LTC Must Be Placed on Candidates’ Radar Screen

Published in the Woonsocket Call on May 29, 2016

Presidential candidates might just think twice about their political campaign positions on long-term care. With the graying of nation’s voters, Congress will be pushed to put long-term care on its policy agenda. When the dust settles after the Democratic and GOP conventions, the winning candidates must address long-term care issues in their debates before the November election.

In 2013, America’s age 65 or older population made up only 14 percent of the total population, but by 2040, this demographic group will nearly double to comprise about 22 percent. According to the U.S. Department of Health and Human Services the majority of these individuals will require some form of long-term care services (specifically, help with activities of daily living—such as cooking, bathing, or remembering to take medicine—that can be provided in a home or institutional setting.)

Misconceptions About Medicare and Social Security

Survey results in a 17 page report, “Long-Term Care in America: Expectations and Preferences for Care and Caregiving, released by Associated Press (AP)-NORC Center for Public Affairs Research, notes that most older Americans expect Medicare and Social Security to pay for long-term care services while these federal programs generally do not. The survey findings also indicate that respondents, age 40 and over, strongly supported public policies that help a person save for long-term care services and for those that defray the cost of care giving, including state paid family leave programs.

“This survey provides much-needed data on how people perceive the issue of long-term care in the United States,” says Trevor Tompson, director of The AP-NORC Center, in a statement released on May 16, 2016 with the survey findings… “The need for long-term care services and support to assist seniors with activities of daily living is increasing exponentially. Financing high-quality services so that the costs are manageable for families and governments will remain a big challenge for decision-makers,” he added.

“Older Americans of today and tomorrow have a 50 percent chance of living with substantial and often expensive daily needs,” adds Dr. Bruce A. Chernof, President and CEO of The SCAN Foundation. “Medicare and Social Security were not built to cover long-term care, leaving American families unprotected, and as the survey shows, unaware of this fact,” he says.

The AP-NORC survey found that while older Americans’ confidence in being financially prepared to pay for long-term care services remains low overall, there has been a slight increase in public confidence over the past four years, consistent with other measures of consumer confidence post-recession, according to the Consumer Confidence Index. In 2013, 27 percent reported feeling very or extremely confident in their ability to pay for long-term care, increasing to 29 percent in 2014, 32 percent in 2015, and 36 percent in 2016.

The polling finds reveal that a widespread misconception as to what Medicare covers for long-term care services. Older respondents, with an annual household incomes less than $50,000, are more likely to expect to rely on government programs such as Social Security, Medicare, and Medicaid, while those with higher incomes expect to rely more on personal savings to pay for their needed long-term care services. Still, 3 in 10 of these wealthier older Americans report that they will rely on Medicare to support their care as they age. This reflects common misperceptions among older Americans about the long-term care services that Medicare covers, notes the AP-NORC survey.

Thumbs Up to Aging in Place

Seventy seven percent of the survey respondents would prefer to “age in place” and receive care in their own home, w with far fewer preferring to receive care in a senior community (11 percent), a friend or family member’s home (4 percent), or a nursing home (4 percent). Among those respondents who prefer to receive care at home, there are gender differences in preferences for who provides that care: men would prefer to receive care from a spouse (51 percent vs. 33 percent), and women would prefer to receive care from their children (14 percent vs. 35 percent).

There is widespread support for policies to help caregivers face the costs of providing long-term care, with 72 percent supporting state programs to provide paid family leave, 83 percent supporting tax breaks for caregivers, and 73 percent supporting a Social Security earnings credit for caregivers taking time out from the workforce to provide care.

According to the AP-NORC survey, forty-three percent of the survey respondents have either been caregivers in the past or currently providing long-term care to a family member or close friend. Among those with experience as caregivers, 4 in 10 report having to miss work to provide care.

The researchers found that prior experience with long-term care is associated with greater support for several public policies to help people finance long-term care and to help alleviate costs for caregivers. These individuals expressed higher levels of concern about aging and are more likely to anticipate that it is at least somewhat likely that a loved one will need care in the next five years, compared to those without direct care giving experience.

Finally, one-third of the survey respondents reported having done no planning at all for their own long-term care needs. This 2016 finding is similar to the 31 percent who said the same in 2015 and remains lower than the 47 percent and 44 percent who said they had done no planning in 2014 and 2013, respectively.
One Size Does Not Fit All

Meghan Connelly, Chief Program Development at Rhode Island’s Division of Elderly Affairs, provides some thoughts about the findings of the AP-NORC survey. “Long-term care options are not “one-size-fits-all”. In Rhode Island, there are a number of choices one can make, ranging from living independently and receiving care at home to nursing home care. This report highlights that consumers want options when it comes to making these decisions for themselves, or assisting loved ones with long term care choices,” she says…

Connelly adds, the AP-NORC survey “supports the findings of past research: that the overwhelming majority of people want to receive long term care services at home,” noting that in the Ocean State there are many home- and community-based care options. She says that”home care may be available through a physician’s office; at the time of discharge from a hospital or nursing home; or through referrals to state-subsidized programs administered by agencies under the Executive Office of Health and Human Services.”

“The AP-NORC survey also underscores the need to adopt progressive financial policies that support family caregivers who provide the greatest percentage of needed long term care to their elderly or disabled loved ones at home,” warns Connelly.

Greg Crist, Senior Vice President of Public Affairs at the Washington, D.C.-based American Health Care Association (AHCA), notes, “This data generally tracks what our own research has shown: Americans don’t think of this topic every day, and honestly, this is a topic they’d rather avoid. No one likes the thought of aging, and with that aging, the increasing likelihood they will help in their later years. No one welcomes a loss of independence. But here’s the good news – the sector is adapting and innovating.”

Crist asserts nursing homes are meeting the challenge of caring for aging baby boomers. “We’re meeting the growing demands of Boomers, particularly as clinical needs grow, but also in offering amenities such as custom dietary menus, social media communities, and personal rehab care plans that speed recovery times. Whether in Rhode Island or elsewhere, this is an evolving health practice, recognizing that change is needed to meet the new preferences of older Americans,” notes Crist.

Listen to the Older Voters

The AP-NORC survey findings mirror other “long-term care perception” studies released by AHCA and AARP. Democratic presidential candidates Hillary Clinton, Bernie Sanders, and GOP standard bearer Donald Trump must not forget the needs of America’s exponentially growing older population. These older voters do not want to fall through the nation’s public policy safety net when they require the most assistance, paying for costly long-term care services. As the survey report notes, older Americans strongly support Family Leave programs and also call for government administered Long Term Care Insurance programs.

For a copy of the report go to


Survey: Many Put Retirement on Hold

Published in Woonsocket Call on May 15, 2016

The Associated Press (AP)-NORC Center for Public Affairs Research, funded by The Alfred Sloan Foundation, released a study this month that finds that departing the workforce at the traditional retirement age of 65 is no longer a reality for most older Americans. This new study extends the research of an earlier 2013 retirement study to look at efforts made by older workers to improve career skills and their plans to adjust the parameters of work in later stages of their work life. It also takes a look at a variety of implications of the trend of working longer along with the motivations for doing so.

The 10 page report, released on May 10, 2016, finds that there are large numbers of older Americans who are currently, or who expect to be, working longer. However, researchers caution that this does not necessarily mean that older workers are continuing with the same employment circumstances indefinitely. Many are either reducing their hours to part-time status or are planning to switch to a new employer or even a new field. (The AP-NORC study confirms the findings of an AARP retirement study reported in my September 14, column, entitled “Still Getting the Job Done” that noted “new retirement activity.”)

The Graying of America’s Work Force

The AP-NORC survey comes at a time when the size of the nation’s older population is larger than it has ever been and projected to keep growing, say the researchers. Between 2003 and 2013, the number of Americans age 65 and older rose from 35.9 million to 44.7 million. In the next quarter century, this number is expected to rise to 82.3 million. The percentage of the overall population that falls within this group will rise from 14.1 percent in 2013 to 21.7 percent in 2040, notes the study.

“The circumstances and future plans of older Americans must be well understood by decision-makers,” said Trevor Tompson, director of The AP-NORC Center. “Not only are older Americans going to work longer, but 4 in 10 respondents are planning to change career fields in the future. These results point to significant changes in the American workforce with impacts likely felt by workers and employers.”

No Plans for Retirement

Here is a sampling of key findings reported in The AP-NORC’s “Working Longer” study:

According to the survey, a quarter of older workers say they plan to never retire, with this response being more common among lower-income workers than higher-income workers. Specifically, 33 percent of those earning less than $50,000 a year saying they will never retire, compared with 20 percent of those who earn $100,000 or more.

The findings also indicate that more than half of older workers plan to be employed past the traditional retirement age of 65 or already have worked past this age. Additionally, six in 10 older workers age 50 to 64 plan to work past the age of 65. Nearly half of those who are 65 and older say they already work or plan to work during this later stage of life, notes the study.

The study reveals that members of the workforce who are age 65 and older are not limiting themselves to occasional work–this group reports an average of 31 hours per week in the workplace.

Additionally, more than 4 in 10 Americans age 50 and older have spent at least 20 years working for the same employer at some point in their careers. These workers are more excited and less anxious about retirement than those without such long histories with a single employer, says the study..

The findings also show that a majority of the older Americans who are planning to remain in or rejoin the workforce are planning to switch either professional fields or employers in the future. Those who are age 65 and older are especially likely to plan a change. In addition, a sizeable minority of older workers are taking steps to keep their skill sets fresh by pursuing job training or additional education.

Finally, a quarter of adults age 50 and older have looked for a job in the past five years. Many of them are encountering difficulties in the job market, with a third reporting that it has been so difficult that they’ve given up looking at some point during their search.

Fear of Outliving Retirement Savings

“One could say that the [The AP-NORC] survey simply leads us back to the same ‘old’ story,” said AARP Rhode Island State Director Kathleen Connell. “But what is ‘old’ and what are we going to do about it? The survey provides more data to underscore the need for policy changes as well as a refocusing on employment and retirement. In a single generation, the world has changed. On the upside, the numbers reflect people in better health working longer, and many of those folks continue to be fulfilled in their jobs. But we all know that for most people this trend stems from the fear of outliving savings, often compounded by the inability to save substantially for retirement.

“Worries about Social Security are in the mix, also, as people worry that benefits someday may not cover the cost of housing, food and healthcare. The thought of any future reduction in Social Security benefits is daunting. That’s why AARP continues to ask presidential candidates to ‘Take a Stand,” by providing specific plans to address necessary changes in the program. As we have been saying, doing nothing is not an option.

“One of the encouraging trends revealed in the survey is that many workers over 65 say they are certain that they will change jobs or careers before they retire. It says to me that the message is kicking in that reaching what we once accepted as ‘retirement age’ no longer holds people back.”

A total of 1,075 interviews were conducted for this AP-NORC survey with adults age 50 and older representing the 50 states and the District of Columbia. Interviews were conducted in English and Spanish. The combined response rate is 14.2 percent. The overall margin of sampling error is +/- 3.9 percentage points at the 95 percent confidence level, including the design effect. The margin of sampling error may be higher for subgroups.

Survey: Older Americans Puzzled About LTC Programs and Services

Published in Woonsocket Call on July 19, 2015

Planning for your golden years is key to aging gracefully.  But, according to a new national survey looking at experiences and attitudes, most Aging Boomers and seniors do not feel prepared for planning or financing their long-term care for themselves or even their loved ones.

This Associated Press (AP)-NORC (NORC) Center for Public Affairs Research study, funded by The SCAN Foundation, explores a myriad of aging issues, including person-centered care experiences and the special challenges faced by the sandwich generation.  These middle-aged adults juggle their time and stretching their dollars by providing care to their parents, even grandparents while also financially assisting their adult children and grandchildren.

Older American’s Understanding of LTC

This 21 page survey report, released on July 9th, is the third in an annual series of studies of Americans age 40 and older, examines older Americans understanding of long-term care, their perceptions and misperceptions regarding the cost and likelihood of requiring long-term care services, and their attitudes and behaviors regarding planning for possible future care needs.

The survey’s findings say that 12 percent of Americans age 40 to 54 provide both financial support for their children and ongoing living assistance to other loved ones.   Federal programs are often times confusing to these individuals, too.   More than 25 percent are unsure whether Medicare pays for ongoing living assistance services like nursing homes and home health aides. About 1 in 4 older Americans also overestimate private health insurance coverage of nursing home care.

Researchers noted that about half of the respondents believe that a family member or close friend will need ongoing living assistance within the next five years. Of those who anticipate this need, 7 out of 10 reports they do not feel very prepared to provide care, they note.

More than three-quarters of those surveyed age 40 or older who are either receiving or providing ongoing living assistance indicate that their care includes at least one component of “person-centered care.”  This approach allows individuals to take control of their own care by specifying preferences and outlining goals that will approve their quality of life.

The survey also finds that most of those reporting believe that features of “person-centered care” have improved the quality of care

Paying for Costly LTC Services

The 2015 survey findings are consistent with AP-NORC survey findings from previous years, that is older Americans continue to lack confidence in their ability to pay the costs of ongoing living assistance.  Medium annual costs for nursing homes are $91,260; the cost for at-home health is about half that amount, $45,760, says the report.

Finally, only a third of the survey respondents say that they have set aside money for their care. More than half report doing little or no planning at all for their own ongoing living assistance needs in their later years.

“The three surveys on long-term care [by AP-NORC] are helping us create a comprehensive picture of what Americans 40 and older understand about the potential need for these critically important services,” said Director Trevor Tompson, at the AP-NORC Center in a statement. “Experts estimate that 7 in 10 Americans who reach the age of 65 will need some form of long-term care, and our findings show that many Americans are unprepared for this reality,” he says.

Dr. Bruce Chernof, President and CEO of The SCAN Foundation, says that the 2015 study takes a look at public perception regarding long-term care and most importantly, how people can plan for future long-term care needs.  “The insight provided by this research is critical because it will help us promote affordable health care and support for daily living, which are essential to aging with dignity and independence.” he says.

AP-NORC’s 2015 study results are validated by other national research studies, says AARP Rhode Island State Director Kathleen Connell.    “AARP’s research, both nationally and state by state, reveals that people in the 50+ population are concerned about the cost of retirement and especially long-term care,” she says, observing that “very few people seem worry free on this question and rightfully so.”

 Beginning the Planning Process

Connell adds, “I would say our response to this survey is that it adds to the awareness that people need to start thinking about this at an earlier age. And that means not only focusing on saving but also getting serious about health and fitness.”

What can a person do to better prepare for paying for costly long-term care and community based services?   “ has an abundance of information on long-term care. There’s advice on long-term care insurance, a long-term care cost calculator and many other resources. We also need to remain strong as advocates for programs that support seniors. Social Security, Medicare and Medicaid need to remain strong in order to support Americans entering the most vulnerable chapters of their lives,” she says.

Amy Mendoza, spokesperson for the American Health Care Association (AHCA), a Washington, DC-based trade association that represents over 12,000 non-profit and proprietary skilled nursing centers, assisted living communities, sub-acute centers and homes for individuals with intellectual and development disabilities, calls for increased conversations to help planning for potential future need.  “Given that the need for long-term or post-acute care is a life changing event, it demands some considerable thought, discussion and research,” says Mendoza.

“AHCA’s “Care Conversations” program helps individuals have the honest and productive discussions needed to plan and prepare for the future long-term care needs,” adds Mendoza.  Care Conversations has a Planning Tools page on its website which provides information on advance directives. Learn more at:

Todd Whatley, a certified elder law attorney, notes that some of his best clients are middle age adults who after taking care of their parents want to avoid costly nursing home or community based care services.  “They are then suddenly very interested in some type of [insurance] coverage for the extraordinary expense of long term care when a year earlier, they had no interest whatsoever,” he says.

Whatley, President-Elect of the Tuscan, Arizona-based National Elder Law Foundation, suggests contacting a financial planner or Certified Elder Law Attorney when purchasing long term care insurance, “Get early advice from someone with their best interest at heart.  There are many times that a person simply doesn’t need this product financially, but most people do.

To locate a Certified Elder Law Attorney, contact Lori Barbee, Executive Director, National Elder Law Foundation.  She can be reached at 520-881-1076 or by email:

For a copy of the study, go to

Herb Weiss, LRI ’12 is a Pawtucket-based writer covering aging, health care and medical issues.  He can be reached at



Poll Calls Upon Congress to do “the people’s work”

Published in the Pawtucket Times, January 10, 2014

Four months ago, public anger reached a boiling point when the Republican-led House, controlled by its minority faction of Tea Party members, and the Democratic majority in the Senate failed to agree to an appropriations continuing resolution.
As a result of this budget impasse, a 16 day federal shutdown forced the furlough of 800,000 federal employees and another 1.3 million were required to report to work without known payment dates.

Public polls at that time blamed the GOP for turning its back on the nation by putting partisan politics first rather than doing the People’s business.” The popularity of Congress sank to a new historic low with heated partisan conflict echoing throughout the hallways of Congress.

Hammering Out an 11th Hour Deal

Senator Ted Cruz (R-Texas) with the blessings of conservative groups, including the Heritage Action, the Club for Growth, Freedom Works, and the Senate Conservatives Fund, forcefully pushed House Speaker John Boehner (R-Ohio) to offer continuing resolutions not acceptable to President Obama and Congressional Democrats to politically force a delay or to defund the Patient Protection and Affordable Care Act (called “Obamacare”). Strong GOP opposition, spearheaded by Tea Party lawmakers, to raising the nation’s debt ceiling almost forced the government to run out of money to pay its bills.

After weeks of intense political bickering, Congress finally hammered out a political compromise, one that would open the doors of government, but also raise the debt ceiling to keep the nation from free-falling off the fiscal cliff. A failure to raise the debt ceiling could have resulted in the nation’s credit rating being downgraded. If this occurred, average Americans might have seen higher interest rates for mortgages, car loans, student loans and even credit cards. Higher business expenses, due to expensive borrowing rates, might have forced businesses to stop hiring or even to lay off employees. Housing prices might have drop and retail sales slow. The 11th hour compromise kept the American tax payer and business community from taking a huge hit in their pocketbook.

Although Cruz and Tea Party lawmakers in both chambers viewed shutting down the federal government and not raising the debt ceiling as a way to put excess government spending on the chopping block economy, there was economic damage. According to the economists at Standard & Poors, the total cost of the political gridlock to the nation’s economy that occurred before Christmas was estimated to be $24 billion.
Americans Lack Confidence in Congress

With the new Congressional session beginning this month, a new national poll released last week by AP-NORC Center for Public Affairs reveals that few Americans have faith in the current political status with Congress receiving low marks on its performance of upholding the views of most Americans while only 9 percent say it is doing a good job.

According to the poll that comes months after the first government shutdown in 17 years, 70 percent lack confidence in the federal government’s ability “to make progress on important issues facing the nation in 2014.”

However, the poll findings indicate that the respondents have a little bit more faith in their local and state governments, with 45 percent saying that they are at least moderately confident in their state government and 54 percent having at least moderate confidence with elected officials at the local level.

The federal government receives low marks on its performance. For instance, 55 percent believe the government is doing a poor job of representing the views of most Americans while only 9 percent say it’s doing a good job.

Meanwhile, the poll’s results find Americans are more pessimistic than optimistic on matters such as the nation’s ability to produce strong leaders, America’s role as a global leader, and the opportunity to achieve the American dream.

The People’s preferred agenda for the government in 2014 includes a diverse set of policy issues that range from economic problems to social policies to foreign affairs, notes the poll. Health care reform tops their list of priorities, mentioned by 52 percent of respondents as one of the top ten problems, followed by unemployment (42 percent), the economy in general (39 percent), and the federal deficit (31 percent).

“While it is very easy to ask people to choose a single ‘most important problem’ and to build a list for the answers, the reality is that government has to address many issues at the same time,” said Trevor Tompson, director of the AP-NORC Center. “This survey, with data about the public’s priorities on a range of policy issues, provides policy makers with rigorous data as they seek to understand the public’s outlook on where the country is now and what the action agenda should be for the year ahead.”

Wendy Schiller, Associate Professor of Political Science and Public Policy at Brown University, notes that the AP-NORC poll reveals “broader concerns expressed in national opinion polls, and by the average Rhode Islander “that our country seems to be slipping on lots of levels.”

Schiller, a frequent guest on Rhode Island PBS’s “A Lively Experiment,” notes that aging baby boomers and seniors worry about issues facing the younger generations, personal debt resulting from student loans to national debt. On the other hand, “Younger folks worry about how they will take care of their parents and grandparents, as well as providing for their own retirement,” she says.

“In a state like Rhode Island, which has such a strong family centered culture, these issues weigh heavily on almost everyone’s minds,” observes Schiller.

One of the poll’s positive findings was that the respondents did not cite healthcare for seniors as a pressing issue even though they did express concern over Social Security and health care reform, adds Schiller. “Preserving Medicare is as important, if not more, to the physical and financial well-being of seniors, so I found it striking that it was not as large a concern [as other issues].”

The polls negative findings of a distrust of government, rather than just a disappointment, concerns Schiller, noting that “Democracies do not fare well when the people lose faith in their government.”

As indicated by the poll, Schiller believes that Rhode Island state elected officials are viewed more positively by voters than those serving in Congress. But, 2014 will be a challenging year for them, especially with issues like the 38 Studios debacle, pension reform issues, and Rhode Island job growth. Schiller believes that “If the General Assembly can increase the trend towards greater transparency and accountability, than they might be able to reverse the downward slide of public faith in government.”

As noted in the poll, “public opinion about Congress is at an all-time low,” says Darrell M. West, Ph.D., Vice President and Director of Governance Studies at the Brookings Institution. “People are disenchanted with the hyper-partisanship in Washington, D.C., and the inability of congressional leaders to address major policy problems, he says, noting that the government shutdown was very disturbing to mainstream and people now worry about Congress getting anything done.

West, a former Brown University professor and a prominent Rhode Island political commentator, does not see a major resurgence of bipartisanship in this Congress.
“The parties have incentives to highlight their differences rather than compromise their principles. That will make it difficult for the parties to work together, he says.

But West sees an indicator that the GOP might move away from its ties to the Tea Party that put a damper on reaching across the aisle to get the people’s work done. “The only promising sign is Speaker Boehner’s declaration of independence from the right-wing. A month ago, Boehner criticized outside conservative groups and said they had lost all credibility. If he really believes that, it may embolden him to work on immigration reform and pass needed legislation”, says West.

Because of the complexity of today’s domestic and foreign policy, the People want and need their elected officials to quit this partisan bickering and join together to solve the enormous problems that face the nation, warns well-know Rhode Island activist, Susan Sweet, a keen watcher of state, national, and global politics. “Without the political will to stand together and strengthen the People of America, this great experiment in democracy could decline and fall,” she says.

The AP-NORC national poll was conducted by The Associated Press-NORC Center for Public Affairs Research from Dec. 12-16, 2013, with 1,141 adults. Additional information about how the survey was conducted, including the survey report and the survey’s complete topline findings can be found on the AP-NORC Center’s website at

Herb Weiss, LRI ’12, is a Pawtucket-based writer covering aging, health care and medical issues. He can be reached at