KFF Health Tracking Poll - October 2021: Home And Community Based Services And Seniors’ Health Care Needs

Key Findings

• The October KFF Health Tracking Poll finds one in five adults in the U.S. report receiving ongoing support for daily activities such as bathing, dressing, or remembering medications, and a similar share say they are providing those type of services for a close friend or family member. About one in five adults (18%) also say they or a family member need either new or additional support from paid nurses or aides beyond what they are currently getting. The most common reason why people haven’t gotten the support they need is cost. More than three-fourths of those who say they need more help (14% of all adults) say “not being able to afford the cost of the care” is a reason why they or their family member has not received the additional support from paid nurses or aides.
• Many unpaid caregivers say providing support to friends or family members has caused them to worry or stress (77%), experience worsening of their own mental health (50%), financial strain due to inability to work (42%), or worsening of their own physical health (38%). Unpaid caregivers are more likely to be racial and ethnic minorities, those with lower education, and report lower levels of household income.
• Significant shares of older adults in the U.S. report difficulty paying for various aspects of health care, especially services not generally covered by Medicare. Four in ten older adults (41%) report difficulty paying for dental care while three in ten report difficulty affording hearing or vision care (30%). Dental, vision, and hearing coverage are three benefits not generally covered by Medicare but are part of Democratic lawmakers’ proposals as part of the reconciliation spending package.
• Many older adults who are eligible for Medicare also report putting off or foregoing medical care due to costs. While Medicare helps older adults pay for routine doctor visits and hospital stays, substantial shares of lower income older adults report putting off or foregoing services not covered by Medicare. Overall, more than four in ten older adults in households earning less than $40,000 annually report delaying or going without some form of medical care over the past year due to costs (compared to 24% of older adults with household incomes over $40,000), including dental care (34%), vision care (20%), and hearing services including hearing aids (16%).
• With substantial shares of the public reporting financial strains associated with help with everyday activities for themselves or family members, and seniors reporting difficulty paying for some health care expenses, the latest KFF poll finds broad support for many of the proposals in the reconciliation package being currently discussed in Congress.

Home And Community Based Services

One in five adults, including 27% of adults 65 and older, say they are currently receiving ongoing support with everyday activities from either a family member (19%), a friend (11%), or paid nurses or aides (5%). Additionally, nearly four in ten (38%) adults say a family member gets ongoing help from at least one of these sources including another family member (30%), paid nurses or aides (16%) or  friends (12%).

About one in five adults (18%) say they or a family member need either new or additional support from paid nurses or aides beyond what they are currently getting. The most common reason why people haven’t gotten the support they need is cost. More than three-fourths of those who say they need more help (14% of all adults) say “not being able to afford the cost of the care” is a reason why they or their family member has not received the additional support from paid nurses or aides. Other reasons include not being able to find someone to provide the services (47%, or 8% of all adults)¹, being worried about being exposed to coronavirus (40%, 7% of all adults), being afraid or embarrassed to get help (32%, 6%), or being too busy or unable to find the time to get help (20%, 4%).

With many reporting difficulty paying for cost of home and community based care, the poll also gauged support for Democratic proposals to increase funding to Medicaid to pay workers and expand home and community-based services (HCBS). Medicaid is the primary payer for long-term services and supports (LTSS), including home and community-based services (HCBS), that help seniors and people with disabilities with daily self-care and independent living needs. Majorities across partisans (79% total, 95% of Democrats, 76% of independents, 67% of Republicans) support increased funding to Medicaid to pay workers and expand home and community-based services (HCBS).

The toll On Unpaid Caregivers

With Congress discussing possible new tax credits to help with home and community based care, one in five adults (21%) say they are currently providing unpaid support with everyday activities to either a friend or family member, excluding the type of care young children need. Majorities across partisans also favor new tax credit to help people pay for such care (82% total, 94% of Democrats, 80% of independents, 73% of Republicans).

The KFF October Tracking Poll finds unpaid caregivers are more likely to be Black or Hispanic (14% and 21%) compared to those who are not unpaid caregivers (10% and 15%). About eight in ten unpaid caregivers to family and friends do not have a college degree, and about half have household incomes under $40,000.

Consistent with recent focus groups conducted by KFF, the poll finds most unpaid caregivers (85%, 18% of all adults) report experiencing at least one of several negative outcomes due to their caregiving responsibilities. Over three-fourths of unpaid caregivers (16% of all adults) say they have experienced stress or worry related to the care of the individual they are caring for, with an additional half (11% of all adults) say they have experienced a worsening of their own mental health as a result of providing this ongoing support. About four in ten (9% of total) say they have experienced financial strain, such as losing a job or having to work reduced hours. A similar share (38% and 8% of total) also say they have experienced a worsening of their own physical health.

Expanding Medicare Benefits

With Congress debating changes to the current Medicare program, eight in ten adults—and nearly all older adults—say Medicare is important to them and their family members. This includes at least seven in ten adults across partisanship, income groups, and racial and ethnic identity.

Significant shares of older adults in the U.S. report difficulty paying for various aspects of health care, especially services not generally covered by Medicare.² Four in ten older adults (41%) report difficulty paying for dental care while three in ten report difficulty affording hearing or vision care (30%). Two in ten report difficulty affording their prescription drugs. Additionally, one-third report difficulty affording their out-of-pocket health care costs and one in five report the same about their monthly health insurance costs – shares comparable to those who report difficulty affording other household expenses such as rent or mortgage, gasoline, monthly utilities, or food and groceries.

Dental services are the most common type of medical care that people have delayed or gone without with about with about one in four (23%) of adults ages 65 and older saying they have put off dental care in the past year due to cost. This is followed by vision services or eyeglasses (15%) and hearing aids (13%). Dental, vision, and hearing coverage are three benefits not generally covered by Medicare.

Few older adults report delaying or going without a doctor’s office visit (6%), hospital services (5%) or mental health care (2%) due to cost. Overall, three in ten adults 65 and older report delaying or going without certain medical care during the past year due to cost (32%).

Even among older adults who are eligible for Medicare, those with lower incomes report delaying or going without care at higher rates. More than four in ten older adults in households earning less than $40,000 annually report delaying or going without some form of medical care over the past year due to costs (compared to 24% of older adults with household incomes over $40,000). While Medicare helps older adults pay for routine doctor visits and hospital stays, substantial shares of lower income older adults report putting off or foregoing dental care (34%), vision care (20%), and hearing services including hearing aids (16%) that are not generally covered by Medicare.³

A large majority of the public (90%) favor expanding Medicare coverage to include dental, vision, and hearing coverage, including 97% of Democrats, 90% of independents, and 85% of Republicans. This proposal is also largely favored by adults 65 and older, including 96% of those in that age group who identify as Democrats or Democratic-leaning and 82% of their Republican counterparts. Proposals aimed at curbing the price individuals have to pay for their prescription drugs are favored by majorities of the public with at least eight in ten overall and at least three-fourths across partisans saying they favor each of the proposals asked about. Eighty-eight percent of adults favor limiting how much drug companies can increase the price for prescription drugs each year to not outpace the rate of inflation (including 93% of Democrats, 86% of independents, 89% of Republicans) and a similar share (85%) favor placing an annual limit on out-of-pocket prescription drug costs for people on Medicare (favored by 88% of Democrats, 85% of independents, 84% of Republicans). The proposed changes to Medicare drug negotiations as part of the reconciliation package poll findings were released earlier this week.

The Affordable Care Act

Views of the 2010 Affordable Care Act are still largely driven by party identification with nearly nine in ten Democrats saying they view the law favorably, while three-fourths of Republicans say they hold an unfavorable view. Independents are slightly more favorable than unfavorable with more than half saying they hold a positive opinion of the ACA. KFF has been polling on the ACA since its passage and since 2017 views have been more favorable than unfavorable but still sharply divided on party lines.

The COVID relief bill passed in early March 2021 providing additional financial help for people who buy their own health insurance coverage. Previous KFF polling found that a small minority of those likely eligible for additional financial help or coverage reporting going online to see if they qualify for a different or cheaper health insurance plan.

Among those under 65 years old, nine percent of those who are either uninsured or buy their own coverage reported going online in the in the two months before mid-May 2021 to see if they qualify for a different or cheaper health insurance plan or Medicaid as part of the COVID relief package. Four months later, the latest KFF polling finds that about one in four (23%) of those likely eligible for this assistance have gone online to see if they qualify, though majorities (75%) still have not.

In addition, changes to health insurance coverage provided under the Affordable Care Act continue to be seen through a partisan lens, with overwhelming majorities of Democrats and smaller majorities of Republicans expressing support. Overall, eight in ten adults favor making permanent the financial help to low- and moderate- income Americans who buy their own health insurance coverage (94% of Democrats, 79% of independents, 63% of Republicans). Three in four favor the federal government stepping in to provide insurance options for lower income people living in states that haven’t expanded their Medicaid programs (94% of Democrats, 76% of independents) but this is supported by a small majority (54%) of Republicans.

While the poll finds broad support for many of the Democratic proposed changes to the country’s health care system including the ACA, Medicaid, and Medicare, the poll did not ask about the potential costs and savings associated with each provision, or the size and scope of Democrats’ broader legislative plan, which includes many provisions unrelated to health care.