As Americans age, an increasing number of Americans will need long-term care. But, the availability of long-term care is on the decline. Here’s how to prepare, according to Mark Miller in a piece for The New York Times.
Next year, the first of the baby boomer generation will turn 80. And, in the next ten years, 11 .8 million Americans will be over 85; today there are about six million. In 35 years, 19 million Americans will be over 85.
We don’t have enough workers to care for this older population. Salaries are absurdly low, $16.72 an hour in 2023. And, now that the Trump administration is pushing undocumented workers out of the country, we will have even fewer care workers. Today, more than one in four care workers are immigrants.
The cost of long-term care is also rising at a rapid pace, more than three times the rate of inflation. Costs rose ten percent for some services in the last year.
Medicare does not cover long-term care. It only covers short-term stays in skilled nursing homes for a narrow group of people who need daily skilled care and who were hospitalized in the 30-days prior to nursing home admission.
Medicare does not cover help with activities of daily living for people who do not need skilled care. Yet, many people simply need help with bathing and toiletting and dressing and eating and do not require skilled care. And, even when you qualify for Medicare coverage of skilled nursing care or home care, you may struggle to get it, particularly if you are in a Medicare Advantage plan
Few people plan for long-term care, even though one in five will have a serious need for long-term care and, of those remaining, more than half will have some need for long-term care.
What can you do to prepare for your long-term care needs?
Understand the costs of long-term care. Cost will depend on how much care you need and where you live. In 2024, care in an assisted living facility cost around $6,000 a month. Care in a private nursing home cost more than $10,000 a month.
Recognize that Medicaid cuts will make it harder for people to qualify for Medicaid. Today, Medicaid pays for long-term care for more than six in ten people. For people with few assets and little income, Medicaid covers long-term care in nursing homes and at home, depending upon the state you live in. That won’t be possible if Congress cuts Medicaid by $715 billion, as the House reconciliation bill provides.
Appreciate that with fewer immigrants in the US, it could be harder and costlier to find qualified caregivers.
Know that long-term care insurance is extremely costly and too often useless. People with long-term care insurance who need long-term care might find they are not covered. Usually, policies require you to wait several months before they kick in. And, they only kick in if you meet their triggers–such as needing help with at least two activities of daily living–which can be hard to meet. Moreover, premiums rise from one year to the next, sometimes substantially. So, many people end up dropping policies they can no longer afford, after spending a lot on premiums for several years.
Consider planning ahead and setting aside money to cover long-term care. Where do you want to live as you grow older and infirm? If possible, you should set aside the money to cover your long-term care costs for five years. You can use your IRAs and other retirement savings to cover these costs.
Social Security income can help with costs. To get the most of your Social Security benefit, try not to claim Social Security until you are 70. Delaying claiming benefits will give you 25 percent more monthly income.
Talk to your family members about your wishes and possible needs. Keep in mind that if you are unable to set aside money for your long-term care, family members might need to stop working or reduce their workload to care for you.
Here’s more from Just Care:
- Two in five older adults needing long term care do not get it
- Long-term care insurance is broken
- Medicare Advantage plans have little reason to address people’s long-term health needs
- If you need long-term care services, how will you get them?
- Planning for long-term care; you’re more than likely to need it
