Long-term care is when someone needs assistance with physical needs over an extended period, including taking medication, bathing, going to the bathroom, cleaning around the house, or transportation to doctor appointments. According to data from the U.S. Department of Health and Human Services, 70% of Americans over the age of 65 will require long-term care.
With a high chance of requiring long-term care post-retirement, it is important to start planning for the future. Accessibility and affordability for long-term care can vary across state borders, making it tricky to find the perfect spot if you are looking to relocate at some point after you retire.
The U.S. Centers for Medicare and Medicaid Services says Medicare and most health insurance plans don’t pay for long-term care. Medicare will only cover up to 100 days of a skilled nursing facility, with days 20 through 100 requiring co-pays. Instead, these long-term care services are provided through Medicaid or by private long-term insurance plans.
According to data from the U.S. Department of Health and Human Services, 70% of Americans over the age of 65 will require long-term care.
Kali Thomas, Ph.D., is the Associate Director of Health Services Research at the Center for Equity in Aging at Johns Hopkins University. She notes what differentiates states in their long-term care is their investment in aging programs and services.
Title III under the Older Americans Act (OAA) includes provisions for state matching funds. It encourages states to spend more on services from older Americans to receive more federal contributions. As expected, states that spend money on these services provide better long-term care resources.
"I have conducted research that shows states that increased spending on their personal care services funded through Title III, as well as their home-delivered meals, 'Meals on Wheels service' — saw a reduction in the population of low care residents in nursing homes who could be cared for in the community," Thomas says. "States have discretion with how much money they contribute to their aging and disability network services and that influences the kind of care people receive."
In many cases, financial well-being dictates one’s ability to provide long-term care. Some older middle-class Americans have "Medicaid spend-down," which occurs when an older adult makes more than the Medicaid income limit, but the state allows a person to subtract non-medical expenses from their income in order to qualify.
"If you are rich, you can buy whatever you need, and if you are poor and you qualify for Medicaid, then you have access to Medicaid’s long-term services and supports," Thomas explains to Healthnews. "If you fall anywhere in the middle and need long-term care, you will likely end up quickly exhausting resources paying for that care and completely impoverishing yourself before you qualify for Medicaid."
Thomas points to the AARP’s Long Term Services and Supports State Scorecard as a useful tool to understand the efficiency of each state’s long-term care resources. One of those five elements AARP used to grade states was affordability and access. Indicators contributing to this score were home care and nursing home costs, long-term care insurance, Aging and Disability Resource Center/No Wrong Door functions, Medicaid for low-income Americans with disabilities, Medicaid buy-in, and Medicaid HCBS presumptive eligibility.
Washington state and Washington D.C. were the only parts of the country to receive tier-one scores for affordability and access. Large states like California and Texas ranked toward the middle of the pack, sitting at 30th and 22nd, respectively. Meanwhile, Florida, the country's third-largest state, ranked 44th in the category. New York sat just outside the top ten at number 11.
Along with affordability and access to long-term care, the AARP graded states on four other elements including choice of setting and provider, safety and quality, support for family caregivers, and community integration.
Best states for long-term care according to AARP:
- District of Columbia (Washington D.C.)
Worst states for long-term care according to AARP:
- West Virginia
- South Carolina
Although each state may vary in its long-term care, and some may provide better resources than others, Thomas cites planning for aging as the most important step for having long-term care needs fulfilled.
I think it matters less where you are and more about planning and having conversations and being thoughtful. People can cobble together things they need, but you don’t want to be doing that in a time of crisis. You want to be having these conversations early and often. The most important thing we can do is push for a national dialogue around the topic and normalize the conversation around aging and planning for services as we age.- Thomas
Planning for long-term care also helps alleviate the pressure on family members, who are often likely to provide caregiving. In March, the AARP revealed family caregivers provide $600 billion in unpaid care across the U.S.
The U.S. Centers for Disease Control and Prevention lists high blood pressure, Alzheimer's disease or other dementias, and heart disease as the top three chronic conditions present in long-term care residents. The NIH says those with Alzheimer’s disease should look for long-term care options as soon as possible. LongTermCare.gov provides more information on long-term care needs and available benefits for those seeking options.