Most Maui residents 50 years and older believe that they will need long-term care by at least age 75, but they're not planning for that eventuality, an AARP survey showed.
Sixty-one percent believe that they will be at least 75 years old before they will need long-term care, according to the survey of 133 Maui residents done Nov. 9 to 26, part of a larger 800-person statewide survey by AARP released last week.
Fifty-four percent of those surveyed agree with the statement: "I am not planning for my own long-term care because I am just trying to meet my daily living expenses."
But they are clearly worried about it. The survey showed that 65 percent of respondents "are not confident" that they can afford the cost of long-term care for one year in a nursing home.
Twenty-three percent of respondents said that they would use personal savings and assets for long-term care; 20 percent said Medicaid, 16 percent said long-term care insurance and 12 percent Social Security.
Long-term care for the aging American population is becoming a major public health issue because baby boomers have begun reaching retirement age. Between 2007 and 2030, the number of people 85 and older, many of whom will require long-term care, will grow by almost two-thirds, a Hawaii Long-Term Care Commission report said.
"The long-term care system in Hawaii is broken," the report released last year said. "Long-term care is expensive and beyond the financial reach of most people."
Medicare and private health insurance do not cover long-term care, and few people have private long-term care insurance, the report said. When people deplete their personal resources, they are left to Medicaid, the health care program for the poor.
Long-term care is beyond the financial reach of most people. The latest Genworth Cost of Care Survey of last year showed that the median annual rate for one year in a nursing home was $126,000, up from $107,000 in 2008.
Trying to obtain long-term health insurance isn't cheap either. In 2008, the average premium for private long-term care insurance policies providing a $150 daily benefit amount and three years of coverage was $2,329 per year if purchased at age 60, the long-term care report said.
There is more than a financial issue when it comes to long-term health care. Ignorance was a major problem cited by those involved in the treatment and care of the elderly on Maui and was shown in the survey. When asked if they had "given lots of thought" to future long-term health care needs, the responses were evenly split at 48 percent between "agree" and "disagree." The remainder was "not sure."
"We all think we are going to die in our sleep, and that's really not what happens," said Michele Potts, chairwoman of the Core Leadership Team with Aging with Aloha, a coalition of groups and organizations that deal with aging issues.
Tony Krieg, chief executive officer of Hale Makua Health Services, noted that one of the major recommendations of the long-term care report was the need to break that ignorance of aging and life in the twilight years.
"It (the report) does suggest that there needs to be a longer-term education and awareness campaign," he said.
Residents need to begin thinking about the cost of long-term care, who will care for them, the fact that Medicare and Social Security do not provide long-term care. Krieg noted that 80 percent of patients in the nursing home are on Medicaid and that the reimbursements don't cover the actual cost of care.
Medicare will offer reimbursements for strokes or injuries such as hip fractures, but once the conditions are cured or managed the payments end.
"Yeah, so we get stuck," he said.
The AARP survey had a question about the establishment of a long-term care insurance program, into which all working residents would pay a monthly premium and be eligible for limited long-term care services.
Sixty-six percent supported the idea; 21 percent were against. The remainder didn't take a position.
For those who supported the program, 38 percent were willing to pay between $50 and $74 per month in premiums, 26 percent were willing to pay between $75 and $124 per month and 23 percent were willing to pay between $125 and $199 per month.
In the AARP survey, the vast majority of respondents, 74 percent, agreed with the statement: "I do not want to depend on my family or friends for my long-term care needs." Yet, 57 percent agreed with the statement: "My family or friends will take care of me if I need long-term care."
There needs to be a conversation with family members about their care in their waning years, said Potts. People need to write down their wishes and establish meaningful advanced directives.
"People don't have the conversation with their families about what their wishes are," she said.
So then, family members are left to make those decisions without guidance. They may rely on their own desires, but Potts points out that "the reality is that we all want different things."
There is an aversion to talking about death in America, she said.
"We don't talk about dying," she said. "We are all dying. We don't know what our time is. . . . We just don't talk about it anymore."
On the other hand, Krieg does see attitudes evolving.
"I do think there is a change," he said. "People are beginning to think about how to plan."
* Lee Imada can be reached at firstname.lastname@example.org.