North America Long Term Care Market Outlook, 2031

Market Drivers

• Unprecedented demographic aging and rising care dependency: North America is experiencing a historic demographic transformation. In the United States, the population aged 65 and older reached 61.2 million in 2024, representing 18.0% of the total population, with the 85+ cohort, which has the highest per capita utilization of long-term care services, reaching 7.5 million. Canada's older population reached 8.1 million in 2025, representing 19.5% of the population, with the 85-and-over cohort projected to grow substantially in the coming decades. Mexico's population aged 60 and above reached 17.1 million in 2025, accounting for 12.8% of the total population, with projections indicating this will reach 33.4 million by 2050. The prevalence of chronic conditions, cognitive impairment, and functional limitations among older persons creates sustained demand for long-term care services across all care settings.
• Structural workforce shortages and high turnover: North America faces chronic shortages of qualified healthcare professionals across all clinical categories. In the United States, the long-term care sector faces a steep task to recruit and retain more than 20 million workers by 2040, with immigrants comprising 28% of the direct care workforce. Canada faces severe nursing shortages, with the number of healthcare providers choosing to work in long-term care shrinking, highlighting a growing reliance on private staffing agencies. In Mexico, only 8.8 million of the 17.9 million people aged 60 and above have social security coverage, creating significant gaps in workforce availability. These workforce gaps compel care providers to utilize temporary and permanent placement services, creating sustained demand for staffing solutions.
• Policy reforms and government investment in care infrastructure: Governments across North America are actively reforming their long-term care systems to address growing demand. In the United States, the 2025 reconciliation law is projected to reduce federal Medicaid spending by $911 billion over ten years, with significant implications for home- and community-based services. Canada is implementing national long-term care standards and the Safe Long-Term Care Act, with provinces investing in new bed capacity and home care expansion. Mexico has initiated the Salud Casa por Casa program, deploying healthcare workers to provide home visits to elderly individuals and people with disabilities. These policy developments are reshaping the financing, delivery, and regulation of long-term care services across the region.

Market Challenges

• Rising care costs and affordability pressures: The cost of long-term care services in North America continues to rise, creating significant affordability challenges for families. In the United States, the median annual cost of a private room in a skilled nursing facility exceeded $116,800 in 2023, while assisted living monthly costs average $5,419. In Canada, monthly assisted-living fees range from $2,565 to $4,030, a level 40% of older Canadians cannot meet without selling assets. In Mexico, the average monthly cost of care services for older adults is approximately 22,500 pesos, while the average household income is 25,955 pesos, making formal care unaffordable for most families. These cost pressures are compounded by rising labor costs, regulatory compliance requirements, and limited public reimbursement rates.
• Workforce retention and burnout crisis: Healthcare workforce retention is a critical challenge across North America. The United States faces 17.6% RN turnover in long-term care settings, with 30% first-year nurse attrition contributing to significant operational disruptions. Canada faces 40% attrition among nurses aged 35 and under, with the long-term care sector experiencing particularly acute shortages. In Mexico, 75.5% of doctors and 67.3% of nurses face complex employment situations, with low wages and poor working conditions contributing to high turnover. Burnout, poor work-life balance, and the physically demanding nature of care work are driving healthcare professionals to leave the profession or reduce their working hours, further exacerbating workforce shortages and sustaining demand for agency staffing.
• Regulatory complexity and geographic disparities in access: The regulatory complexity of healthcare professional licensing across North America creates barriers to workforce mobility. In the United States, state-level licensing requirements complicate cross-state staffing, while Canada faces provincial regulatory differences that limit workforce mobility between provinces. Geographic disparities in access are pronounced, with rural communities across all three countries facing acute shortages of qualified care workers. In the United States, about one in five nursing home residents lives in a rural facility, and these facilities are disproportionately affected by workforce shortages and financial pressures. Canada's remote regions face registered nurse vacancy rates of 13.7%, more than double the rate in accessible regions. Mexico's geographic maldistribution of healthcare professionals leaves some municipalities without any specialist physicians.

Market Trends

• Shift toward home- and community-based care: A fundamental shift in long-term care delivery is occurring across North America, with services increasingly being delivered in home and community settings rather than institutional facilities. In the United States, 87% of the 9.7 million Medicaid LTSS users in 2023 received services in home- and community-based settings. Canada is prioritizing home care investments to reduce pressure on long-term care facilities, with government policies emphasizing aging in place. Mexico's Salud Casa por Casa program represents a major expansion of home healthcare infrastructure, deploying 19,300 healthcare workers to provide periodic home visits to 8.2 million older adults and people with disabilities. This trend is driven by beneficiary preference, government policies promoting community-based care, and the relative cost-effectiveness of home care compared to institutional care.
• Technology adoption and digital transformation: Technology adoption in long-term care delivery is accelerating across the region, with telehealth, remote patient monitoring, and AI-enabled care management becoming increasingly common. Healthcare providers are implementing enterprise workforce management platforms that integrate scheduling, credentialing, compliance tracking, and contingent workforce procurement in real time. In the United States, the federal government has developed a shared digital platform to allow up-to-date medical information to be shared between the NHS and care staff. Canada is investing in digital health infrastructure to support home care and improve coordination between care providers. These technology investments are enabling the shift toward home-based care, improving care coordination, and enhancing the quality and safety of long-term care services.
• Growing private sector investment in senior living: Private sector investment in senior living and long-term care is growing across North America, driven by favorable demographics and the recognition of long-term care as an investable asset class. In the United States, the assisted living sector is expected to grow significantly, with private equity firms investing heavily in senior living communities. Canada has over 2,000 licensed long-term care homes, with 54% privately managed and 46% publicly owned. Mexico's private hospital sector is expanding rapidly, with 2,300 private hospitals representing 64% of all facilities. Real estate developers and private equity firms are entering the market, creating new models of senior living that integrate health care, hospitality, and social programming.

Policies

• The Centers for Medicare & Medicaid Services in the United States administers the Medicaid program, which is the single largest payer for long-term services and supports, funding approximately 59.1% of nursing home patient days and supporting substantial home- and community-based services through waivers and state plan amendments.
• The 2025 reconciliation law in the United States is projected to reduce federal Medicaid spending by $911 billion over ten years, roughly a 14% reduction in federal funding for the Medicaid program, with significant implications for long-term care financing and service availability.
• Canada's federal government has developed national long-term care standards and the Safe Long-Term Care Act, providing guidance for delivering services that are safe, reliable, and centred on residents' needs, with funding from Health Canada to support enhanced engagement and consultations with Canadians.
• The Canada Health Act establishes the framework for the publicly funded healthcare system, influencing hospital staffing requirements and workforce planning across Canadian provinces, with provincial governments introducing minimum nurse-to-patient ratios as a policy tool to address staffing shortages.
• Mexico's National Care Policy, established by Law No. 15.069/2024 and regulated by Decree No. 12.562/2025, established the National Care Plan with 79 concrete actions across five strategic axes, prioritizing elderly individuals who require care and support for basic and instrumental activities of daily living.
• Mexico's Home Care Program for the Elderly (Padi), instituted by Ministry of Health Ordinance GM/MS No. 9.584 of December 22, 2025, represents a significant milestone in systematizing home-based care for elderly individuals restricted to their homes with stable chronic conditions or functional decline.
• The Older Persons Act, 2006 in South Africa and similar legislation across North America provide legal frameworks for shifting emphasis from institutional care to community-based care, regulating the registration and management of residential facilities, and combating elder abuse.