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Your growth lies in educating the public about LTC options

A review of adult children and their involvement in providing seniors housing and care for their relatives is a real eye-opener. Long term care facilities have incredible potential for growth, but confront an uninformed and often confused adult child population.

The National Investment Center for the Seniors Housing & Care Industries (NIC) recently completed a study on adult children and how they influence their parents' housing and long term care decisions. What the study discovered was at once disconcerting and hopeful. It seems many adult children--often the decision-makers for their parents as they advance in age--are unfamiliar with the variety of senior services available to their parents. This lack of education inhibits their ability to make what could be a better decision for their parents when they need to obtain home health care or another level of care.

The answer, one might derive after studying the data from the NIC study, is to educate the adult child in advance of when he or she will have to make a decision for a parent or relative.

"This is the most comprehensive study that's ever been done examining the adult child's role," says NIC Executive Director Robert G. Kramer. Following are excerpts from the study--conducted by Margaret Wylde, president and CEO, and her team at ProMatura Group LLC--provided through an interview with Kramer and NIC Research Director Harvey N. Singer.

NIC conducted a telephone survey of more than 1,500 "adult children" between the ages of 45 and 64 from all across the United States who are, have been, or believe they will be responsible for the well-being of a parent, relative, or other older adult. The object of the study was to learn about the roles, knowledge about housing and care options, and decision influences of adult children who may be responsible for the housing and health care of an older adult.

The sampling was skewed slightly toward higher income (which Kramer and Singer explain to be inevitable in a telephone survey) and higher education. "Almost a third of our 45-54-year-old respondents had more than a $75,000 household income," Kramer explains. Twenty-six percent of 55-64-year-olds had an income over $75,000.

"The objective was to do an in-depth study of the adult child and their role and responsibilities to housing and care decisions: What is their knowledge of their options, and how do they influence these decisions?" explains Singer. "We tried to make sure we had statistically significant respondents." Here are some of the stats on respondents:

* 65 percent said they would have responsibility for an older adult should that need arise in the future

* 14 percent said they are responsible for an adult using home health care

* 3.5 percent had a relative in congregate care or independent living unit in a CCRC within the past 24 months

* 6.9 percent had a relative in an assisted living facility within the past 24 months

* 10.6 percent had a relative in a SNF within the past 24 months.

"We're not making the claim that this is the proportion of older adults in these types of facilities," Singer qualifies. "We used quota sampling to get significant numbers whose parents were using some form of independent living facility, ALF, or SNF." Names were purchased from a commercially available list.

There is much teaching to do

The study reveals the level of knowledge--as well as the opinions--that these adult children have about senior services. There is apparently a wealth of information that could (and should) be made available to these decision-makers.

For instance, points evident from the study included that almost half (49 percent) of adult children who have future responsibility for a senior are uninformed about assisted living options; 60 percent are not familiar with independent living; and some 73 percent are not familiar with the idea of CCRCs; 71 percent, however, said they were familiar with home health care; nursing home familiarity was somewhat higher.

These numbers are staggering. It does, however, suggest where much of the hope for the facility-based long term care industry lies: in raising consumer awareness and education about the variety of care available. "There are still a lot of folks out there who are confused or uneducated about their options for their parent," Kramer concurs.

Say what you mean

Terminology continues to be confusing and irregular, even for those who have a parent in care. Less than 4 percent of respondents who had a parent or relative in independent living used the term "congregate" living in any fashion. "It's not a word that's on the lips of even those whose relatives are in such a facility," says Singer. Some 22 different terms were used by respondents to label assisted living communities; in 68 percent of the cases the word "assisted" was used in some way. Sixteen different terms were used to label the SNF, although the majority (78.6 percent) did use the term "nursing home".

Assisted 'what'?

Another finding in the area of knowledge of services is that assisted living in particular is considered as an option of care by only a small proportion of adult children. "What we're saying is, when they're thinking about what options they may turn to for their relative, assisted living--for that matter any form of seniors housing--does not come up high on the radar screen at all," says Kramer.

"We asked, 'When your older relative is unable to live without assistance, what will you do?'," says Kramer. The following stats were derived from verbatim responses, not menu-driven replies:

* 32 percent said the family member would likely move in with them or another family member

* 14 percent said they would arrange home health care

* 10 percent said they would arrange for other types of paid personal care (such as meal services, chore services, and companion services)

* 9 percent said they didn't know what they'd do

* 9 percent said they'd take care of the older relative but didn't know how the care would be provided

* 9 percent said they would move their parent to a nursing home

* 6 percent said they would move their relative to assisted living.

"Facility-based care is not the top-of-the-mind solution with children who will have to make these decisions in the future," says Kramer. "This is particularly significant to the assisted living industry. Nursing homes are something people are aware of but want to consciously avoid; people, however, don't know about assisted living as an option, only 6 percent would consider this." Given the phenomenal growth of assisted living, it could be surmised that there could be even greater growth if there were greater awareness in the adult child population.

"That's significant because for those who have put their family member into a long term care facility, 60 percent said it was done in a crisis situation. If you're a provider and your type of care is not top-of-the-mind, you can't expect the child to carefully research alternatives at the time of crisis," Singer says.

The sandwich generation speaks

"We found striking differences from those whose relative was in an assisted living community from those whose relative was not," says Singer. "Those who had chosen assisted living were most likely to reflect the characteristics and pressures of the 'sandwich' generation (who have both an older relative to care for as well as their own children under the age of 18 living at home.) These people are likely employed full-time and have the greatest number of living parents, stepparents, and mothers-in-law for whom they're responsible. They have fewer siblings with whom they can share responsibility for the relative's care. (More than a quarter of them had no one with whom they could, share responsibility.) This clearly is the profile of the adult child who's most likely to choose assisted living as the care option of choice," says Kramer,

A finding that goes counter to what has been believed is the amount of income. Even residents of market rate (not just subsidized) seniors housing and care properties, and their adult children, need substantially less income than commonly believed.

A common industry benchmark has been that the senior needed $25,000 annually as a minimum income. What NIC found was that two thirds of the residents in such a market rate property earn less than $25,000. They're probably using other means in addition to their annual incomes to pay for this, such as drawing on other assets, or are receiving assistance from family members. "Other research has found that by the time a senior is 75 years or older, he or she starts 'disinvesting,' subtracting from assets instead of adding to savings," says Singer. "What we also found in previous NIC studies and verified here is that the family--specifically the adult child--contributes to a great extent in helping to pay for this type of property."

"In fact, adult children are providing more than the parents are aware, according to our studies," says Kramer. "So it's clear that people don't necessarily need the $25,000 and above, as was previously thought. They're getting significant financial support from their families."

"It's also commonly believed that to be a good potential market for assisted living the adult child had to earn in excess of $75,000. In fact, more than half--including many who are helping their parents--earn less than $75,000," says Singer. Breaking it out further, Singer explains that 70 percent of children with parents in an assisted living facility have an income of less than $100,000 annually; 55 percent have incomes less than $75,000; almost a third have incomes less than $50,000. "The same general conclusions hold for those whose parents or relatives are in SNFs or in congregate living facilities," he adds.

So seniors are willing to use their assets and not just their annual income; similarly, kids find a way to make it possible. "It says that for many whose parents are in ALs or SNFs, there's such a need for the services that they find a way to make it happen," says Kramer.

"What was found here that was not heretofore known is the extent to which these children are helping," says Singer. "Almost a quarter of those children with relatives receiving home care or in SNFs, AL, or independent facilities did provide financial assistance to the tune of more than $500 a month," explains Singer.

Home health care and related services are a very significant competitor for Al and SNF properties. "These are much more top-of-the-mind options and receive stronger consideration from these adult children," says Singer. That's no surprise to providers in the industry, but perhaps the ratio coupled with the general lack of knowledge of assisted living are the surprises.

"As a nation we face quite a challenge for how we'll pay for the cost of long term care. Long term care insurance may play an increasingly important significance," says Kramer. "Adult children will become more sensitized over the next 20 years. Perhaps we'll have a better LTC insurance product. The Baby Boomers are first dealing with their parents' needs; soon, they'll be dealing with their own," he says. "Where it used to be that having a will and planning for retirement were the extent of our responsibilities, during the next 20 years planning for long term care is going to be considered part of planning for one's future," he adds.

Take 'em to school

"You can't choose something you don't know about," says Kramer. "The bad news is half of these adult children don't know what all their options are; the good news is education about what you have to offer should help to solve this," he adds.

Coupled with this is the need to educate the professional community. Eighty-six percent of the home care respondents (kids who said they have a relative receiving home care) said they gathered info through a professional, but the number was half of that, at 43 percent, for those who had someone in assisted living. When asked how they first learned about it, 69 percent of adult children of home health care recipients said they learned about it from a professional, compared with only 24 percent, whose relative was in assisted living. Referral sources are apparently more likely to refer home health care than they are assisted living or skilled nursing. "This suggests another challenge to facility-based care educating the professional community," says Kramer. "As well as the seniors and their adult children," adds Singer. "We think these are significant differences and suggest an obvious course of action for assisted living facilities and SNFs: educate the professionals," summarizes Kramer.

Go to [less than][greater than] to order the study. NIC is a nonprofit organization providing information about business strategy and capital formation for the seniors housing and care industry. Proceeds from the annual conference are used to fund research on issues of interest to the industry, in particular, those that relate to the flow of capital to the industry. The organization celebrates its 10th anniversary this year.
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Author:Zacharia, Mark
Publication:Contemporary Long Term Care
Date:Sep 1, 2000
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