SURVEY MetLife MetLife Long-Term Care IQ Long-Term Care IQ Removing Myths, Reinforcing Realities September 2009 The MetLife Mature Market Institute® Established in 1997, the Mature Market Institute (MMI) is MetLife’s research organization and a recognized thought leader on the multi-dimensional and multi-generational issues of aging and longevity. MMI’s groundbreaking research, gerontology expertise, national partnerships, and educational materials work to expand the knowledge and choices for those in, approaching, or caring for those in the mature market. MMI supports MetLife’s long-standing commitment to identifying emerging issues and innovative solutions for the challenges of life. MetLife, a subsidiary of MetLife, Inc. (NYSE: MET), is a leading provider of insurance and financial services to individual and institutional customers. For more information about the MetLife Mature Market Institute, please visit: www.MatureMarketInstitute.com. Contact: 200 Park Avenue 40th Floor New York, NY 10166 MatureMarketInstitute@MetLife.com GfK Custom Research North America Headquartered in New York, GfK Custom Research North America is part of the GfK Group, the world’s fourth largest market research company. GfK Custom Research North America combines the global resources of the GfK Group with the local knowledge of North America’s leading research and consulting companies delivered by more than 700 employees in the U.S. and Canada. Editorial services provided by Joseph Finora. • Not A Deposit Or Other Obligation Of Bank • Not FDIC-Insured • Not Insured By Any Federal Government Agency • Not Issued, Guaranteed Or Underwritten By Bank Or FDIC • Not A Condition To The Provision Or Term Of Any Banking Service Or Activity • Policy Is An Obligation Of The Issuing Insurance Company © 2013 MetLife Table of Contents Introduction.............................................................................................................4 › Solving the Long-Term Care Riddle................................................................................................ 4 Executive Summary..................................................................................................5 › Overview.............................................................................................................................................. 5 › Background......................................................................................................................................... 5 › Key Findings........................................................................................................................................ 5 › Additional Learning........................................................................................................................... 6 › Summary.............................................................................................................................................. 6 Separating Myths from Realities...............................................................................7 › What Is Long-Term Care?................................................................................................................. 7 › Underestimating the Need................................................................................................................ 7 › Most Care Is Received at Home........................................................................................................ 8 › How Long-Term Care Costs Are Paid For...................................................................................... 8 › How Long-Term Care Insurance Rates Are Determined................................................................. 11 › Additional Learning. ................................................................................................... 12 Conclusion..............................................................................................................14 Methodology...........................................................................................................15 Appendix: Questions and Answers.........................................................................16 METLIFE LONG-TERM CARE IQ 3 Introduction Solving the Long-Term Care Riddle According to Greek mythology, the Sphinx, a guardian at the gates of the ancient city of Thebes, asked all passersby the same riddle: What walks on four legs in the morning, two at noon, and three in the evening? Oedipus, the King of Thebes, was the first to solve the riddle of the Sphinx by responding: “A person crawls on all fours as a baby, walks on two legs as an adult, and uses a cane in old age.” This mythic Greek riddle is a good place to start a long-term care dialogue. In reviewing the responses from the 2009 MetLife Long-Term Care IQ Survey, another riddle emerged: How is it that many of the respondents (Americans between ages 40–70) know what long-term care is and what it may cost, but most continue to be unaware of their potential need for long-term care or how they will pay for it? This study addresses the myths about long-term care and seeks to offer some clues to solve the long-term care riddle. If many know what long-term care is and how expensive it is, why do so few take any action steps to protect themselves against these expenses? 4 Executive Summary Overview In 2004 and again in 2009, the MetLife Mature Market Institute (MMI) used a nationally representative survey to measure public awareness and knowledge of long-term care issues and facts. Due to certain variations in methodology and wording, not all of the questions in the IQ are comparable. The new survey also included additional questions to provide insight into actions people are taking to plan for any potential long-term care needs. While Americans have an increased understanding of some long-term care issues since 2004, overall they did not do as well as anticipated. Only 21% scored 70% or higher on the quiz, and on average, the respondents correctly answered just over half (5.2) of the 10 quiz questions. Key Findings This year’s survey reveals: › Many respondents understand what longterm care is, and how much it costs. › More than half underestimate the need for long-term care as people age, including for themselves. › A majority do not know who pays for long-term care. › Few are taking action to protect themselves from these expenses. Background As a follow-up to the 2004 Long-Term Care IQ, the MMI conducted a similar survey in 2009 to determine whether or not awareness had improved over the five-year period. While the overall score this year (52%) is unchanged from that found in the 2004 study and results show improvement in awareness in some areas, there still remains a significant lack of understanding of long-term care issues overall. A wide range of the population ages 40–70 is unaware of its potential need for care and how to pay for it. Most are not taking appropriate steps to protect themselves from potentially catastrophic expenses. ›M ore than eight in 10 respondents (85%) understand that long-term care could be the result of a variety of causes such as Alzheimer’s disease, an accident, or a chronic or disabling condition. › Just over one-third know that most longterm care services are received in one’s home. While the number of respondents (37%) who do know this has increased since the 2004 survey (18%), there continues to be a very low overall awareness level. ›O ver four in 10 (43%) are able to correctly identify the national average monthly cost for assisted living. ›T wo-thirds (66%) are unable to identify which programs or insurance policies pay for long-term care services. ›O nly 18% know long-term care insurance rates are primarily based on age, but almost nine in 10 (87%) are aware a comprehensive policy covers care at home, in an assisted living facility, and in a nursing home. ›L ess than one-half (45%) can correctly identify how many households are caring for an adult family member or loved one. ›O ver six in 10 (64%) are aware that transferring financial assets to your family would not allow you to qualify immediately for Medicaid payment of long-term care. METLIFE LONG-TERM CARE IQ 5 Executive Summary › Fewer than four in 10 (36%) know that 60%–70% of 65-year-olds will require long-term care services at some point in their lives. Additional Learning In order to examine respondents’ behaviors and attitudes toward long-term care issues, and also to identify common traits among the respondents, additional questions not included in the 2004 survey were asked. › Just over a third (35%) of respondents believe they will need long-term care in the future. › Caregivers are more aware of some long-term care issues than non-caregivers. Almost half (47%) of those who are currently providing regular care know that most people receive services in their own home; only 37% of non-caregivers answered correctly. › Many younger respondents are delaying purchasing long-term care insurance because of competing financial obligations, but are giving up lower cost as a result. Less than one in five 40- to 49-year-olds knows that age is a primary factor in determining rates. › The number of correct answers increases by age showing that respondents who are older know this subject better than their younger counterparts. Older respondents ages 60–70 had, on average, more correct answers than those ages 40–49 (5.44 versus 4.92). › Respondents with at least a college education are more likely to have a greater number of correct answers than those with a high school education or less. College graduates had, on average, 5.68 correct answers and those with a high school education had, on average, 4.83 correct answers. 6 Summary While long-term care knowledge has increased in some areas since 2004, serious and potentially costly misconceptions remain. Many middleaged and older Americans still fail to grasp longterm care’s fundamental concepts, which sets the stage for future difficulties should their need for this type of care arise. Still others continue to underestimate the potential need for long-term care and mistakenly believe they will be covered by resources that do not pay for such care. There appears to be a lack of action among many respondents. Only 9% currently have a long-term care insurance policy, and of those who do not, just 9% are planning to purchase one at some point. Further, many do not realize that long-term care insurance rates are based on the age at purchase, and therefore postponing the purchase of a policy at earlier years can prove more costly in the long run. A gap continues to exist between knowing about the need for long-term care and taking steps to ensure coverage. Separating Myths from Realities What Is Long-Term Care? Respondents showed considerable awareness of what long-term care is and the circumstances under which it may be needed. Nearly seven in 10 (68%) correctly identified that longterm care does not refer to ongoing medical treatment at home or in a hospital, but rather ongoing assistance with daily functional tasks, such as bathing, dressing, and eating. Older respondents were more likely than younger ones to correctly define long-term care. Those ages 50–70 (74%) more often answered correctly than those ages 40–49 (60%). A large majority (85%) of respondents know that long-term care may be a result of Alzheimer’s disease, an accident, or a chronic or disabling condition. Nearly half of respondents in 2004 and 2009 (45%) correctly identified how many households are caring for an adult family member or loved one. Underestimating the Need While 60%–70% of people over age 65 will need long-term care services at some point in their lives,1 only 36% of respondents answered correctly. Over half of the respondents underestimated the actual number, with one in six (17%) who believe the proportion to be only 20%–30%. Clearly, there is a disconnect between knowing about the need for long-term care and taking steps to ensure coverage. While the need for long-term care can happen at any age, it is most likely to occur at older ages and the proportion of those 65 and older is projected to rise from about 13% of the population in 2009 to 20% in 2040, according to the U.S. Census Bureau. The changing demographics point to a need to raise awareness of long-term care issues. Percentage of People Over Age 65 Who Will Need Long-Term Care 17% 20%–30% 40%–50% 36% 60%–70% 36% CORRECT ANSWER 80%–90% 10% Question: Approximately what percent of people over age 65 will require some long-term care services at some point in their lives? Percentages do not total 100% due to rounding. 1 According to the National Clearinghouse for Long-Term Care Information (U.S. Department of Health and Human Services, 2009), about 70% of individuals over age 65 will require at least some long-term care services during their lifetime. METLIFE LONG-TERM CARE IQ 7 Separating Myths from Realities Long-Term Care Myth: Most long-term care is received in a nursing home. Long-Term Care Fact: Most long-term care is received in one’s own home. Most Care Is Received at Home More than one-third of the respondents (37%) know that most long-term care services are received at home, which is significantly more than in 2004 (18%). Interestingly, younger respondents (ages 40–49) were more likely (41%) than 60- to 70-yearolds (32%) to note correctly that long-term care is most often received in one’s own home. Older respondents were more likely to name a nursing home as the place where most receive long-term care services. This may represent a “knowledge gap” between the generations as to where long-term care is generally provided. Nearly all respondents are aware that long-term care is not administered in a hospital. Most respondents anticipating a need for long-term care would like to receive such care in their own homes either by a professional or family member. Only 25% would prefer an assisted living facility, and just 3% would choose to receive their care in a nursing home. How Long-Term Care Costs Are Paid For As long-term care costs can seriously weaken one’s ability to enjoy a financially comfortable retirement, it is surprising that many people do not understand who truly pays for long-term care. While many are all too aware of the rising cost of long-term care, a majority are unsure who pays for it. Where Is Most Long-Term Care Received? 37% In their own home In their own home CORRECT ANSWER 18% In an assisted living facility In an assisted living facility 28% 27% In a nursing home 32% 55% In a hospital 1% 0% Question: Where do most people receive long-term care services? 2009 2004 Percentages may not total 100% due to rounding. 8 28% 27% 32% In a nursing home 1% In a hospital 0% 18% 37% 2009 2004 Only one-third (34%) of respondents realize that health insurance, disability insurance, or Medicare will not pay for expenses associated with long-term care. Similarly, a large number of caregivers (76%) are unaware which insurance or programs pay for long-term care. Nearly 20% of respondents believe disability insurance will cover their long-term care costs. One-third (33%) feel Medicare/Medigap will cover them, while 14% believe their health insurance provider will do so. While Medicare/ Medigap and private health insurance may cover some of the same services that people with long-term care needs receive such as home care and care in a nursing home, they will only do so under limited circumstances such as a skilled need as defined by Medicare or the health insurance policy. An example would be services at home or in a skilled nursing facility for rehabilitation following a hip fracture. These insurances would not cover ongoing daily care needs, often referred to as “custodial care,” that are associated with a long-term care illness. Fortunately, awareness of the cost for assisted living has increased from the 2004 levels. Today, some 40% of respondents correctly noted the national monthly cost of long-term care in an assisted living community was between $2,000 and $4,999, compared to just 28% five years earlier. Half (51%) of the respondents believed the cost was actually higher. Further, for those who do not plan to purchase a long-term care insurance policy, most of them are unsure or have not thought about how to pay for these services should the need arise. This is especially true for younger respondents (ages 40–49), as over half (53%) have not considered how they would pay for long-term care. About 25% of 60- to 70-year-olds also have no plan regarding how to pay for longterm care. Overall, nearly 30% report not being sure about how to pay for long-term care, while nearly 40% admit not having thought about it. Long-Term Care Myth: Medicare, health insurance, and disability insurance pay for long-term care expenses. Long-Term Care Fact: Long-term care insurance is the only form of private insurance coverage to pay for ongoing long-term care expenses. METLIFE LONG-TERM CARE IQ 9 Separating Myths from Realities Types of Insurance That Cover Long-Term Care CORRECT ANSWER None of the above 34% Health Insurance 14% Medicare/ Medicare Supplement (Medigap) 33% Disability Insurance 19% Question: In the event that you needed extended care due to an accident or to a chronic illness, whether in your own home, in an assisted living facility, or in a nursing home, what type of insurance would pay for your expenses? Ironically, 87% of respondents correctly understand that comprehensive long-term care insurance pays for all forms of long-term care services. The repercussions resulting from the confusion as to who pays for long-term care services promise to be particularly challenging, since the majority of respondents believe other forms of insurance will pay for their long-term care. While many respondents can name which services are associated with long-term care, they are largely mistaken when it comes to identifying who will pay for it. Another long-standing myth concerns the transfer of assets in order to qualify for Medicaid, a payer of long-term care expenses for those with limited income and assets. Just under two-thirds (64%) are aware that the immediate transfer of financial assets to your family would not allow you to qualify for Medicaid payments for long-term care. Long-Term Care Myth: I can immediately qualify for Medicaid to pay for my long-term care by transferring assets to a family member. Long-Term Care Fact: When a person applies for Medicaid coverage to pay for their long-term care, the state will conduct a review, or “look-back,” of financial records over the five years prior to application to see if assets were transferred for less than fair-market value. If they were, the application can be denied. 10 Long-Term Care Myth: Family history, income, and age are all primary factors when calculating long-term care insurance. Long-Term Care Fact: Age is a primary factor in calculating long-term care insurance premiums. How Long-Term Care Insurance Rates Are Determined Understanding how long-term care rates are determined represents the greatest gap among respondents, as less than 20% correctly answered this, while the vast majority (71%) incorrectly noted that family history, income, and age are all factored into the rates. An applicant’s age is a primary factor in calculating long-term care insurance premiums. The decision to put off purchasing a long-term care insurance policy can result in paying a higher rate when they do buy a policy. The ongoing premium is calculated based on the age at which an individual enrolls for coverage. The cost of waiting can also disqualify one from receiving a more favorable rate. For example, in addition to paying a higher rate at an older age, an individual’s health may change over time. Waiting to purchase insurance may also result in a person receiving a more expensive rate because of health problems. There is also a possibility that the individual may no longer be eligible for any coverage because of health conditions. Basis of Long-Term Care Insurance Rates Age 18% CORRECT ANSWER Income Family history 9% 1% All of the above 71% Question: Long-Term Care Insurance rates are primarily based on…? Percentages do not total 100% due to rounding. METLIFE LONG-TERM CARE IQ 11 Separating Myths from Realities Additional Learning Despite awareness of some key long-term issues, there appears to be a lack of action to obtain coverage among most respondents. Only 9% currently have a long-term care insurance policy, and of those who don’t, just 9% are planning to purchase one at some point. This is despite the fact that 35% say they believe they will need long-term care services for themselves in the future. Almost half (46%) of those who are separated, widowed, or divorced have no plans to purchase a policy. Other MetLife Mature Market Institute research suggests that these individuals are most likely to be financially vulnerable should they face the need for long-term care services.2 The survey also found that two-thirds (67%) of those who do not plan to purchase longterm care insurance state that the reason is that a policy is too expensive. Their response may be due in part to the fact that only a small percentage of respondents realize that the rates are based primarily on age, pointing to their lack of awareness that rates are lower when policies are purchased at younger ages. Many of those surveyed (38%) responded that their spouse would provide for their primary long-term care needs. This was closely followed by those naming a professional caregiver as their primary provider (35%). Just 17% named their adult children and only 10% listed another family member. Older respondents (ages 50–70) were more likely to state that their care would come from a professional caregiver, not a spouse, perhaps reflecting that at later ages, a spouse may require care or be unable to provide care. More Education Needed: The long-term care industry, insurance companies, as well as the federal and state governments need to do a better job in educating the public about what it is, where it is delivered, and how individuals pay for it. 2 The MetLife Family Matters Study, MetLife Mature Market Institute, February 2008. 12 Where People Look for Long-Term Care Information 35% State educational programs 50% Federal programs 28% Municipal/community resources 61% Long-term care service providers 45% Family and friends 40% Insurance company representative 17% Financial advisor Other 5% Question: Which of the following are useful resources for you for obtaining long-term care information? Multiple responses permitted. Despite being more knowledgeable about longterm care issues, older respondents are less likely to purchase long-term care insurance than their younger counterparts. Almost half (47%) of the 60- to 70-year-olds have no plans to purchase a policy compared to 36% of those ages 40–49. Older respondents are more inclined to use personal savings than an insurance policy when it comes to long-term care (17% of those ages 60–70 compared to 5% of those ages 40–49), even in view of the significant out-of-pocket costs for long-term care. Other sources many people find useful are federal and state programs, employee benefit plans, family and friends, and insurance company representatives. Overall, the place people go to most frequently for long-term care information is long-term care service providers, such as assisted living communities, home care agencies, or nursing homes. While they may perceive providers as a useful source, it appears that people are not seeking information until they are near or in a situation of needing this type of information. METLIFE LONG-TERM CARE IQ 13 Conclusion While we may never have to answer a riddle in order to continue on a journey, chances are most people will one day need to plan for their long-term care needs and how to pay for them. Americans’ knowledge of some key components of long-term care has increased since 2004, yet there still remain serious misconceptions about the potential need for this type of care. More importantly, people need to take action to protect themselves against these expenses. › Long-term care awareness is increasing. However, it is doing so in an inconsistent manner and many misconceptions remain among the American population. › A large percentage of the population ages 40–70 is unaware of their potential need for care as well as how to pay for it. › Many erroneously think the federal government or health insurance cover longterm care expenses. Medicare, Medicare 14 Supplement Insurance, or standard health or disability insurance plans do not pay for ongoing long-term care expenses. › Many respondents believe long-term care is received in a nursing home when, in fact, most long-term care is received at home. › Respondents continue to misunderstand that age is a primary factor in calculating longterm care insurance premiums, adversely affecting their decision making about this coverage for their long-term care needs. While there have been sporadic improvements in some areas of knowledge and consistency of some misconceptions, most adults have yet to connect-the-dots about their long-term care needs, financing, income protection, and their own decision making and actions to address these issues. An important part of the solution to the long-term care riddle lies in educating the public about the realities of long-term care. Methodology During February and March 2009, the MetLife Mature Market Institute commissioned a follow-up to its 2004 national study to again measure knowledge and understanding of long-term care issues. The MetLife Long-Term Care IQ was conducted by GfK Custom Research North America. A total of 1,021 respondents ages 40–70, who were the co- or primary household financial decision makers, completed the web-based survey. Participants were members of GfK and SSI’s (Survey Sampling International) Internet panels. topic remained the same. In addition, answer options for one question were adjusted to keep pace with changes in information on the subject. The 2009 MetLife Long-Term Care IQ consisted of 10 questions—seven of which were taken from the 2004 study along with three new questions. The wording in some questions was slightly modified, although the content and The margin of error for the survey was plus or minus three percentage points. Data were weighted to be representative of the population. A demographic breakdown of participants is found below. A new feature to the 2009 MetLife Long-Term Care IQ is a set of additional questions assessing respondents’ behaviors and attitudes toward various long-term care-related issues. These questions were added to compare common traits of those who performed well on the survey and to help identify implications. Respondent Demographics Age: 40–49: 40% 50–59: 35% 60–70: 25% Household Assets: Less than $50,000: 46% $50,000–$249,999: 22% $250,000 or more: 10% Gender: Male: 49% Female: 51% Household Income: Less than $30,000: 28% $30,000–$49,999: 28% $50,000–$99,999: 27% $100,000 or more: 9% Employment Status: Full-time: 36% Part-time: 15% Not employed: 25% Retired: 24% Marital Status: Married: 57% Single: 17% Separated, widowed, or divorced: 26% Education: High school or less: 51% Some college: 18% College grad or higher: 30% Percentages may not total 100% due to rounding or non-response. METLIFE LONG-TERM CARE IQ 15 Appendix: Questions and Answers Answers Offered % Selected* IQ Questions 3 4 Ongoing medical treatment at home Chemotherapy Ongoing assistance with day-to-day activities such as bathing, dressing, or eating Alzheimer’s disease An accident Chronic or disabling conditions All of the above 1 out of 2 1 out of 5 1 out of 10 1 out of 15 Where do most people receive long-term care services? In their own home In an assisted living facility In a nursing home In a hospital What is the 2008 national average monthly base cost for assisted living? Less than $2,000 $2,000–$4,999 $5,000–$7,999 $8,000 or more True True, as long as I only transfer money to my children True, as long as I am in a nursing home 13% False 64% Medicare/ Medicare Supplement (Medigap) Disability insurance Health insurance None of the above 20%–30% 40%–50% 60%–70% 80%–90% Age Income Family history All of the above Nursing home Home care Assisted living All of the above Long-term care refers to a situation when a person needs… 1 Ongoing medical treatment in a hospital 10% The need for long-term care may be a result of… How many households are personally providing care to an adult family member or other loved one? Transferring financial assets to your family or loved ones would allow you to qualify immediately for Medicaid payment for long-term care. In the event that you needed extended care due to an accident or to a chronic illness, whether in your own home, in an assisted living facility, or in a nursing home, what type of insurance would pay for your expenses? Approximately what percent of people over age 65 will require some long-term care services at some point in their lives? Long-term care insurance rates are primarily based on… A comprehensive long-term care insurance plan covers the cost of: 2 19% 3% 2% 13% 37% 5% 15% 45% 28% 43% 33% 17% 18% 5% Percentages may not total 100% due to rounding or no response. * By 2009 MetLife Long-Term Care IQ respondents. On this page, correct answers are highlighted in blue shaded boxes. 16 7% 19% 36% 9% 3% 1% 6% 30% 32% 27% 14% 36% 1% 4% 68% 85% 9% 1% 24% 34% 10% 71% 87% Appendix continued: Additional Questions and Answers Additional Questions Answers Offered % Selected* Do you plan to purchase a long-term care insurance policy…? 1 Within the next 6 months How do you plan to pay for long-term care services if you need them in the future?* 2 Own savings or other personal financial resources Why don’t you plan on purchasing a long-term care insurance policy?* 2 If you were to need longterm care at some point during your life, who do you anticipate being the primary provider for your care needs? Do you think you will need long-term care sometime in the future? What type of care would you prefer most? 3 1% How many hours per week are spent providing this regular care? 4 Do you expect to have to provide this type of regular care in the future? 5 Which of the following are useful resources to you for obtaining long-term care information?** Unsure Medicaid Borrow money Assistance from adult children Other means Don’t know It’s too expensive I won’t need it I won’t be eligible I’m too young It’s too confusing I’m waiting for a better policy Your spouse Your adult children Other family member(s) Professional health care provider(s) Assisted living Nursing home All of the above 5–7 hours 10% 8–10 hours 17% 11–15 hours 16–20 hours More than 20 hours 33% 12% Municipal/ community resources Long-term care service providers Family and friends Insurance company representative Financial advisor Other 67% 38% Yes 19% 6% 8% 17% 65% Home care by a professional Home care by family member(s) 30% 92% Less than 2 hours 2–4 hours Yes 9% 3% 28% 3% Haven’t thought about it 39% Other 21% 35% 25% 3% 15% 6% 1 B ase: Does not currently have long-term care insurance. 2 Base: Does not plan to purchase long-term care insurance. 3 Base: Believes they will need long-term care in the future. 4 Base: Currently providing regular care to adult relative. 5 Base: Currently not providing regular care to adult relative. 8% Don’t know No 25% 75% State educational programs Federal programs 35% 7% 6% No 8% 4% 10% 1% 40% No 35% Yes 0% 51% Don’t plan to purchase one 3% 10% 2% In the next year to 5 years Over 5 years from now from now 3% 26% Are you [or your spouse/ partner] personally providing regular care to an adult relative, such as personal care (i.e., bathing, dressing, walking) or similar assistance? In the next 6 months to a year from now 50% 28% 61% 45% 40% 17% 5% Percentages may not total 100% due to rounding or no response. * By 2009 MetLife Long-Term Care IQ respondents. ** Multiple responses permitted. METLIFE LONG-TERM CARE IQ 17 18 For access to publications by the MetLife Mature Market Institute, including the consumer guide, The Essentials: Long-Term Care Insurance, please visit www.MatureMarketInstitute.com. METLIFE LONG-TERM CARE IQ 19 www.MatureMarketInstitute.com 200 Park Avenue, New York, NY MMI00205(0909) © 2013 Metropolitan Life Insurance Company L0513323355[exp0416]