Understanding the Growing Need for Long-Term Services and Supports

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People who live with disabling conditions often need assistance. They may require help with the activities of daily living, including bathing, eating, and getting dressed. They may also need assistance with the instrumental activities of daily living, including money management and housekeeping.

The kinds of help that people need over an extended time to cope with disabling conditions are collectively known as long-term services and supports (LTSS). The term encompasses services provided by paid or unpaid caregivers, healthcare professionals, assisted-living facilities, nursing homes, and social services agencies.

Studies show that LTSS needs are about the same for people of all races and ethnicities and both genders. While people of all ages may need LTSS, those who are age 80 or older are the fasting growing group of LTSS recipients. That population group continues to grow as the baby boom generation continues to age. While younger family members have traditionally provided home-based care, the trend toward smaller families has resulted in fewer children and grandchildren who are available to help their older family members address their functional limitations.

Future LTSS Needs

The Department of Health and Human Services estimates that more than half of all adults will need paid LTSS after turning 65. About 39% are expected to need nursing home care at some point.

Unfortunately, adults with low lifetime earnings are likely to have LTSS needs at an earlier age than more affluent adults. Younger people with strong earnings tend to maintain healthier lifestyles and to treat healthcare problems before they become chronic. Thus, the people who are more likely to need LTSS shortly after retirement are those who can least afford it. 

Regardless of lifetime earnings, however, DHHS expects more than half of older adults to use paid LTSS at some point after reaching age 65. Short- and long-term nursing home stays are common as adults grow older. Individuals with greater wealth are more likely to have short-term stays in nursing homes than individuals with less wealth, usually because they have insurance or savings that will cover the cost. However, older adults who stay in nursing homes for longer than two years are more likely to have low lifetime earnings, in part because they are more likely to qualify for Medicaid funding of a long nursing home stay.

Planning for the Future

Although people are more likely to need LTSS as they grow older, planning for that need is not often seen as a high priority. A survey of Americans between the ages of 40 and 70 found that only 43% believed they had a significant chance of ever living in a nursing home. 

Most survey participants expressed concern about losing their independence. Most were receptive to the idea of depending on family members to help them care for themselves, although a majority were unwilling to move in with adult children. Only 44% expressed a willingness to use the equity in their home to fund LTSS.

Most survey participants agreed that having long term care insurance would provide peace of mind. On the other hand, most survey participants acknowledged that they give a higher priority to competing uses for their money. A recent survey of people between the ages of 40 and 64 who had household incomes between $75,000 and $150,000 found that only 10% had invested in long-term care insurance. 

Long-term care insurance can be expensive. Its benefits may expire while an LTSS recipient is still in need of care. Unfortunately, as long as American government declines to cover LTSS care as a Medicare benefit, the burden will continue to fall on family members and Medicaid programs to serve the LTSS needs of older adults.

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