Most older Americans unprepared for long-term care needs, study reveals significant knowledge gaps
Nearly two-thirds of Americans over 50 wrongly believe Medicare would cover nursing home costs, new polling data reveals.
The survey exposes widespread misconceptions about long-term care funding and preparation, with many holding mistaken beliefs about payment options and future needs.
University of Michigan researchers found that 62 per cent of older adults incorrectly assume Medicare would pay for permanent nursing home care, despite this not being covered by the programme.
Only 29 per cent of respondents correctly identified Medicaid as a funding source for nursing home costs, although it pays for nearly two-thirds of all long-term nursing home care for eligible lower-income adults.
The findings from the National Poll on Healthy Aging highlight concerning trends in care planning, with 52 per cent reporting they aren’t worried about potentially needing long-term care and 57 per cent believing it unlikely they will ever require such services.
This contradicts national statistics showing 70 per cent of people who survive to age 65 will eventually need some form of long-term care service.
Ana Montoya, associate professor of internal medicine at U-M who is a geriatrician, said: “These data reveal gaps in what older adults think and want when it comes to long-term care, and what they’ve actually done to prepare.”
The poll, based at the Institute for Healthcare Policy and Innovation and supported by AARP and Michigan Medicine, found only half of respondents had taken even one of five key preparatory actions for future care needs.
Most common steps included designating a durable power of attorney for medical care (27 per cent) and identifying a potential caregiver (24 per cent). Just 5 per cent had discussed long-term care plans with healthcare providers.
When asked about preferences, most respondents said they would prefer receiving care in their own home, either from family or friends (52 per cent) or paid caregivers (21 per cent). Few preferred assisted living facilities (6 per cent), moving in with family (6 per cent) or nursing homes (1 per cent).
Julie Bynum, geriatrician, said: “Worry about long-term care runs especially high among these older adults, who have already experienced limitations to their daily activities. We also found less confidence about planning for long-term care among older adults who say their mental or physical health is fair or poor, compared with those who say they’re in good or excellent health, regardless of disability status.”
The research revealed generally negative perceptions of institutional care settings, with 59 per cent reporting mostly negative impressions of nursing homes compared with 25 per cent feeling similarly about assisted living facilities. Many expressed financial concerns, with 62 per cent lacking confidence they could pay for nursing home care and 58 per cent doubtful about paying for assisted living.
Jeffrey Kullgren, poll director and primary care physician, said: “The fact that only 5% of older adults had talked with a health care provider about their long-term care plans, and only 27% had formally designated someone to make medical decisions for them if they become unable to do so, suggests we have a tremendous opportunity to help people prepare.”
Indira Venkat, senior vice president of research at AARP, said: “This poll shows a troubling disconnect between what older adults think Medicare and Medicaid cover and the reality, one that often delays planning and leaves family caregivers to shoulder the burden. AARP is committed to helping people understand their long-term care options and take action early, with trusted tools and resources to support both older adults and their family caregivers.”
The nationally representative survey was conducted by NORC at the University of Chicago for the Institute for Healthcare Policy and Innovation in August 2024, gathering responses from 3,486 adults aged 50 to 94 across the United States.
