Coming to grips with long-term care

Needing long-term care isn't inevitable, but plans still should be made for the future

Needing long-term care isn't inevitable, but plans still should be made for the future

April 27, 2006|by CANDICE BOSELY

Among others, they are questions that might keep an older person awake at night.

Will I have to go to a nursing home or an assisted living facility? What if I do and don't like it? How long will I have to stay there?

If I'm able to stay at home, will I be able to have a friend or family member care for me instead of a stranger? If not, how can I find someone competent and trustworthy?

And, finally, how much is my long-term care going to cost? Will I have to deplete my savings or be a burden to my family?


Needing long-term care at home or moving into a nursing home or assisted living facility isn't inevitable, but plans still should be made for the possibility, experts advise.

According to information compiled from other sources by AARP, people 65 and older have a 40 percent chance of entering a nursing home. Of those, 10 percent will remain in a nursing home for five years or more.

In Maryland, the average yearly cost to stay in a nursing home is more than $67,000, the cost is more than $68,000 in Pennsylvania and the cost tops $59,000 in West Virginia, according to AARP information.

Costs to stay in an assisted living facility are lower, as is the cost of having an aide come into one's home.

It makes sense, and data supports the notion, that most people would rather stay at home as they grow older.

Two-thirds of all long-term care provided is informal care provided at home. Often it is provided by a spouse or, especially common, a daughter, said Enid Kassner, senior policy adviser at the Maryland office of AARP.

Older people who have a smaller family or whose family lives far away might end up paying out of pocket for care, or using a public program like Medicaid.

Medicaid, however, often only will help after a person has depleted all of his or her savings, Kassner said. Medicare, in virtually all cases, doesn't provide assistance unless skilled nursing care or physical therapy is needed, meaning it likely won't help people who need help with everyday tasks such as bathing, dressing, using the toilet or shopping, she said.

Too many people only begin thinking about long-term care when such difficulties arise, or when a parent begins to need long-term care, Kassner said.

"Unfortunately most people are in a state of denial about how important it is" to plan for long-term care, she said.

Kassner said it's generally advised that people start considering their long-term care options when they are in their 40s and 50s. That's also when people are still raising children or paying for a child's tuition, and paying a mortgage and other expenses.

As a result, Kassner said, planning for long-term care becomes a low priority.

That shouldn't be the case since "the future" can come sooner than expected.

Some options

So what can older people do?

Among the advice Kassner gave is for people to consider their own health history and that of their families. A family history of MS, Parkinson's disease, Alzheimer's or other serious conditions might mean a person is more likely to have to enter a nursing home.

Buying insurance for long-term care costs also is possible.

Those who can afford to pay the premiums for such insurance should be sure to invest in a good plan that includes adjustments for inflation, Kassner said.

A report published in February by the Urban Institute looked at the situation some older Americans face.

The study, titled "A Profile of Frail Older Americans and Their Caregivers" indicated in its executive summary that in 2002 about 8.7 million people age 65 and older living at home reported some type of disability that limited their ability to perform basic personal activities or live independently. About 2 million people - nearly two-thirds of them women - were severely disabled.

By comparison, about 1.4 million older people lived in nursing homes in 2002, the study states.

The report addresses a variety of topics, including the responsibility of unpaid caregivers, such as a person's spouse or child.

Unpaid caregivers who assume primary responsibility for the personal care of a frail older adult average 201 hours of help per month, which is more than a typical full-time job, the report states.

The report can be downloaded for free at

Uncertainty about planning

Not everyone lays awake at night pondering questions about future care needs.

"How does one plan for long-term care?" rhetorically asked Tom Logan, 63, who lives with his wife outside Hedgesville, W.Va.

He pondered whether long-term care planning would have benefited either of his parents, given that his mother died 30 days after being taken to a hospital, while his father was able to stay in his home for three years afterward.

Logan said his father was alert, could still play the piano and sing hymns when he died. He died the night after Logan visited him and sat and talked with him.

"I would like to be able to plan to go out like that," said Logan, who retired as a dean at Montgomery College in Montgomery County, Md.

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