Long-term care is a hot topic as more and more Baby Boomers require some level of care or assistive services at the same time that we face a shortage of paid caregivers in this country. While no one wants to think that they themselves will need help as they grow older, the reality is that a majority of people over the age 65 will require some level of long-term care services during their lifetime. So, for many people, the question then becomes, “How long will I need long-term care services?”
Let’s dig into a few important questions surrounding long-term care, which can greatly impact your retirement planning, senior living decisions, and finances.
What exactly is long-term care?
This is the first question that must be answered in order to best plan for the future. The National Institute on Aging (NIA), part of the National Institutes of Health (NIH), sets out a comprehensive description of long-term care:
“Long-term care involves a variety of services designed to meet a person’s health or personal care needs during a short or long period of time. These services help people live as independently and safely as possible when they can no longer perform everyday activities on their own.
“Long-term care is provided in different places by different caregivers, depending on a person’s needs. Most long-term care is provided at home by unpaid family members and friends. It can also be given in a facility such as a nursing home or in the community, for example, in an adult daycare center.”
The NIA goes on to explain that “personal care” is the type of long-term care that is most commonly needed by seniors. “Personal care” typically means those everyday activities of daily living (ADLs) that all of us do — things like getting bathed and dressed, using the toilet, personal grooming, and eating, as well as sitting, standing, and moving about.
Assistance with instrumental activities of daily living (IADLs), which include things like cooking, cleaning, transportation, laundry, and managing finances, also fall under the category of long-term care, as do health and medical services, such as those provided by a home health worker, in a skilled nursing facility (also called a nursing home), or in a rehabilitation center.
Who needs long-term care?
It is common for people to require long-term care when they have an ongoing or degenerative health condition, or have a disability, but the need for long-term care also can arise quite suddenly. For instance, when someone suffers a heart attack or stroke, has an accident, or even when they undergo surgery, it can result in the need for long-term care services. The need can be temporary (such as during the surgery recovery process) or permanent (such as with the later stages of dementia).
Most often, however, the need for long-term assistance or care services develops gradually, as people get older and frailer, decline physically and/or mentally, or as an illness or disability worsens.
Yes, it stands to reason that as you get older, you’re more likely to need some level of long-term care services, but the reality is a bit more nuanced than that. The NIH sets out a few factors that contribute to your likelihood of needing assistance or care.
- Age: The likelihood of needing long-term care generally increases the older a person gets.
- Gender: Women are more likely than men to need long-term care services, primarily because women typically live longer than men.
- Marital status: Those who are single or widowed are more likely than married people to need long-term care services from a paid caregiver since they may not have a family member who is available to offer unpaid care.
- Lifestyle choices: Those who smoke, have an unhealthy diet, or poor exercise habits are at a higher risk of needing long-term care at some point.
- Health and family history: These factors (some of which are out of one’s control) also impact your odds of requiring care. For example, those with chronic conditions like diabetes and high blood pressure are more likely to need care.
What are the odds I’ll need some level of care?
The website for the American Association for Long-Term Care Insurance (AALTCI) quips that your odds of needing some level of long-term care services for some period of time is either 0 percent (you will not need it) or 100 percent (you will need it). This is of course an oversimplification of the answer to this question, but it speaks to the unpredictability of life faced by seniors who are trying to assess their likelihood of needing care at some point and plan accordingly.
According to the U.S. Department of Health and Human Services (DHHS), approximately 70 percent of people who turned 65 in 2020 will require some degree of long-term care services during their lifetime. But keep in mind this is an average. Your personal odds of needing care — either paid or unpaid, in-home or in a care facility — are impacted by those factors above like gender, lifestyle choices, and health conditions.
Of course everyone wants to think they will be in the 30 percent who will not need care, and hopefully you will be, but statistically speaking, the odds aren’t in your favor. That’s why it’s important to bear in mind that the longer you wait to make a plan for your potential long-term care needs, the fewer options you may have in terms of who will care for you and where you will receive that care.
For instance, once you require care services, you typically will no longer be able to move into a continuing care retirement community (CCRC, or life plan community) since most require new residents be able to live independently at move-in. For those who plan to remain in their current home as they age, a lack of planning can result in the inability to find high-quality, affordable in-home paid care if the need arises.
These are among the reasons it is so crucial to be proactive and not reactive — to have a plan should a care need arise either gradually or suddenly. The healthcare system in this country is very advocate-centric, so such planning can help ensure you have a supportive team in place if and when the need for long-term care arises for that 70 percent of people who end up needing it. The reality is that, too often, not having a plan in place and a team working with you and your family can result in unnecessary suffering by all involved.
So, how long will I need long-term care?
Let’s get down to brass tacks: This is the question that people really want answered. Unfortunately, without the benefit of a crystal ball, there is really no way to know for certain how long you’ll need long-term care services, but there are some data points that can help you better anticipate your potential needs.
The DHHS lays out useful data on the average amount of time people turning 65 in 2020 might expect to require some type of long-term care — again, either paid or unpaid, in-home or in a care facility like an assisted living community or a nursing home.
Not surprisingly, on average, women need care longer than men since they tend to live longer. The average woman turning 65 in 2020 will need some type of long-term care services for 3.7 years, whereas men in that same cohort will need care for 2.2 years, on average.
In many cases, those years of care begin in the home, oftentimes provided by unpaid loved ones (most often a spouse/partner or adult child). As the care recipient’s needs increase, however, they may need to transition to paid in-home care services and eventually paid care outside of the home, such as in an assisted living community or skilled nursing facility.
But there is an important caveat to these DHHS statistics about how long you might expect to need long-term care. The data forecasts that approximately one in three of those who turned 65 years old in 2020 will likely never need care services, but, on the other hand, one out of five (20 percent) will need long-term care for longer than five years.
Keep in mind these are just averages, but, will you be the one in three who never needs care, or will you be the one in five who requires long-term care for more than five years?
What will my care cost?
This is another crucial topic when it comes to long-term care, but it is also a large topic. Check back next week for our follow-up blog post on the potential cost of long-term care services.
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