Long term care often is viewed as an inevitable expense of old age. In reality, people cannot predict what they will need. On average, someone turning age 65 this year will need either formal or informal long term care for three years, but this average masks enormous variation. While some 30% of 65 year olds will not need any long term care before they die, 20% will need care for more than five years.
Few people have insurance against the expense of long term care, which can reach $26,000 a year at home and more than twice that amount in an institution. Medicare covers long term care only tangentially through its limited skilled nursing facility and home health benefits. The private health insurance policies that cover most working-age Americans for acute health care services provide little protection for long term care. As a result, almost half of formal long term care is financed by the federal-state Medicaid program, which becomes available only when a person is impoverished.
Why has this situation not given greater impetus to reforming the financing of long term care? To learn more, the National Academy of Social Insurance’s study panel on long term care commissioned a poll of baby boomers (those aged 40 to 60) and seniors (aged 60 or over). Peter D. Hart Research Associates and American Viewpoint–two of the nation’s leading survey research firms–conducted the poll.
The poll found a high level of public concern about paying for long term care and widespread discontent with the current system of financing. Americans seem to understand that the financing of long term care is a serious policy problem and are receptive to change. Specifically, among adults aged 40 and over:
o The vast majority (90%) recognizes that affording the costs of long term care is a difficult proposition, including 62% who say it is very difficult. Affording long term care is considered far more difficult than problems that sometimes receive more attention, such as finding high-quality care or information about government financial help.
o Nearly three-quarters are concerned either a great deal (54%) or a fair amount (18%) about paying for long term care–a proportion nearly identical to proportions expressing concern with paying for a major illness or a comfortable retirement.
o Seven in 10 believe that government should do more to help people meet the costs of long term care (see Figure 1).
The poll also provides some guidance on public attitudes that might promote or impede developing a better LTC policy. On the positive side, the survey showed boomers and seniors have similar attitudes toward financing as a policy problem and that direct personal experience with long term care was not necessary for concern about the issue. Further, about half the respondents found several facts very convincing as reasons for policy action to improve long term care financing–including the aging of the population, high and rising long term care costs and expenditures, heavy dependence on family members as caregivers, and limited Medicare coverage or private insurance for long term care.
Particularly noteworthy was a strong negative reaction to the description of current Medicaid policy, which requires individuals virtually to exhaust their assets before becoming eligible. Respondents found this to be one of the most convincing reasons to do more about LTC.
As the pollsters observe, “The image conjured by informing people about the Medicaid spend-down requirement is obviously troubling even for people who generally are not inclined to support more action on long term care affordability–half of…those who say that long term care costs are a moderate or low priority for the nation (51%) find this message very convincing.”
Further, after hearing that Medicaid covers care only after individuals have exhausted virtually all their own resources, 41% of respondents concluded that the system of paying for LTC “is broken and needs a complete overhaul,” and another 30% thought that it needs major improvements (see Figure 2).
The results of the survey clearly demonstrate that Americans age 40 and over are deeply concerned about LTC and believe that more must be done to help people meet its expense, according to the pollsters. Slightly more than half of respondents believe addressing LTC costs should be a high priority for the nation, including a third who say it should be a very high priority.
“Fundamentally,” the pollsters conclude, “Americans are looking for a balance between personal responsibility and government assistance as the nation addresses the challenge of financing long term care.”