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 In focus groups with older adults and their middle-aged children,
certain themes dominated parents’ decisions about whether or not to
purchase coverage for themselves.
Tapping into those themes could help families talk about aging
parents’ needs and everyone’s expectations, according to the
researchers.
“Adult children in particular have a role to play in their parents’
long-term care, because they will likely be affected by whatever
their parents decide,” said lead author Nina Sperber of the Durham
VA Medical Center and Duke University, both in Durham, North
Carolina.
“Having early and productive discussions with parents about their
long-term care wishes can help to prevent difficult outcomes both
for parents and their family members later on,” Sperber told Reuters
Health in an email.
Long-term care insurance helps pay for assistance with activities of
daily living. This type of care is rarely provided by employer-based
health insurance and Medicare only covers limited amounts of care
under specific conditions.
But long-term care insurance isn’t popular. Only about 13 percent of
U.S. adults over the age of 65 have this type of insurance, Sperber
and her coauthors write in The Gerontologist.
The researchers held eight focus groups in Boston, Chicago and
Charlotte, North Carolina, each with 10 participants.
Two groups included older parents with long-term care insurance, two
included older parents without the insurance and four groups
contained adult children whose parents either did or didn't have the
insurance.
The older parents in both groups valued their autonomy. They
generally said they wanted their children’s support but didn’t want
to burden them. And most said they wanted children to play an
advocate role in their care but not to be “changing diapers”
themselves.
But many of the adult children said they felt they were expected to
care for the parents.
Parents who had purchased long-term care insurance emphasized their
own autonomy and that of their children. Those who hadn’t focused
more on the high cost of the insurance and their preference for
spending that money now on their families, such as for
grandchildren’s education, rather than on their own future needs.
The researchers also found that when children discussed long-term
care with their parents, they were able to influence their parents’
decisions.
“Even though there may appear to be a disconnect between children
and parents about expectations for parents’ long-term care, they can
in fact find common ground,” Sperber said.
For example, a point of agreement is that both parents and children
desire support without burden, she said.
“But these shared expectations may not surface unless there is
family discussion and planning,” Sperber said.
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Sperber said long-term care insurance can be helpful, although it is
not for everyone.
“Many people who are good candidates just do not obtain it due to
lack of information about what it covers or what they risk if they
do not have it,” she said. “These products can be especially
beneficial for middle income people who do not have enough resources
to entirely self-insure but will also not qualify for Medicaid."
Sperber said people are generally better off buying this insurance
when they’re younger, because the cost is lower.
“A good time is later middle age,” she said, “Otherwise, even though
your premium is lower, you could pay more in total because you’ll be
paying over a longer period of time.”
Joshua Wiener, a long-term care researcher with RTI International in
Washington, DC, who wasn’t involved in the study, told Reuters
Health that private long-term care insurance can be useful for
particular individuals who can afford it and for whom it serves a
purpose.
But, he said, “From a public policy perspective the private
long-term care insurance market is in very bad shape and it's
unlikely to play a major role in terms of financing long-term-care.”
“The vast majority of companies who sold policies 10 years ago have
now left the market,” Wiener said. Premiums have gone up
dramatically, and they were unaffordable for most people to start
with, he added.
“So unless something happens to the overall market to change those
dynamics, private long-term care insurance from a policy perspective
is going to stay the niche product and can't be counted as a
solution for the vast majority of older people,” he said.
A lot of private long-term care insurance has been sold as asset
protection, even though surveys consistently show - as this study
did, too - that the main reason people buy private long-term care
insurance is for their sense of autonomy, he noted.
“I think that's one of the reasons why long term care partnership
programs have had such modest success,” Wiener said.
Wiener also said that family dynamics play a part in these decisions
and he’s not sure those dynamics can be changed easily.
“The article alludes to creating messages, whether these messages
are what, in fact, affect actual decision-making I don't know,” he
said.
SOURCE: http://bit.ly/1xG4P3S The Gerontologist, online September
10, 2014.
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