Transcript No Slide Title

LONG TERM CARE
•The Aging of America
•Assisted Living - Nursing Homes
• The Aging of America
• ELDERLY AMERICANS ARE
JUST ABOUT THE ONLY GROUP
OF U.S. CITIZENS WHOSE
HEALTH CARE IS UNIVERSALLY
INSURED AS AN ENTITLEMENT.
• HOWEVER, ELDERS WHO NEED
LONG-TERM CARE HAVE MUCH
LESS PROTECTION.
• MEDICARE, THE FEDERAL
PROGRAM FOR THE ELDERLY
AND DISABLED, COVERS MANY
OF THE COSTS OF ACUTE
MEDICAL CARE BUT ONLY
TANGENTIALLY COVERS SOME
LONG CARE SERVICES.
• MEDICAID, THE
FEDERAL/STATE HEALTH
PROGRAM, COVERS LONGTERM CARE BUT ONLY FOR
PEOPLE WHO ARE POOR OR
WHO BECOME POOR PAYING
FOR LONG-TERM CARE OF
MEDICAL CARE.
• MORE THAN TWELVE MILLION
PEOPLE IN THE UNITED
STATES, ABOUT HALF OVER
AND HALF UNDER AGE 65,
NEED SOME KIND OF LONG
TERM CARE. ABOUT A THIRD
OF THESE PEOPLE HAVE CARE
NEEDS THAT ARE
SUBSTANTIAL.
• SUPPORT FOR CARE FALLS
LARGELY OUTSIDE MEDICARE’S
SCOPE. MOST LONG-TERM
CARE IS PROVIDED BY
FAMILIES AND FRIENDS IN THE
COMMUNITY.
• MEDICAID IS A DIFFERENT
STORY.
• 7% Medicaid Beneficiaries
utilize 52% of all Medicaid
spending.
• One half are elderly
• One third are disabled and
under age 65
• The rest are adults or children
not classified as disabled
• PEOPLE WHO NEED LONG-TERM
CARE OFTEN DO NOT GET THE
CARE THEY NEED OR PREFER,
AND FAMILIES’ CAREGIVING
AND FINANCIAL BURDENS ARE
OFTEN HEAVY.
• CHANGING DEMOGRAPHICS
POSE A FURTHER CHALLENGE.
CURRENT ESTIMATES
SUGGEST THAT THE DEMAND
FOR LONG-TERM CARE AMONG
THE ELDERLY WILL MORE
THAN DOUBLE IN THE NEXT
THIRTY YEARS.
• AGING DEMOGRAPHICS
Projection of U.S. Population, by age, 1995-2050
100
Population in millions
90
80
70
60
Ages 85+
Ages 75-84
Ages 65-74
50
40
30
20
10
0
1995
2000
2005
2010
2015
2020
2025
2030
2035
2040
2045
2050
• GENERAL PROFILE:
 CURRENTLY, THERE ARE 34 MILLION
AMERICANS AGED 65 AND OVER, ALMOST
13% OF TOTAL POPULATION.
 BY 2030, THIS NUMBER WILL GROW TO 69
MILLION WHICH WILL REPRESENT 20% OF
THE POPULATION.
 BY 2050, THERE WILL BE 80 MILLION
AMERICANS 65 AND OLDER.
• GRAYING OF AMERICA
THE ELDERLY POPULATION
INCREASED 11-FOLD FROM 19001994.
THE NON-ELDERLY POPULATION
INCREASED 3-FOLD.
FROM 1995 TO 2030 THE AMERICAN
POPULATION WILL INCREASE BY
50%.
IN THE SAME TIME PERIOD, THE 65+
AGE GROUP WILL INCREASE BY
135%.
PEOPLE OVER 85 WILL BE THE MOST
LIKELY TO HAVE CHRONIC NEEDS.
THERE ARE CURRENTLY 3 MILLION
AMERICANS OVER 85.
THIS NUMBER IS EXPECTED TO
REACH 8 MILLION BY 2030.
BY 2050 THE NUMBER OF
AMERICANS OVER 85 IS EXPECTED
TO BE 28 MILLION.
 SOME 75 MILLION AMERICANS WERE
BORN IN THE YEARS 1946-1964.
FROM 2010 TO 2030 THE
POPULATION OF ELDERLY AGED 65
TO 84 IS EXPECTED TO GROW 80%.
THE POPULATION OVER AGED 85
WILL GROW 48%.
THE POPULATION UNDER AGE 65
WILL INCREASE ONLY 7%.
• WHERE DO OLDER AMERICANS
LIVE?
Living Arrangements
of Older Men and Women
100%
90%
Percent
80%
70%
With non-relatives
60%
With other relatives
50%
With Spouse
40%
Alone
30%
20%
10%
0%
65-74 years
75+ years
Men
65-74 years
75+ years
Women
 67% OF ALL OLDER NONINSTITUTIONALIZED PERSONS LIVE
IN A FAMILY SETTING.
 ABOUT 9.9 MILLION AMERICANS
LIVE ALONE. 70% OF THOSE ARE
WOMEN.
21 MILLION AMERICAN HOUSEHOLDS
ARE HEADED BY OLDER AMERICANS,
USUALLY WOMEN (78%).
78% OWN THEIR HOMES AND 22%
PAID RENT.
1.6 ELDERLY AMERICANS LIVE IN
NURSING HOMES.
•FINANCIAL STATUS
 IN 2004, SOCIAL SECURITY WAS
THE MAJOR SOURCE OF INCOME
FOR 89% OF OLDER COUPLES AND
INDIVIDUALS.
 PROVIDED 40% OF TOTAL
HOUSEHOLD INCOME.
FOR 63%, SOCIAL SECURITY
PROVIDED AT LEAST HALF OF
HOUSEHOLD INCOME.
FOR 26%, SOCIAL SECURITY
PROVIDED ALMOST ALL OF THE
INCOME.
FOR 14%, SOCIAL SECURITY WAS
THE ONLY SOURCE OF INCOME.
IN 2006, MEDIAN INCOME WAS
$21,784 FOR MEN AND $12,495 FOR
WOMEN. MEDIAN INCOME FOR
FAMILIES HEADED BY AN OLDER
PERSON WAS $37,765.
 ABOUT 3.4 MILLION ELDERLY
PERSONS ARE BELOW THE POVERTY
LEVEL.
ANOTHER 2.4 MILLION ARE
CONSIDERED NEAR-POOR.
9.4% OF ELDERLY WHITES ARE POOR.
25.3% OF ELDERLY AFRICANAMERICANS ARE POOR.
24.4% OF ELDERLY HISPANICS ARE
POOR.
• OBSERVATION
THE OLDEST BABY BOOMERS ARE
NOW IN THEIR SIXTIES, AND THE
ABILITY OF OUR PUBLIC AND
PRIVATE INCOME SECURITY AND
HEALTH PROGRAMS TO MEET THEIR
EVENTUAL RETIREMENT NEEDS IS
DRAWING INCREASED ATTENTION.
WASHINGTON — The baby boomers' stampede for
Social Security benefits has begun.
• The nation's "first" baby boomer, a
retired teacher from New Jersey,
applied for Social Security benefits
Monday, signaling the start of an
expected avalanche of applications
from the post-World War II
generation.
• Social Security Commissioner
Michael Astrue called it "America's
silver tsunami."
• An estimated 10,000 people a
day will become eligible for
Social Security benefits over
the next two decades.
• The Social Security trust fund, if
left alone, is projected to go
broke in 2041.
THE COMING DECADES ARE LIKELY
TO SEE A SIGNIFICANT INCREASE IN
THE DEMAND FOR LONG TERM CARE
SERVICES, PARTICULARLY AT THE
FIRST BOOMERS REACH 85 IN 2030!
• WHO NEEDS LONG-TERM CARE?
• DEFINITION:
 LONG-TERM CARE REFERS TO A BROAD
SET OF PAID AND UNPAID SERVICES FOR
PERSONS WHO NEED ASSISTANCE
BECAUSE OF A CHRONIC ILLNESS OR
PHYSICAL OR MENTAL DISABILITY.
ADL – PERSONAL ASSISTANCE WITH
THE ACTIVITIES OF DAILY LIVING.
EATING, BATHING, DRESSING,
GETTING INTO AND OUT OF BED OR
CHAIR, AND USING THE TOILET.
IADL - INSTRUMENTAL ACTIVITIES
OF DAILY LIVING.
ADDITIONAL ACTIVITIES NECESSARY
FOR INDEPENDENCE SUCH AS
PREPARING MEALS, MANAGING
MEDICATIONS, AND SHOPPING FOR
GROCERIES.
• ASSISTED LIVING
 THE AMERICAN ASSOCIATION OF HOMES AND
SERVICES FOR THE AGING DEFINES ASSISTED
LIVING AS A PROGRAM THAT PROVIDES
AND/OR ARRANGES FOR THE PROVISION OF
DAILY MEALS, PERSONAL AND OTHER
SUPPORTIVE SERVICES, HEALTH CARE AND
24-HOUR OVERSIGHT TO PERSONS RESIDING
IN A GROUP RESIDENTIAL FACILITY WHO
NEED ASSISTANCE WITH ACTIVITIES OF
DAILY LIVING.
MORE THAN ONE MILLION SENIORS
LIVE IN ASSISTED LIVING
RESIDENCES.
ASSISTED LIVING RESIDENCES
MOSTLY SERVE RESIDENTS WHO ARE
IN THEIR MID-EIGHTIES AND
REQUIRE ASSISTANCE WITH THREE
ACTIVITIES OF DAILY
LIVING…DRESSING, EATING, OR
BATHING.
• THE “RESIDENT” IS AN 83
YEAR-OLD WOMAN WHO IS
WIDOWED OR SINGLE.
• TYPES OF SERVICES
 PROVISION OF MEALS,
HOUSEKEEPING, MEDICATION
ASSISTANCE, INCONTINENCE CARE,
AND LIMITED NURSING SERVICES.
• THE INDUSTRY
 IN 1998 THERE ARE CLOSE TO 11,800
ASSISTED LIVING FACILITIES IN THE
UNITED STATES.
 THE ASSISTED LIVING INDUSTRY IS
THE FASTEST GROWING SEGMENT OF
THE SENIOR HOUSING INDUSTRY.
OF ALL NEW SENIOR HOUSING, 75%
IS DEVOTED TO ASSISTED LIVING
FACILITIES.
• THE VALUES OF ASSISTED LIVING
 ALLOWS INDIVIDUALS TO REMAIN AS
INDEPENDENT AS THEY PREFER AND
STILL RECEIVE NECESSARY SERVICES.
 SENIORS ARE ABLE TO AGE WITH
MORE DIGNITY.
COST-EFFICIENT, CONSUMERDRIVEN, AND FLEXIBLE WHICH
ACCOMODATES MANY TYPES OF
RESIDENTS.
RESIDENTS ABLE TO RECEIVE
INDIVIDUAL ATTENTION.
WHAT IS THE COST OF ASSISTED
LIVING?
RATES RANGE FROM UNDER
SEVERAL HUNDRED DOLLARS A
MONTH TO MORE THAN $3,000 A
MONTH.
• FOUR BASIC MODELS:
ALL-INCLUSIVE RATE MODEL: ALL
SERVICES ARE INCLUDED IN A FLAT
MONTHLY FEE. THE RESIDENT PAYS
THE SAME RATE REGARDLESS OF
THE AMOUNT OF SERVICES USED.
BASIC/ENHANCED: A CORE SET OF
SERVICES IS OFFERED FOR A FLAT
MONTHLY FEE.
• A LA CARTE/FEE-FOR-SERVICE: ALL
SERVICES ARE PRICED AND CHARGED
SEPARATELY. IN THIS MODEL, THE
RESIDENT PAYS FOR ONLY THOSE
SERVICES RECEIVED
SERVICE LEVELS: RESIDENTS ARE
ASSESSED ACCORDING TO A
NUMERICAL RATING SYSTEM AND
ASSIGNED TO ONE OF SEVERAL
LEVELS OF CARE.
– EACH LEVEL OF CARE REPRESENTS
MORE INTENSE SERVICE NEEDS WITH A
HIGHER FEE ATTACHED.
• OTHER SOCIAL SERVICES
AVAILABLE – COMMUNITY
BASED ORGANIZATIONS
• PROGRAMS OF INTEREST:
• SOCIAL SUPPORT (IN HOME
SERVICES, CASE MANAGEMENT)
• CAREGIVING (EDUCATION,
RESOURCE AND SUPPORT,
RESPITE
• CHRONIC DISEASE SELF
MANAGEMENT (INFORMATION,
CLASSES, SUPPORT GROUPS.
MANAGE CHRONIC DISEASES)
• PHYSICAL ACTIVITY
• PROGRAM TYPE
• SOCIAL SUPPORT SERVICES
• SOCIAL SUPPORT PROGRAMS
GENERALLY SERVE FRAIL OR
VULNERABLE OLDER ADULTS,
OFTEN IN THE HOME OR IN AN
ADULT DAY CENTER.
• CAREGIVING SERVICES
• CAREGIVING PROGRAMS ARE
TARGETED TOWARD A FAMILY
MEMBER OR OTHER
“INFORMAL” CAREGIVER.
• ADDRESSES THE ISSUE OF
DEMENTIA AND TAKING CARE
OF THE VERY FRAIL.
• DISEASE SELF-MANAGMENT
• HEALTH PROMOTION
PROGRAMS WORK WITH OLDER
ADULTS TO PROMOTE HEALTH
LIFE STYLES AND SELF-CARE
SKILLS.
• PHYSICAL ACTIVITIES
• PHYSICAL ACTIVITY
PROGRAMS OFFER MIXTURES
OF EXERCISE AND HEALTH
EDUCATION TARGETED AT
IMPROVING BALANCE,
FLEXIBILITY, STRENGTH, AS
WELL AS OVERALL HEALTH.
• QUALITY OF ACCESS
• IMPROVING QUALITY OF LIFE
• TYPES OF ORGANIZATIONAL PARTNERS
• BARRIERS TO EXPANSION
End
• End of Lecture for October 26th
• 2011, 6th period.
• Questions?
• Assisted Living – Nursing Homes
• NURSING HOMES
 ALMOST 1.5 MILLION PEOPLE CURENTLY
LIVE IN NURSING HOMES.
 A 65-YEAR-OLD HAS A 43% CHANGE OF
ENTERING A NURSING HOME AT SOME
TIME IN HIS OR HER LIFE.
OVER 52% OF ELDERLY WOMEN AND
33% OF ELDERLY MEN WILL USE A
NURSING HOME BEFORE THEY DIE.
HOW MANY NURSING HOMES ARE IN
THE UNITED STATES?
ACCORDING TO RECENT STATISTICS,
THERE ARE OVER 17 THOUSAND
NURSING HOMES WITH MORE THAN
1.8 MILLION BEDS.
GOVERNMENT: 7%
NONPROFIT: 28%
FOR PROFIT: 65%
• WHO ARE NURSING HOMES FOR?
AN OLDER PERSON IS MORE LIKELY
TO NEED NURSING HOME CARE IF
THE FOLLOWING FACTORS EXIST:
ADVANCED AGE
CHRONIC DISABILITY
DETERIORATING MENTAL AND
PHYSICAL CAPACITIES
LIVING ALONE, OR LACK OF FAMILY
MEMBERS TO PROVIDE HELP.
TIME SPENT IN A HOSPITAL OR
OTHER HEALTH FACILITY.
76% NEED HELP IN USING THE
TOILET
71% NEED HELP WHEN MOVING
FROM BED TO CHAIR
46% NEED HELP WHEN EATING.
• HOW MUCH DOES IT COST?
CMS DATA SHOWS THAT THE COST
OF CARE IN FREE-STANDING
NURSING FACILITIES AVERAGE $127
PER DAY OR OVER $46,000 A YEAR.
JACKSONVILLE = $63,875
ORLANDO = $68,620
MIAMI = $82,125
• AVERAGE LENGTH OF STAY
 65 AND OVER IS 838 DAYS
 65-74 IS 1,064 DAYS
 75-84 IS 864 DAYS
 85+ IS 713 DAYS
– NURSING HOME FUNDING
 MEDICARE: 9%
 PRIVATE INSURANCE: 3%
 MEDICAID: 50%
 INDIVIDUALS OR FAMILIES 38%
• NURSING HOME EXPENDITURES
WHO PAYS?
– WHAT IS THE FUTURE FOR
NURSING HOMES?
NURSING HOMES AND PERSONAL
CARE FACILITIES EMPLOY ABOUT 1.6
MILLION WORKERS AT 21,000 SITES.
BY 2005, EMPLOYMENT LEVELS WILL
RISE TO AN ESTIMATED 2.4 MILLION
WORKERS.
CENSUS BUREAU PREDICTS THAT
THE NUMBER OF NURSING HOME
RESIDENTS WILL INCREASE TO 2.2
MILLION BY THE YEAR 2000, 2.6
MILLION BY 2010, AND 3 MILLION BY
2020.
• End of Lecture for 7th Period,
October 26th, 2011
• Questions?