Odds of Needing Long-Term Care

Great excerpt from the Wall Street Journal - June 10, 2019

Retirement columnist Glenn Ruffenach also answers a question about how much risk to take with investments in retirement

What are my chances of needing long-term care? Can you point me toward some good statistics?

Several resources can help. The numbers vary, but the message is clear: Many of us will need some type of long-term care as we age.

Ask a Question

To start, the Administration for Community Living, a part of the Department of Health and Human Services, has published a good primer on long-term care, which includes figures about the likelihood of needing care and how much care the average American might require. (Go to longtermcare.acl.gov and click on: The Basics.)

According to the administration, about seven in 10 people (69%) turning age 65 today will need, at some point, some type of long-term-care services—either at home, in their community or in a facility. Typically, women need care longer (3.7 years, on average) than men (2.2 years). And while about one-third of people who are 65 may never need long-term care, 20% will need it longer than five years.

Source: Department of Health and Human Services

A more detailed look at long-term care, published in 2015 by Health and Human Services and revised in 2016, looks at the risk of people developing a disability and needing help with “activities of daily living,” such as bathing, dressing and eating. The study estimates that about half (52%) of Americans turning 65 today will “develop a disability serious enough” to require long-term services and support—and about one in six (17%) will end up spending at least $100,000 out-of-pocket for such services. (Go to aspe.hhs.gov and search for: Long-Term Services and Supports for Older Americans.)

(Note: AARP, the Washington-based advocacy group, has summarized the HHS findings in a more-readable form. Go to aarp.org and search for: Long-Term Support and Services.)

A new way to save for the biggest expense in retirement

By Morey Stettner, MarketWatch.com

Published: June 3, 2019 2:23 p.m. ET

Older Americans increasingly opt for ‘continuing care at home’ plans or join programs that foster community support

After surviving cardiac arrest in 2013, Martin Faga left the hospital to begin his recovery at home. It didn’t go smoothly.

“It wasn’t clear what care or help I needed,” says Faga, 77.

While his health improved over time, the retired chief executive of Mitre Corp., a nonprofit organization that runs federally funded research-and-development centers, knew he’d want more support if he needed in-home care again. So in 2015, he and his wife jumped at the chance to join a newly launched program offered by Goodwin House, a local nonprofit continuing-care retirement community.

As members of Goodwin House at Home (GHAH), the Fagas stay in their home of 35 years in Falls Church, Va., while receiving long-term-care benefits that kick in if they experience cognitive or physical decline and need help with activities such as eating, bathing or dressing. Those benefits include an insurance contract that covers costs related to long-term care — such as paying for home health aides — and care management from a licensed social worker who can coordinate the hiring of in-home aides, oversee care after discharge from a hospital and evaluate the type of nursing home or other facility that would make the most sense if the couple ultimately needs to move out of their home.

The couple paid an upfront membership fee of more than $180,000 — and continue to pay about $1,000 a month — for a plan that’s 90% refundable if they terminate the contract. In return, the couple can receive a daily benefit up to $402 to pay in-home caregivers if either of them cannot perform at least one daily-living action, with a maximum lifetime benefit of about $1.1 million. It is one of five plans that GHAH offers; others have lower upfront fees based on one’s age and benefit level.

“At first blush, the care-management component may seem like a minor secondary benefit,” Faga says. “But it’s not. It’s equally important to the long-term-care-insurance component.”

In 2017, for example, Faga underwent major heart surgery. His GHAH care manager arranged for all follow-up services including in-home visits by a nurse, physical therapist and occupational therapist.

“She was very engaged and monitored all of that,” he recalls. “And because it’s Goodwin House calling a provider, the provider has to perform or it’ll lose lots of business. If I had to call care providers on my own, I’m only one person, so I have less clout.”

“If I had to call care providers on my own, I’m only one person so I have less clout.” — Martin Faga

Faga and his wife also gain peace of mind knowing that if they ever need to move into an assisted-living facility, their GHAH membership will pay off.

“They will never leave you hanging,” he says. “If all of a sudden something bad happens and we have to move, they can work something out among the 50 or so facilities in this area. We know where to turn, and our daily benefit can go toward paying the facility.”

Less insurance, more options

Faga isn’t alone in his concern about where to turn if physical or cognitive decline set in. Aging baby boomers often worry about who will take care of them if they’re unable to manage on their own.

Since the 1980s, some people nearing retirement have mitigated this concern by buying long-term-care insurance. But that’s no longer a popular option, as policies have become more restrictive with longer waiting periods before benefits kick in (up from an average of 20 days in 1990 to 93 days in 2015), lower monthly benefits, shorter benefit periods and less protection against rising costs due to inflation.

Meanwhile, annual price increases ranging from 25% to over 100% have put the plans out of reach for many retirees. Most insurers stopped selling long-term-care policies; today, only about a dozen companies offer new policies, down from more than 100 in the 1990s. Traditional long-term-care insurance may not even exist in a few decades.

“It’s hard to imagine that the retail model of long-term-care insurance is viable in the years ahead,” says Thomas West, a partner at Signature Estate & Investment Advisors in Tysons, Va.

West, a financial adviser and long-term-care expert, says insurers’ actuarial errors made many policies unsustainable and often unprofitable. Low interest rates, lower “lapse rates” (in which fewer policy holders chose to drop their coverage than insurers predicted) and a higher volume of claims than originally projected hit insurers like a triple whammy, leaving many consumers unwilling or unable to renew their policies amid skyrocketing premiums.

With an ever-increasing elderly population, the stakes keep getting higher. As insurers either pull out of the long-term-care market or price their products so high that few can buy them, the upshot is more people are unequipped for the staggering cost of dementia, chronic disease or other perils of old age.

As pre-retirees peer into the future, they need to expand their horizons and consider new solutions to gird for higher long-term-care costs. Advances in longevity mean retirement can last for 25 years or more. About one out of every four 65-year-olds today will live beyond 90, and one out of 10 will live past 95, according to the Social Security Administration.

But living longer comes at a price: More than half of people (52%) turning 65 will need at least some long-term-care services in the future.

“The costs of long-term care exceed what many people can afford,” says Jean Accius, vice president at the AARP Public Policy Institute in Washington, D.C.

He says the median cost of a nursing home is about $100,000 a year, an assisted-living facility costs an annual $45,000 a year and in-home care goes for $33,000 a year for 30 hours of care per week.

It takes a village

When it comes to long-term-care costs, your options vary with location. There are more than 30 “continuing care at home” offerings across the country, says Karen Skeens, executive director of Goodwin House at Home in Alexandria, Va.

Contact your state insurance department to see if any of these still-evolving programs exist where you live. But don’t get too excited: Aside from the steep upfront fee, you must be in fairly good health as you may undergo a medical screening to qualify.

In the past few years, another promising grassroots trend is spreading across America: the so-called village movement. There are now nearly 250 villages in 47 states, where seniors benefit from neighbors who contribute their time and talents.

“We serve primarily middle-class folks with everything from transportation to medical appointments to social visits to making sure they get their groceries,” says Barbara Sullivan, executive director of the Village to Village Network in St. Louis. It’s easier to self-fund your long-term-care costs if you can depend on your community to fill at least some of your daily needs.

About one out of every four 65-year-olds today will live beyond 90, and one out of 10 will live past 95, according to the Social Security Administration.

Unlike the continuing-care-at-home model with its substantial costs, the village concept is a bargain. Annual membership for individuals ranges from $50 to $900, depending on a particular village’s staffing level and other factors.

“Membership can more than pay for itself if you add up all the transportation you’ll get” over the course of a year, Sullivan says. Check the network’s national map to see if there’s a village in your area.

Despite innovative initiatives to address looming long-term-care costs, the unknown nature of what’s to come can prove harrowing. Such fears have led at least one state to propose its own solution.

Lawmakers in Washington state are debating a Long Term Care Trust Act that would establish a public long-term-care benefit. Under the bipartisan bill, workers would pay 0.58% of their wages into the trust program and could claim benefits for services such as skilled nursing care, meal preparation and home health services if they couldn’t perform at least three tasks of daily life.

“Soon-to-be retirees need to anticipate the likelihood that they’ll need long-term care help and budget for it,” says West, of Signature Estate & Investment Advisors. “Programs like continuing care at home, and the village concept can drive better actuarial outcomes and extend the notion of insurance to keep people living at home longer.”

Care.com Puts Onus on Families to Check Caregivers’ Backgrounds—With Sometimes Tragic Outcomes


Kirsten Grind, Gregory Zuckerman and Shane Shifflett

March 8, 2019 6:35 p.m. ET

On a warm July morning last year, Amelia Wieand left her twin toddlers at an in-home day-care center outside Knoxville, Tenn. She had read about the facility on Care.com, the largest online marketplace for babysitters and other caregivers.

The listing said the center was state-licensed. It wasn’t, state records say. In fact, after receiving reports that the woman who ran it was watching up to 11 children, a state agency had obtained an injunction two months earlier barring her from operating an unlicensed facility.

None of that was available to Care.com members such as Ms. Wieand. At one point, the day-care center indicated to clients there was a problem with its license, but assured Ms. Weiand and other parents it was taking care of the matter.

Hours after being dropped off, the children, Elyssa and Elijah, a month away from their second birthdays, were pulled out of the baby sitter’s pool. Both died.

Care.com Inc., CRCM -4.08% with about 32 million members in over 20 countries, charges up to $39 a month to see listings on its site. Shares of the Waltham, Mass.-based company have quadrupled in three years as revenue has surged. Its biggest stockholder is Capital G, a fund backed by Alphabet Inc.

Behind Care.com’s appeal is a pledge to “help families make informed hiring decisions” about caregivers, as it has said on its website.

Still, Care.com largely leaves it to families to figure out whether the caregivers it lists are trustworthy. It does what it calls “preliminary screening” of them, which isn’t a full background check, and doesn’t verify credentials. It does no vetting of day-care centers listedon its site.

Care.com suggests that customers purchase additional screening packages, which cost $59 to $300.

In about 9 instances over the past six years, caregivers in the U.S. who had police records were listed on Care.com and later were accused of committing crimes while caring for customers’ children or elderly relatives, according to an investigation by The Wall Street Journal, which reviewed police records, court records and local media reports. Alleged crimes included theft, child abuse, sexual assault and murder.

The Journal also found hundreds of instances in which day-care centers listed on Care.com as state-licensed didn’t appear to be.

Care.com said it has made more than 1.5 million successful matches since it began service a dozen years ago.

Sheila Lirio Marcelo, chief executive, chairwoman and founder, said the company invests heavily in ensuring the safety of members. She said the marketplace is designed for “shared responsibility overall,” with families having the option to pay for more screening.

“Care.com is a marketplace platform, like Indeed or LinkedIn,” Ms. Marcelo said. “Like those services, we do not generally verify the information posted by users, interview users or conduct employment-level background checks.”

The company said it sends many messages during the membership application process—through its website, emails and other alerts—stating that it doesn’t fully screen caregivers and that parents are responsible for background checks.

In February, after questions from the Journal, Care.com began sending families a prominent alert in the final stage of the membership application process. A company spokeswoman said that was in development in the 2018 fourth quarter.

Ms. Marcelo described problems involving caregivers listed on the site as rare but “very heartbreaking.” The spokeswoman said, “The loss of these children is an unimaginable tragedy. Our thoughts and prayers have been and remain with the family.”

Ms. Marcelo and the company declined to discuss any specific incident, including that of the twins. The spokeswoman cited respect for the parties involved, confidentiality obligations and other legal concerns.

In Seattle a year ago, police responded to a call saying a babysitter had been seen stroking the vaginal area and buttocks of a 7-year-old girl in his care, police and court records show. That babysitter remained on Care.com’s site for weeks, during which time he allegedly also molested a young boy and his friend, based on a second police report.

On March 28 of 2018, Care.com emailed clients who might have used the caregiver, Colin Cutler, saying he had been removed from its website. The email went out about seven weeks after the initial police report.

Jen Walsh, who had found Mr. Cutler on Care.com and used him to care for her 9-year-old son, overlooked the email, which didn’t include Mr. Cutler’s name in the subject line and was one of many emails customers receive. The body of the email named him and gave possible reasons for a caregiver to be removed, without saying which if any applied to Mr. Cutler.

Ms. Walsh said she didn’t learn of his alleged assaults until she Googled his name months later while looking for his contact information. At that point, local news media had reported allegations against him.

“I was literally paying them every month and they don’t even call me about this,” Ms. Walsh said.

Mr. Cutler pleaded guilty to child molestation, assault and communication with a minor for immoral purposes in Superior Court of Washington for King County, and was sentenced to five years in prison. A 10-year-old boy he was accused of molesting wrote to the court saying the incident “made me feel like my life was hell.”

An attorney for Mr. Cutler declined to comment. It couldn’t be determined how soon after the police reports Care.com learned of them because the company wouldn’t discuss the case.

Ms. Marcelo said the company doesn’t notify members of every account closure, but if there is a “significant safety concern” from law enforcement or member of the public, it will notify anyone who has communicated with that member.

Barrett Howell, a Katten Muchin Rosenman LLP law partner who has advised companies on transparency including online disclosures, said the company “should have an ironclad policy that as soon as there’s reason to believe a caregiver has potentially victimized someone that notification of the alleged wrongdoing goes out to potential victims.”

Care.com’s screening practices set it apart from some companies in the gig economy, in which online platforms connect independent workers with short-term assignments. The dog-walking site Rover, food-delivery startup DoorDash and handyman-finder TaskRabbit all require workers to share their Social Security numbers and pass company-provided background checks before being approved for assignments. Uber Technologies Inc., which has been a subject of criticism for how it monitors drivers, last year began to include continuing background checks on workers in the U.S. in addition to initial screening.

A firm called CareLinx that focuses on senior care runs background checks on all caregivers, who pay about 20% of the cost, said Chief Executive Sherwin Sheik. The policy “cuts off my growth and the profitability of our company goes down,” he said. “It’s not cheap.” Care.com said CareLinx has a model more like a caregiver agency rather than just a website.

The company said the preliminary screening of new caregivers includes checking multijurisdictional criminal databases and the National Sex Offender Public Website, and can take up to 48 hours. Ms. Marcelo said 10% are rejected within 24 hours.

She said it is unclear why some who have police records make it through the preliminary screening. “There are no guarantees in a human business to take this risk to zero.” she said. Care.com noted that state, local and federal record-keeping of criminal history is fragmented and not standardized.

“We are safer than word-of-mouth,” she said.

Ms. Marcelo, who previously was at venture-capital firm Matrix Partners as an entrepreneur in residence, said she got the idea for the firm after trying to find care for her father, who’d had a heart attack, and her two children. The company launched in 2006, and after it went public in 2014 she became one of the few female CEOs of public tech companies.

Some incidents sparked conversations among senior employees about the company’s approach to background checks, said people close to the company. One was in 2012 when a 3-month-old girl died under the care of a Waukegan, Ill., babysitter whom the parents found on Care.com and who allegedly had a criminal record.

The babysitter had become frustrated with the baby on a changing table and struck her in the head, fracturing her skull, according to prosecutors in a subsequent criminal case. They also alleged she left the baby alone twice that day, both times taking a cab to buy wine.

The babysitter, Sarah Gumm, pleaded guilty to first-degree murder in Lake County, Ill., circuit court and received a 23-year prison sentence in a plea deal, according to the Lake County State’s Attorney’s office. An attorney for Ms. Gumm said she disputes the cause of the minor’s death and said, “We are investigating to exonerate her of that offense.”

The parents sued Ms. Gumm and Care.com alleging wrongful death. They said a background check should have shown the caregiver had a record of two citations for driving under the influence and “a battery matter,” according to their suit in Wisconsin state court. The suit said the parents had paid a fee for the highest level of background check; Care.com disputed that. The case was settled on undisclosed terms.

In a Nebraska case, a court threw out a suit against Care.com filed by a couple whose 4-month-old son died in the care of a sitter they found on its site. In filings in the 2014 case, Care.com argued it was “analogous to other job search sites such as Monster.com and Careerbuilder.com” or even directories such as Craigslist. The judge in Douglas County, Neb., district court said Care.com wasn’t responsible.

The sitter in whose care the child of Nebraskans Ashley and Christopher Bell died is serving 70 years to life for child abuse resulting in death, according to court records.

A federal law that Care.com has sometimes cited in its defense is known as Section 230, which says technology companies aren’t liable for content posted by their users. The law, established in the mid-1990s to give protection to websites, has recently come under attack by lawmakers who say it shields tech giants at a time when they are an ever-larger force in the economy.

Ms. Marcelo said Care.com is always looking to improve its processes but has never considered changing its marketplace platform model to include running in-depth background checks on all caregivers. She said doing that would mean raising prices and making them too high for many families.

“Our mission has been to provide a more cost-effective alternative to nanny agencies,” she said.

Care.com contracts with third-party vendors to do background checks when families order them. Information found in such a check is provided to the family, who can decide whether to share it.

A separate unit of Care.com has employees who provide backup day care for staffs of companies such as Starbucks Corp. , Twitter Inc. and Facebook Inc. In that unit, Care.com said, the caregivers get a higher level of screening because they are on-demand workers needed on short notice.

Edwin Dorsey, a Stanford University student who has written critically about Care.com on websites and at one point bet against its stock, used a pseudonym to test the site’s screening in October 2017. He applied to join Care.com as a provider using a photo of Harvey Weinstein and the email harveythebabysitter@gmail.com.

After just under a day on the site, and after he had begun applying for jobs as Harvey Weinstein, Care.com removed the profile.

Mr. Dorsey said, “Anyone can go on and lie about their name, credentials, and apply to babysitting jobs.” He said he no longer has a position in the stock.

A Care.com spokeswoman said, “This fraudulent profile, which was created by someone who has said he is betting against Care.com, was posted in an attempt to discredit our safety procedures. In fact, he validated our protocols because he was discovered and removed within 36 hours.”

The Journal found hundreds of instances in which day-care centers appeared to be falsely listed on Care.com as being licensed. The Journal cross-referenced phone numbers, addresses and facility names with records of licensed child-care providers from the five states with the most day-care providers returned by Care.com search results: California, Texas, Pennsylvania, Florida and New York.

In Pennsylvania and Florida—the states with the most comprehensive data—a total of nearly 3,000 caregivers were shown on Care.com profiles as licensed by the state. The Journal couldn’t locate records for 22% of them in databases maintained by agencies charged with overseeing child-care facilities. The Journal found by contacting day-care centers that some appeared not to exist or not to be aware they were on the site.

Care.com states on listings that it doesn’t verify licenses, in small gray type at the bottom, and includes this in a list of safety facts on the site.

A spokeswoman said that Care.com, like other companies, adds listings found in “publicly available data,” and that most day-care centers on its site didn’t pay for their listings. She said in the next few years Care.com will begin a program in which it vets day-care centers. Day-care centers aren’t a significant part of Care.com’s business.

Care.com has disclosed it is under investigation by the district attorneys of San Francisco and Marin County, Calif. It said San Francisco is looking into “the accuracy and clarity of our disclosures about the sex offender registry search available to consumers through our website,” while Marin is focused on the clarity of its automatic-renewal disclosures. Care.com said it is in discussions with the DAs about a proposed joint settlement.

In Massachusetts last year, Care.com paid about $480,000 to settle an allegation it misled families there about the scope of background checks they purchased. Care.com denied to local media at the time that information on its website was misleading, which was the claim in the case.

In Tennessee, the in-home day-care business Ms. Wieand used to care for twins Elyssa and Elijah last summer was called Om Baby. Its operator, Jennifer Salley, advertised it on Care.com as recently as March 2018 as being state-licensed, according to documents provided by the Tennessee Department of Human Services after a public-records request.

“We treat the day care similar to a preschool with lots of learning, reading, art and, my favorite, lots of loving,” the ad said.

Ms. Wieand didn’t find the center on Care.com, according to a person familiar with her interactions, but she was a member of Care.com and relied in part on information it provided about the day-care center as she researched child care.

State records show the Department of Human Services had received a complaint three years earlier that Ms. Salley was running a day-care business without a license and was watching five to 11 children. State law permits watching no more than four unrelated children without a day-care license.

After another complaint to the state agency in January 2018, state records show, a caregiver at Ms. Salley’s business emailed parents saying that seven children would have to be “let go” as Ms. Salley was “preparing to obtain her license.” The Journal found no record she ever applied.

The email to parents also said that Ms. Salley hadn’t seen her own children for 168 days. Ms. Wieand heard from Ms. Salley that this was due to a dispute between Ms. Salley and her mother, said the person familiar with Ms. Wieand’s interactions.

By May 2018, state records show, the Department of Human Services fielded two more complaints, from a caller who said Ms. Salley was still watching “at least 10 children.”

That person also stated that Ms. Salley was paid at least once with pain pills, according to records of the complaint, without saying what kind of pills or providing any proof.

Department of Human Services employees visited Ms. Salley’s home more than once. One visit revealed children shut into rooms by themselves, according to agency records. One room “smelled of feces” from a toddler who had been left alone in a “closed and darkened bedroom,” say records of the visit in May 2018.

That month, Ms. Salley agreed to an injunction sought by the agency that prohibited her from operating a day-care center without a license.

At one point on the morning of July 20, about two months after this injunction, a babysitter at Om Baby couldn’t locate Ms. Wieand’s twins and went to look for them, according to police records and records of a 911 call.

“I’ve got two babies that have drowned in the pool,” a caregiver calling from Ms. Salley’s cellphone sobbed to 911 operators.

Repeated efforts to reach Ms. Salley for comment were unsuccessful. An attorney for her said that “because this case is still pending, we are unable to comment on any of the specifics of this tragic accident. However, Ms. Salley is utterly heartbroken over the death of both Elijah and Elyssa.”

The Knox County sheriff’s office in Tennessee said it has referred the matter to the Knox County district attorney’s office, which declined to comment, citing ethics rules.

The state Department of Human Services, noting that a person can care for four children without a license, said it believed Ms. Salley was operating legally on the day of the deaths.

An attorney for the twins’ parents said “they are committed to investigating fully the wrongful conduct that led to Elyssa and Elijah’s deaths, and they hope their efforts may spare other families such a senseless tragedy.”

—Jim Oberman, Lisa Schwartz and Scott Barker contributed to this article.

Write to Kirsten Grind at kirsten.grind@wsj.com, Gregory Zuckerman at gregory.zuckerman@wsj.com and Shane Shifflett@dowjones.com.

Appeared in the March 9, 2019, print edition as 'Care.com Puts Onus On Families to Check Hires.'

Member Login
Welcome, (First Name)!

Forgot? Show
Log In
Enter Member Area
My Profile Log Out