Transcript Trends in Aging - Florida State University College of Law

Trends in Aging and
Long-Term Care
August 17, 2007
LTC Expenditures Florida
Trends in Aging & Long-Term Care
1. Number of aged will continue to grow
2. Increases in retirement age and favorable
dependency ratios
3. Favorable long-term care nursing home utilization
trends expected to carry for another 25 years
•
Improved health and lower disability rates
•
Lower rates of widowhood
•
Growth of Assisted Living Facility (ALF) and Continuing
Care Retirement Community (CCRC) industries
•
Well developed network of home care providers
Trends in Aging & Long-Term Care
4. Nursing home reimbursement rates growing five
percent over inflation
5. Shortages of health care professionals and
paraprofessionals
Growth in Aging
7,000,000
6,000,000
5,000,000
4,000,000
3,000,000
2,000,000
1,000,000
0
Growth in Retirees and Oldest Old
Florida
1970
1990
2004
2010
2020
2030
Year
Persons 85 and Older
Persons at Retirement Age
Growth in Aging
3.0
2.8
60-84
85+
Relative Growth
2.6
0-59
2.4
2.2
2.0
1.8
1.6
1.4
1.2
1.0
1990
1995
2000
2005
2010
2015
2020
Share of Elder Population
Florida
30%
25%
20%
85+ Share
Ret.Age Share
15%
10%
5%
0%
1970
1990
2004
2010
Year
2020
2030
Dependency Ratios
Dependents per working
age adult
Florida
1.20
1.00
0.80
0.60
0.40
0.20
0.00
1970
1990
2004
2010
2020
2030
Year
Retirees
Children <20
Disability Rates
1. Since 1984 disability rates have been declining at
about one percent per year.
2. This trend is expected to continue. Between 2000
and 2050 the rate of severe disability among the
elderly is projected to be cut by half.
3. Older Floridians are 45 percent less likely to require
long-term nursing home care than elders from other
states.
Disability Rates (cont.)
Number of Americans 65 and Older with Any Chronic Disability
(1982-2006)
10
9.8
9.5
9.3
Projected at 1984
Disability Prevalence
9
Millions
8.5
8.3
8
7.5
7.5
7.0
7
7.1
7.1
7.0
Actual Older Persons
with Disability
6.5
6.4
6.4
6
1982
1989
1994
1999
2006
Source: AARP Public Policy Institute based on 1994 National Long Term Care Survey and U.S. Census Bureau
population projection middle series.
Shift to Assisted Living Facility
(ALF) Care
90,000
81,305
77,928
80,000
Nursing Home Beds
68,842
70,000
74,723
80,243
80,998
76,108
72,960
76,514
70,624
67,189
81,218
79,550
75,671
74,767
70,590
64,706
66,295
67,439
60,000
56,918
50,000
51,064
44,181
40,000
39,473
ALF Beds
30,000
20,000
18,543
10,000
0
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Informal Care Trends
Stable marriage rates and declining disability
imply that growth in the elderly population can
actually lower demand for nursing home care
because:
•As the elderly male population grows more
rapidly than the population of elder females,
the availability of spousal care rises.
• The supply of healthy caregivers rises.
Informal Long-Term Care
Florida Long-Term Care Resources
Publically Funded
Long-Term Care
14.5%
Non-Publically Provided
Long-Term Care
85.5%
Nursing Home Use Growth Florida
12.00%
10.00%
10.18%
8.00%
7.58%
6.00%
4.00%
3.34%
3.00%
2.12%
2.15%
1.63%
2.00%
1.44%
1.04%
1.32%
0.25%
0.00%
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
0.54%
0.07%
2000
2001
-0.55%
-2.00%
-4.00%
2002
2003
2004
2005
-0.75%
-2.02%
Trends in Demand Nursing
Home Care
Summary Demand Factors
LTC Demand Factors (U.S.=100)
Medicaid 65+
65+ Live Alone
65+ Self Care
Disability
65+ Self Care or
Mobility Disability
70
75
80
85
90
95
100
Florida’s Long-Term Care Costs Are
Lower Than Other States
FL ORUS
FL ORUS
Nursing Home
Expenditures Per 65+
All Long-Term Care
Expenditures Per 65+
FL ORUS
Percent of 65+ Population
in Nursing Facilities
Negative Trend:
Nursing Home Per Diem Growth
$160.00
$150.00
Growth Rate 6.7 Percent
Yearly
$149.61
$150.10
$140.00
$137.58
$130.00
$127.92
$120.00
$100.00
$112.98
$107.31
$110.00
$95.18
$99.87
$90.00
1997
1998
1999
2000
2001
2002
2003
2004
Costs: Nursing Home
Budgets Growth
Re la tive Gro wth
2.25
2.00
1.75
1.50
1.25
1.00
1991
1993
1995
1997
1999
Medicaid Bed Utilization
Nursing Home Budget Growth
2001
Trends in Nursing Home Costs
Policies to Control the Growth in
the Public Cost of Long-Term Care
Support and encourage family and
personal responsibility



Education
Support and foster development of
affordable long-term care options
Aging Resource Centers as local contact for
education, information and referral
Policies to Control the Growth in
the Public Cost of Long-Term Care
(cont.)
Support health promotion and wellness



Social
Intellectual
Physical
Policies to Control the Growth in
the Public Cost of Long-Term Care
(Cont.)
Support a public long term care system that

Favors community based care
 Promotes deinstitutionalization
 Removes any institutional bias


Is customer centric
Has flexibility
 Funding follows the consumer across care settings
 Service dollars can be used to supplement rather than
substitute for personal/family resources
 Services can be used on a preventive basis
Policies to Control the Growth in
the Public Cost of Long-Term Care
(Cont.)
Support a public long-term care system that


Prioritizes and targets services based on risk
Maximizes return on investment
 Integration/maximization of federal funding streams
 Integration of care
 Risk transfers/sharing
 Administrative efficiencies
Comments & Suggestions
Horacio Soberon-Ferrer, Ph.D.
Florida Department of Elder Affairs
850-414-2089
[email protected]
Comparison of Annual Cost Per Customer of Programs Serving Florida's Elders
State Fiscal Year 2005 - 2006
Nursing Home
$44,836
Medicaid Nursing Home
Diversion Program
$21,063
Increasing Frailty
Medicaid Assisted Living
for the Elderly Waiver
$8,740
Alzheimer's Disease
Initiative
$8,323
Medicaid Aged/
Disabled Waiver
$7,933
Community Care
for the Elderly
$4,680
Home Care
for the Elderly
$2,329
Older Americans Act
$1,891
$0
$5,000
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000
$45,000
Annual Cost Per Person
$50,000