Long-Term Carein Connecticut:ASurvey

Long-Term Carein Connecticut:ASurvey ofaarpmembers April2008

Long-Term Care in Connecticut: A Survey of AARP Members Report Prepared by Katherine Bridges Copyright 2008 AARP Knowledge Management 601 E Street NW Washington, DC 20049 http://www.aarp.org/research/ Reprinting with Permission

AARP is a nonprofit, nonpartisan membership organization that helps people 50+ have independence, choice and control in ways that are beneficial and affordable to them and society as a whole. AARP does not endorse candidates for public office or make contributions to either political campaigns or candidates. We produce AARP The Magazine, published bimonthly; AARP Bulletin, our monthly newspaper; AARP Segunda Juventud, our bimonthly magazine in Spanish and English; NRTA Live & Learn, our quarterly newsletter for 50+ educators; and our website, AARP.org. AARP Foundation is an affiliated charity that provides security, protection, and empowerment to older persons in need with support from thousands of volunteers, donors, and sponsors. We have staffed offices in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. Acknowledgements AARP staff from the Connecticut State Office, State Affairs, and Knowledge Management contributed to the design and implementation of this study. Special thanks go to AARP staff including John Erlinghauser and Claudio Gaultieri, AARP s Connecticut State Office; Donna Delano-Neuworth, State Affairs; Rachelle Cummins, Darlene Matthews and Jennifer Leslie, Knowledge Management. Thanks also go to Michael Schuster, Office of General Counsel, for his review of the report. FGI Research insured timely and high quality data preparation. Joanne Binette, AARP Knowledge Management, managed all aspects of the project. Katherine Bridges wrote the report. For more information, contact Katherine Bridges at (202) 434-6329.

Survey Summary AARP Connecticut members are concerned about long-term care access and affordability: they want a system that is affordable, easy to navigate, and will provide services at home. One of the significant barriers to accessing long-term care services is its fragmented delivery and payment system. The Federal Government recognizes this issue and has developed a grant program to help streamline information and application for services. In 2003, federal funding allowed for development of the first grants for the Aging and Disability Resource Centers, programs committed to developing single points of entry for making service delivery faster, application simpler, and information dissemination more efficient. Currently, Connecticut is considering implementation of such a program. AARP s Connecticut state office, in an effort to determine the support for developing a single point of entry system, as well as to learn more about its members opinions and concerns about long-term care conducted a mail survey of members in the state between October 22 and November 19, 2007. The survey specifically explored respondents preferences of where to receive long-term care services, their confidence in being able to find and afford these services, and their support for candidates who work to make home- and community-based long-term care services more available for those who want to remain at home for as long as possible. This survey of 755 AARP members found that: Two out of three Connecticut AARP members want to receive long-term care services in their own homes. Importantly, about three-quarters say that they would be more likely to vote for a candidate for state office who supports providing more homeand community-based services to allow people to stay at home for as long as possible. Most Connecticut AARP members are not they will be able to afford longterm care and are very concerned about being able to afford these services. More than four out of five members think it should be either a top or high priority for Connecticut to ensure that older persons and persons with disabilities have affordable long-term care choices. Connecticut members believe it is important to have a central place to get information and help applying for all types of long-term care services, and support the state developing a system that would allow them to do so. Currently, only onequarter of members say they are they would know how to find long-term care services if they were needed. Long-term care is an issue that impacts and concerns many Connecticut AARP members. Members want to have the choice of affordable long-term care services that will allow them to stay in their homes for as long as possible. Given their strong preference for in-home long-term care options, their concern about affordability, and their desire for having a single point for finding information and accessing services, Connecticut policymakers should work to improve the long-term care system to address these issues. Long-Term Care in Connecticut: A Survey of AARP Members 1

Findings Connecticut AARP members overwhelmingly prefer to receive long-term care in their own homes and say they would be more likely to vote for a candidate who would work to make this happen. If long-term care was needed for themselves or their families, six in ten Connecticut AARP Members want to have this care provided by family, friends, and personal care aides. Notably, one in five would prefer to receive care in a residential setting such as an assisted living facility. Very few would prefer to receive care in a nursing home. At home 59% Preferred Long-Term Care Setting (n = 755) Assisted living 21% Not sure/ refused 19% Nursing home 1% To further this point, three-quarters (74%) of Connecticut AARP members say they would be more likely to vote for a candidate for state office who supported providing more home- and community-based services to allow people to stay in their homes as long as possible. A majority of Connecticut AARP members say they or a family member are likely to need long-term care services in the next five years. Nearly three in ten Connecticut AARP Members say they or a family member are extremely or very likely to need long-term care services in the next five years while another quarter say they are somewhat likely to need this type of care. Likelihood of Needing Long-Term Care Services in the Next Five Years (n = 755) Very likely 16% Extremely likely 12% likely 27% Not at all likely 7% Not very likely 24% Not sure/ refused 14% Long-Term Care in Connecticut: A Survey of AARP Members 2

Most Connecticut AARP Members are not they will be able to afford long-term care for themselves or their family and are very concerned about being able to afford these services. Currently, the cost of long-term care services can vary greatly depending on a person s needs. For example, in Connecticut, the average annual cost of having a home health aide provide care for 10 hours a week is approximately $20,000. 1 Assisted living averages $42,000 a year in the State, while care in a nursing home costs about $109,000 a year. 2 Survey respondents were asked how they are about being able to afford long-term care services for themselves or for their family. More than half say they are not very or not at all about being able to afford long-term care services for themselves or their family members for one year. This lack of confidence is shared by seventy percent of members when considering having to pay these costs for five years. Confidence in Being Able to Afford Long-Term Care for 1 Year (n=755) Confidence in Being Able to Afford Long-Term Care for 5 Years (n=755) Not at all 31% Extremely 7% Very 10% Not at all 46% Extremely 3% Very 6% Not very 21% Not sure/ refused 9% 22% Not very 23% 13% Not sure/ refused 9% Considering the fact that only one in five members (20%) report that they have long-term care insurance coverage to help with these high costs, it is not surprising that two out of three Connecticut members are extremely (29%) or very (33%) concerned about being able to afford long-term care services for themselves or family members should the need arise. Moreover, these opinions are aligned with the high percentage of members that think it should be either a top (43%) or high (40%) priority for Connecticut to ensure that older persons and persons with disabilities have affordable long-term care choices. 1 Metlife Mature Market Institute (September, 2007). The Metlife Market Survey of Adult Day Services & Home Care Costs.: http://www.metlife.com/applications/corporate/wps/cda/pagegenerator/0,4132,p8895,00.html 2 Metlife Mature Market Institute (October, 2007). The Metlife Market Survey of Nursing Home & Assisted Living Costs.: http://www.metlife.com/applications/corporate/wps/cda/pagegenerator/0,4132,p8895,00.html Long-Term Care in Connecticut: A Survey of AARP Members 3

Relatively few AARP members feel they are well-informed about home- and community-based long-term care services, and only a quarter are they would know how to find services in their community. Only 15 percent of members say they are well-informed about long-term care services provided at home and in the community. Mostly members are somewhat, not very, or not at all informed about these services. More importantly, confidence in knowing how to find services in the community are lacking with only one-quarter saying they are they would know how to find such services if they were needed. Most often members say they would rely on their physicians (38%) for such information, and many would rely on families and friends (25%). How Well Informed Members Feel They Are About Home and Community-Based Services (n=755) Not very informed 28% Not at all informed 12% Extremely informed 4% Very informed 11% Confidence in Being Able to Find Community Long-Term Care Services if Needed (n=755) Not very 19% Not at all 8% Extremely 8% Very 18% Not sure/ refused 9% informed 40% Not sure/ refused 9% 38% Nearly all Connecticut members believe it is important to have a central place to get information and help applying for all types of long-term care services, and support the state developing such a system. Given the level of confidence and knowledge about finding services, it is validating to see that more than four in five members say that it is extremely or very important to have a central place where they could get information or referrals for all types of long-term care services both government and private and where they could learn about and apply for these services and benefits. Accordingly, 84 percent of members support the State establishing such a system. Importance of Having a Central Place for Information and Referrals (n=755) Importance of Having a Central Place to Learn About and Apply for Services (n=755) Extremely important 50% Very important 33% Extremely important 53% Very important 29% Not very/not at all important 2% Not sure/ refused 4% important 8% Not very/not at all important 1% Not sure/ refused 9% important 8% Long-Term Care in Connecticut: A Survey of AARP Members 4

Methodology This mail survey explores the opinions and experiences of AARP Connecticut members on health and long-term care. AARP conducted the 2007 Connecticut Member Survey between October 22 and November 19, 2007. Three separate samples were randomly selected from AARP s membership database: 2,000 members statewide and an additional 1,500 African American members and 1,500 Hispanic members in the state. Members were selected proportionate to each of three age groups: 50-59, 60-74, and 75+. Each selected member received a pre-notification postcard, the survey itself, a reminder postcard, and a second survey. From the statewide sample, 755 members returned the survey, for a response rate of 40 percent. The sampling error for this survey sample is +/- 3.6 percent. 3 From the African American sample, 433 surveys were returned for a response rate of 29 percent and a sampling error of +/- 4.8 percent. From the Hispanic sample, 425 surveys were returned for a response rate of 28 percent and a sampling error of +/- 4.9 percent. The data for all three samples are weighted by age group to represent the AARP Connecticut member population. This report contains the results of the long-term care portion of the survey with the statewide sample. The results of the health care questions are contained in a separate report, as are those for each of the samples of African American members and Hispanic members. 3 This means that in 95 out of 100 samples of this size, the results obtained in the sample would fall in a range of about 3.6 percentage points of what would have been obtained if every eligible AARP member household in Connecticut had been surveyed. Long-Term Care in Connecticut: A Survey of AARP Members 5

Respondent Profile Most Connecticut AARP Members report being in good to excellent health. How Members Rate Their Overall Health (n=755) Excellent 13% Very good 34% No answer 6% Poor 2% Fair 13% Good 32% More than two out of three Connecticut AARP Members say they always vote and another one in five say they do so most of the time. Three-quarters are extremely (41%) or very (34%) interested in state government activities that affect residents age 50 and older. Voting Frequency (n=755) Interest in State Government Activities (n=755) Always 68% Most of the time 17% Extremely interested 41% Very interested 34% Not sure/ no response 3% Never 3% Some of the time 5% Seldom 4% Not sure/ no response 2% Not very/ Not at all interested 4% interested 18% Long-Term Care in Connecticut: A Survey of AARP Members 6

Age Respondent Demographics (n=755) 50-59 60-69 26% 30% 70+ 37% Gender Female Male 46% 49% Income <$20K 14% $20K-<$50K 28% 50K+ 45% Employment Employed 40% Retired 50% Not Working 5% Education High school or less 33% Some college 25% College grad+ 35% Marital Status Married 53% Widowed Other 19% 20% 0% 20% 40% 60% 80% 100% Long-Term Care in Connecticut: A Survey of AARP Members 7

Annotated Questionnaire Long-Term Care in Connecticut: A Survey of AARP Members 8

2007 AARP Connecticut Health Care Survey n=755 AARP Members Sampling error: +/-3.6% Health Care Services 1. How satisfied are you with the quality of health care in Connecticut? 27% Very satisfied 39% satisfied 13% Neither satisfied nor dissatisfied 10% dissatisfied 5% Very dissatisfied 6% Missing / No Answer 2. Do you think the quality of health care in Connecticut is better than it was five years ago, worse than it was five years ago, or has it stayed about the same? 19% Better 55% Stayed the same 19% Worse 6% Missing / No Answer 3. How worried are you about each of the following? Extremely worried Very worried worried Not very worried Not at all worried Missing / No Answer a. Having to pay more for your health care.. 35% 28% 23% 6% 3% 5% b. Not being able to afford the health care services you think you need... 27% 23% 26% 13% 5% 6% c. Not being able to afford the prescription drugs you need... 26% 22% 26% 14% 7% 6% d. The quality of health care services you receive getting worse... 12% 18% 30% 26% 9% 6% e. Finding a health care provider that is conveniently located... 7% 11% 22% 38% 16% 6% f. Finding a health care provider that accepts your insurance... 12% 14% 25% 28% 14% 8% g. Not being able to pay for the costs associated with a major illness or injury... 31% 20% 25% 12% 6% 7% h. Your family, such as your children and grandchildren, not being able to have affordable and accessible healthcare... 31% 24% 23% 9% 6% 7% Long-Term Care in Connecticut: A Survey of AARP Members 9

4. How important do you think it is for the State of Connecticut to make health care more affordable to all residents? 56% Extremely important 29% Very important 9% important 2% Not very important 1% Not at all important 3% Missing / No Answer 5. How important do you think it is for the State of Connecticut to reduce the number of residents without health care coverage? 46% Extremely important 33% Very important 12% important 3% Not very important 2% Not at all important 4% Missing / No Answer 6. How strongly do you agree or disagree that all Connecticut residents should have access to affordable and adequate health care coverage? 71% Strongly agree 17% agree 5% Neither agree nor disagree 2% disagree 1% Strongly disagree 4% Missing / No Answer 7. How strongly do you agree or disagree that each of the following groups should contribute to a system so that everyone can have basic health care coverage? Strongly agree agree Neither agree nor disagree disagree Strongly disagree Missing / No Answer a. Employers... 55% 25% 6% 2% 2% 10% b. Employees... 35% 34% 9% 6% 3% 14% c. Individuals.... 32% 29% 13% 7% 5% 14% d. Government... 59% 19% 4% 5% 4% 9% 8. Would you be more or less likely to vote for a candidate for public office if he or she supported the development of a health care system that made available the same basic coverage to all Connecticut residents, or would it not make a difference in how you vote? 63% More likely to vote for candidate 25% Would not make a difference in voting choice 8% Less likely to vote for candidate 5% Missing / No Answer Long-Term Care in Connecticut: A Survey of AARP Members 10

9. If the State of Connecticut made changes to the health care system, how strongly would you support or oppose each of the following proposals to do so? a. Consolidate all the money and resources now being spent by employers, individuals, government and insurance companies to operate the current health insurance system and replace it with a new system, administered entirely by state government and covering all Connecticut residents. This would require all residents to give up their current health insurance plan and enroll in the new state government plan but would not affect those on Medicare... b. Require all employers with 20 or more employees to provide health insurance for their full-time workers, or be required to pay into a state fund that Strongly support support Neither favor nor oppose oppose Strongly oppose Missing / No Answer 15% 19% 17% 14% 26% 9% 39% 32% 11% 4% 5% 9% would provide insurance for their employees... c. Expand the eligibility of existing state government health insurance programs for lowincome people, such as Husky, to provide coverage for more people without health coverage... 36% 33% 11% 6% 5% 10% d. Require all Municipal and State employees to be a part of one insurance pool administered by the state of Connecticut and gradually expand that pool to cover all uninsured residents.... 23% 28% 21% 8% 9% 10% e. Require every Connecticut resident to have health insurance, either from their employer or another source, and offer a program for individuals and employers to purchase health care with assistance from the state for low income individuals... 38% 29% 12% 6% 6% 9% 10. Do you have any kind of health care coverage, including health insurance or government plans such as Medicare or Medicaid? 83% Yes 6% No SKIP TO QUESTION 13 <0.5% Not sure SKIP TO QUESTION 13 10% Missing / No Answer Long-Term Care in Connecticut: A Survey of AARP Members 11

11. What is your primary source of coverage? (N=628, respondents with Health Coverage) 20% Through current employer 8% Through your spouse s employer 5% On your own, through an individual insurance policy, such as COBRA 9% Through a previous employer or spouse s previous employer (may be a retirement benefit) 1% Veterans or military benefits 1% Medicaid 35% Medicare 3% Other (please specify): 18% Missing / No Answer 12. How are you that you will be able to maintain your present level of health care coverage at an acceptable cost to you over the next five years? (N=628, respondents with Health Coverage) 9% Extremely 18% Very 34% 20% Not very 12% Not at all <0.5% Do not currently have healthcare coverage 3% Not sure 4% Missing / No Answer 13. Thinking about what you currently pay in out-of-pocket medical expenses, including insurance premiums, prescription drug costs, and co-pays, would you say this amount has 79% Increased over the past five years 2% Decreased over the past five years 14% Stayed about the same 5% Missing / No Answer 14. How much do you currently pay in out-of-pocket medical expenses, including insurance premiums, prescription drug costs, and co-pays each month? 9% Less than $50 per month 13% $50 but less than $100 per month 16% $100 but less than $200 per month 33% $200 but less than $500 per month 13% $500 but less than $1000 per month 4% $1000 or more per month 3% Nothing; do not currently pay any out-of-pocket medical expenses 2% Not sure 8% Missing / No Answer Long-Term Care in Connecticut: A Survey of AARP Members 12

15. Given your current overall financial condition, how difficult is it to pay for these monthly out-of-pocket medical expenses? 9% Extremely difficult 12% Very difficult 36% difficult 28% Not very difficult 14% Not at all difficult 2% Missing / No Answer 16. How concerned are you about the possibility of having to file for a medical bankruptcy in the next two years? 4% Extremely concerned 5% Very concerned 16% concerned 29% Not very concerned 38% Not at all concerned 7% Not sure 2% Missing / No Answer 17. Was there a time in the past two years when you needed to see a doctor but could not because of cost? 9% Yes 90% No 2% Missing / No Answer Long-Term Care Services Long-term care refers to supports and services provided over an extended period of time at home, in a community setting such as an adult day care center or assisted living facility, or in a nursing home. These supports and services are available to people of all ages who are frail, ill, or have a disability and who need help with regular daily activities such as getting dressed, bathing, preparing meals, or eating. 18. How likely is it that you or a family member may need long-term care services in the next five years? 12% Extremely likely 16% Very likely 27% likely 24% Not very likely 7% Not at all likely 12% Not sure 2% Missing / No Answer Long-Term Care in Connecticut: A Survey of AARP Members 13

19. If you or a family member needed long-term care services, how would you prefer to receive those services? [CHECK ONLY ONE] 5% Have family and friends provide all the care at home 18% Have care provided at home by a personal care aide 35% Have care provided at home by both family and friends and a personal care aide 21% Have care provided in a home-like setting such as an assisted living facility where housing, food, and personal help are provided 1% Have care provided in a nursing home 16% Not sure 4% Missing / No Answer 20. If you or a family member needed long-term care, how are you that you would know how to find the appropriate services in your community? 8% Extremely 18% Very 38% 19% Not very 8% Not at all 8% Not sure 2% Missing / No Answer 21. If you or a family member needed long-term care services, where would you be most likely to find out about these services? 25% Family/friend 38% Physician 1% Newspaper advertisement 2% Clergy 23% Hospital discharge planner 16% AARP 10% Internet 20% Health and Human Services 4% Telephone book 6% Other: 10% Not sure 1% Missing / No Answer 22. How well informed would you say you are about long-term care services provided at home and in community settings? 4% Extremely informed 11% Very informed 40% informed 28% Not very informed 12% Not at all informed 4% Missing / No Answer Long-Term Care in Connecticut: A Survey of AARP Members 14

23. If you or a family member needed long-term care services, how important would it be to you to: a. Have a central place where you could get information or referrals for all types of long-term care services, both government and private. b. Have a central place where you could find out what services and benefits you are eligible for and apply... Extremely important Very important important Not very important Not at all important Missing / No Answer 50% 31% 8% 1% 1% 9% 53% 29% 8% 1% 1% 9% 24. How strongly do you support or oppose the state of Connecticut establishing a central place where persons needing long-term care services can get information about and help applying for these services? 65% Strongly support 19% support 9% Neither support nor oppose 1% oppose 1% Strongly oppose 5% Missing / No Answer 25. How much of a priority should it be for Connecticut to ensure that older persons and persons with disabilities have affordable long-term care choices in nursing homes, in the community and in their own homes? 43% Top priority 40% High priority 11% Medium priority 1% Low priority 1% Not a priority 4% Missing / No Answer 26. How concerned are you about being able to afford long-term care services for your or your family? 29% Extremely concerned 33% Very concerned 24% concerned 8% Not very concerned 2% Not at all concerned 4% Missing / No Answer Long-Term Care in Connecticut: A Survey of AARP Members 15

27. The cost of long-term care varies depending on the type of services a person receives. In Connecticut, nursing homes cost approximately $109,000 annually. On average, Connecticut assisted living facilities cost approximately $42,000 annually, and the average cost of a home health aide for 10 hours a week in Connecticut is approximately $20,000 annually. The persons receiving the services or their family pay many of these costs out-of-pocket. Knowing that, how are you that you could afford the cost of long-term care for one year? 7% Extremely 10% Very 22% 21% Not very 31% Not at all 4% Not sure 5% Missing / No Answer 28. Knowing that, how are you that you could afford the cost of long-term care for five years? 3% Extremely 6% Very 13% 23% Not very 46% Not at all 5% Not sure 4% Missing / No Answer 29. Do you have any kind of long-term care insurance coverage? 20% Yes 72% No 5% Not sure 4% Missing / No Answer 30. If a candidate for state office supported providing more home- and community-based services to allow people to stay in their own homes as long as possible, would you be more likely to vote for that candidate, less likely to vote for him or her, or would it not make a difference? 74% More likely 2% Less likely 14% Would not make a difference 6% Not sure 5% Missing / No Answer Long-Term Care in Connecticut: A Survey of AARP Members 16

About You The following questions are for classification purposes only and will be kept entirely ial. 31. How would you rate your overall health today? 13% Excellent 34% Very good 32% Good 13% Fair 2% Poor 6% Missing / No Answer 32. Does any disability, handicap, or chronic disease keep you from participating fully in work, school, housework, or other activities? 25% Yes 69% No 6% Missing / No Answer 33. In the last 12 months, have you accessed the Internet from your home or work, or from some other source such as your local library? 57% Yes 37% No 6% Missing / No Answer 34. Are you male or female? 46% Male 49% Female 5% Missing / No Answer 35. What is your age as of your last birthday? (in years) 26% 50 59 30% 60 69 37% 70 or older 7% Missing / No Answer 36. What is your current marital status? 53% Married 5% Not married, living with partner 1% Separated 14% Divorced 19% Widowed 8% Missing / No Answer Long-Term Care in Connecticut: A Survey of AARP Members 17

37. What is the highest level of education that you completed? 9% 0-12 th grade (no diploma) 25% High school graduate (or equivalent) 17% Post-high school education (no degree) 8% 2-year college degree 10% 4-year college degree 5% Post-graduate study (no degree) 20% Graduate or professional degree (s) 8% Missing / No Answer 38. Which of the following best describes your current employment status? 3% Self-employed, part-time 5% Self-employed, full-time 9% Employed, part-time 23% Employed, full-time 50% Retired, not working at all 4% Not in labor force for other reasons 2% Unemployed but looking for work 6% Missing / No Answer 39. Are you of Hispanic, Spanish, or Latino origin or descent? 2% Yes 91% No 7% Missing / No Answer 40. What is your race? 86% White or Caucasian 4% Black or African American <0.5% American Indian or Alaska Native <0.5% Asian <0.5% Native Hawaiian or other Pacific Islander 2% Other 7% Missing / No Answer 41. Thinking about your state elections for Connecticut Governor and Legislators in the last ten years, how often would you say you vote? 68% Always 17% Most of the time 5% Some of the time 4% Seldom 3% Never 3% Missing / No Answer Long-Term Care in Connecticut: A Survey of AARP Members 18

42. How interested are you in state government activities that affect residents age 50 and older? 41% Extremely interested 34% Very interested 18% interested 3% Not very interested 1% Not at all interested 1% Not sure 1% Missing / No Answer 43. What was your annual household income before taxes in 2006? 4% Less than $10,000 10% $10,000 to less than $20,000 18% $20,000 to less than $35,000 10% $35,000 to less than $50,000 8% $50,000 to less than $60,000 9% $60,000 to less than $75,000 11% $75,000 to less than $100,000 17% $100,000 or more 8% Not sure 7% Missing / No Answer Thank you for completing this survey. Please use the postage-paid envelope and return it to State Member Research, AARP, 601 E Street, NW, Washington, DC 20049, by November 19, 2007. Long-Term Care in Connecticut: A Survey of AARP Members 19

AARP Knowledge Management For more information, please contact Katherine Bridges at: 202.434.6329 or e-mail kbridges@aarp.org