My Lovely Wife and I earlier this year finally got around to preparing our descendants for our eventual demise by drafting a will, power of attorney, and healthcare directive. We are not normally as forward-looking as we probably should be, so we left the lawyer’s office feeling like responsible adults for a change.
But results of the latest National Poll on Healthy Aging suggest that we — and most of our contemporaries — may not be as ready for the end as we think we are. We’re not giving nearly enough thought to long-term care.
University of Michigan pollsters questioned nearly 3,500 older Americans about their plans for obtaining the help they may need in their dotage and learned that a surprising portion of the respondents had not only done little planning but also displayed little knowledge of their options. More than six in 10 of those surveyed, for instance, said they expected Medicare to pay for nursing-home care, apparently unaware that it’s a Medicaid benefit — available only to those with incomes low enough to qualify.
At least those folks had been thinking about it. Nearly half (45 percent) of the respondents said the need for long-term care was too far off to consider their options, just over half (52 percent) expressed no concern about those future needs, and almost six in 10 (57 percent) said they doubted that they’d ever need those services. This despite statistics showing that 70 percent of American seniors will need long-term care at some point in their lives.
“As the youngest baby boomers and older Generation Xers approach age 65, these findings show a special need to help them plan and find trustworthy information,” notes Ana Montoya, MD, MPH, an associate professor of internal medicine at the University of Michigan. “Even among those already over 65 and in their Medicare years, we find a sizable minority have not taken key steps to prepare.”
Only 27 percent of respondents said they had designated a power of attorney, and only 24 percent had identified a potential caregiver. An even smaller portion reported that they had modified their living spaces to support aging in place (18 percent), bought long-term care insurance (11 percent), or investigated assisted-living and nursing-home facilities (7 percent).
To some degree, all this may indicate a certain sanguinity about the long-term effects of aging, a sense that the physical, mental, and emotional rigors of old age are just another set of obstacles to overcome — we’ll all just deal with it when we get there. But I’ve come to realize that no amount of planning will reduce the cost or risk of investing in long-term care insurance, nor will it ease concerns about the well-documented horrors awaiting us in many long-term care facilities. With that in mind, it’s easy to understand why so many of my contemporaries seem to figure they’ll just do the best they can when the time comes.
These are the folks who told pollsters they want to stay in their homes and lean on family or friends to provide care, if needed. In a pinch, they said they’d pay somebody to come to their home and give them a hand. But move to a nursing home? Buy long-term care insurance? No thanks.
It’s a different reality for respondents who are coping with a disability or chronic health issues. Among this cohort, pollsters found that more than half of these respondents assume they’ll need long-term care at some point, but they report feeling even less confident about planning for it than their healthier counterparts.
“Worry about long-term care runs especially high among these older adults, who have already experienced limitations to their daily activities,” says University of Michigan geriatrician Julie Bynum MD, MPH. “We also found less confidence about planning for long-term care among older adults who say their mental or physical health is fair or poor, compared with those who say they’re in good or excellent health, regardless of disability status.”
That may help explain why some 4.3 million Americans coping with various stages of cognitive impairment live alone. As Judith Graham reports in KFF Health News, about half of these seniors need help with basic daily activities, but barely one in five qualifies for Medicaid assistance or other publicly funded home healthcare services.
Still, it’s a cohort that tends to be fiercely independent, notes Jane Lowers, PhD, an assistant professor at Emory University School of Medicine, who has been studying people living alone while battling early stages of dementia. That would certainly describe David West.
The 62-year-old former social worker was diagnosed with Lewy body dementia three years ago and lives alone in downtown Fort Worth, Texas. He’s responded to the illness by focusing on exercise and volunteering as well as by joining three dementia support groups. Still, he understands the prognosis. “I will not survive this in the end — I know that,” he tells Graham. “[B]ut I’m going to meet this with resilience.”
And though West has three adult children, he doesn’t expect any of them to provide long-term care for him when he can no longer care for himself. He understands the emotional and financial toll dementia care can extract from anyone who takes it on. It’s a looming crisis without a clear solution. “I don’t know how it’s going to work out,” he admits.
MLW and I — as well as millions of other seniors — could say the same thing.
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