Autonomy, cost are key in decisions on long-term care insurance

By Shereen Lehman NEW YORK (Reuters Health) – Family discussions that emphasize older parents’ independence and their desire to avoid being a burden to adult children could stimulate interest in buying long-term care insurance, researchers say. 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. 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.