Long-Term Care Insurance: Recommendations for Improvement of Regulation 13
constant over time and the increase is due solely to the aging of the population.
16
If increased
obesity results in higher age-specific impairment rates, spending for LTSS for the elderly will
rise to 3.3% of gross domestic product in 2050, according to the CBO. These estimates do not
include the value of informal care. The CBO also projected that the share of nonelderly adults
engaged in caregiving, either formally or informally, will increase from around 5% in 2010 to
10% in 2050, if impairment rates are held constant, and to 11% under the more pessimistic
scenario of increasing impairment rates.
Dementia, LTSS, and LTCI
Dementia is a general term for impairment in a person’s ability to remember, think, or make
decisions that interferes with performing everyday activities. Alzheimer’s disease is the most
common type of dementia. According to the Centers for Disease Control and Prevention (CDC),
5.8 million Americans have Alzheimer’s, and the number of individuals with dementia is
expected to triple over the next 40 years. Deaths from Alzheimer’s in the United States
increased by 145% from 2000 to 2017, making Alzheimer’s the sixth leading cause of death (and
the third leading cause when combined with other types of dementia). Part of the increase may
be due to a greater emphasis on reporting dementia and Alzheimer’s disease as a cause of death.
In any case, the burdens of dementia fall heavily on families and other caregivers—more than 16
million Americans provide unpaid care for people with Alzheimer’s or other dementias.
17
The CDC estimates that in 2016, the percentage of LTSS users diagnosed with Alzheimer’s
disease or other dementias was 41.9% for residential care community residents, 44.5% for
hospice patients, and 47.8% for nursing home residents.
18
Because a diagnosis of severe
cognitive impairment triggers coverage under most LTCI policies, many LTCI claims (roughly
half, according to some industry sources), are filed by policyholders with Alzheimer’s or other
dementias. Therefore, dementia already accounts for a large portion of LTCI claim payments.
While there is evidence that the prevalence of dementia is declining in the United States,
19
population aging is likely to increase demand for LTSS in the future, which may in turn increase
16
Congressional Budget Office, Rising Demand for Long-Term Services and Supports for Elderly People (CBO,
June 2013), available at: https://www.cbo.gov/publication/44363
.
17
See “Promoting Health for Older Adults,” Centers for Disease Control and Prevention, last modified September
2019, available at: https://www.cdc.gov/chronicdisease/resources/publications/factsheets/promoting-health-for-
older-adults.htm; “What Is Dementia?” Centers for Disease Control and Prevention, last modified April 2019,
available at: https://www.cdc.gov/aging/dementia/index.html; Alzheimer’s Association, 2019 Alzheimer’s Disease
Facts and Figures (Chicago: Alzheimer’s Association, 2019), 24-25, available at:
https://www.alz.org/media/Documents/alzheimers-facts-and-figures-2019-r.pdf; Ellen A. Kramarow and Betzaida
Tejada-Vera, “Dementia Mortality in the United States, 2000-2017,” National Vital Statistics Reports 68, no. 2
(March 2019), available at:
https://brainhealthinstitute.rutgers.edu/wp-content/uploads/2019/03/Dementia-
Report_March-2019.pdf; “Alzheimer's Disease and Healthy Aging,” Centers for Disease Control and Prevention,
last modified September 2019, available at: https://www.cdc.gov/aging/aginginfo/alzheimers.htm.
18
“National Center for Health Statistics: Alzheimer’s Disease,” Centers for Disease Control and Prevention, last
modified March 2016, available at: https://www.cdc.gov/nchs/fastats/alzheimers.htm
.
19
Kenneth M. Langa et al., “A Comparison of the Prevalence of Dementia in the United States in 2000 and 2012,”
JAMA Intern Med. 177, no. 1 (January 2017): 51-58, available at: https://www.ncbi.nlm.nih.gov/pubmed/27893041
.