Why Aren't More Older Adults Thinking About Long-Term Care?

Takeaways

• Many older adults underestimate their likelihood of needing sustained, day-to-day care in their later years, and a significant portion of adults aged 50 and older are not adequately planning for long-term care.

After decades of handling our daily personal care needs without giving them a second thought, it is hard to imagine needing help with these tasks. However, research shows that about one in seven adults aged 65 or older will need help with daily care. Help with daily personal care is referred to as long-term care and too many adults assume they won’t need it.

A recent survey of American adults aged 50 to 94 by the University of Michigan’s National Poll on Healthy Aging explored older adults' preparedness for long-term care. The findings indicate that many are unprepared for the financial and logistical aspects of care in a nursing home, assisted living facility, or similar type of setting, with widespread misconceptions about coverage options.

Key Survey Findings

The survey, which was conducted in August 2024, revealed some worrying data.

Perceptions and Planning:

• Only 43 percent of adults aged 50 and older think they will need long-term care.

• Forty-eight percent are unsure how to plan for long-term care needs.

• Forty-five percent said the potential need for long-term care seemed too far off to plan for.

• Just 27 percent have designated a durable power of attorney for medical care, and only 24 percent have identified potential caregivers.

• Only 11 percent have purchased long-term care insurance.

Financial Concerns:

• Most respondents said they were not confident they could afford long-term care services: 62 percent said they would not have enough money for nursing home care, 58 percent for assisted living care, and 51 percent for home care.

• Notably, 62 percent mistakenly believe that Medicare covers permanent nursing home care.

Communication Gaps:

• Only 5 percent have discussed care plans for their future with a health care provider.

• Discussions with family about long-term care are also limited, with just 33 percent talking with a spouse or partner and 30 percent talking with children about these topics.

Not surprisingly, older adults who have a health problem or a disability are more likely to think they will need long-term care versus older adults who aren’t experiencing such limitations (57 percent versus 34 percent). The survey also revealed that adults over age 65 were more likely to think they will need long-term care than adults between 50 and 64 (45 percent versus 40 percent).

Paying for Long-Term Care

Half of the survey participants said they would rely on either their or their family’s personal financial resources if they needed to move into a nursing home permanently. Nineteen percent said they would rely on long-term care insurance.

Twenty-nine percent said they would rely on Medicaid, and 62 percent said they expected their long-term care to be covered by Medicare. The large percentage of those surveyed thinking that Medicare will cover their long-term care needs shows there is a widespread misconception about what Medicare and Medicaid cover.

Medicare vs. Medicaid for Long-Term Care Coverage

Understanding the differences between Medicare and Medicaid  is important for planning for long-term care.

Medicare

Introduced in 1965, Medicare is a federal health care program primarily for Americans who are 65 or older, as well as many individuals with disabilities. There are four basic parts that cover different areas of health care or dictate what is covered and how.

Medicare’s Part A includes coverage of hospital stays and some limited care in a skilled nursing facility under certain circumstances. However, Medicare does not cover long-term care in a nursing home, for example.

Medicaid

Medicaid is a federal- and state-level program that provides comprehensive coverage for low-income adults, children, and individuals with disabilities. Since each state manages its own Medicaid plan, covered services vary across the country. Generally, coverage includes nursing home care, home and community-based services, e.g., personal care assistance, adult day care, and, in some states, assisted living facility costs.

Medicaid eligibility is based on a person’s income and assets. Individuals must often spend down assets well ahead of applying for benefits to qualify.

Care Preferences and Decision-Making

When asked about where they would prefer to receive support with daily activities, survey respondents expressed a range of options, including:

• Their home with family or family caregivers (52 percent)
• Their home with paid caregivers (21 percent)
• Their home without help (14 percent)
• The home of a family member or caregiver friend (6 percent)
• An assisted living facility (6 percent)
• A nursing home (1 percent)

When asked about making decisions about their long-term care, 39 percent said they would let their family make decisions for them, but 61 percent said they would not let their family make decisions for them.

Implications of Survey

This survey found that many older Americans do not think they will need long-term care and have not made plans for how to meet and pay for long-term care needs. This suggests that there is a large portion of the population that is behind on planning for long-term care.

Additionally, many older adults think that the possibility of long-term care is too far off to plan for, and many don’t know how to plan for it. Only about a third of the adults surveyed have discussed long-term care with their spouses or children.

One of the most worrying finds of the survey is that nearly two-thirds of those surveyed think that Medicare will cover their long-term care costs. This likely contributes to many over-50 adults not having an adequate plan in place for how to pay for potential long-term care.

Planning for Long-Term Care

The University of Michigan’s National Poll on Healthy Aging highlights a critical need for increased awareness and proactive planning among older adults regarding long-term care. Understanding the limitations of Medicare and the eligibility requirements of Medicaid is essential to avoid unexpected financial burdens.

Engaging in early discussions with family and health care providers, exploring insurance options, and becoming informed about available resources can better prepare individuals for future long-term care needs. Contact an elder law attorney in your area to learn about your options for long-term care planning.

For additional reading about long-term care planning, check out the following articles:

• Discussing Long-Term Care With Older Adults in Your Life
• 2024 Survey Shows Costs of LTC Continue to Rise
• What a Good Long-Term Care Insurance Policy Should Include
• The Role of an Elder Law Attorney in Medicaid Planning
• Medicare Advantage: An Alternative to Original Medicare