?
Often. Assisted living and home care costs for someone who is chronically ill under a licensed health care practitioner's plan of care can qualify as medical expense deductions, and an adult child who provides more than half a parent's support may be able to claim the parent as a dependent.
Both have income tests and paperwork requirements, so ask a tax professional and keep the facility's itemized statements. A dependent care account at work can sometimes cover adult day care while the caregiver is on the job.
Side by side
| Private funding can | Private funding cannot | |
|---|---|---|
| Choice | Open every licensed building in the area | Guarantee a building will take OSS later |
| Insurance | Draw on long-term care insurance benefits | Turn Medicare into an assisted living payer |
| The house | Fund years of care through sale or rental | Be given away safely within the Medicaid look-back |
| Planning | Buy time to plan the next step | Replace a written plan for when money runs low |
Sources: S.C. Code Regs. 60-84, DPH Healthcare Quality, SCDHHS bulletins and charts, CareScout, CMS and VA rate tables, as cited in each answer. See our editorial standards.
