Out of pocket and/or private pay is attractive to those who do not wish to buy long-term care insurance, or who would be turned down for medical reasons. It hardly needs to be said that reasonably substantial assets that provide steady cash flow are necessary. “Substantial” depends on where you live, among other things, but generally it means at least a few hundred thousand dollars, including income from a pension and Social Security or investments. When searching for any type of senior care or other care services, you may want to go over all your options regarding the cost of facility care vs. in-home care. Often, in-home care can be much more cost efficient to those paying out of pocket and on limited incomes.