10 Myths about Aging and Future Care
The ten myths about aging and future care presented here are widespread beliefs about aging and long-term care, some based on a kernel of truth, that are deeply entrenched in American society. Some are relatively harmless, but others can lead to serious misunderstandings.
Serious Memory Lapses Are Normal in Older Adults
The myth that memory loss is naturally associated with aging is deeply engrained in societal attitudes toward older adults. Sometimes the link is made in a condescending way, and sometimes even as a joke at the older person’s expense. But these so-called senior moments are also experienced by younger people. Who hasn’t been challenged from time to time to recall the name of a movie or book or person? In an era of information overload, some facts or figures go astray. In these instances, the lost information comes back without too much delay.
Although some physiological changes explain the tendency of older people to experience temporary and occasional memory lapses, serious memory lapses are not normal. Some of the joking about memory loss may be displacement of anxiety about dementia. Alzheimer’s disease is one of the most feared diseases of our era, arguably more dreaded than cancer.
Forgetfulness can be distinguished from early signs of Alzheimer’s disease or other forms of dementia. The Alzheimer’s Association says that a typical age-related change involves sometimes forgetting names or appointments but remembering them later. On the other hand, a common sign of Alzheimer’s is memory loss that disrupts your daily life, especially recently learned information. Examples include forgetting important dates or events, asking for the same information over and over, and needing to rely on notes or other memory aids for things you used to handle on your own.
Similarly, many people (of all ages) make occasional errors when balancing a checkbook, but a more worrisome problem is a change in the ability to follow a familiar recipe or keep track of monthly bills.
Some problems typically associated with dementia may not be dementia but may be due to other causes. For example, difficulty reading, judging distance, and determining color may be due to cataracts or other vision problems, not a sign of Alzheimer’s. Medications can cause delirium, which is a temporary condition that may be confused with dementia.
Bottom line: Not everyone who grows older loses his memory, and not every incident of memory loss is a sign of dementia. However, regular and problematic memory loss is not normal and should prompt a checkup with a doctor.
Older People Fall: Not Much You Can Do about It
Falls are the primary cause of injury among older adults and often lead to serious consequences, including death. Despite the dire statistics, the belief is prevalent even among older people themselves that falls are bound to happen and are not all that big a deal. Many think it won’t happen to them even though one in three older adults — about 12 million people — fall each year in the United States.
Some people believe that if they limit their activity or stay at home, they won’t fall. In fact, the reverse is true. Doing strength and balance exercises to build flexibility and ordinary walking are important in preventing falls. And over half of all falls take place at home, including falls that involve head injury and hospitalizations.
Reasonably simple home modifications (removing throw rugs, installing grab bars, improving lighting) can prevent falls. Other measures include asking a physician about side effects of medications, having vision checks, and using mobility aids like canes or walkers after being trained by a physical therapist on how best to use them.
Falls are a serious risk to health and function, not a normal part of aging.
Antibiotics Are the Best Drugs for Older Adults with Coughs and Colds
Antibiotics were the first “miracle” drugs; when they were introduced in the 1940s, they saved the lives of many people with serious infections. But over time they have become prescribed so freely by doctors (often at the request of patients) that they are no longer miracles. In fact, they have created a new set of medical problems.
Antibiotics and similar drugs, together called antimicrobial agents, have been used so widely and for so long that the infectious organisms the antibiotics are designed to kill have adapted to them, making the drugs less effective.
How serious is this problem? Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics, and at least 23,000 people die each year as a direct result of these infections. That’s why doctors are now urging caution to limit the use of antibiotics.
The Centers for Disease Control and Prevention (CDC) reports that about 44 percent of antibiotics prescribed in outpatient settings such as doctors’ offices go to patients with respiratory conditions such as sore throats, colds, coughs, and flu. An estimated half of these prescriptions are unnecessary. These illnesses are usually caused by a virus. Antibiotics work when the illness is caused by bacteria; they don’t work against viral illnesses.
The result has been a global problem of antibiotic resistance. This affects not only individuals who become antibiotic-resistant, but it can also affect whole populations. And there is no endless line of new antibiotics coming along that will take the place of standard drugs.
What can you do? For upper respiratory infections, such as sore throats, ear infections, sinus infections, colds, and bronchitis, the CDC recommends trying to
- Get plenty of rest
- Drink plenty of fluids
- Use a clean humidifier or cool mist vaporizer
- Avoid smoking, secondhand smoke, and other pollutants (airborne chemicals or irritants)
- Take acetaminophen, ibuprofen, or naproxen to relieve pain or fever
- Use saline nasal spray or drops
Of course, check with your doctor, who may give you specific advice about relieving symptoms. Be sure to report any serious symptoms such as fever, chills, pain, or breathing difficulties. Chances are you’ll recover without an antibiotic, but if you do need one, you want it to work.
Americans Dump Their Older Relatives in Nursing Homes
The use of the word “dump” in the formulation of this myth suggests that Americans get rid of their older relatives like so much garbage by leaving them at the nursing-home door and ignoring them from then on. Often there is a comparison to other countries and cultures, where older people are presumed to live at home and are treated with great deference and respect.
This belief about other cultures also has mythic aspects. As more traditional cultures experience demographic changes that include aging and fewer children, more participation of women in the labor force, and urbanization, older patterns of caregiving are also giving way. In 2013, for example, the Chinese government felt it necessary to make visiting an older parent at least twice a year a legal requirement, not just a cultural tradition.
These are the facts: About 1.5 million people, or 4.5 percent of the U.S. population over 65, are residents in one of the nation’s 15,000 nursing homes. Nursing homes are not overflowing: They operate at about 85 percent capacity, and very few (if any) new ones are being built. The percentage of older adults in nursing homes has been steadily declining even as the older population increases; in 1990 it was 5.1 percent. This decline may be related to an increase in home- and community-based services, consumer demand for in-home care, or nursing homes’ focus on enrolling short-term rehab patients (paid for by Medicare and private insurance) as opposed to long-stay residents (paid for largely by Medicaid at lower rates. Even adding in the million or so people in assisted-living facilities (which do not provide nursing-home-level care), this is hardly a picture that supports the myth of abandonment.
Rather than ignoring their relatives, many family members play an important role in residents’ lives, and most nursing homes have both resident and family councils. Why then does this myth persist? All it takes is one news story or anecdote about an older person being placed in a nursing home against his or her will or being ignored by family to strengthen the belief that this occurrence is common.
Many people look back to the “good old days” through a fog of nostalgia, often for a past that never really existed. Believing that Americans abandon their older relatives fits into a worldview that fears changing social structures and family relationships. That may be understandable, but this myth demeans nursing-home residents by portraying them as unloved and unwanted and their family members by suggesting they’re selfish and uncaring.
Medicare Pays for All Long-Term Care
Unlike the myth about abandonment of older people, the myth that Medicare pays for all the living and care expenses you may incur as you age is more of a want than a criticism. Everyone wants it to be true; therefore, it must be. Confusion about what is and is not covered may also be a cause of this false belief. People who need assistance with personal care and other nonmedical care — the conventional view of long-term care — also need doctor and hospital and other services, especially because many of them have multiple chronic conditions as well as difficulties functioning independently. These medical services are covered under Medicare; the nonmedical aspects are mostly not, even when they are as essential to the person’s survival as drugs and doctor visits. Change may be coming, albeit slowly, as evidence mounts that clinical outcomes are influenced by social factors as well as clinical care.
When people hear that someone has gone to a nursing home and Medicare paid the bill, the belief is reinforced. The difference is that the person was in the rehab unit of the facility for a short-term stay, not a resident in a long-stay unit.
This myth is quickly dispelled when home care agencies, assisted-living facilities, or other providers refuse to provide services not covered by Medicare unless the person or family pays. However, this is a rude awakening. Better know from the outset that — Medicare does not cover long-term care, and the failure of many Americans to take long-term care seriously and make other financial arrangements is a serious problem for many families.
Hospice Is Just a Place Where People Go to Die
Most people say that they want to die at home without “all those tubes and monitors,” yet end-of-life care continues to be dominated by aggressive interventions and high costs. Medicare costs for people in the last month of life are heavily weighted toward hospital inpatient stays, including intensive care units (ICUs).
Many policy experts say the reason is Medicare’s fee-for-service structure, which incentivizes technological interventions and expensive tests. But another reason relates to the myth that hospice is a place where people go to die. This remains a barrier for physician referrals and patients’ acceptance of hospice as an alternative approach to a hospital. Hospice is often seen as giving up and abandonment. The modest proposal in health reform legislation that would have encouraged physicians to engage in voluntary end-of-life discussions with their patients (so that individuals’ wishes can be known and respected), which would have included discussions of hospice and palliative care, went down in flames under the politically charged label of death panels.
In fact, most hospice care is given in the place the person calls home, whether that is a residence, an assisted-living facility, or a nursing home. There are some inpatient hospices as well. And hospice is a philosophy of care, not a specific course of treatment, that emphasizes the whole person, quality of life, and relief of symptoms. Hospice is a team approach, with many different professionals providing services and a strong volunteer component as well. Much hospice care is provided by families.
Although the numbers of people opting for hospice services has increased steadily (approximately 1.43 million people received hospice services in 2017), it is still often very late in the course of their disease. According to the National Hospice and Palliative Care Organization, in 2017 the median length of service was 24 days, an increase from 19.1 days in 2011. This means that half of hospice patients and their families received services for about three weeks, while half received services for more than three weeks. Very short stays do not permit the patient and family to receive the full benefits of hospice care, such as understanding the dying process, controlling pains and symptoms, and receiving counseling. Under the Medicare hospice benefit, individuals can receive care for up to six months, and sometimes even longer. Studies have shown that people enrolled in hospice live longer with a better quality of life than those who choose more aggressive options.
While hospice started as a volunteer, nonprofit system of care, it is now dominated by for-profit organizations. In 2017 67 percent of active Medicare Provider Numbers were assigned to hospice providers with for-profit tax status and 29 percent were assigned to those with not-for-profit status. Only 3.9 percent of hospices were run by the government.
Other myths around hospice include the idea that your regular physician can’t be involved (not true) and that active treatments must be discontinued (true only of treatments intended to cure, not those intended to treat symptoms). Hospice focuses on the immediate needs of the person and the family by addressing all their spiritual, emotional, and physical needs.
For more information, see AARP’s “Facts about Hospice.”
Millionaires Take Advantage of Medicaid
You’ve heard this myth many times: A millionaire or zillionaire — a film star, a CEO of a Fortune 500 company, or a highly paid athlete — can legally transfer all his or her assets and after a five-year look-back period become eligible for Medicaid nursing-home care at taxpayer expense. Lots of people believe that the ranks of Medicaid recipients are full of rich people who have done just that.
This myth is bolstered by the occasional news story about a person who defrauded Medicaid by concealing assets. Sometimes people assume estate planning is Medicaid planning. There is no shame in estate planning, and rich people do it all the time but without ever intending to become eligible for Medicaid. The rules for transferring assets are rigorously applied in Medicaid applications, and most people who eventually become eligible for Medicaid have exhausted all their resources.
There is little evidence that people with substantial incomes or assets are improperly transferring them to become eligible for Medicaid. An Urban Institute study showed that people with disabilities who need Medicaid assistance not only had lower incomes and assets when they needed assistance but also were at a disadvantage during their peak earning years. Half of those who received Medicaid assistance for nursing-home care had less than $10,000 in nonhousing assets ten years or more before entering the nursing home. The report concluded, “Among people who spend down, few are asset rich and income poor.” (For more detail, see the AARP blog.)
Who among the 1 percent — our nation’s richest and most privileged — would really want to go through the legal process of losing control of their assets to be eligible for Medicaid? In addition, Medicaid does not provide the kind of special treatment and considerations that the rich and famous expect. Nursing homes do not have suites and special restaurant food and other luxuries for the formerly rich. In Medicaid, formerly rich does not get you anything better than always poor.
Most people look on Medicaid as a last resort. It is a safety net and not a velvet cushion.
If I Need Care, I’ll Wind Up in a Nursing Home
Surveys consistently show that only a third of American adults think that they will need long-term care, when actually about 70 percent of people over age 65 will need at least some form of long-term care during their lifetimes. Part of the reason for this discrepancy is that many people link long-term care to nursing-home care, and they say firmly, “I don’t want to go there.”
In fact, nursing homes are now the last resort, not the first option, in long-term care. Many more options exist to remain at home, with assistance and perhaps home modifications. Long-term services and supports — the new terminology for community care — are alternatives to nursing homes. So are assisted-living facilities, although they do not provide the level of nursing care that may be required for someone who is very ill or has dementia.
Still the myth persists. Because of its staying power, some people are reluctant to engage in long-term care planning because they find the prospect of being in a nursing home not only distasteful but also hugely expensive.
What will they do if they become ill or disabled? Here the answers get a little murky. Some say, “My family will take care of me.” Others say, “I won’t stay around long enough to find out,” suggesting that they will die by suicide at the first sign of debility. This is largely bravado, but it does suggest the depth of anxiety about dependence and illness.
More exposure to alternatives to nursing-home care may help dispel this myth, as would information about changes in nursing homes that create a more inviting environment.
Assisted-Living Facilities Are Regulated Like Nursing Homes
Nursing homes are highly regulated by both federal and state governments. It would seem obvious that assisted-living facilities, promoted as an alternative to nursing homes, would also be regulated in similar ways, but this is not the case.
There are no federal regulations for assisted-living facilities, which vary widely in the population they serve, services, management, and location. In January 2014, however, the Centers for Medicare & Medicaid Services (CMS) issued a rule allowing states to include assisted-living facilities in their home- and community-based waiver programs. Check with your state Medicaid agency to see whether this rule applies to your state. States do regulate assisted-living facilities but license them under different categories and call them by different names.
Generally, state regulations are concerned with assisted-living facilities as congregate housing sites. Fire safety, evacuation procedures, and structural soundness are examples of common standards. They may or may not set requirements for a minimum level of staff training. There may or may not be a nurse on-site at all times. They may or may not require CPR training. State surveyors may visit just once a year or even less often.
More regulation does not necessarily mean better care, but regulations set a baseline. Anyone considering a move to an assisted-living facility should find out what the state regulates and what it doesn’t. It won’t answer all your questions, but at least it’s a start.
Long-Term Care Insurance Covers All Your Needs
The myth that all your long-term needs will be covered by insurance comes with some qualifications. If you have a very comprehensive long-term care insurance policy with a highly reliable company, the policy has built-in options for all the possible variations on what kinds of long-term care you may need, and it has protections for inflation, then it is possible that all your long-term care needs will be covered. But that kind of policy is costly, and the amount you have contributed over many years may not justify the benefits you’ll receive. It is more realistic to expect that a long-term care insurance policy will cover about 60 to 70 percent of expenses.
Long-term care policies are priced by the age of the applicant, the benefit period (the length of time you expect to need long-term care), the setting of care (nursing home, assisted living, home), and other factors. Long-term care insurance can be a valuable asset but has limitations. Newer variations on traditional policies are now available that may provide the level of benefits you need at a more affordable cost.