Out-of-Pocket Expenses for Long-Term Care by Dementia Status and Residential Setting among US Older Adults.
Jing Li, Hannah Bancroft, Krista L Harrison and 3 others
PMID 37863109WHAT IT FOUND
Older adults with dementia in facilities often paid substantial out-of-pocket long-term care costs.
Median monthly costs were $1,467 in nursing homes and $2,925 in other residential care, and median income spent was 82.5% to 97.3%.
Key findings
01For older adults with dementia, median total monthly out-of-pocket long-term care expenses were $1,467 in nursing homes and $2,925 in non-nursing-home residential care.
02Among adults with dementia in non-nursing-home residential care and nursing homes, median out-of-pocket long-term care expense was 97.3% and 82.5% of monthly income.
03Over 90% of adults living in non-nursing-home residential care paid out of pocket to the facility, while 42.2% of adults with dementia in nursing homes had out-of-pocket facility payment.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
This was a cross-sectional snapshot before the pandemic, so it cannot show how costs changed over time or what caused them. Helper payments were self-reported by respondents or proxies, so they may be affected by recall bias. The sample included only Medicare beneficiaries, so it excludes people without Medicare, such as immigrants, who may have higher costs. Facility out-of-pocket payments may be underestimated if state social security supplements were paid directly to facilities. Nursing home residents were only people who later moved into nursing homes during the study, so they may not represent all nursing home residents. Dementia status was classified by a survey algorithm and combined probable and possible dementia, not by clinical diagnosis.
Declared interests
The article reports NIH extramural research support and no conflicts of interest.
The easy way to misread this
Do not read high out-of-pocket costs as proof that facility care is affordable or that families freely chose it. Many dementia facility users spent most or all monthly income, and nursing home facility payments were mostly covered by Medicaid.