Poll: Aging Americans in Denial About Need for Long-Term Care

aging america long term care baby boomers
Mary Washington Healthcare/APAndrea Vassel of Mary Washington Healthcare explains the benefits of an advance directive at Mary Washington Hospital in Fredericksburg, Va., as part of National Healthcare Decisions Day on April 16.
By JENNIFER AGIESTA and LAURAN NEERGAARD

WASHINGTON -- We're in denial: Americans underestimate their chances of needing long-term care as they get older -- and are taking few steps to get ready.

A new poll examined how people 40 and over are preparing for this difficult and often pricey reality of aging, and found two-thirds say they've done little to no planning.

In fact, 3 in 10 would rather not think about getting older at all. Only a quarter predict it's very likely that they'll need help getting around or caring for themselves during their senior years, according to the poll by the AP-NORC Center for Public Affairs Research.

That's a surprise considering the poll found more than half of the 40-plus crowd already have been caregivers for an impaired relative or friend -- seeing from the other side the kind of assistance they, too, may need later on.

"I didn't think I was old. I still don't think I'm old," explained retired schoolteacher Malinda Bowman, 60, of Laura, Ohio.

Bowman has been a caregiver twice, first for her grandmother. Then after her father died in 2006, Bowman moved in with her mother, caring for her until her death in January. Yet Bowman has made few plans for herself.

"I guess I was focused on caring for my grandmother and mom and dad, so I didn't really think about myself," she said. "Everything we had was devoted to taking care of them."

The poll found most people expect family to step up if they need long-term care -- even though 6 in 10 haven't talked with loved ones about the possibility and how they'd like it to work.

long term care americans retirementBowman said she's healthy now but expects to need help someday from her two grown sons. Last month, prompted by a brother's fall and blood clot, she began the conversation by telling her youngest son about her living will and life insurance policy.

"I need to plan eventually," she acknowledged.

Those family conversations are crucial: Even if they want to help, do your relatives have the time, money and knowhow? What starts as driving Dad to the doctor or picking up his groceries gradually can turn into feeding and bathing him, maybe even doing tasks once left to nurses such as giving injections or cleaning open wounds. If loved ones can't do all that, can they afford to hire help? What if you no longer can live alone?

"The expectation that your family is going to be there when you need them often doesn't mean they understand the full extent of what the job of caregiving will be," Susan Reinhard, a nurse who directs AARP's Public Policy Institute, said. "Your survey is pointing out a problem for not just people approaching the need for long-term care, but for family members who will be expected to take on the huge responsibility of providing care."

Those who have been through the experience of receiving care are less apt to say they can rely on their families in times of need, the poll found.

With a rapidly aging population, more families will be facing those responsibilities. Government figures show nearly 7 in 10 Americans will need long-term care at some point after they reach age 65, whether it's from a relative, a home health aide, assisted living or a nursing home. On average, they'll need that care for three years.

Despite the "it won't happen to me" reaction, the AP-NORC Center poll found half of those surveyed think just about everyone will need some assistance at some point. There are widespread misperceptions about how much care costs and who will pay for it. Nearly 60 percent of those surveyed underestimated the cost of a nursing home, which averages more than $6,700 a month.

Medicare doesn't pay for the most common types of long-term care. Yet 37 percent of those surveyed mistakenly think it will pay for a nursing home and even more expect it to cover a home health aide when that's only approved under certain conditions.

Affording Care

The harsh reality: Medicaid, the federal-state program for the poor, is the main payer of long-term care in the U.S., and to qualify seniors must have spent most of their savings and assets. But fewer than half of those polled think they'll ever need Medicaid -- even though only a third are setting aside money for later care, and just 27 percent are confident they'll have the financial resources they'll need.

In Cottage Grove, Ore., Police Chief Mike Grover, 64, says his retirement plan means he could afford a nursing home. And like 47 percent of those polled, he's created an advance directive, a legal document outlining what medical care he'd want if he couldn't communicate.

Otherwise, Grover said he hasn't thought much about his future care needs. He knows caregiving is difficult, as he and his brother are caring for their 85-year-old mother.

Still, "until I cross that bridge, I don't know what I would do. I hope that my kids and wife will pick the right thing," he said. "It depends on my physical condition, because I do not want to be a burden to my children."

The AP-NORC Center poll found widespread support for tax breaks to encourage saving for long-term care, and about half favor the government establishing a voluntary long-term care insurance program. An Obama administration attempt to create such a program ended in 2011 because it was too costly.

The older they get, the more preparations people take. Just 8 percent of 40- to 54-year-olds have done much planning for long-term care, compared with 30 percent of those 65 or older, the poll found.


Mary Pastrano, 74, of Port Orchard, Wash., has planned extensively for her future health care. She has lupus, heart problems and other conditions, and now uses a wheelchair. She also remembers her family's financial struggles after her own father died when she was a child.

"I don't want people to stand around and wring their hands and wonder, 'What would Mom think was the best?'" said Pastrano, who has discussed her insurance policies, living will and care preferences with her husband and children.

Still, Pastrano wishes she and her husband had started saving earlier, during their working years.

"You never know how soon you're going to be down," she said. "That's what older people have a problem understanding: You can be in your 60s and then next flat on your back. You think you're invincible, until you can't walk."

The AP-NORC Center for Public Affairs Research survey was conducted Feb. 21 through March 27, with funding from the SCAN Foundation. The SCAN Foundation is an independent, nonprofit organization that supports research and other initiatives on aging and health care. The nationally representative poll involved landline and cellphone interviews with 1,019 Americans age 40 or older. It has a margin of sampling error of plus or minus 4.1 percentage points.

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Associated Press writer Stacy A. Anderson and News Survey Specialist Dennis Junius contributed to this report.

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Government long-term care primer: http://longtermcare.gov

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102 Comments

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mail4warding

I told my survivors to shoot me if I need the "care" that's given in the nursing homes in NYC ... I'd be better off by far.

April 25 2013 at 1:47 AM Report abuse rate up rate down Reply
1 reply to mail4warding's comment
Robert Weed

That is a great plan ... wow.

April 25 2013 at 5:49 PM Report abuse rate up rate down Reply
ga7smi

soylent geen is arriving soon

April 25 2013 at 1:44 AM Report abuse rate up rate down Reply
rrshere

Denial no, earlier demise ya. Trust me, there already---wish I could.

April 25 2013 at 12:16 AM Report abuse rate up rate down Reply
SPQR

what did everyone do before insurance? Did the pioneers have insurance for being scalped by Indians?....NO So buck up and take care of yourself and just let it happen. You don't ant to live beyond your life expectency...it ain't fun

April 25 2013 at 12:02 AM Report abuse rate up rate down Reply
1 reply to SPQR's comment
ga7smi

doctots provided low cost or free medical services to those in need when I was a child - medical care was affordable 30 years ago

April 25 2013 at 1:42 AM Report abuse rate up rate down Reply
legacykwst

Besides cost, the other thing not mentioned is the possibility that you'll get stiffed by the insurance company or a lot less than you thought you'd get. Already, at least one insurance company that offered long-term care insurance has withdrawn from the market due to unexpectedly high expenses. I heard a financial adviser say that those who need to invest in long-term care insurance are those who can afford it w/o breaking the bank... and who have assets they want to protect. This means that those who needed are usually in the top 25% of wealth. Those above that don't need it because they have the money to pay out-of-pocket. Those who have difficulty affording it, probably should not buy it, but instead gift children as much as they can, and spend down to qualify for Medicaid. Often, even if they do have long-term care insurance, they will end up spending down anyway, because the premiums still have to be met even as one is using longterm care.... Moreover, most policies do not cover all that Medicare does not. So, you'll end up on Medicaid anyway.

April 24 2013 at 10:52 PM Report abuse rate up rate down Reply
1 reply to legacykwst's comment
Robert Weed

Long Term Care insurance pays the claims ... the triggers are clear. Long Term Care insurance is VERY affordable if you buy when you should, when you are younger and healthy as part of your retirement plan. So if you are 45-65, in fairly good health, you can easily afford a good Long Term Care insurance plan ... a plan which addresses the physcial, emotional and fiancial burdens long term care places on family.

I leasrned a lot at these websites: www.completelongtermcare.com, www.infoLTC.org and www.aaltci.org.

April 25 2013 at 5:52 PM Report abuse rate up rate down Reply
setanta54s_back

live long enough to be a burden on the "great society" that bled your paycheck not only weekly but annually via more taxation.

April 24 2013 at 9:52 PM Report abuse +3 rate up rate down Reply
CARLTON

Interesting that this article never mentions the REAL issue: The cost of insurance for long-term care. The cost is outrageous, and many seniors simply don't want to deal with it ..... as they can't afford it. And society doesn't want to deal with the high cost of the insurance either. So everyone simply runs around with their heads in the sand.

April 24 2013 at 9:35 PM Report abuse +2 rate up rate down Reply
1 reply to CARLTON's comment
setanta54s_back

it remains just another insurance embezzlement scam the same as social security/medicare etc etc on and on.
the costs of those alleged "skilled nursing facilities" will wipe out any savings and who in their right mind would want to end up in one of them anyway ?
the same as you're saying,the co$t$ of these insurance policies are off the wall-
most families get through this time with available,reliable,outside help, ontop of a routine followed by family and trusted and loyal friends.

April 24 2013 at 9:57 PM Report abuse +2 rate up rate down Reply
1 reply to setanta54s_back's comment
Robert Weed

While most care is not in a facility, home care is expensive, although less so than a facility. Family can't provide this type of personal care usually since they have jobs and their own families.

A 50 year-old could get a great plan for under $70 a month ... a small amount to plan for the biggest risk we face.

April 25 2013 at 5:58 PM Report abuse rate up rate down
rafol

The commentary on \"Poll: Aging Americans in Denial About Need for Long-Term Care\" misses several facts about LTC, i.e., plans are expensive, insurers can and do change the \'goal posts\', plans may not meet health care requirements at point of need and there is too much inherent uncertainty in LTC plans at present for most prospective clients to commit to any of them with confidence. All of these presage \'extra costs and extra grief\'.

April 24 2013 at 9:11 PM Report abuse +1 rate up rate down Reply
1 reply to rafol's comment
Wayne

wjon67@aol.com

With the potential of "Medical Review Boards" you could be denied down the road...who knows how that will turn out, but I have a much cheaper, much better, more useful solution.

April 24 2013 at 9:30 PM Report abuse +1 rate up rate down Reply
miabchhome

My experience with long term care is that it is a scam.
My mother paid decades of premiums for a policy but as she got old she was not paying her bills for the long term care. We called the insurance company and they refused to tell us what was owed and how we could pay my mother's premiums. The insurance companies hope and pray that the elderly stop making their premiums so they can cancell their policy when the elderly needed the most.

April 24 2013 at 8:38 PM Report abuse +1 rate up rate down Reply
2 replies to miabchhome's comment
setanta54s_back

did you go after them via the atty general and insurance board ?
at the LEAST YOUR MOM HAS THE RIGHT TO KNOW THIS INFO.

April 24 2013 at 9:59 PM Report abuse +1 rate up rate down Reply
Robert Weed

The industry pays out over $7 million A DAY in claims ... not a scam. But if your mom stopped paying her premiums and it wnet beyond the lapse date ... too late, same for your health insurance or home or car ...

April 25 2013 at 6:00 PM Report abuse rate up rate down Reply
vjhgrannie

All this is a reality that very few can see when they are in their 40's, 50.s and 60's if they are healthy. Then, a disease hits, or a fall from having fun at recreation, etc. It costs lots of money to have help, so I would hope one is covered by all parts of medicare (pay the extra for all coverage) then there is some help. Home health however only lasts so long, and then you better have a plan,
as who will take you to the bathroom, or change your bandage, or cook your food, etc. It will happen if you live long enough. My eldest friend who lives alone(86) has someone who brings in food, and mail, and takes her to the doctor, but she pays. She also has five children who will pitch in when the rubber hits the road and she needs full care.

April 24 2013 at 8:05 PM Report abuse rate up rate down Reply