Older Michiganders need more help planning for long-term care needs, poll shows

With one-third of Michigan’s population now over age 50, a new poll looks at how they’re thinking and planning for their future long-term health care needs – and shows many areas where they’re worried, unprepared or hold misconceptions.  

Half of older Michiganders haven’t taken at least one of five important steps to prepare for a future where they might need help with health care or with their daily activities, according to the new findings from the Michigan Poll on Healthy Aging based at the University of Michigan.

And 58% think that if they needed to move into a nursing home permanently, Medicare would pay for it – which the program does not do. Meanwhile, 33% said Medicaid would help pay for a nursing home, when in fact 60% of the state’s nursing home residents have their costs paid by Medicaid.  

Half of older Michiganders think their need for long-term care is too far off to plan for, and only 41% think they’ll ever need some sort of long-term care in their home or at an assisted living facility or nursing home.  

But national statistics show that 70% of people who survive to the age of 65 will need long-term  care services in the future, including nursing home or at-home care, or help with medical care and daily tasks such as making and eating meals, dressing and caring for personal hygiene.

The Michigan poll, based at the U-M Institute for Healthcare Policy and Innovation and supported by the Michigan Health Endowment Fund and Michigan Medicine, U-M’s academic medical center, is being issued on the same day as a national poll report on the same topic, available at https://michmed.org/w4rDR.  

To see and interact with data from the Michigan poll, visit https://michmed.org/ygq7G.  

On May 15, IHPI and the Health Fund will hold a free public webinar about the poll findings and efforts to improve access to long-term care services and supports in Michigan. Learn more and register here.

“Michigan’s population is older than the national average, so these issues are of particular concern for our state,” said poll co-author Ana Montoya, M.D., M.P.H., M.S., an associate professor of internal medicine at U-M who has served as a medical director for nursing homes in southeast Michigan. “While we didn’t see major differences between the Michigan and national populations in their responses to our poll questions on long-term care, the fact that our state’s residents will be confronting these issues sooner makes this an important issue for families, policymakers and community organizations to address.”

Montoya worked on the poll with the IHPI team and co-author Julie Bynum, M.D., M.P.H. She and Bynum are both geriatricians, a type of physician who specializes in the care of older adults.  

Five key steps: How older Michiganders are doing

The poll asked about five items that older adults can do to plan for long-term care needs in the future: completing a durable power of attorney form, identifying potential caregivers among the people in their life, making home modifications to help them ‘age in place’, buying long-term care insurance and looking into or visiting assisted living facilities or nursing homes. 

One key finding that particularly worries Montoya and Bynum is the low percentage (25%) of Michiganders who say they have signed a durable power of attorney form, called a DPOA for short. That’s a legal document that designates a person to make health care decisions in case a person is temporarily or permanently unable to make their own.  

In all, only 13% of Michiganders aged 50 to 64 said they had completed one. Even among those age 65 and up, only 37% had signed a DPOA. Michigan Medicine offers a free DPOA form and instructions for anyone to download, print and complete.  

The percentage of older adults who had taken any of the other four steps was even lower.

In addition to the five items, the poll also asked older adults if they had talked with family or friends, or a health care provider, about options and wishes for long-term care and caregiving. But 46% of Michiganders aged 50 to 64 and 39% of those age 65 and older said they had not discussed these issues with anyone.

Health care providers who take care of older adults can play a significant role, says poll director Jeffrey Kullgren, M.D., M.P.H., M.S., a primary care physician at the VA Ann Arbor Healthcare System and associate professor of internal medicine at U-M.  

“The fact that only 4% of older Michiganders had talked with a health care provider about their long-term care plans, and only 25% had formally designated someone to make medical decisions for them if they become unable to do so, suggests we have a tremendous opportunity to help people prepare,” said Kullgren. “Even making advance directives information and forms available on health system websites, like we do at Michigan Medicine and like the VA does, can help improve access and use.”

Other long-term care views  

The poll also asked older Michiganders about their views on nursing homes, assisted living and home care. A majority (58%) of Michiganders said they have mostly negative views of nursing homes, while the percentage holding mostly negative views about assisted living was much lower at 25%.  

Asked about their level of confidence that they could pay for different kinds of long-term care, the poll shows differences by income level that may not match up with eligibility for state and federal assistance programs.  

For instance, 72% of older Michiganders with incomes below $60,000 were not confident they could pay for nursing home care, when in fact the state’s Medicaid program only provides for people who have lower incomes (300% of poverty) and low levels of financial assets to get nursing home care coverage.  

The poll findings come from a nationally representative survey conducted by NORC at the University of Chicago for IHPI and administered online and via phone in August 2024 among 1,175 Michigan older adults and 3,137 non-Michigan adults ages 50 – 94. The samples were subsequently weighted to reflect the Michigan and U.S. populations.

Read past National Poll on Healthy Aging reports, see past Michigan findings, and learn about the poll methodology.