Article: Making the Best of Long-Term Care for Seniors

This chapter addresses a frequently overlooked retirement expense – the cost of nonmedical custodial care. Most individuals aged sixty-five or older will require Long-Term Care (LTC), also known as Long-Term Services and Supports. LTC includes assistance with activities of daily living (ADLs), such as eating, bathing, dressing, getting in and out of a chair, walking, toileting, and continence; and instrumental activities of daily living (IADLs), such as grocery shopping, banking, bill paying, and filling prescriptions. Most LTC is unpaid family care because paid LTC is very expensive. For example, the average annual cost of LTC is about $100,000 for a room in a nursing home and about $60,000 for 40 hours per week of in-home care. Access to paid LTC currently is a patchwork crazy quilt of public (federal, state, and local) and private funding mechanisms. Medicare generally does not cover LTC, although many people assume it does. State-run Medicaid programs provide significant LTC funding – but only to Medicaid-eligible persons with low income and almost no savings. This chapter first explores the implications – for current and future seniors and their caregivers – of increased longevity and other trends on unpaid family LTC and on publicly funded and privately funded paid LTC. Second, this chapter surveys alternative means of accessing and funding LTC. Third, this chapter notes LTC trends, innovations, legal developments, and proposals that might improve the LTC outlook for seniors and their families.