Assisted-living facilities aren't retirees' first choice for long-term health care, but they aren't the last resort, either.

According to a recent report from Caring.com, just 53% of people 65 and older would consider an assisted-living facility for their long-term care. However, that contrasts with 64% of those ages 30 to 64.

“In some cultures, senior living facilities have been seen as taboo, as in: ‘I would never put Mom in a home,’” said Dayna Steele, Caring.com’s chief caring expert and the author of Surviving Alzheimer’s with Friends, Facebook and a Really Big Glass of Wine. “But most of today’s assisted living communities are really nice and nothing like the negative stereotypes of the past.”

In fairness, younger generations realize the difference between nursing homes -- which cater to those who need 24-hour care -- and assisted-living facilities built to help those who are no longer able to live on their own, but not infirm enough for a nursing home or old enough for a full-fledged retirement community. Still, 18% of all respondents have an overall bad impression of senior living facilities, thanks largely to the (in some cases, earned) stereotype of nursing home and elder care facilities as dreary, generic dormitories doubling as death's waiting room.

A UBS survey of wealthy investors found that, when asked what they feared most as they aged, 15% said they dreaded life in a nursing home. That trailed only surviving on life support (34%) and being a burden to their children (42%). Meanwhile, when insurer Nationwide asked women 50 and older about long-term care options, 67% say they would rather die than live in a nursing home.

However, the U.S. Census Bureau predicts that the population of Americans aged 65 and older will grow to greater than 80 million by 2050, and that the number of people likely to require long-term care is expected to more than double from 12 million today to 27 million during that span. Unfortunately, according to UBS, just 39% of investors have talked with children about who will take care of them in old age. Only half (50%) have factored health care costs into their overall financial plan, and only 23% have saved for their future care.

When you ask investors what they actually want, the overwhelming answer is that they'd rather stay home. According to UBS, 89% would like to stay in their current home, while 54% would consider assisted living a viable option. Only 15% would opt for their child's home, compared to 12% who'd choose a nursing home. As for who actually provides the care, 80% of investors want their spouse to care for them and 67% want a home health aide. Just 27% want a child to care for them.

Among Caring.com respondents, 41% who wouldn't consider a senior care facility of any kind would rather live on their own. Roughly 29% would choose to live with or be cared for by family. Of the women surveyed by Nationwide, 73% prefer to get long-term care in their own home, but only 51% think they will.

"Maintaining self reliance is important to the vast majority of investors," says Paula Polito, Client strategy officer for UBS Wealth Management Americas. "Having a plan in place for long-term care before they actually need it will help them avoid burdening their children."

While assisted living facilities can help ease that burden, they can only do so if you keep your family informed of your plans. While 66% of women surveyed by Nationwide are worried they will become a burden to their family as they get older (compared to 50% of men), 78% say they are concerned about having money to cover long-term care. Despite those fears, 62% haven’t talked to anyone about long-term care costs. More than 40% of women with a spouse and 60% of women with at least one child aren’t talking with these loved ones about health care costs because they don’t want them to worry.

Well, maybe they should worry. About 8% who told Caring.com they wouldn't consider an assisted living facility did so because they think it is too expensive. Among UBS's wealthy investors, 57% say long-term health care is important to them, but just 48% think they'll be able to find it. About half (49%) said they are “highly concerned” about rising healthcare costs.

This is having a significant effect on retirement planning for the women who were surveyed by Nationwide. While 64% say they are “terrified” of what health care costs may do to their retirement plans, 47% are willing to give all their money to their children so they could be eligible for Medicaid-funded long-term care.

“The sacrifice women make for their families at the expense of their health and finances does not come cheap,” says Shawn Britt, director of long-term care initiatives, advance consulting group at Nationwide. “Many women spend much of their lives taking care of others, giving up earned income and benefits which makes planning for long-term care so much more important. But not talking about long-term care now can do more harm than good to their family later.”


Maybe you won't choose an assisted living facility, but making your family wait until the last minute for that answer can be disastrous. As UBS discovered, 47% of respondents who currently provide care described it as a heavy burden, while 41% described it as moderate and just 12% said it was minimal.

“Even for those who have discussed future health and long-term care decisions, there still is a lot that goes unsaid and unasked between parents and their children,” says Sameer Aurora, head of client strategy for UBS Wealth Management Americas. "It’s a tough conversation, and no one wants to even think about it, let alone talk about it, but it’s important to get everyone on the same page before it’s too late.”

This article is commentary by an independent contributor. At the time of publication, the author held no positions in the stocks mentioned.