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Around two-thirds of Americans over age 65 will need long-term care, either through at-home health care services in the home or an assisted living facility or nursing home. Yet more than 90 percent of those surveyed in the Genworth Financial “2013 Annual Cost of Care” report haven’t talked about critical long-term care issues with their spouse, partner or adult children.

Genworth Financial asked survey participants how long-term care issues impact relationships, jobs, stress and anxiety for those in the circle of care — care recipient, primary caregiver, secondary caregiver and families involved.

Having a plan before there is a need is crucial.

“Discussions about long term care issues often lead to patients experiencing less depression, less pain and less anxiety,” says Amy D’Aprix, an expert in aging and care giving. Care recipients should talk to their loved ones about what their options are for care, how it will be financed and what family members might be involved in care giving. Genworth offers help starting the conversation.

long-term care costsAverage costs

The survey reveals the average cost of various services nationwide:

  • Homemaker services (hands-off non-medical care like cooking and running errands): $18/hr.
  • Home health aides (hands-on non-medical care like bathing and dressing): $19/hr.
  • Adult daycare (social, non-medical, community-based setting for some part of the day): $65/daily
  • Assisted living facility (single occupancy, 1 bedroom, hands-on medical care): $3,450/monthly
  • Nursing facility (semi-private room, 24-hr care): $207/daily
  • Nursing facility (private room, 24-hour care) $230/daily

Nursing facility care has increased more than $16,000 a year since Genworth’s 2008 survey. The cost of a private room in a nursing home has risen 4.45 percent annually, nationwide, since 2008, with this year’s median cost at $83,950 per year.

Assisted living facility costs vary dramatically by state. In Florida, the average annual cost is $36,000, in Texas; $40,035 and in New York; 47,400.

However, home care rates have remained relatively flat over the past five years. One reason may be because homemaker and home health aides are considered unskilled labor and the organizations that provide these services do not have the expense of maintaining a stand-alone health care facility.

Find out the costs of care where you live.

How will you pay for long-term care?

Medicare is an option for those over ag 65 or disabled. Home health services may be covered under certain conditions. For care in a nursing facility, however, only 100 days are covered per benefit period after a three-day hospital stay, 20 days are covered at 100 percent and days 21 to 100 require a co-pay.

Medicaid generally covers those with low incomes and limited resources and may cover some home services as well as facility care, but Medicaid limits the amount of assets you may own and the monthly income you receive before you are eligible for coverage. Eligibility varies by state and there are restrictions for transferring assets out of your name to receive benefits.

Self-insurance means you or a family member pay out-of-pocket for care services.

Long-term care insurance will pay for a wide variety of home and facility care up to the policy limitations. Many states participate in the Long Term Care Insurance Partnership Program, which allows patients to access Medicaid if they reach their LTC policy limits, while still retaining more assets than normally allowed under Medicaid. Generally, those who own a long-term care insurance policy that meet the partnership requirements may participate in their state’s partnership program.

Fear of Alzheimer’s

The Alzheimer’s Association reports that the cost of care related to Alzheimer’s, including health care, long-term care and hospice, will soar to a projected $1.2 trillion per year by 2050, depleting the financial reserves of many families, along with the nation’s Medicare funds.

In a study conducted by Age Wave on behalf of Genworth, 61 percent of respondents ranked having Alzheimer’s disease as their single greatest fear later in life.

The Alzheimer’s Association estimates that approximately 5.2 million Americans of all ages have Alzheimer’s disease. This includes an estimated 5 million people age 65 and older and approximately 200,000 people under age 65 who have younger-onset Alzheimer’s.

One in nine people age 65 and older and about one-third of people age 85 and older have Alzheimer’s disease. Yet 49 percent of survey participants had not considered the possibility of needing long-term care.

Other interesting statistics

Care recipients

  • 34 percent are mothers receiving care from adult children.
  • 12 percent are fathers receiving care from adult children.
  • 9 percent are spouses receiving care from a spouse.

Who pays?

  • $14,000 paid by care recipient (excluding cost of facility).
  • $8,000 paid by family members (excluding cost of facility).

Eighty-eight of survey participants said household income was reduced 34 percent due to a long-term care event.

How they paid for care

  • Dipped into savings/retirement funds.
  • Borrowed, took a reverse mortgage or sold home.
  • Reduced savings, vacation and family expenses.

The full survey is available as an iPhone app.