Poll reveals short-term thinking about long-term care

Whether they’re counting on Medicare to pay for something it doesn’t currently pay for, thinking they can deal with the issue later, or thinking they won’t need it at all, a new poll reveals major gaps in knowledge and preparation regarding long-term care among Americans aged 50 and over.  

Nearly two-thirds (62%) believe Medicare would pay for their care if they needed to permanently move into a nursing home. But Medicare generally doesn’t cover this kind of care. It also doesn’t pay family caregivers to take care of someone at home.  

The poll also asked about Medicaid, which pays for nearly two-thirds of all long-term nursing home care and is open to adults with lower incomes. Only 29% of older adults said they expected Medicaid to cover their nursing home costs.

The poll also shows that nearly half (45%) of older adults think their need for long-term care is too far off to think about, 52% aren’t worried about their potential need for long-term care, and 57% think it’s unlikely they’ll ever need such care.  

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 findings come from a new report from the University of Michigan National Poll on Healthy Aging. The poll is based at the U-M Institute for Healthcare Policy and Innovation, and supported by AARP and Michigan Medicine, U-M’s academic medical center.

The poll, designed with help from two U-M geriatrics specialists who study long-term care, also asked adults aged 50 and over if they had taken any one of five key actions to prepare for eventual long-term care needs.  

Only half had taken even one of these five key actions, with the most common being designating a durable power of attorney for medical care (27%) and identifying someone in their lives who could be their caregiver (24%).  

Most also said that if they did need help with daily activities, they would most prefer to get it in their own home either by family or friends (52%) or by paid caregivers (21%) or without any help (14%). Fewer said they most prefer to move into an assisted living facility (6%), move in with a family member / friend caregiver (6%) or a nursing home (1%).

The poll also asked if older adults had discussed their long-term care plans and options with a family member or friend. Just over half (52%) said they had.  

Differences by age and health status

“These data reveal gaps in what older adults think and want when it comes to long-term care, and what they’ve actually done to prepare,” said Ana Montoya, M.D., M.P.H., an associate professor of internal medicine at U-M who is a geriatrician and has served as a medical director for nursing homes.

She points to the finding that only 37% of people aged 50 to 64 had taken at least one of the action steps the poll asked about. Answering a separate question, 41% had discussed long-term care plans with someone.

“As the youngest Baby Boomers and older Generation Xers approach age 65, these findings show a special need to help them plan, and find trustworthy information,” she added. “Even among those already over 65 and in their Medicare years, we find a sizable minority have not taken key steps to prepare.”

In all, 66% of those age 65 and over have spoken to anyone about their long-term care plan and 65% have taken at least one of the specific action steps the poll asked about. The remainder had not.

Montoya’s colleague Julie Bynum, M.D., M.P.H., notes that the poll shows that older adults who have a health problem or disability that limits their daily activities are much more likely to say they will eventually need long-term care, at 57% compared with 34% of those without such an issue.  

“Worry about long-term care runs especially high among these older adults, who have already experienced limitations to their daily activities,” said Bynum, who is also a geriatrician. “We also found less confidence about planning for long-term care among older adults who say their mental or physical health is fair or poor, compared with those who say they’re in good or excellent health, regardless of disability status.”

Findings about nursing homes and assisted living

Nursing homes did not fare well in older adults’ estimation, with 59% saying they have a mostly negative impression and only 13% saying they have a mostly favorable impression, with the rest being unsure. By comparison, 25% said they have a mostly negative impression of assisted living, and 41% have a mostly positive impression, with the rest unsure.  

Whatever their impression, 62% said they aren’t confident they could pay for a nursing home, and 58% said the same about paying for assisted living.

The new report’s authors hope their findings will inform federal and state agencies, and nongovernmental organizations, that are focused on aging. Many states including Michigan are working to implement the No Wrong Door approach developed by federal agencies to help older adults and their families easily get help finding long-term services and supports, or LTSS. 

Health care providers who take care of older adults must also play a 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 5% of older adults had talked with a health care provider about their long-term care plans, and only 27% 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.”

“This poll shows a troubling disconnect between what older adults think Medicare and Medicaid cover and the reality, one that often delays planning and leaves family caregivers to shoulder the burden,” said Indira Venkat, Senior Vice President of Research at AARP. “AARP is committed to helping people understand their long-term care options and take action early, with trusted tools and resources to support both older adults and their family caregivers.”  

Michigan findings and webinar

In addition to the national poll report, the team compiled data for Michigan adults aged 50 and older compared with those in other states; an interactive data visualization is available at https://michmed.org/ygq7G. 

An article summarizing the Michigan findings is available at : https://michmed.org/MDy4R. The Michigan Poll on Healthy Aging is sponsored by the Michigan Health Endowment Fund.

IHPI and the Health Fund will host a webinar on May 15 about the Michigan findings. Learn more and register at ihpi.umich.edu/long-term-care-webinar.

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 3,486 adults ages 50 to 94 across the U.S. The sample was subsequently weighted to reflect the U.S. population. Read past National Poll on Healthy Aging reports and about the poll methodology.