Long-Term Care History, Risks, and Current Events

This post is being updated today, August 29th, 2024 with the copyright credit given to WebCE. I failed to list them initially as the source of this article and post. This information posted is all from them, NOT ME. Please be aware of this update. My sincere apologies to all involved. Their website is www.webce.com

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The term long-term care (LTC) has been in use for a very long time, although its implication has changed over the years. At one time, the elderly and infirm were shipped off to old age homes or rest homes for their care. Now we seldom hear these terms. Today, long-term care is defined more broadly, yet it has become very specialized. The modern definition of long-term care is not one service; rather, it encompasses a wide range of assistance and support services provided over an extended period, all of which are collectively designed to meet the medical, personal, and social needs of those who cannot fully support themselves. As such, some refer to it as “long-term services and supports,” or LTSS. The primary goal of long-term care is to maintain a patient’s maximum functional independence. ?

A report prepared by the U.S. Senate Special Committee on Aging (February 2000) described long-term care as “. . . differing from other types of health care in that the goal of long-term care is not to cure an illness, but to allow an individual to attain and maintain an optimal level of functioning.” Long-term care pertains to the organization, financing, and delivery of sustained medical and human services to people in need. It is expected to grow dramatically, given the aging population.

Settings for Long-Term Care Long-term care comprises many different services aimed at helping people with chronic conditions compensate for restrictions they have in their ability to function independently. Those who need long-term care have diverse physical and mental disabilities that require different types and levels of care. Accordingly, long-term care can take place in a variety of settings, including:

? in an individual’s home

? at sites in the community

? in an assisted living facility (ALF)

? in a skilled nursing facility (SNF)

Receiving care and services at home or in a community setting allows an individual to continue to live at home rather than be placed in a nursing facility or other type of residence.

Central to managing long-term care is enabling those who prefer to remain in their homes to be able to do so and to maintain their independence if possible. Types of Long-Term Care encompasses many levels of assistance and support. These include both medical and nonmedical care. In other words, long-term care helps to meet both health and personal needs. Though long-term care may include advanced and sophisticated medical care, it often consists simply of hands-on assistance by others. For example, those with mental disabilities may not need medical care but do require supervision and direction.

Types of LTC services, therefore, vary from helping a robust 50-year-old stroke victim relearn grooming skills to providing 24-hour skilled nursing care for a 90-year-old suffering kidney failure.

Medical Long-Term Care In absolute medical terms, long-term care is chronic care with the aim of management, control of symptoms, and maintenance of function.

Chronic care differs from acute care, which is medical care aimed at treating physical problems directly in an attempt to permanently cure or control them. From a medical perspective, long-term medical care includes treatment for or application of the following:

? falls, fractures, and injuries

? pulmonary and cardiovascular disorders

? psychiatric disorders

? kidney and liver malfunction

? prescription drug treatment

? lab work

? surgeries

? similar medical issues

Medical LTC might include medical support services for people with degenerative conditions such as Parkinson’s disease or stroke; those with prolonged illnesses such as cancer or heart disease; or people with cognitive disorders like Alzheimer’s disease.

Nonmedical Long-Term Care Long-term care also has a nonmedical scope. Many individuals requiring long-term care are not, in fact, ill. Long-term care on the nonmedical front is more like custodial care. Its purpose is to assist people with support services for daily tasks such as bathing, grooming, eating, dressing, and similar activities. This form of LTC may involve the most private and intimate aspects of a person’s life—personal hygiene, dressing, and toileting. These primarily “low-tech” services are designed to minimize, rehabilitate, or compensate for loss of independent physical or mental functioning. Other, less personal long-term custodial care needs may involve tasks such as preparing meals, running errands, and performing household chores.

Custodial care may be provided by persons without special professional skills or training. Custodial care is intended to maintain and support an existing level of well-being and to preserve health and prevent its further decline. Its primary focus is on aiding with activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

Activities of Daily Living (ADLs) Most people take for granted routine daily activities such as getting into or out of bed, taking a shower, getting dressed, and eating breakfast. ADLs are the basics of self-care. The extent to which one is able or unable to perform ADLs is considered one of the most reliable ways to assess the need for long-term care services limited mobility or cognitive impairment, these pursuits can be hardships. These ordinary activities are called. ADLs are a measure of functional or physical capacity. ADL Examples Representing a broad range of functional and physical abilities, the following are considered fundamental self-care ADLs:

? bathing

? maintaining continence

? eating

? toileting

? dressing

? transferring (getting out of a bed or chair)

Residents in LTC facilities need help with an average of four ADLs. Individuals receiving health care in their homes need help with an average of two and a half ADLs. Private insurance policies and Medicaid rely on ADL measures as triggers for benefits. An insurance policy or Medicaid guidelines will specify the number of ADLs for which assistance is required—typically two out of six—for LTC benefits or payments to begin. All insurance policies must list the ADLs that trigger benefits.

Cognitive impairment also triggers long-term care, often involving loss of functional or physical abilities. Instrumental Activities of Daily Living (IADLs) Normal aging and illness can hamper the ability to perform the tasks necessary to live independently. Therefore, individual function levels must be assessed as a means of planning for specific services or providing personalized rehabilitation. Such assessments can also establish baseline functionality, and changes may show the need for additional resources or medical treatment.

When measuring levels of functioning, instrumental activities of daily living (or IADLs) are used. Patients are scored on whether they can perform IADLs independently, if they require some help, or if they are entirely dependent on assistance. IADLs typically involve interaction with a person’s environment, whether in the home or in the community.

The following tasks are typically considered IADLs:

? using the telephone—Is the patient able to look up numbers, dial, receive, and make calls without help? Is the patient able to answer the phone or dial the operator in an emergency, or does he or she require a special telephone or help in getting the number and dialing? Is the patient unable to use the telephone?

? traveling—Is the patient able to drive a car or travel alone on buses or taxis; able to travel with a companion; or unable to travel?

? shopping—Is the patient able to select and purchase food and clothing; unable to shop without assistance; or unable to shop at all?

? preparing meals—Is the patient able to plan and cook full meals; able to prepare light foods but unable to cook full meals alone; or unable to prepare any meals?

? housework—Is the patient able to do heavy housework, for example, scrubbing floors; able to perform light housework while requiring help with heavy tasks; or unable to do any housework?

? taking medicine—Is the patient able to prepare and take medications in the right dose at the right time; able to take medications but only with reminding or with someone to prepare the medications; or unable to take medications without supervision?

? managing money—Is the patient able to manage finances, for example, paying bills or balancing a checkbook; able to manage daily purchasing but needs help paying bills and managing the checkbook; or unable to handle money at all?

A person’s level of IADL abilities is used as a measurement of functionality. Unlike activities of daily living, which represent the fundamentals of self-care, IADLs are not considered absolutely necessary for basic functioning.

Long-Term Care Risks and Statistics

The statistics associated with the risk of needing and utilizing long-term care services are sobering. As the population ages and as lifespans increase, the at-risk numbers are also sure to rise.

First, there is the growing population of elderly. By 2030, it is projected that the aged 65 and older will be more than 73 million, almost one and one-half times the number today.

Second, according to the U.S. Department of Health and Human Services, about 70 percent of individuals over age 65 will require at least some type of long-term care services during their lifetimes. Over 40 percent will need care in a nursing home for some period.

The following factors increase one’s risk of needing long-term care:

? age—The risk generally increases as one gets older. Age is the most significant risk factor leading to long-term care.

? marital status—Single people are more likely to need care from a paid provider.

? gender—Women are at a higher risk than men, primarily because they tend to live longer.

? lifestyle—Poor diet and exercise habits can increase one’s risk.

? health and family history—These factors also impact one’s risk.

In addition, studies have revealed certain other individual-level factors that are statistically associated with the risk of needing care in a nursing home or an assisted living facility. These include the following:

? income—Persons with lower current income have a higher risk of moving to a care facility than do persons with higher incomes.

? education—Those with lower levels of education face a higher risk of transition to a care facility.

? family structure—The presence of potential caregivers has a strong and significant effect on the risk of transitioning to a nursing home or assisted living facility. Those who are single and have no living children are almost three times more at risk of being admitted to a facility than married individuals with children.

? geography—Those who live in the Midwest are more at risk of having to transition to a care facility than in other parts of the country, as are those who live in a rural area compared to a metropolitan area.

Who Is at Risk? Understandably, most people associate the need for long-term care with the elderly, and statistically, the risk of needing long-term care increases with age. However, this need is not confined solely to the aged.

According to an article written for Georgetown University Long-Term Care Financing Project, nearly 43 percent of those who need long-term care are between the ages of 18 and 64. At younger ages, congenital defects and accidents are the primary causes leading to the need for long-term care.

At Middle Ages (45 to 55), congenital diseases contribute to the risk.

After age 70, individuals are subject to the same congenital diseases, as well as to multiple health conditions and frailty.

Other facts and statistics regarding long-term care point to its growing prevalence:

? More than 6 million elderly Americans need assistance from family or friends if they are to live at home.

? At least two-thirds of all home-care assistance is provided free by family members and friends.

? Of people turning 65, 69 percent will need some long-term care before they die.

? More than half of the U.S. population will require some type of long-term care during their lives (nursing home care, home health care, assisted living, or rehabilitative facility care)

? Of men turning 65, 58 percent will need some long-term care

? Women are more at risk than men—once they turn 65, 79 percent of women will need some long-term care at some point before death

? Among those turning 65, 52 percent will need long-term care for at least one year before they die, and 20 percent will need more than five years of care

? The average nursing home stay is approximately two and a half years.

? After 2021, the population in nursing homes is expected to increase substantially. This is the year the oldest baby boomers will turn 75. As the population ages, research has predicted the nursing home population to grow to three to four million residents.

?

Long-term care is a social issue because it is one of public welfare. We find ourselves facing a complexity of concerns related to long-term care— everything from accessibility to how to pay for it. Our aging population and its increased longevity combine to make LTC a challenging social issue. We are faced with responding to the emerging needs of an increasingly elderly population. Adding to the complexity is that the LTC population is not a single, homogeneous group. Members of this group are diverse in race, education, health, and economic status. No single strategy is suited to meet the needs of the many.

Advances in Medical Technology Medical advances have increased the number of years we live and have decreased the number of early sudden deaths. Identifying asymptomatic diseases through screening—for example, for colon cancer, breast cancer, hypertension, high cholesterol, and osteoporosis—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 but not always experiencing 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 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.

Family Members as Caregivers At the turn of the twentieth century, families remained intact. In fact, it was common for three generations to live under one roof. Elders were cared for by younger generations. The community was supportive, and neighbors often pitched in when necessary. But with the arrival of the automobile and the advent of air travel, families began to scatter. Today, we are more mobile than ever, and, unfortunately, elders are frequently left behind to care for themselves. The swiftly expanding elderly population has produced a great demand for personalized care and medical services. Clearly, this enormous need is placing financial strains on the elderly and their families, government programs, private health insurance companies, and LTC facilities.

Despite private funds, long-term care insurance policies, and government funding for long-term care, family members who provide unpaid long-term care for their loved ones face a considerable financial and emotional impact. This type of care is referred to as noninstitutional care. According to the Family Caregiver Alliance, most caregivers are employed and among those age 50 to 64, an estimated 60 percent work full or part time. 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.

The Toll of Elder Care in the Workplace As employees’ elder-care obligations swell, the cost to employers also increases. A study from the MetLife Mature Market Institute documented that the cost to U.S. business of working caregivers is estimated, conservatively, at slightly more than $13 billion per year in added health costs.

Other effects include lost productivity, absenteeism, workday interruptions, and employee turnover. The total estimated aggregate loss of wages, pensions, and Social Security benefits to these working caregivers is $3 trillion.

While many employers realize that these costs can be reduced by providing elder-care programs designed to curb productivity losses and employee stress, others are concerned about the costs of offering elder-care assistance and maintaining equitable benefits for those employees who do not have elder-care responsibilities.

Work-Related Issues Associated with Elder Care In addition to lost productivity, absenteeism, workday interruptions, and employee turnover, other work-related issues associated with caring for elderly parents and other relatives include:

? tardiness

? stress

? excessive phone calls

? unavailability for overtime

? reduced hours

? health problems

? diminished quality of work

? increased risk of work-related accidents and injury

Those with elder-care responsibilities are typically at the height of their careers at 50 to 60 years of age. Their elderly parents need assistance, but often, the resources are not there: they have no LTC insurance policy or surplus income to help with care. They can’t afford to scale back on their hours or jeopardize their careers.

Consumer Attitudes and Understanding Another social factor associated with the growing long-term care need is 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 care far surpasses the coverage purchased to cover long-term care. Whereas almost all older individuals are protected from high acute care costs through Medicare and private Medigap insurance, a very small percentage have purchased long-term 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—Long-term care insurance can be expensive. Many of today’s older consumers with middle to low incomes cannot afford the 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.

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 for. 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.

Reasons to Plan for LTC But for every reason why people do not plan 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 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.

Financial Planners, like myself, serve the senior market and represent products for retirement and late-life needs. I find that I have an important role and responsibility to play in helping individuals and their families address the need for long-term care.

First, I can illuminate the need to plan for this risk and the importance of doing so. I can also provide education and guidance on how to meet this need, which may include purchasing long-term care insurance, as well as other alternatives.

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 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.

LTC Costs Compared The following chart shows how these LTC costs generally compare with each other. These types of providers and services will be discussed in detail. LTC Costs Compared

In more specific terms, the following are current costs for various types and levels of care, as reported in the Genworth Cost of Care Survey, reflecting median costs as of 2021.

Home-Based Care

? homemaker services—Nationally, the median annual rate charged by a noncertified but licensed home-care agency for homemaker services is $53,800. Homemaker services include housekeeping, cooking, and running errands.

? home health aide services—Nationally, the median annual rate charged by a noncertified but licensed home-care provider for home health aide services is $55,000. Home health aides help with ADLs, not medical care.

Community-Based Care

? adult day health care—Nationally, the median annual rate charged for adult day health care (which provides therapeutic, social, and other support services in a community-based setting) is $19,200.

Facility-Based Care

? assisted living facilities—Nationally, the median annual rate for a private one-bedroom unit in an assisted living facility is $51,600. These rates exclude one-time community or entrance fees.

? nursing homes—Nationally, the median annual rate for a singleoccupant private room is $105,850. The median rate for a semiprivate room is $93,000 per year.

Considering that the average length of stay in a nursing home is two and a half years, the total cost of an average stay today would be about $232,500 to $264,600. For many, this expense could easily consume a lifetime of savings. Others may not be able to cover the cost at all.

Connect with me to discuss your situation. I have specialized in Long-Term Care for years. Protecting Your Assets with Long-Term Care Insurance is a Smart Decision. It Provides Protection and Peace of Mind. Why Risk Draining Your Assets if/when you have a need. What If the Money You Need for Care is Illiquid or will Force You to Pay Capital Gains or Income Taxes on it? Why Minimize Your Beneficiaries Inheritance if You Need Home Care, an Assisted Living or Skilled Nursing Facility? Even if You can Self-Insure, let's have a discussion. Send me a message. Thanks for Your Attention.

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