- About 70% of people turning 65 will need some long-term care, and 20% will need it for more than five years (Administration for Community Living).
- 93% of older adults have at least one chronic condition, and 78.8% have two or more (CDC). Routine blood markers are often the first sign one is developing.
- A marker is a signal, not a diagnosis. A1C, cholesterol and lipoprotein(a), and kidney tests matter most for the common paths to care; several conditions have no blood test at all.
- Care is expensive and mostly not covered by Medicare: about $80,080 a year for a full-time home caregiver and $114,975 for a semi-private nursing home room at 2025 national medians (CareScout; Medicare.gov).
- The best time to ask questions, of your doctor, your family and your retirement plan, is when the first number moves.
What Are Blood Markers?
A blood marker, or biomarker, is anything in a blood sample that can be measured and tied to what is happening in the body. Some are familiar from every annual physical: blood sugar, cholesterol and the creatinine used to estimate kidney function. Others are newer, such as the p-tau217 proteins linked to Alzheimer’s disease, now measured by blood tests the FDA has cleared to help evaluate adults with memory symptoms.
Blood markers do three different jobs, and it helps to know which one a test is doing:
- Screening looks for a problem before symptoms appear, such as an A1C at a routine visit.
- Diagnosis helps confirm or rule out a condition when symptoms are present.
- Monitoring tracks a known condition and whether treatment is working.
Genetic tests are a fourth category. They don’t measure what is happening now; they show inherited risk that never changes. That permanence is why they deserve their own questions, covered below.
A blood marker is a signal, not a sentence. Its value is time: time to treat, to change course and to plan while every option is still open.
The Chronic Conditions That Most Often Lead to Long-Term Care
Long-term care means help with everyday activities such as bathing, dressing, eating and moving safely, usually because a chronic condition has worn down independence over time. The odds are high: someone turning 65 today has almost a 70% chance of needing some long-term care. Women need it longer on average (3.7 years) than men (2.2 years) (ACL).
Chronic disease is close to universal by retirement. In 2023, 93.0% of older adults reported at least one chronic condition and 78.8% had two or more. The most common were high blood pressure (61.4%), high cholesterol (55.1%) and arthritis (51.3%) (CDC, Preventing Chronic Disease). Conditions also travel together: diabetes, high blood pressure and kidney disease feed each other, and all three raise the risk of heart disease and stroke.
The Dependency Series covers the 12 conditions that most often lead to long-term dependency. The table below lists the blood markers worth knowing for each, and their limits.
| Condition | Blood markers and tests to know | What they cannot tell you |
|---|---|---|
| Dementia & memory loss | FDA-cleared p-tau217 blood tests help evaluate adults with memory symptoms (FDA; Alzheimer’s Association). APOE4 is a risk gene, not a diagnosis. | Not intended for people without symptoms; a result needs a clinician’s full evaluation. |
| Stroke | Risk markers you already get: A1C, cholesterol, lipoprotein(a), kidney function. Emergency stroke blood tests such as GFAP are still being studied (Frontiers in Neurology). | No routine blood test rules a stroke in or out; sudden symptoms mean calling 911. |
| Parkinson’s disease | No blood test diagnoses it. Genetic tests (such as LRRK2 and GBA) find risk variants (Parkinson’s Foundation); a skin biopsy test detects abnormal alpha-synuclein (CND Life Sciences). | Diagnosis still rests on a neurological exam. |
| Arthritis | Osteoarthritis has no diagnostic blood test; blood work mainly rules out other types, such as rheumatoid arthritis (Arthritis Foundation). | X-rays and the exam carry most of the weight. |
| Autoimmune diseases | The ANA test screens for autoimmune activity, but many healthy people test positive (Mayo Clinic). Multiple sclerosis has no blood test (NINDS). | A positive ANA alone is not a diagnosis. |
| COPD & lung disease | Guidelines recommend a one-time alpha-1 antitrypsin test for everyone with COPD (AATD guideline). | Breathing tests (spirometry), not blood, diagnose COPD. |
| Diabetes | A1C below 5.7% is normal, 5.7–6.4% is prediabetes, and 6.5% or above is diabetes (CDC). Autoantibody tests can flag type 1 years early (ADCES). | A diagnosis needs a second confirming test unless symptoms are clear (NIDDK). |
| Heart disease | A lipid panel, plus lipoprotein(a) measured at least once in adulthood (National Lipid Association). | One number is a risk signal, not a forecast. |
| Kidney disease | Both eGFR (blood) and urine albumin (UACR) are needed to stage kidney disease (KDIGO); APOL1 gene testing explains some family risk (National Kidney Foundation). | Early kidney disease usually has no symptoms, so the lab trend is the early sign. |
| Cancer | Shield is a blood test for colorectal cancer screening in average-risk adults 45+, and a positive result needs a colonoscopy (Guardant Health). PSA is an individual decision at ages 55–69 (USPSTF). An FDA advisory committee has voted in favor of a multi-cancer test (GRAIL). | Blood tests do not replace recommended screenings. |
| Falls & fractures | A bone density scan (DXA), not a blood test, diagnoses osteoporosis; blood work looks for causes such as low vitamin D or calcium problems (American Family Physician). | Fall risk is judged by balance, strength, vision and medications. |
| Vision & hearing loss | No blood test screens for common vision or hearing loss. Sudden vision changes with headache or jaw pain may prompt ESR and CRP tests for giant cell arteritis (clinical review); genetic testing can clarify some inherited eye diseases (American Academy of Ophthalmology). | Regular eye and hearing exams remain the screening tools. |
Early Signs Worth Taking Seriously
For several of the most common conditions, the earliest sign isn’t something you feel. It’s a number. Prediabetes and early kidney disease usually cause no symptoms, so a rising A1C or a falling eGFR may be the only warning for years. Other early signs are things families notice before the person does: repeated questions or missed bills, a new tremor, shortness of breath on stairs, a near-fall, or turning up the television.
Sudden changes are different. Sudden weakness or numbness on one side of the body, trouble speaking, or sudden vision loss calls for emergency care, not a blood test.
Questions to Ask Your Doctor About Blood Test Results
Bring these to your next appointment, or send them through your patient portal when a result is flagged:
- What question is this test answering? Is it screening for something I don’t have symptoms of, diagnosing something I do, or monitoring something already known?
- What is my number, what is the normal range, and how has it changed? The trend across several visits often says more than one result.
- Does this result need to be confirmed? Many diagnoses, including diabetes, require a second test (NIDDK).
- Is this test FDA-cleared or approved for someone like me? Some newer tests are cleared only for people who already have symptoms.
- If it is abnormal, what happens next, and how soon? Ask for the follow-up test, the specialist and the timeline in writing.
- What would move this number in the right direction? Medication, diet, activity, sleep or treating another condition.
- Is this a genetic test, and who else does it affect? Genetic results are permanent and can matter to siblings and children. Federal genetic privacy protections do not extend to long-term care, life or disability insurance (NHGRI), which is why the order of testing and planning matters.
- Will my plan cover this test? Coverage differs between screening and diagnostic use.
How Long-Term Care Affects Retirement, Estate Preservation and Family
A chronic diagnosis is a medical event, but long-term care is mostly a financial and family one. Three facts drive most of the impact.
Medicare does not pay for long-term care
Medicare.gov is direct: Medicare and most health insurance, including Medicare Supplement (Medigap) policies, don’t pay for long-term custodial care at home, in the community or in a nursing home. You pay all costs for non-covered services, including most long-term care (Medicare.gov). Medicare’s limited coverage of skilled care after a hospital stay is a different benefit.
The costs reach retirement savings quickly
At 2025 national medians, a non-medical home caregiver costs $35 an hour, or $80,080 a year at 44 hours a week. Assisted living runs $74,400 a year, a semi-private nursing home room $114,975, and a private room $129,575 (CareScout). For a married couple, the larger risk is often to the spouse who stays healthy, whose income and savings must last long after care ends.
Estates and the family home
When savings run out, Medicaid may pay for care, but it has rules that reach into estate planning. For enrollees 55 and older, states are required to seek recovery of nursing facility and home and community-based care costs from the person’s estate. They may not recover while a spouse, a child under 21, or a blind or disabled child survives (Medicaid.gov). Transfers made to qualify are reviewed under a look-back period that is 60 months in most states (MedicaidLongTermCare.org).
The family pays in time, health and money
63 million Americans, nearly 1 in 4 adults, are family caregivers. Nearly 1 in 4 provide 40 or more hours of care a week, and nearly half have had at least one major financial impact, such as taking on debt or stopping savings (AARP and the National Alliance for Caregiving). Dementia shows the scale most starkly: the lifetime cost of care was estimated at $405,262, and family caregivers bear 70% of it (Alzheimer’s Association).
Case Study: When Three Lab Results Became a Family Plan
The Hendersons are a composite family, not real people. Their story combines patterns common to the conditions in this series. The costs use 2025 national medians from the CareScout Cost of Care Survey; real costs vary widely by location and care needs.
Year zero: three numbers in a patient portal
Tom Henderson is 66 and newly retired in Southwest Florida. His wife, Linda, is 63. At Tom’s annual physical, three results come back flagged: an A1C of 6.2%, inside the prediabetes range; an eGFR in the low 60s with albumin in his urine; and blood pressure that has crept up for three visits in a row. Nobody says “emergency,” and Tom feels fine. The results sit unread in the portal.
Each of those numbers ties to a white paper in this series: diabetes, chronic kidney disease, and cardiovascular disease. Together they also raise the risk of the condition that changes the Hendersons’ plans: stroke.
Year four: the phone call
At 70, Tom has a stroke. After the hospital and a short rehabilitation stay, he comes home needing help to bathe, dress and move safely. That help is custodial care, which Medicare does not pay for. The family hires a home caregiver 44 hours a week, the full-time schedule CareScout uses, at a national median of $80,080 a year. Linda covers nights and weekends.
Years five through eight: the costs compound
Two years later, after a fall and a second hospitalization, Tom moves to a nursing home. A semi-private room carries a national median of $114,975 a year. After five years of care, the running total reaches $505,085 at today’s prices, before inflation.
What it does to the retirement, the estate and the family
- Retirement: The Hendersons had saved about $600,000. Paying privately, care uses most of it, leaving Linda, who could live another 20 years, with a fraction of the plan they built for two.
- Estate: The house they meant to leave their children becomes the largest remaining asset. If Tom later needs Medicaid, states are required to seek repayment from the estates of enrollees 55 and older for nursing home and home care costs, though not while a spouse survives (Medicaid.gov). Gifts made to qualify are reviewed under a look-back that runs 60 months in most states (MedicaidLongTermCare.org).
- Family: Their daughter, Sarah, drives 90 minutes each weekend and uses her vacation time for appointments. She joins the 63 million Americans who are family caregivers, nearly half of whom report a major financial impact, such as taking on debt or stopping savings (AARP).
What year zero could have looked like
The flagged results were the earliest, cheapest moment in the whole story. Asking a few questions at that visit could have led to treatment, a follow-up schedule and lifestyle changes. Just as important, it would have started a family conversation while Tom was healthy: who would help, where the documents are, and how care would be paid for while every planning option was still open. None of that guarantees a different outcome. It does change who makes the decisions, and when.
Questions to Ask Your Family and Your Retirement Plan
The doctor’s visit is one conversation. These are the other two, and they are easier while everyone is healthy:
- Your family: If one of us needed daily help, who would provide it, and what would it cost that person in work, health and time? Where are the durable power of attorney, health care surrogate designation, will and account lists?
- Your retirement plan: What would three years of care cost where we live? Which savings would be used first? What would remain for the healthy spouse? CareScout’s survey shows local costs by ZIP code (CareScout).
- Your estate: What happens to the house if Medicaid ever pays for care? Which decisions are affected by the look-back rules? These are questions for an elder law attorney and a qualified financial professional, ideally before a diagnosis narrows the choices.
Read the White Paper for the Diagnosis Your Family Is Facing
The Dependency Series is a free, 12-part educational library. Each white paper explains how one condition progresses, the blood markers and tests that matter, what care it typically requires, and the effects on the person, the caregiver and the family’s finances.
Explore The Dependency SeriesCommon Questions About Blood Markers and Long-Term Care
What are blood markers?
Blood markers, also called biomarkers, are measurable substances in a blood sample, such as sugar attached to hemoglobin (A1C), creatinine used to estimate kidney function, cholesterol particles, or proteins linked to Alzheimer’s disease. A marker shows that something is happening in the body. On its own it rarely makes a diagnosis; doctors read it alongside symptoms, an exam, imaging and repeat results.
Which blood tests matter most for the chronic conditions that lead to long-term care?
The everyday ones carry the most weight: A1C for prediabetes and diabetes, a lipid panel plus a one-time lipoprotein(a) test for heart and stroke risk, and eGFR with a urine albumin test for kidney disease. Newer tests, such as FDA-cleared p-tau217 blood tests for adults with memory symptoms, add detail for specific conditions. Several conditions, including Parkinson’s disease, osteoarthritis and multiple sclerosis, have no blood test that diagnoses them.
What questions should I ask my doctor about my blood test results?
Ask what question the test is answering, what your number and its range mean, how it has changed since the last test, whether it needs to be confirmed, what the next step is if it is abnormal, and what would move the number in the right direction. For any genetic test, also ask who else in your family the result affects.
Can a blood test predict whether I will need long-term care?
No. No blood test predicts long-term care. Some markers show a higher risk of conditions such as diabetes, kidney disease, heart disease or stroke, which are among the most common paths to needing daily help. The value of an early marker is time: time to treat, change habits and plan while every option is still open.
Does Medicare pay for long-term care if a chronic condition gets worse?
Generally not. Medicare.gov states that Medicare and most health insurance, including Medigap, do not pay for long-term custodial care such as help with bathing and dressing, at home or in a nursing home. Medicare can cover a limited skilled stay after a hospitalization, which is different from ongoing custodial care.
How can a chronic illness affect retirement savings, an estate and family members?
At 2025 national medians, a full-time home caregiver costs about $80,080 a year and a semi-private nursing home room about $114,975. Paid privately for several years, that can consume savings meant for a surviving spouse. If Medicaid later pays, states must seek recovery from the estates of enrollees 55 and older, though not while a spouse survives. Family caregivers often absorb lost wages, debt and stopped savings.
Topics in This Post
Educational content only, not medical, legal or financial advice. The case study is an illustrative composite. Named tests are referenced for identification only and are not endorsements. Sources for this post (all accessed October 2026):
- Administration for Community Living — How Much Care Will You Need?
- CDC, Preventing Chronic Disease — Trends in Multiple Chronic Conditions Among US Adults (2025)
- CareScout — 2025 Cost of Care Survey, national medians
- Medicare.gov — Long-term care coverage
- Medicaid.gov — Estate Recovery
- MedicaidLongTermCare.org — Medicaid’s Look-Back Period
- AARP and the National Alliance for Caregiving — Caregiving in the US 2025
- Alzheimer’s Association — 2026 Alzheimer’s Disease Facts and Figures
- CDC — A1C Test for Diabetes and Prediabetes
- NIDDK — The A1C Test & Diabetes
- ADCES — Type 1 diabetes autoantibody screening
- KDIGO — 2024 Clinical Practice Guideline for CKD, Executive Summary
- National Kidney Foundation — APOL1-mediated kidney disease
- National Lipid Association — Lipoprotein(a) management simplified
- U.S. Food and Drug Administration — FDA clears first blood test used in diagnosing Alzheimer’s disease
- Alzheimer’s Association — FDA clearance of the Elecsys pTau217 blood test
- Frontiers in Neurology — Blood biomarkers in acute stroke (2026)
- Parkinson’s Foundation — Genetics and Parkinson’s
- CND Life Sciences — Syn-One skin biopsy test
- Arthritis Foundation — Tests for osteoarthritis
- Mayo Clinic — ANA test
- NINDS — Multiple sclerosis
- Chronic Obstructive Pulmonary Diseases — Alpha-1 antitrypsin deficiency guideline
- Guardant Health — Shield blood test FAQ
- U.S. Preventive Services Task Force — Prostate cancer screening
- GRAIL — FDA advisory committee vote on the Galleri multi-cancer test
- American Family Physician — Osteoporosis
- Review — Giant cell arteritis diagnosis and laboratory markers
- American Academy of Ophthalmology — Genetic testing for eye disease
- National Human Genome Research Institute — Genetic Discrimination and GINA
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