The Ultimate Long-Term Care Guide

Updated: August 17th, 2019 Read Time: 12:20

The Ultimate Long-Term Care Guide is used to fill in the blanks on valuable information you need to know about long-term care and what to look for in buying Long-Term Care Insurance.

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Types of Long-Term Care Services

We need Long-Term Health Care services due to illness, accidents or the impact of aging. Long-Term Care is defined as the assistance needed when we are unable to care for ourselves due to chronic illness, physical injury, cognitive (mental) impairment, or frailty.  Healthcare professionals, health insurance providers, and Medicare classify this type of care as custodial care, as opposed to skilled, acute or rehabilitative care.  The focus of long-term care is on assistance with the normal activities of daily living or supervision due to memory loss from Alzheimer’s or other forms of dementia. 

These include:

  • Getting around inside and outside of the home (ambulating).
  • Activities of Daily Living (ADL’s) – Eating, Bathing, Dressing, Toileting (being able to get on and off the toilet and perform personal hygiene functions), Transferring (being able to get in and out of bed or a chair without assistance), Continence (being able to control bladder and bowel functions).
  • Dressing and grooming, as in selecting clothes, putting them on, and adequately managing one’s personal appearance.
  • Toileting, which means getting to and from the toilet, using it appropriately, and cleaning oneself.
  • Bathing, which means washing one’s face and body in the bath or shower.
  • Transferring, which means being able to move from one body position to another. This includes being able to move from a bed to a chair, or into a wheelchair. This can also include the ability to stand up from a bed or chair in order to grasp a walker or other assistive device.
  • Assistance needed with Instrumental Activities of Daily Living (IADLs), such as managing finances, such as paying bills and managing assets. Handling transportation, either via driving or by organizing other means of transport. Shopping and meal preparation. This covers everything required to get a meal on the table. It also covers shopping for clothing and other items required for daily life. Housecleaning and home maintenance. This means cleaning kitchens after eating, keeping one’s living space reasonably clean and tidy, and keeping up with home maintenance. Managing communication, such as the telephone and mail.
  • Managing medications, which covers obtaining medications and taking them as directed

Who is at Risk for Needing Long-Term Care Services & Supports?

People think of long-term care as something that happens to older people. While that is true, with the advances in medical science we survive health events and accidents more often. If we don’t die but don’t recover, we will need extended care services. If we do survive, we continue to age and can be impacted by aging issues. Former First Lady Rosalynn Carter was the first major public figure to speak about long-term care and caregiving. She said: "There are only four kinds of people in the world: those who have been caregivers, those who are currently caregivers, those who will be caregivers, and those who will need caregivers."

She championed the cause of those Americans — a group now numbering over 65 million — who long-term care services and supports for loved ones who need help and assistance with normal living activities or supervision due to memory loss from Alzheimer’s or other forms of dementia.

Many people might remember “Superman” Actor Christopher Reeve required extensive long-term care services following an accident. Reeve said in a book that his life of “privilege” ended as a result of the accident and the costs and burdens related to his extended care.

There are other famous people who, like the rest of us, are impacted by illness, accidents or the impact of aging. Former First Lady Jacqueline Kennedy-Onassis required long-term care in her extended battle with lymphoma. 

It was August of 1994 when former President Reagan was diagnosed with Alzheimer’s disease. He was age 83 at the time. Just think, once the most powerful man on the planet with so many memories going back decades and decades, beginning to lose those memories which helped make him the man he was. The impact on his wife Nancy and the rest of the family and friends was tremendous.

There are far too many well-known people to list them all.  We know many of the names Michael J. Fox, Montel Williams, Dudley Moore, and former Attorney General Janet Reno, have developed chronic diseases and may all need long-term care for many years. The names that have more meaning to people are those of their loved ones who need extended care due to illness, accidents or the impact of aging.

The celebrities, just like the rest of us, are impacted by being human. Just like us, they have families, savings, and lifestyle that become impacted by the costs and burdens of Long-Term Care. It happens at all ages. As we age the risk just increases.

Who do you know, friends, family, co-workers, neighbors, who need help with everyday living activities or require to be supervised due to Alzheimer’s or other forms of dementia?

There are many factors which impact our chances of needing extended care at some time in our lives. This includes our family history. Simple genetics can make you a higher risk. Lifestyle decisions such as your diet, activity level, smoking, and drug use, the environment and stress levels all come into play. If you have family longevity you will probably live longer as well. Longevity itself is a risk for long-term care. As we age we also have a higher risk for dementia.     

An active lifestyle can create a higher risk due to the chance of accidental physical injury. Yet, active people in good health have greater longevity now than ever before.  Preventative medical care, today’s medical technology, and new medications help prevent and control diseases that in the past were often fatal. Thus, we are living longer. Unfortunately, too often we live with chronic conditions requiring us to need extended care. The unfortunate downside of living longer is our increased risk that due to aging we develop conditions requiring some form of help, assistance, and supervision.

Today, short-term fatal illnesses are mostly limited to undetected or poorly controlled heart disease, rapidly progressing cancer, a massive stroke, or rare events such as an aneurysm. 

There are many chronic health conditions which impact us as we start to approach our “fragile 50s” These include heart disease, chronic pulmonary disease, cancer, debilitating arthritis, and complications of diabetes. This is the time many people start taking medications to control our blood pressure and cholesterol. We start putting on a few pounds. We have more aches and pains. Our knees hurt. Our neck hurts. Our hips hurt. It is part of being human.

Then there are also neurological disorders such as Parkinson’s disease or Multiple Sclerosis, fractures from osteoporosis, strokes (resulting in paralysis), Alzheimer’s disease and accidents.  And let’s not forget, becoming frail due to advancing age may be the most significant reason why people need assistance.

What Are the Statistics on Long-Term Care Risk?

There is a lot of data. First, the only statistic that is important is this one: it will either happen to you or it won’t. However, there are all sorts of research, along with common sense, that supports the need to plan for the financial costs and burdens of aging and health.

The U.S. Department of Health and Human Services indicates that if you reach the age of 65 you have a one in seven chance of needing some long-term care service and support before you pass. That is a 70% chance. If you had a 70% chance of winning the lottery you would go buy a few tickets!

U.S. Department of Aging, the Census Bureau, the healthcare sector, and the insurance industry indicate that: 43% of all people over the age of 65 will be admitted to a nursing home at some time in their lives; over 40% of Americans receiving long-term care today are under 65 years old; Alzheimer’s disease affects 47% of all people over age 85: the average expense for care of an Alzheimer’s patient will vary greatly based on how much family support and help there is: 50% of all seniors over the age of 85 will require some form of assistance with activities of daily living, and the average stay in a nursing home will once again vary depending on the individual circumstances.  For some lucky ones, it is brief and for others, it may be many, many years.

There are more statistics!

The American Association for Long-Term Care Insurance (AALTCI), a national consumer education and advocacy group, says 52.1% of all new Long-Term Care Insurance claims in 2017 began in the home setting. Just the major insurance companies paid over $9.2 Billion in claims to American families in 2017 alone. Those are real numbers, not just stats.

12% of those admitted to a nursing facility stay for 5 years or longer and many have received other forms of care prior to the nursing care. Generally, people receive other means of care before going to a nursing facility. 

Here are some current stats from a Christine Benz article in Morningstar:

  • 52.3%: The expected percentage of people turning 65 who will have a long-term care need during their lifetimes. 
  • 47.7%: The expected percentage of people turning 65 who will have no long-term care need during their lifetimes.
  • 46.7%: The expected percentage of men turning 65 who will have a long-term care need during their lifetimes. 
  • 57.5%: The expected percentage of women turning 65 who will have a long-term care need during their lifetimes. 
  • 22%: Percentage of individuals over 65 in the highest income quintile who will have a long-term care need of two years or longer. 
  • 31%: Percentage of individuals over 65 in the lowest income quintile who will have a long-term care need of two years or longer. 
  • 10%: Percentage of Americans over age 65 who have Alzheimer's dementia. 
  • 38%: Percentage of Americans over age 85 who have Alzheimer's dementia. 
  • 35%: Projected increase in number of people with Alzheimer's dementia between 2017 and 2030. 
  • 110%: Projected increase in number of new Alzheimer's cases between 2010 and 2050, barring the development of a new treatment to prevent or cure Alzheimer's disease. 
  • 2 years: Average number of years that individuals age 65 and older will have a high long-term care need during their lifetimes.
  • 0.88 years: Average duration of nursing-home stay for men. 
  • 1.44 years: Average duration of nursing-home stay for women. 
  • 22%: Probability of needing more than one year in a nursing home, men.
  • 36%: Probability of needing more than one year in a nursing home, women.
  • 2%: Probability of needing more than five years in a nursing home, men.
  • 7%: Probability of needing more than five years in a nursing home, women.

These are but a few of the many statistics pointing to the fact that the potential need for long-term care is highly probable as we continue to live longer lives.

Despite all the statistics, many of us are in denial about our personal risk of needing care.  Survey’s show most people understand the risk but think it will happen to “the other person”. About half of Americans above the age of 40 believe almost everyone is likely to require long-term care services as they age. However, it appears everyone is pointing to someone else

According to the results of a poll from the Associated Press-NORC Center for Public Affairs Research, only 25 percent think they will need long-term care for themselves.

We all know of people who have died suddenly without ever being sick.  We also know of people who have lived in nursing homes for several years and became impoverished because of an extended illness.  While advances in medical science may still develop cures and effective treatments for medical problems we face with today, it doesn’t end the fact these advances will just lead to more aging, and longevity, itself, is a risk for long-term care. 

The chances we will need long-term care services and supports are very high. Caregiving is hard on family members. Paid care drains savings and adversely impacts lifestyle. All this suggest we have an advance plan to safeguard savings and reduce the burdens placed on loved ones.