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Kaiser Public Opinion Spotlights provide in-depth analysis of public…
Tags: 3 years, affordability, clock care, family member, good job, health care consumers, health care industry, health insurance, health insurance companies, health policy, high quality services, hmos, kaiser, kff, long term care, majorities, nursing home care, nursing homes, pharmaceutical companies, public opinion,Pages: 18
Language: english
Created: Thu Dec 6 11:38:24 2007
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Kaiser Public Opinion Spotlights provide in-depth analysis of public opinion on a variety of health care
and health policy topics. Each Spotlight uses public opinion data from Kaiser surveys and other
sources to examine current views and trends. All Spotlights available at www.kff.org/spotlight.
Updated: December 2007
The Public's Views On Long-Term Care
Most Americans (84%) have had at least some experience with nursing homes either as a
patient or a visitor. In addition, nearly seven in ten (68%) have a family member or close
friend who has been in a nursing home or received long-term care in the past 3 years.
Views On Nursing Homes
Compared with other players in the health care industry, nursing homes rank relatively low
in the share of adults who say they are doing a "good job" serving health care consumers.
While majorities say nurses (84%), doctors (69%), and hospitals (64%) do a "good job"
serving consumers, nursing homes (35%) rank below pharmaceutical companies (43%) and
just above health insurance companies (34%) and HMOs (30%).
Views on the affordability and quality of nursing home care are mixed. While more than
half (55%) of the public agrees that nursing homes provide an affordable way for people to
get round-the-clock care, nearly four in ten (37%) disagree. Similarly, while half (50%) of
the public agree that nursing homes provide high-quality services, four in ten (40%)
disagree. The vast majority of adults (86%) are concerned about the quality of nursing
home care available in the country today. In addition, nine in ten (92%) express concern
about the quality of care provided to seniors and those with disabilities who receive care in
these homes.
Indeed, the public is somewhat wary of nursing home care twice as many adults say being
in a nursing home makes people "worse off" than they were before (41%) as say that
nursing homes make people "better off" (19%). Furthermore, when asked their preference
if they required long-term care, just 4% would choose to get care in a nursing home (4%)
and 17% would choose an assisted living facility. Most (53%) would opt for care at home,
while 21% would prefer to move in with family.
While most Americans agree that nursing home staff members are concerned about the
well-being of their patients (67%), many believe nursing homes are understaffed (75%)
and have staff that are often poorly trained (63%).
2
Paying for Long-Term Care
In terms of paying for long-term care, three in ten (30%) adults believe insurance would be
the main source of funds if they or a family member needed nursing home care. Fewer say
personal savings (16%) or government programs such as Medicare or Medicaid (13%)
would be the main source. In reality, private insurance is estimated to pay for a small
share of nursing home expenses (8%), while Medicaid (46%) is the major source of
financing for nursing home care.
Few Americans report having long-term care insurance - just over two in ten (21%) adults
say they have a long-term care policy. The most commonly cited reason among those
without a policy is cost (59%). However, nearly one-third (32%) of people without long-
term care insurance say it's just not something they've ever thought about.
There is a fair amount of concern about paying for long-term care, with nearly three in ten
(28%) adults saying they are "very" worried that they won't be able to pay for nursing
home and home care services in the future. Just over one-quarter (26%) of adults say they
have given "a lot" of thought to how they will pay for long-term care, and this share
increases with age.
Government's Role In Long-Term Care
Americans see a role for government in regulating nursing home quality. About six in ten
(64%) adults agree that there is not enough government regulation of the quality of nursing
homes and almost half (48%) said nursing homes are not paid enough by the government
and other insurers.
Sources of Information About Nursing Homes
Many Americans are unsure of where to get advice and information about nursing homes
57% say they would not know where to go for advice or information if a family member
needed nursing home care. The public seems most comfortable getting information and
advice about nursing home care from personal sources. Many more say they would be
"very likely" to go to friends and family (59%) or their doctor (54%) for information,
compared with government websites (27%), community service agencies (25%),
books/reports (25%) or government programs (23%).
Click on a title below to jump to that section of the Spotlight:
Experience With Long-Term Care
Concern About Long-Term Care
Planning For Long-Term Care
Views On Benefits Of Nursing Homes
Views Of Nursing Homes In Relation To Other Industries
Views On Nursing Home Care
Perceived Quality Of Long-Term Care
Impressions Of Nursing Home Care And Staffing
Where Do Views Of Nursing Homes Come From?
Cost of Nursing Home Care
Long-Term Care Insurance
Tax Credits For Long-Term Care Insurance
Government Regulation Of Nursing Homes
Knowledge Of Government Programs
Sources Of Information About Nursing Home Care
Why Do People Rely On Medicaid To Pay For Nursing Home Care?
3
Experience With Long-Term Care
Half (50%) of the public says a family member or someone they know well has been in a
nursing home in the past 3 years. Half (53%) also says that in the past 3 years, a family
member or someone they know well has received care either at home or in another type of
facility, such as an assisted living facility, because they needed help taking care of
themselves. Nearly seven in ten (68%) say a family member or close acquaintance has
either been in a nursing home OR received long-term care in the past 3 years.
Experience With Long-Term Care
At any time during the past 3 years, was a member of your immediate family or someone you know well...
Yes No
A resident in a
50% 50%
nursing home
Receiving care at
home or in another
type of facility, such 53% 46%
as assisted living
Either in a nursing
home or at home/in 68% 31%
another type of facility
Source: KFF Update on the Public's Views of Nursing Homes and Long-Term Care Services (conducted October 110, 2007)
4
Concern About Long-Term Care
There is a fair amount of concern about paying for long-term care, with nearly three in ten
(28%) saying they are "very" worried that they won't be able to pay for nursing home and
home care services.
Middle-aged adults are more worried about paying for nursing home care than their younger
and older counterparts. More than three in ten (32%) adults ages 30-64 say they are
"very" worried about paying for nursing home care, compared with fewer than two in ten
adults ages 18-29 (18%) and just under one-quarter of seniors (24%).
Concern About Long-Term Care
How worried are you that you won't be able to pay for nursing home and home care services?
Percent "very" worried...
Very Somewhat
worried worried Total 28%
Ages 18-29 18%
25%
28%
Ages 30-49 32%
Don't
know 1% 17%
Ages 50-64 32%
29%
Not too
worried Ages 65 and
24%
over
Not at all
worried
Source: Kaiser Family Foundation Health Poll Report Survey (conducted June 2-5, 2005)
5
Planning For Long-Term Care
Just over one-quarter of Americans (26%) say they have given "a lot" of thought to how
they will pay for long-term care. Not surprisingly, the share of adults who say they have
thought about how to pay for long-term care increases with age. While just one in ten
(10%) adults ages 18-29 say they have given these plans "a lot" of thought, more than two
in ten (23%) adults ages 30-49, three in ten (33%) adults ages 50-64 and four in ten
(43%) seniors say the same.
Planning For Long-Term Care
When thinking about your financial needs in retirement, how much thought have you given to how to pay for long-
term care in a nursing home or home heath care costs not covered by Medicare?
A lot of A little No
thought thought thought
Total 26% 41% 33%
Ages 18-29 10% 37% 53%
Ages 30-49 23% 41% 36%
Ages 50-64 33% 45% 22%
Ages 65 and over 43% 41% 16%
Source: Kaiser Family Foundation Health Poll Report Survey (conducted June 2-5, 2005)
6
Views On Benefits Of Nursing Homes
Adults express mixed feelings about the benefits that nursing home care provides. Half
(50%) of adults agree that nursing homes provide high-quality services for people who need
them, but a substantial share, about four in ten (40%), disagrees. And, while slightly over
half (55%) of the public agrees that nursing homes provide an affordable way for people to
get round-the-clock care, nearly four in ten (37%) disagree with this statement (including
22% who "strongly" disagree).
Views On Benefits Of Nursing Homes
Percent who agree/disagree with the following statements ...
Strongly Somewhat Somewhat Strongly
agree agree disagree disagree
Nursing homes provide high-quality
services for people who need them 12% 38% 21% 19%
Nursing homes provide an affordable
way for people who need round-the- 21% 34% 15% 22%
clock care to be able to get it
Source: KFF Update on the Public's Views of Nursing Homes and Long-Term Care Services (conducted October 110, 2007)
7
Views Of Nursing Homes In Relation To Other Industries
Compared with other players in the health care industry, nursing homes rank relatively low
in terms of the share of adults who say they are doing a "good job" serving health care
consumers. A large majority of the public say nurses (84%) are doing a "good job" serving
consumers, and somewhat smaller majorities say the same about doctors (69%) and
hospitals (64%).
Fewer adults say pharmaceutical companies (43%) do a "good job" serving health care
consumers, and fewer still say nursing homes (35%), health insurance companies (34%),
and HMOs (30%) do a "good job".
Views Of Nursing Homes In Relation To Other Industries
Percent who say each of the following is doing a "good job" serving health care consumers...
Nurses 84%
Doctors 69%
Hospitals 64%
Pharmaceutical or drug companies 43%
Nursing homes 35%
Health insurance companies 34%
HMOs/managed care plans 30%
Source: Kaiser Family Foundation Health Poll Report Survey (conducted June 2-5, 2005)
8
Views On Nursing Home Care
The public is wary of whether nursing home care benefits patients. Twice as many adults
say being in a nursing home makes people "worse off" than they were before (41%), as say
that nursing homes make people "better off" (19%). Although, almost one-quarter (23%)
of adults believe being in a nursing home doesn't make much difference in patients' well-
being.
Furthermore, few people say they would choose to get care in a nursing home when given
multiple options. Only 4% of adults say when they get older, if they are unable to care for
themselves for an extended period of time, that they would prefer to get care in a nursing
home, while nearly two in ten (17%) would prefer to move into an assisted living facility.
Over half (53%) say they would prefer to receive care in their own homes, and two in ten
(21%) would prefer to move in with family.
Views On Nursing Home Care
For most people who move into a nursing home, When you get older, if you become unable to care for
do you think being in the nursing home makes yourself for an extended period of time, which of the
them better or worse off than they were before, or following would you prefer? (2007)
doesn't it make much difference? (2005)
Better Worse Receive care
off off in your home Move in
with family
41%
21%
19%
53%
17%
17%
23%
Move into an
Don't assisted living
know No facility
difference None/Other/ 4% 4%
Don't know Move into a
nursing home
Sources: Kaiser Family Foundation Health Poll Report Survey (conducted June 2-5, 2005);
KFF Update on the Public's Views of Nursing Homes and Long-Term Care Services (conducted October 110, 2007)
9
Perceived Quality Of Long-Term Care
The vast majority of adults (86%) are concerned about the quality of nursing home care
available in the country today, including half (51%) who say they are "very" concerned.
Similarly, when asked about seniors and people with disabilities who live at home and need
help caring for themselves, nine in ten (92%) adults say they are concerned about the
quality of care provided to these groups, including nearly six in ten (59%) who say they are
"very" concerned.
Furthermore, three in ten (31%) say the quality of nursing homes has gotten worse over
the past five years twice as many as those who say it has gotten better (14%). About
one-third (32%) say quality has stayed the same in the past five years.
Perceived Quality Of Long-Term Care
How concerned are you, if at all, about the quality of...? During the past five years, do you think that the
quality of nursing homes in this country has...
Very Somewhat Not too/Not at all
concerned concerned concerned Gotten
worse
Nursing home Gotten
care available better 31%
in this country 51% 35% 12%
14%
today
Care provided to 32%
24%
seniors and people 59% 33% 7% Don't
with disabilities know
living at home
Stayed about
the same
Source: KFF Update on the Public's Views of Nursing Homes and Long-Term Care Services (conducted October 110, 2007)
10
Impressions Of Nursing Home Care And Staffing
Most Americans believe the staff of nursing homes are concerned for residents' well-being
(67% agree). Despite their perception, just under half (46%) agree that nursing homes are
a decent place to stay, with fewer than one in ten (8%) who "strongly" agree, while a
similar share (44%) disagree that they are a decent place to stay. Many Americans also say
nursing homes are understaffed (75%) and staff are often poorly trained (63%).
Impressions Of Nursing Home Care And Staffing
Percent who agree ... Strongly Somewhat Somewhat Strongly
agree agree disagree disagree
Nursing homes don't have enough staff 53% 22% 8% 4%
The staff at nursing homes are often poorly trained 35% 28% 16% 8%
Nursing homes have staff who are concerned
19% 48% 13% 12%
about the well-being of their patients
Nursing homes are a decent place to stay 8% 38% 21% 23%
Source: KFF Update on the Public's Views of Nursing Homes and Long-Term Care Services (conducted October 110, 2007)
11
Where Do Views Of Nursing Homes Come From?
The public's views on nursing homes come mainly from personal experience or the
experience of friends and family. Nearly three-quarters of adults say their impressions of
nursing homes in this country are based mainly on the experiences of friends and family
(43%) or their own experience (31%). Just over two in ten (21%) say they rely mainly on
information from media sources such as TV and newspapers. Indeed, many people have
had first-hand experience with nursing homes, since over eight in ten (84%) say they have
been a patient or a visitor in a nursing home.
Where Do Views Of Nursing Homes Come From?
Percent who say their impression of nursing homes in Have you ever been in a nursing home, either
this country is based mainly on... as a patient or as a visitor?
Experience of
friends and family
Yes
Own
experience
43%
31%
84% 16% No
21%
5%
Other/ Information from television,
Don't know radio, or newspapers and
other media
Source: Kaiser Family Foundation Health Poll Report Survey (conducted June 2-5, 2005)
12
Cost Of Nursing Home Care
More than four in ten Americans correctly guess that one year in a nursing home costs
between $60,000 (26%) and $80,000 (18%) per year (national average for a private room
is approximately $70,000/year1). About one-third of the public underestimate the cost
(26% say $40,000 a year and 6% guess $20,000) and 16% overestimate that a year of
nursing home care would cost about $100,000.
Three in ten (30%) adults believe that insurance would be the main source of funds to pay
for nursing home care if they or a family member needed it. Fewer say personal savings
(16%) or government programs such as Medicare or Medicaid (13%) would be the main
source. Very few say family (3%) or Social Security (2%) would pay nursing home bills.
Three in ten (30%) Americans don't know or refuse to say how they would pay for long-
term care if they or a family member had to go to a nursing home.
In fact, Medicaid is the largest source of financing for nursing home care, paying almost half
(46%) of nursing home expenses, while private insurance pays for just 8%. More than one-
quarter of nursing home expenses (28%) are paid out-of-pocket.2
Cost Of Nursing Home Care
Which of the following do you think comes closest If you or a family member had a long term illness or
to what one year in a nursing home would cost? disability and had to go into a nursing home, how
*National average approx $70,000/year would the bill mainly be paid? (OPEN-ENDED)
$20,000 6% Insurance 30%
$40,000 26% Self/Savings 16%
Medicare/Medicaid/Gov't 13%
$60,000 26%
Family 3%
$80,000 18%
Social Security 2%
$100,000 16%
Other 7%
Don't know/Refused 7%
Don't know/Refused 30%
Source: Kaiser Family Foundation National Survey on the Source: Kaiser Family Foundation Health Poll Report Survey
Public's Views About Medicaid (conducted April-May 2005) (conducted June 2-5, 2005)
1
Kaiser Family Foundation, Health Care and the 2004 Election: Long-Term Care 2004
2
Kaiser Commission on Medicaid and the Uninsured, Medicaid and Long-Term Care, March 2005
13
Long-Term Care Insurance
Just over two in ten (21%) adults say they had a long-term care insurance policy, while
nearly seven in ten (68%) say they do not.
The most commonly cited reason among those without a policy is cost. Nearly six in ten
(59%) adults without a long-term care policy say the cost was a major reason they don't
have a policy. Around three in ten (32%) admit long-term care was just not something
they think about, while about the same share (30%) say the policies don't cover enough of
the expense of long-term care.
About one-quarter (24%) of those without long-term care insurance expect that their family
will take care of their long-term care needs. And about two in ten say a major reason they
don't have long-term care insurance is that Medicare (23%) or Medicaid (21%) will cover
the cost of care.
Long-Term Care Insurance
Do you have a private long-term care insurance Of the 68% who say they do NOT have long-term
policy, (insurance that pays for nursing home and care insurance, percent who say each of the following
home care services over a long period of time? is a major reason why not...
The policies cost too much 59%
No
Yes
It's not something you ever
32%
thought about
21%
The policies don't cover
30%
enough of the expenses
68%
Family will take care of
24%
11% your long-term care needs
Don't
know Medicare will cover your
long-term care costs 23%
Medicaid will cover your
long-term care costs 21%
Source: Kaiser Family Foundation Health Poll Report Survey (conducted June 2-5, 2005)
14
Tax Credits For Long-Term Care Insurance
The public is mixed on whether a federal tax-credit would encourage them to buy long-term
care insurance. About half (48%) say a tax credit would make them more likely to buy a
policy, while the same share (48%) say it would not.
Younger adults appear to be more encouraged by the prospect of a tax credit over half
(51%) of adults ages 18-64 say a tax credit would make them more likely to purchase long-
term care insurance, while just over one-third (34%) of seniors say the same.
Tax Credits For Long-term Care Insurance
If the federal government were to give you a tax deduction or tax credit, would this make you more likely to
purchase long-term care insurance, or wouldn't it make any difference?
Yes No Don't know
Total 48% 48% 4%
Ages 18-64 51% 47% 2%
Ages 65 and over 34% 55% 10%
Source: Kaiser Family Foundation Health Poll Report Survey (conducted June 2-5, 2005)
15
Government Regulation Of Nursing Homes
Many adults believe the government is not doing enough to regulate the quality of nursing
homes. Over six in ten (64%) adults agree that there is not enough government regulation
of the quality of nursing homes (19% disagree with this statement), and nearly six in ten
(59%) say the government is not enforcing quality standards for nursing homes (22%
disagree).
Almost one-half (48%) of the public says nursing homes are not paid enough by the
government and other insurers, while one-quarter disagrees (26%). More than one-quarter
(26%) aren't sure whether nursing homes should be paid more or not.
Government Regulation Of Nursing Homes
Percent who agree/disagree with the following statements ...
Agree Disagree Don't know
There is not enough government regulation
of the quality of nursing homes (2007) 64% 19% 16%
Government is not enforcing quality
59% 22% 18%
standards for nursing homes (2005)
Nursing homes are not paid enough
money by Medicare, Medicaid, and 48% 26% 26%
other insurers (2005)
Sources: KFF Update on the Public's Views of Nursing Homes and Long-Term Care Services (conducted October 110, 2007);
Kaiser Family Foundation Health Poll Report Survey (conducted June 2-5, 2005)
16
Knowledge Of Government Programs
Fewer than four in ten (38%) adults are able to correctly identify Medicaid as the primary
source of health insurance for low-income and people who need long-term care. Many
believe Medicare (32%) is main source of insurance for these groups, while 14% say some
other program, and 17% don't know.
Knowledge Of Government Programs
Which of the following government programs is the primary source of health insurance for low-income people
who need nursing home care or home care over a long period of time... (*Correct answer)
Medicare Medicaid*
38%
32%
17% 14%
Don't
know Other program
Source: Kaiser Family Foundation National Survey on the Public's Views About Medicaid (conducted April-May 2005)
17
Sources Of Information About Nursing Home Care
Many Americans are unsure of where they would go to get advice and information about
nursing homes. Nearly six in ten (57%) say they would not know where to go for advice or
information if a family member needed nursing home care; about four in ten (41%) say
they would know where to go.
The public seems most comfortable getting information and advice about nursing home care
from personal sources. About six in ten (59%) say they would be "very likely" to go to
friends and family for information or advice about nursing home care, and more than five in
ten (54%) say they would be "very likely" to rely on their doctor.
Around one-quarter of the public say they would be "very likely" to get information from
government websites (27%), from community service agencies (25%), books or reports
(25%) or government programs (23%).
Sources Of Information About Nursing Home Care
If you or a family member needed nursing home, Percent who say they would be "very likely" to go to each
do you know where you would go for advice or of the following for advice or information about nursing
information? home care...
Friends or family
Yes, know 59%
No, not members
where to sure where
go to go
Your doctor 54%
Information on the Internet
41% from government agencies 27%
57%
A community service
25%
agency
Books or reports on how to
choose these services 25%
2%
Government programs that deal
Don't know 23%
with problems of the aging
Source: Kaiser Family Foundation Health Poll Report Survey (conducted June 2-5, 2005)
18
Why Do People Rely On Medicaid To Pay For Nursing Home Care?
When asked about some of the reasons why people might rely on Medicaid to pay their
nursing home bills, much of the public says that people not having family support to pay
their bills (80%) is a major reason, as well as people not having long-term care insurance
(79%), or not having other insurance that covers nursing home care (76%).
About two-thirds of people say that Medicare not paying for long-term care (68%) is a
major reason, and that people haven't planned ahead to pay their own bills (65%). And
fewer adults believe that people are dependent on Medicaid because they don't plan on
going into a nursing home (46%).
Why Do People Rely On Medicaid To Pay For Nursing Home Care?
Percent who say each is a major reason why people rely on the Medicaid program to pay their nursing home bills...
They do not have family members who are willing or
80%
able to pay their nursing home bills
They do not have long term care insurance 79%
Their other health insurance does not cover the
76%
cost of nursing homes
Because Medicare does not pay for long term health
care costs 68%
They have not planned ahead, so they do not have
65%
the money to pay for their own bills
They planned on staying at home and not going
46%
into a nursing home
Source: Kaiser Family Foundation National Survey on the Public's Views About Medicaid (conducted April-May 2005)