Posts

Paying for Personal Care in PA: Stuck Between a Rock and a Hard Place

Personal Care Homes (PCH) and Assisted Living Residences (ALR) are housing options typically for older adults that provide hands-on care with activities of daily living such as bathing, dressing, grooming and offer three meals a day, activities and medication monitoring. The average annual cost of a personal care home or assisted living in Pennsylvania is $41,400¹. While some older Pennsylvanians are fortunate enough to pay privately for these services, a much larger percentage simply cannot. Either way, many of those who need these levels of care are often mistaken on how it will get paid for. Many seniors and/or their families think that Medicare or Medicaid (aka Medical Assistance) will pay for some or all of personal care or assisted living. But, regrettably neither offer coverage in Pennsylvania, therefore private out-of-pocket payment tends to be the primary funding source for PA seniors. But, a fair number of states like Florida, North Carolina and Maryland do provide full coverage through their state Medicaid program. For full details on all 50 states, click [here].

For many older Pennsylvanians who begin to decline and struggle to live safely at home, moving to a personal care home can be the perfect solution. However, again due to average monthly costs of $3,450¹, it’s just not an option for many.

Of course this is nothing new, so state funded programs through Home and Community Based Services (HCBS), also known as Waiver Funded Services or Waiver Programs, were created to provide alternatives. They provide support and services that enable individuals to remain in a community setting rather than being admitted to a long-term care facility. Some of these waiver funds particularly aimed at helping seniors include adult day programs, non-medical home care, home modification grants and environmental adaptation services. While these are helpful, they may fall short for someone who cannot live alone safely 24 hours a day, for instance those with a dementia diagnosis. In cases where placement is an absolute must, the other option is nursing home placement; because if financially eligible, Medicaid will pay for them to be in a nursing home. The problem with this is that a number of these people don’t actually need true nursing care. For example, someone with moderate dementia may be in decent physical health, but because of safety or behavioral issues coupled with little income and no assets, nursing placement becomes the only option. Thus – “becoming stuck between a rock and a hard place.”

Some good news

There are two direct funding sources that will provide partial or possibly full coverage for PCHs and ALRs in PA. The first is Supplemental Security Income (SSI) and second is the Aid and Attendance Pension Benefit through the U.S. Department of Veterans Affairs.

Not to be confused with Social Security income that most everyone receives after retirement, Supplemental Security Income is strictly a needs-based program determined by one’s income and assets and, of course, physical need. It exists for people age 65+, as well as blind or disabled people of any age, including children.

To meet the SSI income requirements, you must have less than $2,000 in assets (or $3,000 for a couple) and a very limited income. SSI provides a number of benefits like the Supplemental Nutrition Assistance Program (SNAP), formerly known as food stamps. It also provides a monthly payment for the PA “Domiciliary Care or “Dom Care” program. As stated on PA Aging website, “Dom Care was created to provide a home-like living arrangement in the community for adults age 18 and older who need assistance with activities of daily living and are unable to live independently. Dom care providers open their homes to individuals who need supervision, support, and encouragement in a family-like setting.

Dom care residents are matched to homes that best meet their special needs, preferences, and interests. Dom care homes are smaller than the traditional personal care home in that home providers care for no more than three dom care residents. Unlike larger personal care homes, dom care homes are the individual providers’ homes. They are inspected annually to ensure they meet health and safety standards. If the home and provider pass this inspection, they become certified.

The local Area Agency on Aging is responsible for the initial certification and ongoing annual inspections of Dom Care homes in their area. They are also responsible for the placement of individuals into certified Dom Care homes.”

Supplemental Security Income in Pennsylvania will also cover monthly Personal Care/Boarding Home (PCBH) costs at $1,189.30 per eligible person or $2082.40 per eligible couple∗. The drawback to this funding option is that personal care homes must be willing to participate and accept these shortfall amounts. Thus, finding a participating facility can be a challenge. To get a list of facilities that accept SSI payments, please contact your local County Area Agency on Aging.

Next, the V.A. Aid and Attendance benefit provides an additional monthly pension to eligible veterans and/or their surviving spouses. Eligibility is based on income and assets, war-time service status and physical/medical need. This additional monthly stipend can be used for community based services, but can also be used to cover costs associated with placement in a personal care home or assisted living setting. To learn more click [here].

Lastly, another alternative in Pa, which falls under the category of community support is the LIFE (Living Independence for the Elderly) program. A person continues to live at home, but LIFE offers heavier partial day services and care to keep them there for as long as possible. “…it is an option that allows older Pennsylvanians to live independently while receiving services and supports that meet the health and personal needs of the individual [such as physician, nursing and rehab services, transportation and heavy physical assistance.]

Living Independence for the Elderly (LIFE) is a managed care program that provides a comprehensive, all-inclusive package of medical and supportive services. The program is known nationally as the Program of All-Inclusive Care for the Elderly (PACE). All PACE providers in Pennsylvania have “LIFE” in their name. The first programs were implemented in Pennsylvania in 1998.” This is a program, if eligible, Medical Assistance (Medicaid) will pay for.

Final thoughts

In Pennsylvania, those who can afford to pay privately for the assistive care facilities, the burden is mostly on you. If you are someone who might qualify for coverage based on low income and assets, you may be fortunate enough to find a local option. But for a large chunk of older adults who fall between these two extremes, I wish I had more options to share. My advice is to be more proactive and anticipate the possibility of needing care as we age. Be mindful of unnecessary spending or gifting after retirement. Become more familiar with placement options and related costs. And most importantly, save more for retirement and earmark it for future care! We’re all living longer and care is not getting any cheaper. And although senior advocacy groups like LeadingAge™ PA continue the push to have ALR/PCHs receive partial government funding; current legislation is trending away from covering institutional types of care.

For more information or help on this topic, please contact Messiah Lifeways Coaching at 717.591.7225 or coach@messiahlifeways.org.

¹Genworth Financial Cost of Care Survey 2017
∗Current SSI rates as of 2018

 

Financial Stewardship, Medicaid and Long-Term Care

Our children are our world, and we strive to love, nurture and provide for them throughout their lives. Eventually as they leave the nest, our wish for them is to grow up into caring, intelligent, resilient, successful adults. Furthermore, despite their own successes and achievements or their lack of, we will also want to leave them a legacy. Legacy comes in many forms, but in this case I am talking about a financial legacy. Big or small we want to leave something behind for them to invest, enjoy or simply supplement their needs. I believe it’s part of being a good parent, a way for us continue to give and support them even after we are gone.

With that said, as a parent ages and retires, the idea of a leaving a legacy starts to evolve a bit. Life gets in the way, like the cost of living, health problems, and unforeseen circumstances. However, if we are fortunate enough, we can make it through to the other side. Therefore, if we have been smart with our investments, retirement, and managing our money, hopefully there will be a sizable nest egg for us to live on and enjoy after retirement and subsequently pass on to our kids – right?

Here’s where all this build-up is leading to. I’m not a financial expert, so I’m not necessarily focusing on the size of that nest egg or how you amass it, but rather how prudent and accountable we will be with that money. Upon retirement – yes we’d like to travel, buy that RV, put that addition on the house, or as mentioned earlier leave an inheritance to family upon our demise. However, aside from having money to live on, pay bills, and the aforementioned “fun stuff,” there is a very vital piece missing from this spending plan. That is – we need to think about covering the costs of chronic health issues, subsequent medical care, and in many cases the need for long-term care, like nursing care or home care.

Costs and Statistics of Needing Care

Unfortunately, there are many misconceptions about the costs, payment, and need for long-term care. According to the 2015 Genworth Financial Cost of Care Survey, the national average cost of nursing care is $91,250/year and assisted living or personal care comes in at $43,200/year. Likewise, for those who have care come into their own home, at $22/hour nationally, you could end up paying $45,760/year for 40 hours/week of non-medical home care. Most of these costs will be paid out-of-pocket or indirectly out-of-pocket through privately purchased long-term care insurance. Many people mistakenly assume Medicare and Medigap insurances cover these needs long-term; however, we know they cover 100 days or less for nursing and do not cover assisted living or non-medical home care at all. Lastly, we are living longer than ever after retirement, thus requiring more money to live on and potentially to be used for extended care. Statistically, it is going to happen to the best of us. Estimates show that 70% of people turning age 65 can expect to use some form of long-term care during their lives.

Rethinking Retirement Allocation and Regulatory Issues

So what does this all mean? First, that big shiny nest egg may not be as big as you might’ve thought. Also, we need to change the conversation and our mindset on retirement funds as we get older. Many people are aware of this dilemma, and they are taking the proper steps to ensure that need, disposable income and legacy are balanced.

Once Medicare exhausts and private funds are depleted, nursing care is then covered by Medicaid (a.k.a. Medical Assistance) for those who financially qualify. For those who are trying to manipulate or work around the system, there are some regulatory checks and balances that the Centers for Medicare & Medicaid Services (CMS) have put in place. Most notably is the 5-year look back period required when someone applies for Medicaid, which was part of the Deficit Reduction Act of 2005 (DRA). This can track back 60 months of allocations to assure no large gifts were transferred or assets or properties were sold below market value, which if uncovered, could result in a period of Medicaid ineligibility for a period equal to the amount those assets could have covered in nursing care. Therefore, this could render someone who is unable to pay privately and ineligible for Medicaid, no way to pay for their care. This is not a good place to be in. However, typically in this situation the nursing home would have to “eat” the cost, because despite having the right to ask them to leave, most facilities would not. Other implications include the nursing home taking legal action to recoup those transferred assets or invocation the Filial Responsibility Law, though rarely used, gives the power to go after family members’ own assets to pay for overdue resident balances.

Allocation Ignorance and Sheltering

In many instances older adults just don’t understand the implications and impact of “illegitimate gifting or transfer.” Recently, an older gentleman told me that he sold his home to his daughter for $1 within the last year. It was clear to see his health was declining and not unfathomable that he might need nursing care in the near future. He is a prime example where Medicaid ineligibility and the 5-year look back may provide a harsh reality for him and his daughter. I explained possible outcomes and strongly urged him to talk with an eldercare attorney to get things squared away, although, there are some estate-planning techniques out there though legal are a bit shrewd. There’s a whole industry predicated on helping adult children “shelter” a parent’s assets to keep them from having to pay privately for a nursing home.

But let’s assume someone lawfully transfers assets outside the 5-year look back period or moves money into a living trust; there are two other problems that arise. One, we put the burden on other taxpayers and the already stressed Medicaid system that will pay fully for mom’s care, while the recipient revels in the “gift” free of any financial responsibility. Secondly, if an individual is deemed eligible day-one for medical assistance, it can really limit their choice of nursing homes. Many nursing homes cap their amount of Medicaid patients, making them difficult to get in to. So it simply limits the number of nursing homes for you to choose from, typically leaving homes that are often “less desirable” as their only options.

Beyond Medicaid

Along with state-funded medical assistance for nursing care, many facilities such as Messiah Village offer benevolent or charitable care in personal care and even in independent living. Quite often in non-profit communities, it’s a part of our mission to care for residents even if they have depleted all their assets. Our benevolent care is funded by the generosity of past and present residents, families, and staff, plus many other donor sources. Applying for benevolent care follows a similar process to the Medicaid application. So essentially, we need full disclosure of usable assets to prove a resident’s financial hardship. Over the years it has been a pretty elementary process. But as healthcare costs rise and consumers become savvier, the practice of sheltering, shielding or protecting assets is becoming more prevalent. Again while this practice is legal, it begins to put a strain on systems like Medicaid and our benevolent care fund. It forces the government and us to dig deeper for financial disclosure and could limit the amount of free care we can provide. Last year alone, Messiah Village provided approximately $2.3 million in charitable care. This includes the contractual loss we absorb from the low Medicaid per diem reimbursement as well as the direct benevolent care we provide. And while most have been good stewards with their money, spent down, and will deservedly benefit from our charitable care, there are others that will receive it too, despite having manipulated the system.

Real Need Versus Manufactured Need

Medicaid and charitable care programs were inspired to care for the truly needy. Otherwise, I believe those with the financial means have an obligation to pay for their care or protect wealth with long-term care insurance, and not by sheltering it or “fooling” the system to get early eligibility. As I stated in the very beginning, I love my kids and will care and provide for them for as long as I can, but I expect them to understand and appreciate that if I need to pay for care, it may potentially deplete their inheritance.

Finding the Right Place (Part 3- Nursing Care)

So far in this three-part series, we have examined finding the right personal care home [part 1] and assisted living residence [part 2] for a loved one. Now the focus turns to nursing care, which includes skilled or intermediate nursing care, as well as rehabilitation.

Of all three levels to research this may be the most challenging and angst-ridden choice of all. Let’s face it, most people do not want to go to a nursing home, and family members can feel a great deal of guilt and trepidation during this process. At least with personal care or assisted living your parent or spouse is likely healthier and fairly independent and can embrace and even enjoy making a move. But when it comes to the point of needing nursing care, often times you may be making the primary decisions for a loved one who may be too ill or incapable of choosing on their own.

Defining Nursing Care
First, let’s clearly define nursing care. Skilled nursing provides continual daily nursing care and rehabilitation under the supervision of a physician. Examples of skilled care include physical therapy, intravenous injections, and wound care. Medicare A will pay up to a maximum of 100 days per benefit period, as long as there continues to be a skilled need within that period. Otherwise, if custodial care, like assistance with bathing, tolieting, feeding, or medication monitoring, becomes the exclusive need, it is then considered intermediate nursing care, which Medicare does not pay for. Intermediate nursing care is either private pay or covered by privately purchased long-term care insurance or by Medicaid (aka Medical Assistance) for those who qualify. And just like personal care and assisted living, the healthcare professionals involved with their care should be able to recommend whether nursing care is necessary.

A Wild and Emotional Goose Chase
First off, health care has changed and time is typically of the essence, especially when choosing a nursing home. The entire process of picking a nursing home will differ from the other two options for several reasons. First, the pace will be much faster. Most of the time with personal or assisted care, you’re not dealing with an emergency or critical placement. But with nursing, if an injury or illness occurs in the blink of an eye, the ever-shrinking time someone spends in the hospital doesn’t give you much leeway to research and choose a facility before their discharged and deemed unsafe to return home. Another issue is that you may have to negotiate or settle on a choice because of no availability, or certain facilities may not be able to meet your loved one’s needs, and in some cases insurance may influence your options. For instance, does the facility take Medicare or Medicaid? Meanwhile as you’re on this goose chase you’re likely dealing with the physical, emotional and mental complexities that you and your loved one are enduring. This is not meant to send you into a panic, but rather to provide a dose of reality that many families face after a loved one is hospitalized and or is recommended for nursing care.

If you are comfortable using a computer, which I assume you are if you are reading this, then technology can help expedite this process much faster. Just as with choosing a personal care home or assisted living, there are online resources to obtain a clear concise list of nursing homes in your area. The PA Department of Health- Nursing Care Facility Locator link provides a list county by county. It details their contact information, and you can compare the following information: non-profit versus for-profit status, number of beds, payment options, and nursing hours per resident per day. As you peruse this link, please note that the state required nursing hours per resident per day is 2.7 hours. You can also key in on the patient care and building safety inspection surveys. Medicare.gov also offers a nursing facility locater by zip code and displays the national five-star rating-system for nursing homes in your area. You can also visit eldercare.gov or call 1-800-677-1116 for more information on long-term care choices nearby.

As you begin to whittle down those choices based on the information you’ve gathered online, you can start to apply some of the previous principles to narrow the choice even further. Again to streamline the search, be sure to call for availability and ask about admission criteria and financial guidelines. Recommendations from the doctor, clergy or a social worker can at times be helpful. However, remember to ultimately make your own judgment. Next comes the all-important tour. Once you arrive for your scheduled tour, don’t be afraid to ask questions. Now is the time to ask. Also if a resident or a resident’s family allows, talk to them about the care and their experience. Take notice of your surroundings using your eyes, ears and especially your nose. Inquire about amenities on-site for your loved to go to like an activity area, gift shop, restaurant or library. Ask to talk with the activity or enrichment staff, or request an activity calendar and menu. For further questions to ask and a nursing home checklist, go to medicare.gov/NHCompare.

Once you have toured your revised list, submitted an application, and the facility has accepted your loved one and offers a bed, you will then work with their admissions department and the hospital to coordinate the sign-in and the admission itself. Be sure that you have their insurance cards and other important documents like a power of attorney and living will available for copy. And remember, this quite often is a rapidly moving process.

Plan Ahead as Much as You Can
Despite that finding nursing care is the most challenging to plan ahead for and can be a sensitive subject to discuss, be as proactive as you can be. If you recognize that a parent’s or spouse’s health is declining, doing some preliminary research can be a great help. Planning ahead also gives them a bigger role in the decision-making process, which is important in making this difficult transition. It’s also good to have several options, in case the first option has no openings. The hospital won’t let mom hang out until her first choice opens up. However, you do have the right to move her from that nursing facility to her first choice once they have an opening. Lastly, you’ll find that most facilities require an application and typically don’t have an application fee. So, if you really want get a jump on planning, submit an application ahead of time for future need. Hopefully you or your loved may never need to make that move, but if you do, you’re that much ahead of the game.

For more tips and information about choosing the right nursing home for a loved one, please contact the Coach at 717.591.7225 or email coach@messiahlifeways.org.

Financial Legacy vs. Financial Prudency

Our children are our world. For my wife and me, our priorities for my son and daughter are to love, nurture and provide for them for a lifetime. Eventually as they leave the nest, our wish for them is to grow up into caring, intelligent, resilient, successful adults. However, despite their own successes and achievements or their lack of, we will also want to leave them a legacy. Legacy comes in many forms, but in this case I am talking about a financial legacy. Big or small we want to leave something behind for them to invest, enjoy or simply supplement their financial status. Most of us would agree, it’s part of being a good parent, a way for us continue to give and support them even after we are gone.

With that said, as a parent ages and retires that idea of a leaving a legacy starts to evolve a bit. Life gets in the way, like the cost of living, health problems, and crisis can arise. However, if we are fortunate enough, we can make it through to the other side. Therefore, if we have been smart with our investments, retirement, and managing our money, hopefully there will be a sizable nest egg to live on and enjoy after retirement and subsequently pass on to our kids – right?

Here’s where all this build up is leading to. I’m not a financial expert, so I’m not necessarily focusing on the size of that nest egg, but rather how prudent and accountable we will be with that money. Upon retirement – yes we’d like to travel, buy that RV, put that addition on the house, or as mentioned earlier leave an inheritance to family upon our demise. However, there is a very vital piece missing from this spending plan. And aside from having money to live on, pay bills, taxes, and other incidentals, we need to think about chronic health issues and the subsequent medical care and in many cases the need for long-term care, like nursing care or personal care. Unfortunately, there are many misconceptions about the costs, paying for and needing long-term care. According to a 2012 Metlife Mature Market Survey the national average cost of a nursing care is $90,520/year and assisted living or personal care comes in at $42,600 annually. Furthermore, for those who need care but don’t want to move from their own home, at $21/hour nationally you could end up paying $43,680 a year for 8 hours of care per day for 5 days a week for non-medical home care services. Next, most of these costs will be directly out-of-pocket or indirectly through privately purchased long-term care insurance coverage until you deplete all those assets. Lastly, to compound these continually inflating costs is the length of time people will need long-term care. It’s great that medicine and science are helping us live longer, but one of the consequences is that we will require more money to live on because we aren’t dying 5 or 10 years after retirement. It’s more like 15 or 20.

I digress – so what’s my point? First, that big shiny nest egg may not be as big as you might think. Also we need to change the conversation and our mindset on leaving that financial legacy to our descendants. Many people are aware of this dilemma, and they taking the right and legal steps to ensure all bases are covered. They realize their first priority is to cover their own healthcare and medical needs, and then what’s leftover can go to their loved ones. However, there are some estate-planning techniques out there that while legal are a bit unsavory. There’s a whole industry predicated on helping adult children “shelter” a parent’s assets, which could eventually put the burden on other taxpayers via Medicaid (a.k.a. Medical Assistance) to pay for nursing home care if they ever need it. Fortunately, there are some fail safes in place like the five year look back period required when someone applies for Medicaid. This can track back 60 months of spending to insure no large gifts or transfer of assets or properties were sold below market value which, if uncovered, could result in a period of ineligibility for Medicaid for a period equal to the amount those assets would have paid for nursing care. Therefore, this would render someone who is unable to pay privately and not yet eligible for Medicaid no way to pay for their care. Typically in this situation the nursing home would have to “eat” the cost. Additionally, even if someone lawfully transfers assets outside the 5 year look back period and are eligible day one for medical assistance, it can still create a precarious situation. As a Medicaid patient from day one, it really limits your choice of nursing home. Many nursing homes limit their amount of Medicaid patients. So it simply limits the number of nursing homes for you to pick from.

Along with state-funded medical assistance for nursing care, many facilities such as Messiah Village offer benevolent or charitable care in personal care and even in independent living. Quite often in non-profit communities, it’s a part of our mission to care for our residents even they have depleted all their assets. Our benevolent care is funded by the generosity of Messiah Village, its residents, families, staff (past and present), plus many other donor sources. Applying for benevolent care follows a similar process to the Medicaid application. So essentially, we need full disclosure of usable assets to prove a resident’s financial hardship. Over the years it has been a pretty elementary process. But as healthcare costs rise and consumers become savvier, the practice of sheltering, shielding or protecting assets is becoming more prevalent. Again while this practice is legal it begins to put a strain on systems like Medicaid and our benevolent care fund. It forces the government and us to dig deeper for financial disclosure and could limit the amount of free care we can provide. For our fiscal year ending June 30, Messiah Village will have paid out nearly $4 million in charitable care dollars. This includes the contractual loss we absorb from the low Medicaid per diem reimbursement as well as the direct benevolent care we provide. And while most have been good stewards with their money, spent down and will deservedly benefit from our charitable care, there are others that will receive it too, despite having manipulated the system.

Programs like Medicaid and our benevolent care program were created to care for the needy. Otherwise, we have an obligation to pay for our own care or to protect our wealth with private insurance and not by sheltering it to get early eligibility. As I stated in the very beginning, I love my kids and I will care and provide for them for as long as I can, but I expect my kids to understand and for myself to remain prudent if I need tap into and use part or all of my legacy to pay for my care.

“It won’t happen to me”- Don’t bet on it.

Earlier this week I held one of my Coaching workshops entitled “Making the Move versus Aging in Place.” It’s main purpose is to help individuals or their loved ones that are struggling with the choice of moving to a retirement community or care facility as opposed to continuing to live at home as they age. I highlighted the options, costs and the pros and cons to both paths. But an underlying theme of the workshop, along with Lifeways Coaching in general, is the virtue of planning ahead and being proactive. On average people do more planning and research on a summer vacation or a car than they do on choosing a nursing home or home care agency for themselves or a loved one. However, it’s nice to know that some people are starting to get it. The day after the workshop I was so pleased to receive this great article, by Jennifer Agiesta and Lauran Neergaard, from one of the workshop attendees that echos the concern for how unprepared and in denial people really are about future care.  Thank you Terri for sharing. Please read and heed…


 

Americans in denial about long-term care

By Jennifer Agiesta and Lauran Neergaard, Associated Press

We’re in denial: Americans underestimate their chances of needing long-term care as they get older — and are taking few steps to get ready.

A new poll examined how people 40 and over are preparing for this difficult and often pricey reality of aging, and found two-thirds say they’ve done little to no planning.

In fact, 3 in 10 would rather not think about getting older at all. Only a quarter predict it’s very likely that they’ll need help getting around or caring for themselves during their senior years, according to the poll by the AP-NORC Center for Public Affairs Research.

That’s a surprise considering the poll found more than half of the 40-plus crowd already have been caregivers for an impaired relative or friend — seeing from the other side the kind of assistance they, too, may need later on.

“I didn’t think I was old. I still don’t think I’m old,” explained retired schoolteacher Malinda Bowman, 60, of Laura, Ohio.

Bowman has been a caregiver twice, first for her grandmother. Then after her father died in 2006, Bowman moved in with her mother, caring for her until her death in January. Yet Bowman has made few plans for herself.

“I guess I was focused on caring for my grandmother and mom and dad, so I didn’t really think about myself,” she said. “Everything we had was devoted to taking care of them.”

The poll found most people expect family to step up if they need long-term care — even though 6 in 10 haven’t talked with loved ones about the possibility and how they’d like it to work.

Bowman said she’s healthy now but expects to need help someday from her two grown sons. Last month, prompted by a brother’s fall and blood clot, she began the conversation by telling her youngest son about her living will and life insurance policy.

“I need to plan eventually,” she acknowledged.

Those family conversations are crucial: Even if they want to help, do your relatives have the time, money and knowhow? What starts as driving Dad to the doctor or picking up his groceries gradually can turn into feeding and bathing him, maybe even doing tasks once left to nurses such as giving injections or cleaning open wounds. If loved ones can’t do all that, can they afford to hire help? What if you no longer can live alone?

“The expectation that your family is going to be there when you need them often doesn’t mean they understand the full extent of what the job of caregiving will be,” Susan Reinhard, a nurse who directs AARP’s Public Policy Institute, said. “Your survey is pointing out a problem for not just people approaching the need for long-term care, but for family members who will be expected to take on the huge responsibility of providing care.”

Those who have been through the experience of receiving care are less apt to say they can rely on their families in times of need, the poll found.

With a rapidly aging population, more families will be facing those responsibilities. Government figures show nearly 7 in 10 Americans will need long-term care at some point after they reach age 65, whether it’s from a relative, a home health aide, assisted living or a nursing home. On average, they’ll need that care for three years.

Despite the “it won’t happen to me” reaction, the AP-NORC Center poll found half of those surveyed think just about everyone will need some assistance at some point. There are widespread misperceptions about how much care costs and who will pay for it. Nearly 60 percent of those surveyed underestimated the cost of a nursing home, which averages more than $6,700 a month.

Medicare doesn’t pay for the most common types of long-term care. Yet 37 percent of those surveyed mistakenly think it will pay for a nursing home and even more expect it to cover a home health aide when that’s only approved under certain conditions.

The harsh reality: Medicaid, the federal-state program for the poor, is the main payer of long-term care in the U.S., and to qualify seniors must have spent most of their savings and assets. But fewer than half of those polled think they’ll ever need Medicaid — even though only a third are setting aside money for later care, and just 27 percent are confident they’ll have the financial resources they’ll need.

In Cottage Grove, Ore., Police Chief Mike Grover, 64, says his retirement plan means he could afford a nursing home. And like 47 percent of those polled, he’s created an advance directive, a legal document outlining what medical care he’d want if he couldn’t communicate.

Otherwise, Grover said he hasn’t thought much about his future care needs. He knows caregiving is difficult, as he and his brother are caring for their 85-year-old mother.

Still, “until I cross that bridge, I don’t know what I would do. I hope that my kids and wife will pick the right thing,” he said. “It depends on my physical condition, because I do not want to be a burden to my children.”

The AP-NORC Center poll found widespread support for tax breaks to encourage saving for long-term care, and about half favor the government establishing a voluntary long-term care insurance program. An Obama administration attempt to create such a program ended in 2011 because it was too costly.

The older they get, the more preparations people take. Just 8 percent of 40- to 54-year-olds have done much planning for long-term care, compared with 30 percent of those 65 or older, the poll found.

Mary Pastrano, 74, of Port Orchard, Wash., has planned extensively for her future health care. She has lupus, heart problems and other conditions, and now uses a wheelchair. She also remembers her family’s financial struggles after her own father died when she was a child.

“I don’t want people to stand around and wring their hands and wonder, ‘What would Mom think was the best?'” said Pastrano, who has discussed her insurance policies, living will and care preferences with her husband and children.

Still, Pastrano wishes she and her husband had started saving earlier, during their working years.

“You never know how soon you’re going to be down,” she said. “That’s what older people have a problem understanding: You can be in your 60s and then next flat on your back. You think you’re invincible, until you can’t walk.”

The AP-NORC Center for Public Affairs Research survey was conducted Feb. 21 through March 27, with funding from the SCAN Foundation. The SCAN Foundation is an independent, nonprofit organization that supports research and other initiatives on aging and health care. The nationally representative poll involved landline and cellphone interviews with 1,019 Americans age 40 or older. It has a margin of sampling error of plus or minus 4.1 percentage point.

Here’s the direct link for this story:

http://vitals.nbcnews.com/_news/2013/04/24/17895542-americans-in-denial-about-long-term-care?lite