Financial Preparedness for Long-Term Care Needs in Old Age
With the first of the large baby boom generation poised to retire, there is little evidence that they or the retirees to follow are financially prepared for the risk of potentially catastrophic costs of disability-related long-term care. Both the high cost of insurance and uncertainty about its value are widely thought to account for the lack of preparedness. This chapter reviews evidence on the risk of long-term care, types of long-term care, associated financial risks, and consumer knowledge of these risks. Common and not-so-common options for private financing of long-term care and barriers to their widespread adoption are discussed, and a final section briefly reviews policies in place or proposed for increasing private preparation.
KeywordsAssisted Living Nursing Home Care Home Equity Personal Saving Life Annuity
- AARP. (2006). The costs of long-term care: Public perceptions versus reality in 2006. Washington, DC: Author.Google Scholar
- AHIP. (2004). Long-term care insurance in 2002. Washington, DC: Author.Google Scholar
- Ahlstrom, A., Tumlinson, A., & Lambrew, J. (2004). Linking reverse mortgages and long-term care insurance. Washington, DC: The Brookings Institution.Google Scholar
- Alecxih, L. (2006). Nursing home use by ‘oldest old’ sharply declines. Falls Church, VA: The Lewin Group.Google Scholar
- Burns, B. (2006). Comparing long-term care insurance policies: Bewildering choices for consumers. (AARP Public Policy Institute Issue Paper #2006-13). Washington, DC: AARP.Google Scholar
- Burwell, B., Sredl, K., & Eiken, S. (2009). Medicaid long-term care expenditures in FY 2008. Cambridge, MA: Thomson Reuters.Google Scholar
- Butrica, B. A., Smith, K. E., & Toder, E. J. (2009). How will the stock market collapse affect retirement incomes? (Older Americans’ Retirement Security Brief No. 20). Washington, DC: The Urban Institute.Google Scholar
- CMS. (2007). Summary of long-term care choices: Continuing care retirement communities. Baltimore, MD: Center for Medicare and Medicaid Services. Retrieved from http://www.medicare.gov/LongTermCare/Static/CCRC.asp. Accessed on 31 August 2011.
- DHHS. (2002). Own your future planning guide for long-term care. (Publication No. CMS-11026.). Iowa City, IA: Author.Google Scholar
- Folkemer, D. (2007). A guide to long-term care for state policymakers: The long-term care partnership program. Washington, DC: National Conference of State Legislators.Google Scholar
- Fore, D. (2003). Do we have a retirement crisis in America? (Research Dialogue Issue #77). New York: TIAA-CREF Institute.Google Scholar
- Friedrich, C. (2009). LTC combo products: Recent developments. Presentation at the Society of Actuaries 2009 Life Spring Meeting. Retrieved from http://www.soa.org/files/pdf/2009-co-life-springfield.pdf. Accessed on 31 August 2011.
- Fronstin, P., Salisbury, D., & VanDerhei, J. (2008). Savings needed to fund health insurance and health care expenses in retirement: Findings from a simulation model. (EBRI Issue Brief No. 317). Washington, DC: Employee Benefits Research Institute.Google Scholar
- Johnson, R. W., & Uccello, C. (2005). Is long-term care insurance the answer? (Center for Retirement Research Issue in Brief No. 29). Boston: Boston College.Google Scholar
- Johnson, R. W., & Wiener, J. M. (2006). A profile of frail older Americans and their caregivers. (Retirement Project Occasional Paper No. 8). Washington, DC: The Urban Institute.Google Scholar
- Kasper, J., Lyons, B., & O’Malley, M. (2007). Long-term services and supports: The future role and challenges for Medicaid. (Kaiser Commission on Medicaid and the Uninsured Publication #7671). Washington, DC: Kaiser Family Foundation.Google Scholar
- Kassner, E. (2004). Private long-term care insurance: The Medicaid interaction. (AARP Public Policy Institute Issue Brief #68). Washington, DC: AARP.Google Scholar
- Lakenbach, C. (2009). The case for combination products. Presentation at the Society of Actuaries 2009 Life Spring Meeting. Retrieved from http://www.soa.org/files/pdf/2009-co-life-springfield.pdf. Accessed on 31 August 2011.
- Levy, R. A., Riley, W., Gabay, M., Nyman, J., & Feldman, R. (2005). Analysis of the use of annuities to shelter assets in state Medicaid programs. (Report to the Centers for Medicare and Medicaid Services, Contract No. 500-00-0053 Task Order 2). Retrieved from http://www.cms.hhs.gov/MedicaidEligibility/downloads/annuities.pdf. Accessed on 31 August 2011.
- Lifeplans. (2007). Who buys long-term care insurance? Washington, DC: America’s Health Insurance Plans.Google Scholar
- Merlis, M. (2005). Home equity conversion mortgages and long-term care. Washington, DC: Georgetown University.Google Scholar
- Metlife. (2009). MetLife market survey of nursing home, assisted living, adult day services, and home care costs. Westport, CT: Metlife Mature Market Institute.Google Scholar
- Mollica, R., Sims-Kastelein, K., & O’Keeffe, J. (2007). Residential care and assisted living compendium: 2007. Washington, DC: US Department of Health and Human Services. Retrieved from http://aspe.hhs.gov/daltcp/reports/2007/07alcom.htm. Accessed on 31 August 2011.
- Moon, M. (2005). Retiree health care: Individuals picking up bigger tab. New York: TIAA-CREF Institute.Google Scholar
- Munnell, A. H., Soto, M., & Aubry, J. (2007). Do people plan to tap their home equity in retirement? (Center for Retirement Research Brief No. 7-7). Boston: Boston College.Google Scholar
- Munnell, A. H., Webb, A., Golub-Sass, J., & Muldoon, D. (2009). Long-term care costs and the national retirement risk index. (Center for Retirement Research Brief No. 9-7). Boston: Boston College.Google Scholar
- Murtaugh, C. M., Spillman, B. C., & Warshawsky, M. J. (2001). In sickness and in health: An annuity approach to financing long-term care and retirement income. The Journal of Risk and Insurance, 66(2), 225–254.Google Scholar
- NAIC. (2003). A shopper’s guide to long-term care insurance. Kansas City: Author.Google Scholar
- NASI. (2005). Long-term care: The public’s view. (NASI Health and Income Security Brief No. 8). Washington, DC: National Academy of Social Insurance.Google Scholar
- Pauly, M. V. (1989). Optimal public subsidies of nursing home insurance in the United States. The Geneva Papers on Risk and Insurance, 14(50), 3–10.Google Scholar
- Rothstein, J. (2007). Long-term care partnership expansion: A new opportunity for states. Robert Wood Johnson Foundation: Princeton.Google Scholar
- Social Security Administration. (2009). Fast facts and figures about social security, 2009. (SSA Publication No. 13-11785). Washington, DC: Author.Google Scholar
- Spillman, B. C., & Black, K. J. (2005). Staying the course: Trends in family caregiving. (AARP Public Policy Institute Issue Paper #2005-17). Washington, DC: AARP.Google Scholar
- Spillman, B. C., Liu, K., & McGilliard, C. (2002). Trends in residential long-term care: Use of nursing homes and assisted living and characteristics of facilities and residents. Washington, DC: Department of Health and Human Services. Retrieved from http://aspe.hhs.gov/daltcp/reports/rltct.pdf. Accessed on 31 August 2011.
- Springfield, C. R. (2009). Long-term care insurance combination products – Recent developments. (Presentation at the Society of Actuaries 2009 Life Spring Meeting). Retrieved from http://www.soa.org/files/pdf/2009-co-life-springfield.pdf. Accessed on 31 August 2011.
- Stucki, B. R. (2005). Use your home to stay at home. Expanding the use of reverse mortgages for long-term care: A blueprint for action. Washington, DC: The National Council on Aging.Google Scholar
- U. S. Bureau of Labor Statistics. (2007a). National compensation survey: Employee benefits in private industry in the United States, March 2007. Washington, D.C.: USBLS.Google Scholar
- U. S. Bureau of Labor Statistics. (2007b). National compensation survey: Employee benefits in state and local governments in the United States, September 2007. Washington, D.C.: USBLS.Google Scholar
- Wiener, J. M., Tilly, J., & Goldenson, S. M. (2000). Federal and state initiatives to jump start the market for private long-term care insurance. The Elder Law Journal, 8, 57–102.Google Scholar