Understanding the Context for Long-Term Care Planning

Abstract

Evolving family structure and economic conditions may affect individuals' ability and willingness to plan for future long-term care (LTC) needs. We applied life course constructs to analyze focus group data from a study of family decision making about LTC insurance. Participants described how past exposure to caregiving motivated them to engage in LTC planning; in contrast, child rearing discouraged LTC planning. Perceived institutional and economic instability drove individuals to regard financial LTC planning as either a wise precaution or another risk. Perceived economic instability also shaped opinions that adult children are ill-equipped to support parents' LTC. Despite concerns about viability of social insurance programs, some participants described strategies to maximize gains from them. Changing norms around aging and family roles also affected expectations of an active older age, innovative LTC options, and limitations to adult children's involvement. Understanding life course context can inform policy efforts to encourage LTC planning.

Long-Term Care in Indonesia: The Role of Integrated Service Post for Elderly

“…LTC refers to the provision of daily service and formal and informal support to individuals with physical or cognitive limitations (Broyles, Sperber, & Voils, 2015). LTC has become a concern of the international and regional human rights treaties as well as national constitutions, including the 1966 ICESCR and the 1979 Convention on the Elimination of All Forms of Discrimination against Women (CEDAW).…”

Association of Medicaid Expansion Under the Patient Protection and Affordable Care Act With Use of Long-term Care

“…This association is important because Medicaid finances 50% of all LTC in the US, 6 and nearly two-thirds of all Medicaid spending focuses on older adults and adults with disability. 7 Furthermore, persons with disability prefer to remain in the least restrictive setting and have the right to do so by law (eg, Olmstead decision) 8 , 9 , 10 , 11 ; thus, it is important to understand how any increased access to care affects home care vs nursing home care.…”

Drivers of Long-Term Care Considerations by Persons With Cognitive Impairment

“…In our study, proximity of children was associated with consideration of family care and being married was inversely associated with consideration of formal home care. Available financial resources are associated with LTC insurance purchase (Brown & Finkelstein, 2008; Broyles et al, 2016; Schaber & Stum, 2007; Van Houtven et al, 2015); in our study, financial planning increased the likelihood that patients would consider formal home and institutional care. Our findings did not support the importance of disability/longevity factors and care alternatives related to care partner health and well-being (e.g., care partner burden/mental health) that have been shown to predict desire for institutional care (Cohen et al, 1993; Gallagher et al, 2011; Pruchno et al, 1990; Spitznagel et al, 2006; Sun et al, 2013; Wolff et al, 2018).…”

“…This study is one of the few that applies data-driven machine learning approaches to understand complex social processes that rely on input from a system of actors (e.g., patient, care partner, other family members, care providers; Brown et al, 2012; Broyles et al, 2016; Sperber et al, 2017). Specifically, a benefit of decision tree algorithms is their capacity to capture complex joint effects that are reflective of realities of LTC planning (Brown et al, 2012; Broyles et al, 2016). For example, our decision trees show that while marital status is important for considering formal home-based care, being married operates jointly with whether the patient consulted a financial planner.…”