Seniors’ lifetime care needs

 

"Dr. Munnell's team assessed seniors’ lifetime care needs as low, medium or high intensity, based on how many so-called activities of daily living they needed assistance with. Then the researchers calculated how many older Americans would need help for short (up to a year) or medium durations (one to three years) or for longer than three years.

Their results: Seventeen percent of 65-year-olds will need no long-term care. Almost one-quarter will develop severe needs, requiring many hours of help for more than three years.

Most older people will fall between those poles, with 22 percent having only minimal needs. The largest group, 38 percent, can expect moderate needs — like support while they recover from a heart attack, after which they can again function independently.

Unsurprisingly, the need for more intense or extended care hits some groups harder than others.

 

People who attended college for some period fare far better than those without high school diplomas, the Boston College team found.

 

Black and Hispanic seniors, reflecting entrenched economic and health inequities, are more apt than older white people to develop moderate or severe needs.

And married people are less likely to need extensive care than those who are single. They have higher incomes, Dr. Munnell pointed out, and spouses provide “regular meals and someone nagging you to go see the doctor — all that having another person to care about your welfare entails.”

The researchers calculated how much care retirees would need, how much they could receive from family and how much they could afford to buy (at $22 an hour for a home health aide in 2018). The study determined that 36 percent of people in their late 60s could not cover even a year of minimal care without exhausting their resources; only 22 percent could cover severe needs.

“There’s only a small chance that you’ll need care for an extended period,” Dr. Johnson said. “But a lot of people will need care for a shorter time, and that will take money.”

When the Affordable Care Act passed in 2010, it contained a measure called the Class Act, a voluntary long-term care insurance program that never materialized. Critics feared an actuarial “death spiral”: If only ailing workers enrolled, costs would soon outstrip premiums paid in.

To start a sustainable public insurance program for long-term care, “we’d have to make it mandatory,” Dr. Johnson said. “Everyone would have to contribute.” The payoff: “It would give people peace of mind.”

Washington recently became the first state to establish such a program. Beginning next year, employees must contribute 0.58 percent of their earnings (self-employed workers could opt in, too), or about $290 in annual premiums on a $50,000 salary.

It’s a modest program — starting in 2025, participants can receive up to $36,500 in benefits — but it’s a start on the kind of safety net that the Netherlands, Germany and South Korea already provide. Illinois, Minnesota and Hawaii are also discussing long-term care insurance, Dr. Johnson said.

American families still bear the greatest brunt of responsibility for elder care."