Poll: Americans Want Help to Age in Place

From the National Association for Home Care & Hospice May 4, 2021

Overwhelmingly, Americans want to age in place in their own homes and communities, but want help to do so, citing assistance from Medicare as a key priority, according to a big new survey from the AP-NORC Center and The SCAN Foundation. The findings are consistent with polls done by these groups since 2013.

The “vast majority of Americans (88%) want to stay in their own home or the home of a loved one in the event they need ongoing living assistance as they age,” according to the survey. “Receiving care at their own home is the preferred option for 76%, and 11% would prefer a friend or family member’s home. Just 10% would prefer a senior community, and 2% a nursing home… The desire to age in their own home is consistent across race and ethnicity, as well as urban, suburban, and rural environments.”

The top concern for poll respondents is losing their independence.

According to the survey:

  • Support is high for government action in helping Americans pay for long-term care: 60% favor a government-administered long-term care insurance program similar to Medicare and 63% favor government funding for program to allow people with low incomes to receive care at home.
  • Americans think health insurance companies (52%), Medicare (51%), and Medicaid (41%) should have a large or very large responsibility to pay for ongoing living assistance. Just 35% think individuals and 15% think families should be responsible.
  • 51% think shoring up the Medicare trust fund should be a top priority for the Congress and the Biden administration and another 38% think it is a lower but still important priority. Just 9% think it is not an important priority or shouldn’t be done at all.
  • Common concerns about aging include losing independence as they age (67%), being alone without family or friends around them (60%), and having social needs met (57%). Many also worry about having to leave their home and move into a nursing home (53%) and about experiencing health and safety issues in a retirement community or nursing home (54%).
  • Most Americans do not feel prepared for their own care needs: 69% say they have done little or no planning and just 16% are confident they will have the financial resources they need to pay for long-term care.

Home care services are paid for out of pocket or by Medicaid or private insurance, but over half of all respondents to the poll want Medicare to have a “large” or “very large” part to play in funding long-term care. Another 36 percent say Medicare should play a lesser, but still “moderate” role in paying for home care.

“It would be a revolutionary change — a welcome one, but a revolutionary change,” NAHC President BIll Dombi told Home Health Care News last year. “We’ve long recognized that personal care services often make the difference between an individual staying home or needing an institutional care setting. So it would be quite valuable.”

NAHC and other stakeholders are supporters of Choose Home, a campaign to create a new benefit under the Medicare program to allow for care at home that is equivalent to a skilled nursing facility.

Significant majorities of Democrats favor long-term care insurance programs for poorer people, Republicans are not nearly so supportive. Big majorities of both Democrats and Republicans favor tax incentives to help purchase long-term care insurance.

Only 16 percent of Americans are very confident they will be able to afford care as they age, with women less confident than men. That may explain why, as the survey reveals, most Americans do not discuss plans to pay for long-term care.

“Thinking about their future needs for care, very few Americans have discussed their preferences about ongoing living assistance. Thirty-one percent have done so with their friends and family, and just 11% have with their doctor or other health care provider. Although older Americans are more likely to have these conversations than young people, still just 46% of Americans age 60 and older have expressed their aging preferences with family or friends and just 14% have done so with their health care provider.”