Aging Americans in denial about long-term care need, poll shows

Published April 24, 2013 – Associated Press

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.

Bowman 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.

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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