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Monday, June 30, 2003 - Page updated at 12:00 AM

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Growing Older / Liz Taylor

Longer lives, so long-term insurance is becoming a must

• DEAR READERS: We're living longer, and many of us are dying more slowly. Who will take care of us? What will it cost? Many of you have written, asking about long-term care insurance. Should you buy a policy? What should you look for? So, beginning today, I'm launching a six-part series on long-term care insurance that will appear every other Monday through the summer. This first column will address the "why" — why should you think about buying this complicated insurance?

Long-term care insurance was barely a blip on the radar just 10 years ago. Today it's exploding into view, the result of several seismic shifts that happened when we weren't looking.

The first seismic shift is our lengthening lifespan. Just 100 years ago, the average American died at age 47. Today, it's 76 — and climbing. To demonstrate how dramatic this change has been, consider this astonishing fact: of all the human beings aged 65 who have ever walked the earth, half are alive today.

For most of history, only 10 percent of us could expect to live past 65. Today, 80 percent of us can expect to live, not just to 65, but well into our 70s and 80s — and many boomers should count on living into their 90s and 100s. The fastest-growing segment of the American population is people 85 years and older — a trend that will continue for as long as every person reading this newspaper is alive.

Second shift

The second seismic shift is what kills us. Throughout history, people died from what I call the "quick" killers — accidents, childbirth and infectious diseases like flu, smallpox, pneumonia, and TB. Because they didn't live long — and died quickly — most people didn't require extensive care before they died. But for the few who did, eldercare was provided by families — mainly wives, daughters and daughters-in-law.

Today, thanks to modern medicine and better standards of living, most of us survive what killed our great-grandparents. Now we die from the "slow" killers — cancer, diabetes, strokes and heart conditions. These are chronic and degenerative illnesses that incapacitate slowly, affecting us physically or mentally — or both. We might need care for a week — or a decade. No one can predict.

What hasn't changed is that most eldercare is still provided by families, but families have changed. Women work outside the home and can't provide the 24-hour-a-day care many frail older people need. Many families are geographically separated, with adult children living hundreds or thousands of miles away from their parents.

But also, many so-called "adult children" are themselves getting older and frailer — as are caregiving spouses. An 85-year old mom can easily have a 65-year-old daughter (and 95-year old husband) — in worse health than the mother.

Many of us are living well beyond our capacity to take care of our most basic needs, like shopping, cooking, bathing, dressing, paying bills. Will that be you?

Before you rush to denial, consider this: 76 percent of people polled by Gallup said they never expect to need care someday, yet statistics say that almost half of us who reach 65 will need a nursing home.

The longer you live, the more likely you will need some kind of care. Just 8 percent of women aged 70 need help with bathing, while almost a quarter of women in their 80s do.

So, who will need care, and how do we plan for it if we don't know? The short answer: Plan as though you will, especially if you're female. Since women tend to outlive men, wives often care for their husbands before they die, then they are alone when they need care.

Far-ranging boundaries

"Long-term care" is the term for a broad range of services that fill the functional gaps when people can no longer do for themselves. They're the tasks that sustain us day-to-day. If your mom's too frail to shop and you bring groceries to her, you're providing long-term care. If your neighbor had a stroke and needs help dressing, preparing meals and taking his medications, and he moves to an assisted-living facility, he's receiving long-term care.

Nursing homes are the granddaddy of eldercare — because they were the first — but now many different kinds of assistance exist, including a wide range of home care and adult day services, retirement communities, assisted living facilities, and adult family homes. In fact, there are so many eldercare choices today, many people die without ever going to a nursing home.

Expensive proposition

So who pays for this care? Well, much of it is free because families provide most eldercare. But as a person's needs escalate and their condition worsens, families often can't handle the relentless, intimate, unpleasant, stressful responsibilities. That's when they turn to the professionals — the businesses and individuals we pay to provide care.

And it can be expensive.

A ballpark figure for someone to come into your home and help with meals and shopping is $10-19 per hour (usually with a four-hour minimum); for bathing or dressing assistance, it's $15 to $26 an hour. Residential care is also pricey: A one-bedroom apartment in a retirement community might cost $2,000 a month; an assisted living facility or adult family home, $3,500 a month; a nursing home, $6,000 a month.

Most families have sticker shock at these prices, but it shouldn't come as a surprise. Long-term care services are expensive because they're highly labor-intensive.

A person might need care just twice in four hours — but the caregiver must be paid for the entire four hours. And, although the aides who provide this care are paid poorly — criminally poorly — it adds up. The more care you need, the more expensive it will be.

"Affordable" long-term care is an oxymoron. By 2030, nursing homes are estimated to cost $20,000-$37,000 a month. If you want good care, get used to it.

So who pays? That's the topic for my next column in this series. Watch for it July 14.

Liz Taylor, a specialist on aging and long-term care, consults with families and teaches workshops on how to plan for one's aging — and aging parents. E-mail her at growingolder@seattletimes.com or write to P. O. Box 11601, Bainbridge Island, WA 98110

Copyright © 2003 The Seattle Times Company

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