Do Americans Understand Long-Term Care?

Results from a new national telephone survey found that “Americans continue to misperceive [the] cost and risk of needing long-term care,” said the SCAN Foundation, funder of the survey, in a July 9 e-alert.

The Associated Press (AP)-NORC Center for Public Affairs Research conducted “Long-Term Care in America: Americans’ Outlook and Planning for Future Care,” the third in a series of annual surveys. The results, released in July 2015, are based on interviews with 1,735 adults, age forty and older, in all fifty states and Washington, D.C., during spring 2015.

The survey looks at older Americans’ understanding of long-term care, what they know or do not know about the cost and likelihood of needing long-term care services, and “their attitudes and behaviors” about planning ahead for possible care needs, according to a press release.

Experts estimate that 70 percent of Americans who get to age sixty-five will need some type of long-term care, “and our findings show that many Americans are unprepared for this reality,” commented Trevor Tompson, who directs the AP-NORC Center, in the release.

And, as most of us know, the need for long-term care is only going to increase with the large numbers of baby-boomers turning sixty-five every year now. “With this expanding need comes a demand for ways to maintain high-quality services and to make financing such care manageable for families and governments alike,” the national survey report notes.

Only a third of respondents in this survey said that they are “very or extremely confident” in their ability to pay for ongoing living assistance possibly needed in the future, the report notes. (“Ongoing living assistance” is essentially the people-friendly term for long-term care, Gretchen Alkema of the SCAN Foundation explained to me. It is defined in the survey instrument, she said.)

It is no wonder that respondents are concerned. The report cites a statistic from Genworth Financial that the median cost of nursing home care is now $91,250 per year.

And some 20 percent of respondents did not know if private health insurance covers ongoing nursing home care. (Most such plans do not.) Twenty-seven percent of respondents did not know if Medicare covers ongoing nursing home care. (Medicare, the report reminds us, only pays for intermittent stays in a nursing home.) That second response is troubling, but it is actually not surprising to me, an aging boomer myself.

The report states that the “likelihood of planning for ongoing living assistance increases with a number of factors.” These include being older, having a higher income, having more education, and being in better health.

Majorities of survey respondents were in favor of some policy proposals to help pay for long-term care—such as a government-administered long-term care insurance plan, favored by 59 percent. The report notes, however, that “the already low support” for a requirement that individuals purchase private long-term care insurance “has decreased slightly” from 2014 to 2015.

The 2015 AP-NORC survey explores several new topics that were not covered in the two previous surveys:

• “person-centered care experiences,” which the report defines as “an approach to health care and supportive services” that lets people control their own care “by specifying preferences and outlining goals” for improving their quality of life. One of the tenets of person-centered care is coordinated care across multiple health care providers.
• whether private health insurance plans have a role in paying for long-term care (most do not cover ongoing care by licensed home health aides, the report also explains, but they “typically” do cover medical equipment such as wheelchairs and other assistive devices when a physician deems them “medically necessary.”)
• special challenges for people in the “sandwich generation,” who find themselves providing ongoing living assistance to elderly relatives or friends while at the same time providing financial help to their children.

The broader national survey included an oversample of Californians age forty and older. Survey results from the California respondents are in a separate issue brief titled “Long-Term Care in California: Policy Attitudes and Perceptions,” also funded by the SCAN Foundation, which is located in Long Beach, California.

The survey of Californians included questions about California’s In-Home Supportive Services (IHSS) Program. Most Californians surveyed were not aware of this state government-funded program “that pays for ongoing living assistance for Medi-Cal [California Medicaid] eligible adults,” the brief says. Through IHSS, adults age sixty-five and older and people with disabilities can stay in their homes to receive care there instead of moving to a nursing home or other care facility. The brief also explains how IHSS allows participants to choose their own care provider, who can even be a family member or friend.

As of now, IHSS providers “are not required to have any formal training on providing ongoing living assistance.” After hearing a description of the program, 65 percent of Californians surveyed somewhat or strongly favored a requirement for formal training.

The survey of Californians also found that only 27 percent are confident that they have the finances to pay for long-term care, and that percentage, the brief says, “is significantly lower” than the proportion (33 percent) for people elsewhere in the United States.

Related Health Affairs content:

“To Increase Value In Medicare, Expand Coverage To Long-Term Care,” by Donald Taylor of Duke University, Health Affairs Blog, June 12, 2015.

“Future Demand For Long-Term Care Workers Will Be Influenced By Demographic And Utilization Changes,” by Joanne Spetz and coauthors at the University of California, San Francisco, June 2015 issue.

“Long-Term Services And Supports: What Foundations Are Funding,” GrantWatch column by Lee-Lee Prina, March 2015 issue.

“Expectations About Future Use of Long-Term Services and Supports Vary by Current Living Arrangement,” by Carrie E. Henning-Smith and Tetyana P. Shippee of the University of Minnesota, January 2015 issue.

Other resources:

“Valuing the Invaluable: 2015 Update: Undeniable Progress but Big Gaps Remain,” a report on family caregiving from the AARP Public Policy Institute, released July 16.

“Long-Term Services and Supports: Changes and Challenges in Financing and Delivery,” Alliance for Health Reform June 2015 toolkit, released July 14. The Robert Wood Johnson Foundation funded the toolkit, which was authored by Deanna Okrent.