Caring for Older Adults Video Transcript

And the critical role of family caregiving. This event is especially dear to me since my 89-year-old mother lives with me. Before we begin this presentation, which is going to be extremely informative, I'd like to start by letting everyone know today's session is being recorded. I'd also like to go over event logistics.

Closed captions and a transcript will be provided today by a certified real-time captioner. We will save questions to the end of the presentation. You can then enter questions you have for today's speaker via the chat feature. Finally, if you are encountering any technical issues during the event, please alert us via chat.

We are very privileged to have with us a distinguished expert in this field, Dr. Marc Cohen, professor of gerontology at UMass Boston. Dr. Cohen brings a wealth of knowledge and experience to this discussion. He is the co-director of the LeadingAge Long-Term Services and Supports LTSS Center at UMass Boston and serves as the research director at the Center for Community Engagement and Health Innovation at Community Catalyst. Prior to joining UMass in 2016, Dr. Cohen was the chief research and development officer and former president and co-founder of Life Plans Inc, where he made significant contributions to long-term care research and risk management.

Over his career, Dr. Cohen has conducted extensive research on public policy issues affecting the financing and delivery of LTSS. He has testified before Congress the Bipartisan Policy Center and various other influential organizations. His expertise has been sought after by Governor Patrick's task force on LTSS financing for Massachusetts, the Long-Term Care Financing Collaborative and the National Academy of Social Insurance, where he chaired a study panel on designing state-based social insurance for LTSS.

Dr. Cohen's recent work focuses on improving person-centered care, integrating services into senior housing, enhancing patient engagement in research, and strengthening family caregiving advocacy. He has also addressed the complexities of caring for individuals who are duly eligible for Medicaid and Medicare.

His insights have been widely quoted in major publications such as The New York times, The Wall Street Journal and Time Magazine. Today, Dr. Cohen will guide us through several key learning objectives, providing a comprehensive background on Long-Term Services and Supports, LTSS; understanding the role and dimensions of family caregiving for older adults with functional or cognitive limitations, identifying key challenges and opportunities for family care, giving supports, discussing specific questions and issues that arise in the caregiving experience.

Dr. Cohen's deep expertise in thought leadership promise to make the session both enlightening and impactful. Please join me in welcoming Dr. Marc Cohen.

Thanks very much, Debora. It's a pleasure to be here. And I've already learned something, which is that I absolutely have to cut that bio in half. And I promise I'm going to do that. Let me share my screen, and we can jump right into this.

Can everybody see that OK? Just a thumbs up. That's great. So I'm going to be talking, as Debora said, about Long-Term Services and Supports and family caregiving challenges. A lot of this discussion is going to focus on care for older adults. But I want to acknowledge right up front that many Americans are also caring for dependent adult children and can expect to care for them throughout their life course. Many of the things that I'm talking about apply to caregivers of a disabled adult children.

See if I can-- there we go. Debora already mentioned the purpose. I won't repeat that. Let me jump right into the substance of this talk. So, one of the things, just to set the stage here-- we are experiencing revolution in life expectancy. And just to give you some perspective, in 1900, average life expectancy was 47. In 2024, it's already close to 80. So we have added a tremendous number of years to life.

One of the challenges we have now is, how do we add life to those years? And I think a lot of people are struggling with that. One of the key lessons we already know is that healthy aging requires engagement, continued engagement with community, family, friends, and so on.

The other thing to note, just in terms of context is that we are actually the first generation to reach old age sort of not by accident. We all expect to hit age 65, at least. That was not the case for most of human history. And so it is really true that, while we're all aging, some of us have more experience than others-- 85-year-olds compared to 60-year-olds and so on.

The other thing to note is that the future is already here. It's just unevenly distributed. And what I mean by that is people that are-- we are already living with people who have life expectancies over 100 years of age, OK? Many people born today can expect to live over 100.

And this greater life span means that many more years are going to be spent in retirement. That has all sorts of implications for how we think about labor force participation, even the way we describe retirement. So, many of you probably talk to people all the time that they say that they're retired, but they're working 30 hours here, 20 hours there-- whole new concept of what it means to be retired.

And the other point I'd like to make, which will take up a lot of the talk today, is that we're going to have to-- people are living long enough to experience a significant need for support services, and that will be the focus of today's discussion. And it means that we're going to be spending a lot more time out of the labor force, but with increasing health-related liabilities

And one of the most important of those liabilities is Long-Term Services and Supports. Now, I'm going to refer to it as LTSS because Long-Term Services and Supports is a mouthful. So what is LTSS?

Generally, these are non-medical supportive services that are designed to help people perform basic living activities like bathing, dressing, toileting, and so on. And the cause-- why people end up needing help can be either functionally-oriented. Suppose you have some chronic conditions that-- or you've suffered a stroke or what have. You can no longer perform those activities because of functional limitations; or cognitive, that when you experience cognitive impairment or significant dementia, you're unable to understand fully how to perform those activities or do them safely.

There's a very high correlation between people who have multiple chronic conditions and people who have functional impairments. Now, when we think about Long-Term Services and Supports, they are generally provided in three major settings-- home settings, residential or institutional settings-- and here we're talking about nursing homes and so on-- and then community-based settings-- assisted living facilities, retirement communities, supportive housing, and adult day care.

It turns out, as I will show you, most people with Long-Term Services and Supports needs are actually living at home in the community. And there are two primary providers of care-- family members, primarily spouses and adult children; and paid caregivers, paraprofessionals like home health aides, homemakers, companions and so on. So that's just some basic information on Long-Term Services and Supports.

Now, what's unique about LTSS? And why is it often talked about as something separate and apart from the health care system? First of all, these supportive services are typically palliative rather than curative, which means that they're designed to keep you at a certain level of function, rather than to cure an illness to bring you back to full health. That's number one.

Number two, paid and unpaid services are close substitutes for one another. Now, this is really important, especially when you're thinking about family caregiving. If you think about an acute care need, it requires medical professionals. Whereas, Long-Term Services and Supports often require what are called paraprofessionals or trained family members, neighbors, or friends.

Now, I mean, think about it this way. Suppose you have an appendicitis attack. you go to a-- you don't go to your neighbor or friend to get help for that. You go to a medical professional. But if you have a long-term care need, neighbors, friends, family members can help you to meet that need.

Family caregivers dominate the provision of care. There are over 38 million family caregivers, providing over 35 billion hours of care, valued at more than $600 billion in 2021. Now, whenever I'm listening to a talk and somebody throws out a number, sort of like, is that a big number, or is that a small Number? You need some context to evaluate it.

Here's one context-- the largest public payer of Long-Term Services and Supports is the Medicaid program in Massachusetts. It's called MassHealth. The amount of care provided by family members and the value of that care is more than six times greater than our largest public payer. So that tells you just how much care is being given by family caregivers.

I mentioned a minute ago, three quarters of adults with an LTSS need live at home, and the distribution of need varies widely among the population. As I mentioned at the outset, there are many adults, older adults, that are caring for dependent adult children.

And in fact, 40% of Long-Term Services and Supports costs are for individuals under age 65, OK? It may be the case that most people with LTSS needs are over age 65. And the incidence increases with age, but a significant portion of the costs are incurred by people under age 65. And one of the reasons we focus a lot on this population over 65 is we've got a lot better detailed data and information on that population, so we have more to say.

So in the US, what are we talking about? We're talking about 8 million people require some level of help with their basic activities. And most of those, or many of those, require help in at least two of those activities. Again, activities being bathing, dressing, toileting, transferring, incontinence, and feeding.

Across all ages, roughly 12 million people require some level of LTSS, of which close to 60% are over 65, and 44% are younger people with disabilities. That number is expected to more than double by mid-century, and that's because of increases in life expectancy. Because the need is highly correlated with aging, as people live longer, they're living long enough to experience some of this need.

Now, think about this. When you turn age 65, what's the chance that you will have a Long-Term Services and Supports needs? I'm going to tell you a story. When I've given lectures to professionals in the area of Long-Term Services and Supports, I will often ask-- I'll say-- and people who understand the statistics know the issue.

I will say, well, how many of you think that you will have a significant LTSS need after age 65? And very few people raise their hand, even though they know the statistics. And then I'll say, well, how many people think the person sitting next to you is going to have that need? And everybody raises their hand.

And that gets to some of the issue about denial, the difficulty of imagining our future self having this sort of need. But the fact is, more than half of men and 3 in 5 women will face high levels of LTSS need before they die. So it's very prevalent, and it costs a lot.

This is some data just from a few years ago on the costs of care in nursing homes, assisted living, home maker, and so on. And the expected lifetime costs are over $180,000 if you have a significant need. Now, a lot of that will be paid publicly and so on, but just to make that point.

So let's get to the issue of caregiving. I mentioned that the vast majority of Long-Term Services and Supports care is provided by family members. And this is some data from AARP and the National Alliance for Caregiving that is looking at changes in caregiving in the United States between 2015 and 2020. So, right off the bat, there are more than 50 million people that are providing LTSS to loved ones.

And you can see that has grown, just over this five-year period, fairly significantly. And again, that's because of the fact that you've got age-specific mortality rates declining, more people living longer.

So, nearly 1 in 5 Americans are providing unpaid care to an adult with health or functional needs. And a couple of other points to note are that there's a growing percentage that are caring for more than one person. It may not just be-- Debora mentioned 89-year-old mother who lives with her. There are many people who are having to care for both parents. And you can see this. That of those people who are caregiving, roughly a quarter are caring for two people.

One of the biggest challenges that family caregivers have is coordinating care. And this is just a very simple question about in this survey. And it shows that about a quarter of the people who are providing care have hard time coordinating it. And that's because if you are caring for somebody that has a functional or cognitive limitation requiring support, it's often the case that they also have more medical needs, more pharmaceutical needs and so on. And so being able to coordinate care is very important.

The other thing we're seeing is that there are more people with dementia that are living in the community. I mean, it is a fact that if you go to nursing homes, there's a very high prevalence of residents that have significant dementia because the challenges associated with caring for somebody with dementia are very difficult. It is literally 24-hour-a-day job.

And what we're seeing-- so we see that on the one hand. On the other hand, people are loathe to want to have their loved ones in a nursing home if there are alternatives available. And this was particularly true during the most recent the pandemic.

You can see here that-- and we'll talk more about this-- family caregivers report that their own health is suffering by providing this care. It can be very challenging. And here, 1 in 5 in 2020 say that their own health-- they rate their health as fair or poor when they're given the option to rate it as between, you know, excellent, good, fair, or poor.

So who are today's family caregivers? Well, this might surprise you. 20 years ago, most people thought that the vast majority of-- and they would have been right-- of family caregivers were women. I think it was upwards of 75%. That is shifting a lot, where you're now at a point where 2 in 5 caregivers are men.

People are reporting that-- and I'll give more data on this-- that family caregiving has had financial impacts on them; and in particular, with respect to work. And I'm going to provide some more granular data on that.

Again, a little bit more on profile just to focus on the right side of the screen here. This is the age distribution. And the average age of a caregiver today is 49 years. But you also have older adults caring for very older, very much older parents, right? Close to 20% of family caregivers are over 65. So you've got older adults caring for very old parents for the most part.

How many people? Most people are caring for one individual, but you also have a quarter who are caring for two or more. On the right side of this screen, what you can see is that, oftentimes, it's adult children that are caring for a parent-- sometimes, a grandparent. And about 12% for spouse or spouse or partner.

Average hours per week. I mean, this is astounding. And I want to point out here that these are people who are caring for individuals who have some very significant needs. I mentioned before about, for example, dementia, where that is sort of around the clock.

And then there's some others that just have some smaller support needs. So you can see here that a little over two thirds of caregivers are providing care up to eight hours a week-- sorry, 20 hours a week.

And you've got-- but you've got one 1 of 5, 20% are providing more than 40. On average, it's about 24 hours a week. So now, you divide that by 7; you're talking about a little over three hours a day.

How long do people typically provide this care? On average, when we look across the spectrum of people providing caregiving to older adults, it's about four and a half-- it's about four and a half years. Again, you can see there's a small group, a little less than 1 in 6, if you look at that 14% down there, that have been providing this type of support for 10 years or more. So this is very, very significant. And there's quite a wide distribution.

And what are reported to be some of the big issues that people are having? And when you ask people, here's what old age means. There are a lot of people who, at older ages, become somewhat frail. So it's not as if there's anything-- there's an underlying condition that's keeping them from being able to bathe or dress or what have you, but they may be particularly frail and at risk.

And so without having somebody be able to be there to provide potentially standby assistance or hands-on assistance if they need it, they could be in serious trouble. And so that's what that old age is capturing.

Many people have mobility issues. I mentioned the Alzheimer's and dementia. And then, you can see this is broken out by different types of diagnoses. And many people have multiple diagnoses.

What are some of the financial impacts of caregiving? And for anyone who is a family caregiver, these will resonate with you. So first of all, you've got roughly half of the people who are providing caregiving saying, yes, there are financial impacts. A third in this list below are saying there's more than two. And let's look for a second at some of the impacts.

So, first of all, as we'll get to in a minute, many people have to make workforce accommodations, and that restricts their ability to save money. So you've got 28% said they've stopped saving. Some have had to take on more debt.

And again, this is also related to the fact that if you have LTSS needs-- I don't have a slide here, but I remember it, and I see it in my mind's eye-- that Medicare spends, like, five times more on people with LTSS needs than on people without LTSS needs. So, there's significant medical costs. In those medical costs, oftentimes, there's co-pays, deductibles. Granted, there are limitations, but they're still fairly-- they can be fairly significant, and people have had to take on some debt, and that may be related to that as well.

1 in 5 say they've used up their own personal short-term savings. There's late bills. They've had to borrow money. It can be very financially challenging.

60%, 3 in 5, caregivers today are working. So that's not surprising when you think back to what I said about average age being around 49. So, many people are still in the workforce and are providing caregiving services.

Now, what? What are the impacts on people who are working. They are multiple and they are varied. So here, 3 and 5 working caregivers say they've experienced any of these. And many of them have experienced multiple.

What are we talking about? So, coming in late, leaving early, having to take time off pretty much in an unscheduled way. 1 in 6 have gone from working full time to part time, or they've had to reduce their hours had to take leave of absences.

Some have made workforce accommodations by turning down promotions, retired early. And you can see there are some very significant work impacts. Now, I'm not going to talk about this here, but one of the things I wanted to at least make the point, make you aware of, is that when you are providing caregiving services, and you're having to make these workforce accommodations to the extent that you are earning less, or you have to leave the labor force, that means that the Social Security benefits that are available to you will be reduced. And so you almost have this cycle of threatening your own retirement security to some degree by having to engage in especially longer-term caregiving that forces you to withdraw from the labor force.

This is a really busy slide. The good thing is you don't have to take notes because-- we haven't discussed this, but I'm happy to make these slides available after this. So this is-- we ask people about caregiver challenges that they most frequently encountered. And on the left hand side, it's like, these are the things I'm always experiencing. And on the right hand side, these are things that I often experience.

And so I'm not going to go through all the numbers. But in the boxes on the top is you can see it's like, look, I got to pay for in-home care to supplement my own efforts. This is emotionally draining. It's very hard to get emotional support.

And early on, I mentioned coordination with the doctor and other care providers and people are saying this is pervasive. It's with me all the time.

The list is fairly similar on the other side, except there's one additional one, which is deciding what care is needed. Sometimes, it's hard to know exactly what is needed, and many people don't have the opportunity to really have an address or a place to consult to get that assistance.

So where do caregivers go? What are some of their sources of help or information? First of all, the fact that 80% got any help tells you that this is challenging. That this is challenging.

Most people might like to think and might believe that they're perfectly capable of helping their parent or a disabled adult child and so on and they don't need help. But in fact, 80% have indicated here that they've needed some help. And here's where they get some of their sources of information-- the doctor or health professional and friends and family.

Primarily, what we're talking about here are other people who are experiencing some of the challenges associated with caring for an older adult. And given the numbers that I put up there earlier about how many people, there are probably plenty of family or friends to talk about some of the difficulties. And then you can see some of the smaller responses are government agencies or organizations, social media and so on.

Employers are starting to recognize the importance of providing support to caregivers. And that's because family caregiving can affect productivity, absenteeism, morale. And so you can see here just some statistics that show the percentage of workplace benefits for caregivers. There's paid sick days, flexible. You can see.

Well, we have FMLA here in Massachusetts. This is national, but there's paid sick days, more flexible work hours. There's unpaid family leave, Paid family leave. Here in Massachusetts, where this would be covered under that.

And then there are employers that, as part of their employee assistance plans, are giving information and referral systems and other types of programs. Very interesting-- there's a lot to study here in the area of telecommuting and what has been the impact of that, especially for white collar workers who can work from home.

Telecommuting is both a blessing and a curse. You don't know sometimes where your family responsibilities end and your work responsibilities begin. But it had provided much greater flexibility to family caregivers. There's no doubt about that.

One of the things I was thinking about for this presentation is, are there some things that employers could do that would be helpful for family caregivers? And this is not an exhaustive list, but here are a number of the ideas. Obviously, there's flexible work schedules and work locations if that's possible.

The other thing is, it's really important to be able to talk to people about your challenges, strategies that can be used. So in the second bullet point, I just wanted to make the observation that support groups, career coaching, and financial advising to family caregivers is something that would be very important. I mentioned paid leave already.

There are employers-- these are from some of the best practices of employers. You can imagine hosting sessions to talk to caregiving-employees about how they can take advantage and optimize the benefits that are there because, frankly-- I'll even speak for myself-- I don't think I've ever accessed the employee assistance program at UMass. And I'm guessing there are probably some caregiver benefits, or you could find information about how to get help and support. Training managers to be sensitive about what is happening to people who are providing significant care and emphasizing that it's OK to use some of these benefits that are available without incurring any career risks.

So we've done a lot of work asking people about what would be really helpful to them as it relates to support for family caregiving. And this is from national work, and then I'm going to show you something that we just did recently.

So obviously, there's paid family medical leave that you want the definition of family to be broad. So it includes caring for an older adult, employer programs that I just went through. There are a number of states that are trying to provide some financial benefits like caregiver tax credits. Like, if you provide more than X hours a year, you maybe get a certain amount off of your taxes, a $500 tax credit or a $2,000 tax credit. Programs to both pay family caregivers, that's being thought about in many states, especially because there are tremendous shortages of paid caregivers, OK?

Respite care-- this may not be familiar to you, but for people who are providing Long-Term Services and Supports, as I mentioned, it's difficult work. It's challenging both emotionally, sometimes physically. And so people need a break. And respite care would allow someone, for example, to place the person for whom they're providing care into a facility or a group environment for like a week or so that they could continue to be cared for, but that the family caregiver could be given a break or completely substituting the care with a paid family caregiver.

It's really hard to find care. How do you even go about searching for care? How do you know what needs that the person really has that can be addressed by the formal or paid caregiving market?

Training-- how do you do certain things? For example, there's a right and a wrong way to help somebody get up from a chair or get up from a bed. I mean, the last thing you want to do is not understand that and increase the risk of a fall. And then there's legal support that could be helpful.

This was people's reactions for what they felt would be very helpful in terms of caregiver support. So here you can see the majority, more than 3 in 5 said an income tax credit would help offset some of the costs of care. Think back to the earlier slide that I put up about people incurring all these costs. A program where caregivers could be paid at least some of the hours for the care that they provide, and then paid leave. So this is on a national level.

And more recently we did focus groups with our, some of our partners over at the Retirement Research Center at Boston College. And these, we were talking to adults primarily from underserved communities caregivers. And most of them said, look, we're providing a service. It has value, and we need to be compensated for that.

So you can see here that a little over and 2 in 5 cited that as most important. Some of the costs that they have to spend for caregiving need to be reimbursed. And here's the rest of it.

My last slide is, what are some resources here in Massachusetts or national that could be helpful to support family caregivers? And maybe if you're already caregiving, you're aware of these. Maybe you're not.

So I put the links in. But there's the Massachusetts Family Caregiver Support Program that has resources, tips to help you be more effective and really for self-care also. There are support groups for family caregivers in Massachusetts, and here is one of the links to that.

There's something that-- this is a national-- called the Caregiver Action Network that helps to improve the quality of life for more for the more than 90 million Americans. So, I had said earlier that the data shows 50 million. I'm imagining that this is including a much broader definition since I'm focused primarily on older adults.

And then, the National Alliance for Caregiving, they do a lot of research on family caregiving, policy analysis, and best practice programs. So that might be another place to look for support. So with that, I've spoken for a long time, and I'd be happy to entertain questions that you might have.

And if there aren't any in the chat, that's fine. You can raise your hand or use the little symbol on the bottom. I'll be on the lookout across the squares. Ashley.

Hi. Oh, sorry, John, I stole your thunder.

You can go.

So I'm not a direct caregiver, but I live with someone who is a caregiver for someone. I'm not sure if that is something that you shared, but are there any resources or tips that you have to support those people who are caregivers that we are in the same household with?

I mean, I think many of the-- the first two on that last slide that I put up, many of the resources that are available that would be relevant for somebody living with a caregiver. I did not go into the data about the health effects of caregiving. They're quite pronounced in terms of mortality, morbidity. It's quite difficult.

And so if I didn't mention it or emphasize it enough, I'll do that here. And that is, some of the most important tips have to do with self-care. How do you stay resilient, especially if you're caring for somebody for many years? John?

Thanks so much. This is really great. One question I have-- I don't know if you have any thoughts on it-- is, how much do we have a right to expect that a primary care physician is really going to continue to play a coordinating role in the care for an elder person? As specialists become more a part of the picture, in some cases, many different specialists, you need to go through the primary care to get the referral. But it's my experience that the primary care physician really is no longer playing a coordinating role of the care.

Yeah. That is a really-- that is a really important point. And a couple of things about that and some of the dysfunction in our health care system. So this does require a lot of coordination. And unfortunately, it is not the primary care physician that's going to be doing this. It is the family caregiver that is going to have to do this.

I also want to mention that primary care physicians, by definition, are in the business of curing things. I come in with a pain. They have succeeded when that pain is gone, or I've got-- and this type of care is not curative for the most part. It's palliative. It's keeping people at the same level that they're at, prohibiting them from getting worse, and so on.

So I do not see primary care. If anything, you have a much better chance with the nurses, the nurse practitioners than the primary care physician. They're fighting to get in their 15 visits at 10 minutes or 15 minutes a day. Chanda?

Hi, I have this in the chat, but I'm just going to read it to you if that's OK.

Sure.

"Sometimes, there are cultural challenges associated with elderly care. What is the approach for being sensitive to type of care?"

Yeah. There are some really big cultural differences, so let's make the distinction. This issue doesn't get raised as much for family, the unpaid family caregivers, OK? Because oftentimes, if it's a relative, you're generally from the same sort of culture. You may live in the same area, or even relatives and friends.

Where this becomes a really salient issue is on the paid workforce. And we've done research out in California and other parts of the country that shows. And the other thing is, think about the nature of this care. Somebody needs help bathing, dressing. And you're paying for somebody to come into their home.

So there are major issues with cultural sensitivity, language issues, and trust. And one of the things that we've learned in this literature, and from experience, is that building trust between the paid caregiver and the care recipient is the key to solving a lot of these other issues.

There's also issues about home care agencies not locating in underserved areas. So you have greater supply issues in those areas. So it is a big issue, and there are a lot of people trying to increase the capacity. I should mention, just on the paid caregiver workforce, a third of that workforce is immigrant.

The vast-- now, that is a workforce that is a women's workforce, right? A vast majority. And many are also coming from underserved communities. At last count, you had something, like, they were totally underpaid until the pandemic.

Imagine this-- you had full-time workers caring for elders, some of our most treasured resources. We were losing those to McDonald's because of the pay differential. Now, that's changing quite a bit. More than a fifth of them were getting government assistance themselves while they were providing full-time assistance. Steve. I know you're talking, but you're. on mute.

Sorry.

No problem.

Myself and my sister are caring for my father, who's 95 years old and has dementia. And we're about one month into it now. And you spoke about some of the benefits available on the state and maybe the federal levels. What about help available in the local community? Are you aware of quality community, local-type benefits?

So I would say that it varies a lot. There may be help assistance through faith-based organizations in the community. I would not discount those. In Massachusetts, we have the AAAs, the Area Agencies on Aging. And they may be able to hook you up with resources that you're not aware of.

I mean, that's the problem there. There are like a maze of different potential programs or pieces of information and so on. But it's hard to get it all centralized. And you do have to be a little bit of a Sherlock Holmes in this regard.

I'm aware of Aging Services of North Central Massachusetts. I'm not aware, though, that they would provide any extra benefit, if you would-- a benefit that's just part of this particular community separate from state- and federal-type benefits. But I suppose maybe it's worth looking into.

Yeah, here's what I would say-- they will-- finding paid caregivers, that's one thing. But then there's support services. Honestly, Steve, being hooked up with a group of people that's experiencing the same thing and can give you tips about how to deal with certain issues or might point out things you haven't even thought about. I would not discount the importance of that.

That's a good point.

That can be really helpful over the long haul. I saw a question about long-term-- what are my thoughts on long term care insurance? And actually, that's an area that I've studied and been involved in for most of my career. So here's what I will say about long-term care insurance.

If you have a long-term care insurance policy, and you need Long-Term Services and Supports, you are in really good shape. They're terrific policies for paying benefits, getting the paid care that you need. Many of them provide access to training and resources and so on.

The problem is there are very few companies left in the market that are selling it for a whole host of reasons. And the cost of policies is really out of the reach of most middle class Americans. So you have less than 10% of the population has a long-term care insurance policy.

We did a big study for the federal government looking at claimants. And I mean they-- look, if you're a claimant and you're not happy, then this is terrible insurance. But the vast majority-- like, the long-term care insurance, made a huge difference for them. It's a question of buying it at a relatively young age and having it.

I have a question. So, thank you so much for all of this information. When you were sharing a lot of the information, it really kind of hit home in terms of a lot of the things that I'm doing, and, like, that feeling of not fully understanding everything that you're doing, and that others are also doing something similar. So it brought a lot of clarity in terms of decisions that I've made particular to my mom.

But I guess the question would be-- and I know you shared some resources. But how do you kind explain to other family members kind of like your experience and how you need more support and help and assistance and things like that? Because obviously, especially when you have a parent that lives with you, there's that certain type of, well, she's your responsibility now. So do you have any tips and tricks?

Yeah, there's one trick I have that will do the job. You remember I mentioned respite care, which is, allows-- if you want people to understand what this really means. So then if you trust these people, let's say that potentially their siblings-- that often is the case-- have them give you a week off and trade places with you. People will come very quickly to understand what it means to be a family caregiver.

There's no replacement for experience. You can use all the adjectives, all the descriptors. And if you're not in the mood to hear it, you'll be viewed as a whiner. So if people are not-- and again, these have to be close relatives who can do what you're doing. Ask them to relieve you for a few days. You'll have very different discussions after that.

Any other questions? We have about five minutes. We have time for maybe one more question. I don't see any in the chat, and I don't see any hands up, so I think we can wrap it up.

I first want to thank Dr. Marc Cohen for presenting today. It's been truly enlightening for me as I kind get into that phase of my life as well. So I appreciate that and Thank You very much.

I also want to thank all of you for attending. I hope you found this session helpful. Feel free to email me with questions, and I can pass them along to Marc Cohen if you would like. And we look forward to seeing you at our next event. So, thank you all.

Marc, thank you very much.

Thank you, Marc.

It was a pleasure. And the slides will be made available. So, thank you all very much. Have a great summer, everybody.

Thank you very much.