The Growing Disconnect Between Reality and Perception in Long-Term Care Planning

The University of Michigan's 2025 National Poll on Healthy Aging reveals a striking disconnect between perception and reality among Americans over 50. While nearly two-thirds of older adults will require long-term care services in their lifetime, only 43% believe they will actually need such care.¹ This represents a critical shift in the aging conversation. There is no longer a greater acceptance of institutional care; rather, deep denial exists about its likelihood.¹

The data shows that 57% of adults age 50 and older believe it is unlikely they'll need assisted living, nursing home, or home care services. Perhaps more troublingly, 45% think the issue is "too far off to merit concern,"^5,6 suggesting a psychological defense mechanism rooted in a cultural avoidance of aging and vulnerability. This pervasive underestimation is not mere optimism; it is a dangerous gap between expectation and reality that leaves families, caregivers, and healthcare systems unprepared for what is nearly certain to come.​

Medicare Misconceptions and Planning Paralysis Are the Basis of Denial

The underlying causes of this sentiment reveal complex psychological and cultural forces. The Michigan poll demonstrates widespread misconceptions about Medicare coverage: 62% of older adults mistakenly believe that Medicare will pay for nursing home care,⁶ when in fact it does not. This false confidence creates inertia wherein people believe their healthcare costs are covered, so why plan at all? Additionally, only 27% of older adults have designated a durable power of attorney for medical care, and just 24% have identified potential caregivers.⁶ The "sandwich generation" phenomenon of middle-aged adults simultaneously caring for aging parents while supporting children drives decision fatigue and a tendency to defer long-term planning to the future.

Yet perhaps most revealing is that only 4% of adults have discussed long-term care planning with a healthcare provider.⁵ This silence itself is the problem. Without professional guidance connecting cognitive health, functional independence, and care planning, older adults risk defaulting into denial. The result is an inclination to view long-term care not as a health management challenge, but as an inevitable decline to be avoided through willful ignorance.​

A Turning Point Toward Prevention and Proactive Health Management

Yet, a critical shift in sentiment is emerging -- one driven by new evidence about prevention and the power of proactive cognitive health. The University of Michigan research on attitudes toward elder care reveals that Americans' beliefs about who should pay for aging services have transformed dramatically.⁴ In 2012, only 13% supported government assistance for elder care;⁴ by 2022, this had nearly doubled to 25%.⁴ More significantly, the percentage of Americans believing families alone should provide care dropped from 61% to 48% over the same decade.

This represents a fundamental revaluation: people are increasingly recognizing that aging well requires societal and health-system support, not just family sacrifice. The INHANCE trial (2025) and US POINTER study findings published earlier this year have further shifted the narrative. These landmark studies demonstrate that cognitive training, particularly speed-based cognitive exercises combined with multidomain interventions, can measurably reverse age-related neurochemical decline. What is more, they indicate the potential to reduce dementia risk by 29-48%, depending on engagement levels.⁶ This changes the equation entirely. Rather than viewing long-term care as an inevitable fate, older adults can now see cognitive health as an actionable, measurable path to preserving the independence they fear losing.​

Cognitive Health as a Prevention Tool

This is where sensor-based cognitive training like Thinkie has the power to transform the conversation. While it cannot serve as a replacement for long-term care planning, sensor-based cognitive training is a meaningful a primary prevention tool that could render such planning unnecessary for many. Consistent use of Thinkie's fNIRS-based neurofeedback combined with evidence-based cognitive exercises directly addresses the neurobiological decline² that typically leads to dependence and out-of-home placement. By providing real-time feedback on prefrontal cortex function during cognitive training, Thinkie enables older adults to "view" improvements to their brain health. What was once an abstract concept, cognitive health, is now transformed into a concrete, measurable outcome you can track daily. To wit: the INHANCE trial showed that just 35 hours of structured speed training over 10 weeks produced a 2.3% increase in cholinergic function, thus offsetting the 2.5% per-decade age-related decline.¹

For an older adult committed to consistent use of Thinkie, the potential for cumulative neural preservation could be profound. Moreover, the real-time adaptive feedback that Thinkie provides ensures sustained engagement, addressing the adherence challenges that plague traditional cognitive training approaches. Unlike generic brain training apps that eventually bore users, Thinkie's personalized neurofeedback creates an intrinsic motivation loop: measurable brain health improvement drives continued use, which drives further improvement.​

Citations

1. WEMU News (2025) - University of Michigan poll on older adults' unprepared long-term care needs​
2. University of Michigan National Poll on Healthy Aging (2025) - PDF Report: Long-Term Care: Are Older Adults Ready?​
3. IHPI (2025) - Poll reveals short-term thinking about long-term care​
4. advancingstates.org (2025) - National Findings from the Poll on Healthy Aging​
5. Argentum (2024) White Paper - The Value of Assisted Living for America ​
6. Michigan Medicine (2025) Webinar - Long-term Care: What Do Michigan's Older Adults Need to Know?