Hoping to age-in-place, Americans want long-term care help from Medicare

Given a choice, the vast majority of U.S. adults would still prefer to receive long-term care in their own homes instead of moving into a nursing facility or senior living community, according to a new study from The AP-NORC Center for Public Affairs Research.

But while nearly everyone wants to age in place, few actually have a plan to pay for in-home care services as they grow older. Many believe the government should help fund long-term care services and supports, though the strength of those beliefs is often shaped by party affiliation.

“Americans continue to have a strong desire to age in their own community – either in their home or a loved one’s – and this isn’t just a byproduct of COVID-19 fears,” said Dr. Sarita A. Mohanty, president and CEO of The SCAN Foundation, which funded the study. “People across the political spectrum agree that government should step up to help honor the wishes of older adults.”

The population of Americans 65 and older is projected to more than double by 2060. To better understand that demographic shift and what it means for the United States, The AP-NORC Center and The SCAN Foundation have been conducting a nationally representative survey every year since 2013.

This year, the two organizations completed 1,113 interviews between March 25 and March 29, unveiling their results on Monday.

Overall, 88% of surveyed adults favor getting ongoing living assistance in their own home or in a loved one’s home, according to the study. Just 2% said they would want to age in a nursing home, with just 10% preferring a senior living community.

For the most part, the desire to age in place is consistent across race and ethnicity, in addition to urban, suburban and rural environments. A similar percentage of surveyed Amercans — roughly nine in every 10 — voiced a preference for in-home care in past years as well.

“There is a real opportunity to reshape how care is delivered to aging people in America,” Mohanty said. “[And] to do it in ways that are affordable to the health system and relieve burdens on families.”

For home-based care operators, one of the most interesting takeaways from the AP-NORC Center study is the growing support behind Medicare expansion.

Currently, in-home care services aimed at aging in place are mostly paid for out of pocket, by private insurance or by Medicaid. Yet 51% of the people surveyed said Medicare should have a “very large” or “large” responsibility for ongoing care, with 36% saying Medicare should at least take on a “moderate” role.

The National Association for Home Care & Hospice (NAHC) is among the industry advocates that have discussed what a Medicare home care benefit could mean for the nation’s seniors. There’s widespread support for in-home care in Washington, D.C., but budgetary challenges would make a formal benefit a tall order, NAHC President William A. Dombi previously told Home Health Care News.

“It would be a revolutionary change — a welcome one, but a revolutionary change,” Dombi said. “We’ve long recognized that personal care services often make the difference between an individual staying home or needing an institutional care setting. So it would be quite valuable.”

Over the past few months, home health, hospice and personal care giant LHC Group Inc. (Nasdaq: LHCG) has also been trumpeting an initiative known as “Choose Home.” The general goal of Choose Home would be to enable a nursing home level of care in the home by funding both medical and non-medical in-home care services.

“2021 will also be a year in which we expect to advance Choose Home legislation, which we have begun to socialize with Congress,” LHC Group Chairman and CEO Keith Myers said in February. “For the first time, this important legislation will provide a time-limited, cost-effective benefit that would include Medicare-certified skilled home health services and personal care services.”

Beyond fee-for-service Medicare, the majority of surveyed adults also support policies that would create a government-administered long-term care insurance program or tax breaks for

consumers who purchase long-term care insurance. There is also strong support for the

ability to get long-term care coverage through a Medicare Advantage supplemental benefit.

Despite the overwhelming preference for aging in place, few adults are actually prepared for their own long-term care needs. Less than one-fifth of surveyed adults said they are confident they will have the financial resources they need to pay for care in their senior years.

“Only 16% of the public feels confident about their ability to pay for their care as they age and few have done much to plan for their long-term care,” Jennifer Benz, deputy director of The AP-NORC Center, said. “This study reveals that people have clear preferences about the care they want, but there’s more work needed to help people prepare.”

Americans’ top concern about growing older: losing their independence.

A majority of both Republicans and Democrats support tax breaks for purchasing long-term care insurance and the ability to get long-term care coverage through a supplemental insurance plan, according to The AP-NORC Center. But while a large majority of Democrats favor long-term care insurance and programs for low-income people, there is less Republican support for either government plan.

Housed out of the University of Chicago, The Associated Press-NORC Center for Public Affairs Research conducts, analyzes and distributes social science research in the public interest.

Meanwhile, The SCAN Foundation is an independent public charity devoted to transforming care for older adults.

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