Couple on cruiseMedical advances have most definitely increased the number of years we live and have decreased the number of early sudden deaths. For example, identifying asymptomatic diseases through screening has helped to reduce their incidence and severity.

The overall results of medical advances are that:

 People are living longer and requiring additional years of care. 

 Hospital stays are shorter because more services are available at home.

 People are surviving more accidents, not always with full recovery, creating a

new group of LTC patients.

Some researchers argue that medical advances have increased life expectancy but have not delayed the onset of illness, predicting that declining death rates may actually increase LTC needs. That is, more people are living long enough to develop age-related conditions such as dementia, or they are living longer with existing disabilities and chronic conditions.

Advances in pharmacology and pharmaceuticals also impact the need for long-term care. These advances have not only reduced the symptoms of diseases but also have slowed their progression, thereby increasing longevity. However, increased longevity may necessitate periods of longer care.

The irony is that as medical advances help people live longer, the likelihood increases that long-term care will be necessary.

What is noninstitutional care? 

The U.S. Department of Health and Human Services reports that 31 percent of all caregivers are employed outside the home. This type of care is referred to as noninstitutional care.

Note that employed caregivers spend no less time on elder care than those who are not employed outside the home. Workers who provide elder care spend approximately four hours a day on caregiving in addition to their other responsibilities.

Consumer Attitudes and Understanding

Another social factor associated with the growing long-term care need is current consumer awareness and attitude. Generally, the public at large does not have a good understanding of the long-term care need, including why and how to plan for long-term care. Many simply deny that they will need long-term care; others believe, incorrectly, that Social Security, Medicare, or their existing health insurance will cover the costs.

They do not see long-term care as something one needs to plan for in advance, such as they would retirement. This attitudinal “disconnect” also explains one of the reasons why people may not consider the purchase of long-term care insurance.

According to a report issued by the U.S. Department of Health and Human Services, coverage purchased to cover acute medical care far surpasses the coverage purchased to cover long-term custodial care. Whereas almost all older individuals are protected from high acute medical care costs through Medicare and private Medigap insurance, a very small percentage have purchased long-term custodial care insurance.

This report cited the following, among others, as key factors limiting demand for long-term care insurance:

lack of information – Many underestimate the likelihood of requiring LTC services and the potential costs of those services.

 misperception of public and private programs – Many people believe that Medicare, retiree health plans, or Medicare supplement insurance covers LTC services. This is not the case.

 delayed preparation for/denial of long-term care needs – Many do not think about preparing for long-term care needs until the need arises. At that point, they may be too old or disabled to purchase insurance.

 long lag time between purchase and benefit payment – Long-term care insurance must be purchased before it is needed; often, this means a period of many years between purchase and when benefits are likely to be paid. Consumers prefer to spend their current dollars on coverage that provides a more near-term benefit, such as Medigap policies.

affordability – Many of today’s older consumers have low incomes and cannot afford long-term care premiums.

perception of need – Some consumers decide they do not need long-term care insurance because they have too few assets to protect or have family and friends available to provide care.

Consumer attitudes and perceptions notwithstanding, long-term care is a growing reality. It is also a very expensive reality.

The Cost of Long-Term Care

The medical, personal, and social services necessary because of an accident, a chronic illness, a disability, or simply the phenomenon of aging—services associated with long-term care—are among the most expensive of health care costs, especially considering the great numbers of people affected.

The actual cost of long-term care depends on where the care is received, what type of provider administers the care, and how long the care is required.

Some people require minimal assistance with only a few activities of daily living (ADLs) for a limited time.

Others require skilled nursing facility care for an extended period.

Unfortunately, no one can predict who will be stricken with the need for long-term care, what type of care will be needed, or how long the care will be necessary.

Planning for Long-Term Care

Given the likelihood of needing long-term care and the tremendous cost that this care entails, it is important that individuals plan for it—and the sooner the better. Certainly, there are barriers. For example, people tend not to think about becoming older and needing care, or they don’t anticipate that they will ever need care themselves; they resist the idea of becoming dependent.

They may believe [erroneously] that Medicare or their current health insurance will cover the cost of this type of sustained, ongoing care. They may find it difficult to raise this issue with their loved ones. Or they may underestimate the time and toll that future caregiving will demand of their family or friends.

Some are not aware of the tremendous costs of this care or how it is paid. Some may think of long-term care simply as nursing home care and assume that the “government” will cover the cost. Some are confronted with conflicting financial priorities. And some people may simply not know where or how to begin the planning.

But for every reason why people do not plan in advance for long-term care, there is a reason why they should:

Advanced planning for future care needs will allow for greater independence and choice as to where and how the care is delivered.

 Advanced planning can mean greater financial security, not only for those who may need care but also for their family and loved ones.

 Advanced planning can ease the financial and emotional toll on one’s family and release them from the burden of providing the care, if and when it is needed.

 Advanced planning will avoid the uncertainty, confusion, and mistakes that could arise in the event of a health care need.

 Advanced planning will promote a continued quality of life, as the person defines it, when care is needed.