Public Perception of Long-Term Care Spells Trouble

As long-term care becomes a growing public policy issue, having a clearer idea of the American public’s perception of policy options, finances, and information sources related to ongoing living assistance becomes increasingly important for understanding and successfully addressing the population’s needs. A recent survey conducted by the National Opinion Research Center and the Associated Press interviewed a nationally representative sample of 1,419 adults 40 and better in order to discover their thoughts and understanding related to long-term care policy and expenses, as well as detailing the public’s sources for information on ongoing living assistance and the degree to which these sources are trusted. (For the survey’s finding on experiences and expectations for caregiving, click here.)

In terms of long-term care policy, this study found that 58 percent of participants favored a government-administered long-term care insurance program similar to Medicare. This represents an increase of 7 percent compared to 2013. Eighty-one percent supported tax breaks to encourage saving for long-term care; however, only 34 percent favored the idea of a requirement that individuals purchase private long-term care insurance. Seventy-seven percent were in favor of tax breaks for consumers who purchase long-term care insurance. Seventy-five percent were in favor of a form of long-term care insurance available through their employers that would be portable if they pay the premium after leaving the job, similar to COBRA.  Overall this suggests a good deal of public support for government or workplace support and incentives, while showing less enthusiasm for private insurance purchased directly by an individual (though it is not possible to distinguish to what degree that lack of enthusiasm reflects a dislike of government mandates).

The participants in this survey were also asked who should be responsible for paying the costs of ongoing living assistance. Fifty-four percent said that health insurance companies should have a large or very large responsibility for ongoing living assistance costs. Forty-two percent said that Medicare should have a large or very large responsibility, and 38 percent said that Medicaid should have such responsibility. While 40 percent said that individuals should have a large or very large responsibility for ongoing living assistance, only 19 percent said that families should have such a high level of responsibility for such costs. These attitudes were not affected by whether or not the survey participants had any experience with long-term care, either as a caregiver or recipient. Adults between 40 and 54 years old were more likely than those 65 and better to favor large responsibilities for health insurance companies, Medicare, and Medicaid. Those adults with over $50,000 a year in household income were less likely to think health care insurance companies, Medicare, and Medicaid should have a large or very large responsibility than those who earned less than $50,000.  While here a mix of options are receiving endorsement for bearing a good deal of responsibility, what stands out is the broadly held opinion that families should not bear a large responsibility for ongoing living assistance costs.

As for planning for the finances associated with long-term care, only 29 percent of the individuals surveyed said that they are extremely or very confident that they will have the financial resources needed for care as they age. Thirty-eight percent were somewhat confident, and 32 percent were not too confident or not confident at all.

This survey also revealed that there were many misperceptions about the costs of long-term care providers. The monthly costs of nursing care were underestimated by 56 percent of participants; 22 percent correctly estimated nursing home cost; and 22 percent overestimate nursing home cost. On the other hand, assisted living costs and part-time home health care aides were underestimated more frequently than overestimated. For assisted living, 43 percent overestimated the costs, 25 percent estimated costs correctly, and 32 percent underestimated costs. An even greater percent overestimated the cost of part-time home health care aides, with 52 percent overestimating the costs. Twenty-eight percent estimated the costs correctly while 20 percent underestimated the costs.

This survey also reveals that many Americans over 40 also overestimate the long-term care services that Medicare covers. While Medicare only covers skilled nursing facility stays in certain circumstances and for brief periods of time, 42 percent believe that Medicare pays for ongoing care in nursing home facilities. Additionally, 38 percent mistakenly believe that Medicare covers ongoing care at home from a licensed home health care aide.

These perceptions of preparedness, costs, and coverage suggest that many Americans’ expectations could create a major challenge for policy and the senior living industry, particularly in light of the increasing numbers of older adults in the coming decades.

The study also looks into the information that people are receiving about long-term care. Overall, only 46 percent of all individuals surveyed had received any information about ongoing living assistance within the past year. Of those, 45 percent received it from friends, family, or coworkers. Regarding other sources asked about, 30 percent got information from Medicare, 28 percent from a nursing home or assisted living facility, 27 percent from private insurers, 27 percent from a financial planner or accountant, 20 percent from their family physician, 17 percent from Medicaid, 13 percent from an emergency room physician, and 10 percent from their employer.

The amount of trust that the individuals placed in these various sources of information also varied considerably. Most trusted were family physicians, with two-thirds saying that they trusted their family physician completely or very much. Fifty-seven percent said that they had such a high amount of trust in financial planners or accountants. The only other sources of information that received such a high level of trust were friends, families, and coworkers, as well as employers. Least trusted were private insurers, with only 29 percent saying they trust insurers completely or very much.

Around 60 percent of those individuals who were not currently receiving ongoing living assistance felt that they were at least somewhat likely to require ongoing living assistance someday. However, even with this percentage of participants expecting to need such care, 67 percent of individuals surveyed reported doing little to no planning at all. Nineteen percent reported having done a moderate amount of planning. Asked about specific actions taken, the survey found that participants were more likely to have planned for their death with funeral planning (65 percent) than had planned for needs they might require while living. Fifty-three percent reported having created an advance directive. All other actions asked about had been taken by less than 50 percent of all survey participants: discussing care preferences with family (41 percent), setting money aside for care (32 percent), modifying home to make it easier to live in (28 percent), looking into information about aging issues and ongoing living assistance (20 percent), and moving into a facility designed for older adults (8 percent).

Taken together, these findings suggest a number of challenges for policy and the senior living industry, as well as providing useful insights on the public’s attitudes toward topics pertinent to long-term care policy and the senior living industry. A number of these findings suggest a need for greater public education on the practical and financial realities of aging, from a source that the public feels it can trust.



The Associated Press and NORC. Long-Term Care in America: Expectations and Reality. Accessed June 3, 2014.


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