Module 1: The Basics of LongTerm Care

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Module 1 The Basics of Long-Term Care
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Key Questions

• What is long-term care (LTC)?
• How do people receive LTC assistance?
• How likely is it that a person will need LTC?
• How much does LTC cost?
• Who pays for LTC services?

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Definition of LTC

• Activity
• What words and phrases come to mind when you
  think about LTC?

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Definition of LTC
Activities of Daily Living (ADLs)
Instrumental Activities of Daily Living (IADLs)
Bathing Dressing Eating Using the
toilet Transferring Continence
Grocery shopping Laundry Preparing
meals Housework Managing medication Transportation
Cognitive Impairment loss in intellectual
capacity
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Levels of LTC

• Skilled Care medical care, nursing care, or
  therapy usually delivered by a nurse or other
  trained professional
• Personal Care assistance with ADLs
• Supervisory Care monitoring and supervision, a
  safe or controlled environment, and assistance
  with ADLs, usually for individuals with
  cognitive impairments

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LTC Settings Informal Care

• Informal care unpaid LTC assistance that is
  usually provided by family members, friends, or
  local organizations
• In 1998, nearly one in four Americans provided
  unpaid LTC services
• Providing this care can take a significant toll
  on the caregiver

Source Kaiser Family Foundation, Survey of Long
Term Care from the Caregivers Perspective. 1998.
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LTC Settings Formal Care
Home Care
Residential Care
Community -Based Care
Adult Day Care
Nursing Home Assisted Living Continuing Care
Retirement Community
Skilled Care Personal Care IADL Assistance
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Workforce Issues

• Critical shortage of LTC workers throughout the
  nation
• Factors contributing to the shortage include
• High staff turnover rates
• Fewer informal caregivers available
• An aging population

Source Stone, Robin, and Joshua Weiner. Who Will
Care For Us? Addressing the Long-Term Care
Workforce Crisis. October 2001.
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Workforce Issues Rural Areas

• Especially severe shortages in rural and
  underserved areas
• Factors compounding shortages in rural areas
  include
• Lower wages
• An aging workforce
• Distance between clients

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Lifetime Risk of Needing LTC
Sources Long-Term Care Insurance, Baby Boom or
Bust? Conning Company, 1999. B.C. Spillman
and J. Lubitz, 2002.
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Risk Factors

• There are many factors that may increase a
  persons risk of needing LTC
• Age
• Marital Status
• Gender
• Lifestyle
• Health
• Family History

Source General Accounting Office. Long-Term
Care Current Issues and Future Directions,
April 1995.
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Risk of Needing LTC by Age (during a 12-month
period)
Source Urban Institute, Long-Term Care
Consumers, Providers, and Financing. 2001.
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Risk of Needing Nursing Home Care by Age (during
a 12-month period)
Source Urban Institute, Long-Term Care
Consumers, Providers, and Financing. 2001.
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Cost of LTC (2001)

• Nursing home care 56,000 per year
• Assisted living care 22,500 per year
• Part-time home care 12,000 - 16,000 per year

Source U.S. Department of Labor, National Center
for Assisted Living, and U.S. Census Bureau.
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Cost of LTC in Texas (2003)

• Texas
• Cost of nursing home stay may range from 30,000
  to more than 50,000 per year.
• Average daily rates may range from 90 to more
  than 150 per day
• Dependent on
• Services needed
• Costs in your area
• Source Long Term Care Insurance, July 2004
• Texas Department of Insurance

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Payment for LTC (1999)
Source CMS, National Health Accounts, 1999.
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Payment for Long-Term Care

• Texas
• Most LTC expenses are paid by Medicaid, a state
  and federal assistance program
• Must meet eligibility requirements, including
  income requirements
• The remaining LTC expenses are paid
• Out of pocket by individuals
• Medicare
• Long-term care insurance

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Payment for Nursing Home Care (1999)
Source CMS, National Health Accounts, 1999.
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Case Study 1 Sam

• An 82 year-old man requiring nursing home care
• Care paid for by several sources, which change
  over time

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Case Study 2 Margaret

• An 85 year-old woman who needs LTC services to
  stay in her home
• Uses a combination of formal and informal care to
  meet her LTC needs