How can we be in such deep water and not know we are drowning? The tide keeps rising and our own unwillingness to face the reality of the inexorable pull of caregiver gravity continues to defy reason. Recent numbers now identify 65.7 million Americans as family caregivers. This represents 29 percent of the population. The annual economic value of that caregiving is estimated at $450 billion, and the lifetime loss of income and assets for an average American caregiver is a whopping $303,800. In addition, since 7 in 10 caregivers are still working, this represents a loss to employers of $25 billion annually.
A recent consumer survey conducted by the Office of the Assistant Secretary for Planning and Evaluation/U.S. Department of Health and Human Services, “2014 Survey of Long-Term Care Awareness and Planning,” was evaluated at the recent ILTCI Conference. Past buyer surveys have indicated that the number one driving force for buyers is personal experience. The survey asked those in the 40-70 year age group if they or someone they knew had ever:
• Required long term care—52.8 percent said yes.
• Paid for in-home care for ADLs—31.3 percent had.
• Been a resident in a nursing home or assisted living facility—44.2 percent said yes.
After all our hard work, how many even understood or were willing to acknowledge the real cost of the problem? Only 20 percent knew what a month of nursing home care costs. Only 15 percent knew the cost of an hour of home health care. Only 25 percent knew that Medicaid was the primary payer. Doesn’t it seem a little contradictory that those who reject the wisdom of insurance have no clue what that actually means to them financially? Interestingly, two-thirds knew that waiting to buy a policy increases the cost with age, and 41 percent knew that good health is required. Doesn’t it again seem strange that the very urgency created by potential changes in health and the certainty of higher costs does not seem to influence buying behavior? Perhaps even more disconcerting is the fact that consumers do seem to understand the true nature of the problem.
• 78.9 percent are concerned about becoming poor and relying on Medicaid.
• 90.6 percent are worried about losing their independence.
• 82 percent are concerned about being able to afford quality care.
• 83.3 percent are worried they will lose control/choice over long term care services and support (LTSS).
Consumers do not want to be a burden, yet they apparently want the potential problem to remain a secret. Only 16.8 percent have even discussed the role of family members in long term care with their spouse or family. I’m not sure we are talking about a pleasant surprise. The inconsistencies in thinking become progressively bizarre when you ask what actions they would be willing to take if they needed care.
Seventy-five percent said they would be perfectly happy to rely on spouse/family/friends for needed care, with 69.7 percent even willing to have family or friend move in with them. However, 48.5 percent were not willing to move in with their family, only 42.4 percent would use their home equity for care and, of course, only 28.6 percent would be willing to go to a nursing home. Doesn’t this strike you as perhaps a little inconsistent with such a strong desire to “not be a burden”?
The deeper you dive into consumer thinking the more disoriented you may become. The survey questioned what the prevailing attitudes are toward who is responsible for long term care, and 71.2 percent of consumers immediately responded that, “It is important to plan now for services in the future.” And 58.7 percent said it was the responsibility of individuals to finance their long term care. The corollary of this is also important, as only 37.1 percent believe it is the government’s responsibility to pay for long term care. However, as we would expect, only 11.5 percent of those surveyed own private insurance. The survey then asked about the subject of “trust.” As we try to find common cause and common ground with the public sector, these findings should at least give us some food for thought: 62.7 percent indicated the government should not tell us what to do about LTCI; 51.1 percent said they did not trust the government; and 32.3 percent said they did not trust private insurers.
In conclusion, the survey determined that consumers are concerned about becoming disabled and subsequently becoming dependent on others. Their understanding of LTSS is marginal at best, and yet they don’t seem to mind using free family care when available. They believe individuals should pay and not the government—as long as they are not the individuals in question. There was little support for public LTCI, yet they, of course, were not buying their own policies. The survey also went on to examine which factors involving benefits and costs were the most important. Benefit levels were important as long as they were cheap. And even though private insurance is best, they would accept a mandatory public plan if it came with big benefits and very low premiums.
Is it any wonder we remain frustrated? Consistent rational thought is simply not available for viewing. Maybe it just makes more sense to go ahead and leave us aging Americans outside the cave to freeze. That simple, yet perfectly effective, approach can’t be any more irrational than the clarity of direction and purpose reflected in this survey.
Other than that I have no opinion on the subject.
