Research: Quarter of seniors will have severe care needs
Say you’re a 65-year-old looking ahead, wondering about your health and your finances, pondering what life might be like in 20 years.
You might get lucky, like Susan Green, a retired social worker. At 82, she enjoys hiking, golfing and cross-country skiing with her husband in Ketchum, Idaho. The only assistance they need: a weekly housekeeper.
Or you might be as fortunate as Sally Dorst, also 82, a retired magazine editor who lives on the Upper West Side in Manhattan. A committed museum visitor and concertgoer, she manages personal care and household tasks on her own.
“I’ve always been pretty independent,” she said. “The only thing I need help with is that my ceilings are so tall that I can’t reach them.”
Most older Americans, however, eventually need assistance. Nancy Canu’s granddaughter, Renee Turner, moved into her home in Rochester Hills, Mich., five years ago to care for her. At 92, Canu takes multiple medications for heart failure, and joint pain makes it hard for her to walk more than a block, even while using a walker. Turner, 37, has gradually taken over shopping, cooking, cleaning, doing the laundry and paying the bills.
She administers her grandmother’s medications, drives her to doctor appointments, hovers nearby when she showers and helps her up the stairs. If Turner, a wedding singer and massage therapist, has to be away for more than an hour or two, she recruits another relative to step in.
“It wasn’t a question,” Turner said. “I wanted to be here for her.” Still, she added, “it’s become my full-time job.”
For years, researchers have tried to calculate what proportion of the aging population will need such extensive care.
“Becoming frail and needing help with basic personal care is probably the greatest financial risk people face at older ages,” said Richard Johnson, an economist who directs the Program on Retirement Policy at the Urban Institute.
A 2019 study he undertook for the federal Health and Human Services Department found that over their lifetimes, about 70 percent of older adults will need help from family caregivers, paid aides or some combination, in their own homes or in long-term care facilities. Other surveys have reported roughly similar results.
But such analyses often don’t distinguish between short rehab stays, perhaps after a knee replacement, and the years of round-the-clock care that is required for someone with deepening dementia.
“Even if you need a lot of care, if it’s for a short period, it’s not that big a deal,” said Alicia Munnell, an economist and director of the Center for Retirement Research at Boston College.
Recent work by Munnell and her colleagues explored those nuances. Using data from the federal Health and Retirement Study as well as other federal surveys, they looked at intensity and duration — how much help older Americans will need and for how long.
Her team assessed seniors’ lifetime care needs as low, medium or high intensity, based on how many so-called activities of daily living they needed assistance with. Then the researchers calculated how many older Americans would need help for short (up to a year) or medium durations (one to three years), or for longer than three years.
They found that 17 percent of 65-year-olds will need no longterm care and that one-quarter will develop severe needs, requiring many hours of help for more than three years.
Most older people will fall between those poles, with 22 percent having only minimal needs. The largest group, 38 percent, can expect moderate needs — such as support while they recover from a heart attack, after which they can again function independently.
Unsurprisingly, the need for more intense or extended care hits some groups harder than others. People who attended college for some period fare far better than those without high school diplomas, the Boston College team found. Black and Hispanic seniors, reflecting entrenched economic and health inequities, are more apt than older white people to develop moderate or severe needs.
And married people are less likely to need extensive care than those who are single. They have higher incomes, Munnell pointed out, and spouses provide “regular meals and someone nagging you to go see the doctor — all that having another person to care about your welfare entails.”
When the Affordable Care Act passed in 2010, it contained a measure called the Class Act, a voluntary long-term care insurance program that never materialized. Critics feared an actuarial “death spiral”: If only ailing workers enrolled, costs would soon outstrip premiums paid in.
To start a sustainable public insurance program for long-term care, “we’d have to make it mandatory,” said Johnson with the Program on Retirement Policy. “Everyone would have to contribute.” The payoff: “It would give people peace of mind.”
Washington recently became the first state to establish such a program. Beginning next year, employees must contribute 0.58 percent of their earnings (selfemployed workers could opt in, too), or about $290 in annual premiums on a $50,000 salary.