Transcript Slide 1

Long Term Care
Nancy L. Wilson-Baylor College of Medicine
Huffington Center on Aging-Department of Medicine
Presentation to Citizen’s Health Care Working Group
Houston Hearing
July 26, 2005
Mission Statement: To improve long-term care and
supportive services provided to vulnerable older adults
and family caregivers in Harris County through
collaborative problem solving and strategic planning that
involves consumers, providers, funding organizations,
and other major stakeholders of the long-term care
system.
www.careforelders.org
RWJ Community Partnership Program for Older Adults
Key Issues and Strategies
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Access to Needed Services
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Availability of Affordable Services
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Quality of Care: Major Workforce Issues
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Preparedness for Aging
 Individual/Personal
 Organizational
 Community
Today’s Presentation:
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Population concerned with long-term care is very diverse in terms of
age and level of disability : physical, mental,
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My Expertise and Experience Focused on Older Adults– (60-63%)
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Who I think about:
My brother –in-law who has managed with functional limitations due to
encephalitis : fiercely independent in his own apartment with an electric
wheelchair and dependent on daily assistance
 My neighbors: Mrs. H, 81 who has congestive heart failure and COPD as
well as a closed head injury sustained from a fall. She would like to remain
at home with her husband for the duration of her illness.
 My niece who is 22-years-old who has mental retardation as a result of
complications during birth and has been diagnosed with autism. Her family
would like her to live at home indefinitely , but they need help with her
care, particularly with a program of supervised daily activities.
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Think about the heroic families who support these individuals –and the
workplaces who make accommodations for these families
Definition and Examples
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LTC is difficult to define: boundaries
among primary, acute, and long-term care
have blurred.
 medication
management for elders with
chronic disabilities ?
 Settings of care are confounded with services
Nursing homes provide acute care
 Home Health Care delivers medical treatment
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Long-term care is primarily concerned with
maintaining or improving the ability of elderly people
with disabilities to function as independently as
possible for as long as possible.
Long-term care also encompasses social and
environmental needs and is therefore broader than
the medical model that dominates acute care.
Long-term care is primarily low-tech, although it has
become more complicated as elderly persons with
complex medical needs are discharged to, or remain
in, traditional long-term care settings, including their
own homes.
Services and housing are both essential to the
development of long-term care policy and systems.
 R. Stone (2000) Milbank Memorial Fund
Key Issue: Chronic Disease and Disability
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43.5% of Harris County elders report disability
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55.5% report two or more disabilities
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63,400 need help with basic daily living tasks
Key Issue: Disability and Long Term Care
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Not Just Nursing Homes
A range of services to address functional
needs and support independence
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Everything from a home delivered meal to
institutionally based care
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Escalating costs
National expenditures in long term care
expected to triple to $346 billion/year by
2040
Long-Term Care “Risk”
The risk of nursing home placement
increases with age - 31% of those who are
severely impaired and between the ages of
65 and 70 receive care in a nursing home
compared to 61% of those age 85 and older.
 Most people with long-term care needs (83
percent) live in their own home; among those
living at home, the majority (78 percent) does
not hire any help and only 8% depend only
on paid help
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Long-Term Care is Expensive
• In 2002, the average annual cost for a nursing
home was $51,000 for a semi-private room and
$61,000 for a private room.
• Four hours of home care daily costs $26,000 a
year. (national average)
• The cost of assisted living can range from less
than $10,000 a year to well more than $50,000 a
year (depending on the kind of assisted living
facility and type of services an older person
chooses.) (DHHS:Administration on Aging, 2003))
BILLIONS OF DOLLARS
The value of the services family caregivers provide for
"free" is estimated to be $257 billion a year.
$300
$250
$257
$200
$150
$100
$83
$50
$0
$32
Home Health Care Nursing Home Family & Friends
Care
Source: Expenditure data from HCFA, Office of the Actuary, Levit K. et all,
Health Affairs 2002;21.
Economic reality
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You can save for college—but most of us can’t
“save” for long-term care
Need to Consider how to approach the individual
and social risk
 Physical,
emotional, and social burdens that providing
care impose on the caregiver and its economic costs
to the caregiver and to society.
 Caregiving can conflict with caregivers’ employment,
creating economic losses for caregivers and society.
 Individuals suffer from inadequate attention to basic
needs
Best Practice Approaches with
Potential to Reduce LTC Costs
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Integration of care for long-term care recipients:
 PACE:
Program of All-Inclusive Care for the Elderly
(55+ Medicare/Medicaid population)
 EverCare nursing home managed care (Use of NPs
and PAs to deliver medical care)
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Consumer-Directed Services: Cash and
Counseling Demonstration
Public Policy Support of Private Insurance Plans
and Consumer Education
Other Approaches
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Incorporating Geriatric and Prevention
Approaches to Chronic Illness
A Geriatric Perspective
Finding the Appropriate Balance and the
Right Plan
A
B
C
D
Prolonging
Life
Optimizing Quality
of Life
Increasing age and frailty
Examples of promising complements to
primary care of senior populations
Brief GEM/disability prevention with attention to
primary care adherence in community (HEP, Stuck)
or clinic
 Chronic Disease Self-management and other
proven self-management support programs
 Post-hospital transition care
 Linkage to community Alzheimer’s services and
supports
 Problem-solving therapy for depression
 Post-prescription drug monitoring
 Senior oriented physical activity
(Ed Wagner, Seattle 2005)
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Threats to Health and
Quality of Life
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Physical inactivity
Poor diet and nutrition, obesity
Falls
Alcohol and substance abuse
Depression
Smoking
Infection (flu and pneumonia)
Inability to self-manage chronic conditions
Inattention to clinical preventive services
Social isolation
Underlying Risk Factors –
“The Actual Causes of Death”
Behavior
2000
% of deaths,
 Smoking
 Poor
diet & nutrition/
Physical inactivity
 Alcohol
 Infections, pneumonia
 Racial, ethnic, economic
disparities
18%
17%
4%
3%
?
*Mokdad et al., Actual causes of death in the United States, 2000, JAMA, March 10, 2004.
Threats to Health and Wellbeing Among Seniors
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37% women & 33% men aged 65 – 74 report no
physical activity
24% - obese
33% - fall each year
34% - no flu shot
45% - no pneumococcal shot
47% - no mammogram
88% - at least one chronic condition
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37% experience some activity limitation
Evidence Based Health
Promotion Programs
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Administration on Aging and National Council
on the Aging (www.healthyagingprograms.org)
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Evidence Based Disease Self-Management
National Demonstration Program
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3 of 13 projects in Texas
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Houston
Care for Elders/Sheltering Arms
Depression intervention
Neighborhood Centers, Inc.& St. Joseph’s
Physical activity intervention
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San Antonio and Other Projects Nationally
Chronic disease self management
Diabetes
Heart disease
Nutrition and diet
Falls prevention
Medication management
Contact Information
Nancy L. Wilson
Huffington Center on Aging
Baylor College of Medicine
One Baylor Plaza M-320
Houston, TX. 77030-3498
713.798-3850
[email protected]