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AARP Study Explores Rural Idahoans Long-term Care Needs

 

What do Idahoans in rural communities do for long-term care when there are no services available? Can rural Idahoans afford to pay for long-term care, and how do they plan to pay for it? Where do rural Idahoans go for long-term care information? 

 

All of these questions were posed to residents age 25 and older in the rural community of Cottonwood Idaho in the fall of 2008 in a study being released by AARP Idaho with contributions from the Camas Prairie Horizons Coalition and psychology students from Boise State University. 

 

As Idaho ages, rural communities face greater challenges in providing long-term care support services—personal care, assisted living, adult day care, and nursing home care—for their residents. Cottonwood (population 1,023 in 2007) was selected to be surveyed because the community has virtually no long-term care services, and despite a growing demand for long-term care in Cottonwood, the only nursing home closed in the fall of 2008.

 

Because of an aging population, other rural Idaho communities will be facing similar situations to Cottonwood. According to AARP, between 2007 and 2030, the population of Idahoans age 85 and older will increase 91%. The majority of people in this age group will experience some sort of disability, meaning that they will be much more likely to need long-term care services. 

 

In 2007, according to an AARP report, the average cost of one month in a nursing home in Idaho was $5,637. One month in an Idaho assisted living facility started at $2,327. 

 

Only 3% of those surveyed indicated that they could afford to pay out-of-pocket for the monthly average cost of nursing homes and/or assisted living. Close to half (40%) responded they could pay under $500 a month and the vast majority (68%) responded $1,500 or less. 

 

Medicare covers only a limited amount of long-term care, and specific conditions must be in place. Medicare will pay for skilled nursing home care if a doctor determines the person needs the care after they have been in the hospital at least three days. In 2009, Medicare will cover 100% of the costs for the first 20 days. After 20 days, an individual pays $133.50 a day for up to the next 80 days (80 days = $10,680). Then after those 100 days, all costs are paid out-of-pocket. The survey results, however, show that most respondents did not understand the limitations of Medicare’s long-term care benefit.  

 

A full 65% of respondents listed they would rely upon Medicare to pay for long-term care, and 64% indicated they believed it was Medicare’s responsibility to pay for long-term care. 

 

After Medicare, the second most common response was personal savings and income (61%), followed by the responsibility for paying for long-term care rests with the individual (56%). 

 

Just over half (51%) indicated that they planned on using Medicaid to pay for long-term care, and less than half (44%) thought it was the responsibility of Medicaid to pay for long-term care. Because of the high costs of long-term care, many Americans have to spend down all their savings and other assets, and then rely on Medicaid to pick up the cost of services. As a result, Medicaid pays the largest share of long-term care in America. 

The majority of Cottonwood residents (61%) are willing to move, even a short distance, to receive long-term care. A quarter are not willing to move. 

 

The vast majority (89%) are willing to travel some distance to visit a family member that needed long-term care. Over half (51%) would travel 51 or more miles to visit a family member.

Half of the respondents (53%) indicated that it was ‘very likely’, or ‘somewhat likely’ that a family member would need long-term care in the next five years. When asked about their own likelihood, the vast majority (70%) responded that it was ‘not very likely’, or ‘not at all likely’ that they would need long-term care services for themselves in the next five years.  

 

The most prevalent choice for preferred long-term care setting was in-home care provided by a paid caregiver (70%), followed by assisted living (57%), in-home care provided by an unpaid family member (52%), and then a nursing home (38%). 

 

 

For Idaho to effectively provide information on long-term care, the survey found that the #1  place residents would turn for this information was medical support (36%), followed by a relative or friend (27%). Nearly 20% reported they didn’t know where to turn for long-term care information. 

 

Informal caregiving appears to be the most likely and most common form of long-term care that will be provided in Cottonwood. The survey showed that most residents were married, and the vast majority had adult children; therefore most people have someone who could potentially provide long-term care support. 

 

While it is unlikely that a long-term care service provider could successfully establish a business in Cottonwood and find enough residents able to pay for the average costs of their services out of pocket, they could consider offering lower cost alternative services that people indicated they preferred, such as home care, personal care, or support for caregivers, such as respite care.

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