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So began my introduction to the world of long term care. My stepfather had died the year before, and Mom had been on a steady decline ever since. During my periodic visits to Chicago and in my frequent phone conversations, I had urged most strongly that she come live with me or at least move to a retirement community where she could have both companionship and assistance when needed. Stubbornly independent, Mom had rejected those suggestions. Now the event I (and I'm sure she) feared most had happened. She would probably have to (and ultimately did) go to a nursing home for 24-hour care. Mom died there not quite three years later, the victim of a rapidly spreading cancer. Had she lived, she could have afforded just one more year of that stay before her assets would have been totally exhausted.
Long term care is but three little words. Still, those words cause great concern to retirees. We all see the published statistics, and they seem to get worse, as all sorts of interested groups put them out. What are they? Well, here's a sampling of those I see in print from time to time:
"At 65, the average person's chances of being admitted to a nursing home at some point in their future are more than 4 in 10." (Long Term Care Campaign)
"One person in three who turned 65 in 1990 will stay a year in a nursing home. One person in 10 will stay five years or more." (National Association of Insurance Commissioners)
"In 1994, 7.3 million Americans needed long term care (LTC) services at an average cost of nearly $43,800 per year. By 2000, this number will rise to 9 million Americans at nearly $55,750 per year, and due to inflation, by 2060 it will skyrocket to 24 million Americans paying over $250,000 per year to receive long term care." (Long Term Care Insurance National Advisory Council)
"Recent studies report that two of every five people age 65 and over will enter a nursing home and stay an average of 2.5 years." (Life Insurance Selling, December 1995)
"Within a year after admission as private-pay residents, over 90% of nursing home residents are impoverished." (Life Savings by Harley Gordon, 1994 )
To those of us who are retired, that's scary stuff indeed. And to those of us who have seen it happen to someone in our family, it's devastating. As retirees, just how concerned should we be about the long term care issue? And just what do those sometimes conflicting scare statistics we see really mean? In my next few weekly columns, I'll review some of the facets of long term care to help us all gain a better understanding of how we might resolve this problem in our planning. In this column, we'll look at the definition of long term care. Then, over the next few weeks we'll examine how such care gets paid for by Medicare, Medicaid, and insurance. And along the way we'll examine some of those upsetting statistics in an attempt to determine how we might weigh the odds for our needs in this area more realistically.
Let's look first at the definition of long term care. When we hear that phrase, most of us immediately think "nursing home care," and shudder at the potential costs. While it's true that nursing home care certainly qualifies as long term care, that's really just a part of what's involved. Long term care encompasses a much wider range of services ranging from the care of personal needs through comprehensive medical support. In general, long term care is viewed as the need for help in performing one or more of what's called the Activities of Daily Living (ADL) and, to a lesser degree, what's called the Instrumental Activities of Daily Living (IADL). The National Center for Health Statistics, along with many insurance companies, defines ADLs as bathing, dressing, eating, transferring in or out of a bed or chair, and using the toilet. IADLs include activities essential to leading an independent life in the community such as managing money, doing heavy or light housework, taking medications, shopping, preparing meals, and using the telephone.
Using a broad view of long term care, a report entitled "Mid-Life and Older Americans With Disabilities" published by the American Association of Retired Persons (AARP) states that in 1994 some 9.5 million Americans aged 50 or older received help for one or more ADLs and/or IADLs. Of those, 1.6 million received help for two or more of the five ADLs. The ADL needed most in that population was bathing, followed by dressing, transferring, toileting, and eating, in that order. The IADL needed most was heavy housework followed by shopping, light housework, meal preparation, managing money, and using the telephone.
When I view that list of ADLs and IADLs, in retrospect, I see my mother had problems in at least four areas even before she had her fall. My father and stepmother (who are still living) have combined problems as a couple in five or maybe even six areas. And, as our population of elderly rises, these problems may be encountered by far more folks than they are now. Sadly, there is no easy solution to resolving these issues or paying for their costs. Increasing life spans do not equate to physically healthy lives. Therefore, some outside assistance may be needed, and that aid could be costly in the absence of a loving and willing family nearby. Our national health system seems ill-equipped to provide affordable long term care programs, and the insurance industry has really just begun to develop effective policy coverage to shoulder part of the costs involved.
How, then, should we plan for long term care? We'll begin to answer that question next week when we'll look at how Medicare and Medicaid fit into the long term care picture.
Comments or questions? As always, post away on the Retired Fools message board.
Best... Pixy
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