PPA 419 Aging Services Administration

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PPA 419 Aging Services Administration

• Lecture 6a Long-term Care and Medicaid

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Introduction

• Long-term care services provide assistance to
  individuals with difficulties in
  
• Activities of daily living (ADLs)
• Eating, bathing, dressing, getting in and out of
  bed, using the bathroom
  
• Instrumental activities of daily living (IADLs)
• Housework, laundry, shopping, taking medication,
  transportation.

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Introduction

• Characteristics of community-dwelling elderly
  with substantial long-term care needs (6.4
  million)
  
• 9 over 85
• 29 below 150 percent of poverty
• 28 fair or poor health
• 31 alone, 56 married, 13 with others.

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Introduction

• Characteristics of nursing home residents (1.6
  million)
  
• 72 female
• 49 85
• 64 Medicaid coverage
• 83 need assistance with 3 ADLs
• 70 memory loss.

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Impact of Sociodemographic Change on the Future
of Long-Term Care

• Introduction
• Sociodemographic change can have an impact on
  both the potential demand for long-term care and
  the supply of workers available to provide this
  care.
• Population projections indicate that the sheer
  volume of those likely to demand long-term care,
  along with age distribution, racial and ethnic
  mix, and education level will change over the
  next fifty years.
• Long-term care includes institutional services,
  paid home- and community-based care, and unpaid
  support through family and friends.

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Impact of Sociodemographic Change on the Future
of Long-Term Care

• Long-Term Care Users
• The probability of long-term care increases as
  one gets older, particularly after age 75.

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Impact of Sociodemographic Change on the Future
of Long-Term Care

• Long-term Care Users (contd.)
• Majority of long-term care users (60) are
  elderly.
  
• Higher probability of using long-term care
• Female
• Black
• Widowed or never married
• Less than a high school education

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Impact of Sociodemographic Change on the Future
of Long-Term Care

• Long-term Care Users (contd.)
• 40 percent use only informal care (friends and
  family).
  
• Men
• Minorities
• Married individuals
• Less education
• Nursing facility care
• Female
• Non-minorities
• Widowed over never married

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Impact of Sociodemographic Change on the Future
of Long-Term Care

• Effects of Change on Demands for Care
• The Baby Boom bulge
• Population 65 and over will double by 2050.
• Most rapid growth between 2011-2030
• 85 will drop from 28 to 23 of elderly between
  2005 and 2020, but will jump to 34 by 2050.
  
• Number with at least one ADL limitation will
  increase from five million to eleven million by
  2050, while those with two limitations will
  increase from 2.0 million to 4.6 million.
• Proportion of disabled over 85 will increase from
  36 to 49 percent.
  
• Result Greater demand for long-term care
  services and potentially greater demand for
  institutional services.

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Impact of Sociodemographic Change on the Future
of Long-Term Care

• Effects of Change on Demands for Care
• Minority elders
• An increasing proportion of minorities among the
  elderly might increase demand for long-term care
  services.
  
• African-Americans are 50 percent more likely to
  use long-term care (mostly informal and
  community-based)
  
• Hispanics require less overall care, but rely
  more on informal care.
  
• Better educated elders
• Greater percentage with high school diploma or
  GED.
  
• Education may reduce disability rates.

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Impact of Sociodemographic Change on the Future
of Long-Term Care

• Effects of Change on Demands for Care
• Elders with higher income
• Average income of the elderly will increase 60
  in real terms between 2001 and 2044.
  
• Single women will have largest increases, but
  will still have lowest levels of income.
  
• Incomes for elderly couples and single people age
  85 and over will increase more rapidly than for
  younger groups. The latter will still be about
  30 percent lower than for all elderly.

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Impact of Sociodemographic Change on the Future
of Long-Term Care

• Effects of Change on Availability of Informal
  Support
  
• More spouses
• Percentage of married elderly will increase
  slightly.
  
• More childless individuals
• Nearly twice as many women may not have informal
  support from children.

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Impact of Sociodemographic Change on the Future
of Long-Term Care

• Summary
• By 2050, the number of individuals reaching ages
  that may require long-term care will more than
  double.
  
• Will increase demand for long-term care workers.
• Supply will depend on wages paid, labor force
  participation patterns of older workers, and
  immigration.
  
• Increased numbers of African-American elderly may
  signal increased demand, whereas greater
  education may signal decreased demand.

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Impact of Sociodemographic Change on the Future
of Long-Term Care

• Summary (contd.)
• Diversity will require greater emphasis on
  cultural competency.
  
• Greater education may affect methods of
  communication
  
• Real income may counterbalance costs if costs do
  not increase to match income increases.
  
• Informal supports may decline with declining
  birth rate.
  
• Community based settings may demand more
  transportation.
  
• But Baby boom may overwhelm everything else.

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Long-Term Care Medicaids Role and Challenges

• Over 12 million people in the United States need
  help with basic activities of daily living (ADLs)
  requiring long-term care services (institutional,
  community, informal). 10.6 million in community
  and 1.5 million in nursing facilities
• Elderly are the primary users and among the
  elderly, the very old and those who live alone.

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Long-Term Care Medicaids Role and Challenges

• Spending on long-term care reached 115 billion
  in 1997.
  
• Over 40 percent was financed by Medicaid,
  including half the costs of nursing home care.
  
• However, Medicaid only pays for those who have
  exhausted their financial resources.
  
• More than one-third who entered nursing homes,
  and more than 70 percent who were there at least
  one year, had catastrophic expenses (40 percent
  of income and assets).

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Long-Term Care Medicaids Role and Challenges

• Elderly pay out-of-pocket for 30 percent of
  long-term care costs.
  
• Medicare and private insurance play a limited
  role.
  
• Current system does not adequately cover all
  those with disability needs (up to 20 percent
  report an inability to meet all long-term care
  needs).
• Increases in disabled population and health care
  costs will likely make the problems worse.

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Long-Term Care Medicaids Role and Challenges

• Health Insurance Coverage for Elderly with
  long-term care needs
  
• 57 Medicare and private
• 19 Medicare and Medicaid
• 16 Medicare only
• 3 Medicare and other
• 5 Other and unknown

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Long-Term Care Medicaids Role and Challenges

• For the elderly and nonelderly poor who need
  long-term care, Medicaid is a significant source
  of health insurance
  
• 64 of 18-64
• 44 of 65
• For long-term care itself, Medicaid is a
  significant source.
  
• 115 billion on long-term care (12 of national
  health spending). 66 percent financed by
  Medicaid and out-of-pocket expenses.
  
• 83 billion on nursing home care. 78 percent
  financed by Medicaid and out-of-pocket expenses.
  
• Informal care not included in these costs.

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Long-Term Care Medicaids Role and Challenges

• Medicaid
• 40 of all long-term care costs.
• 50 of nursing home costs.
• 70 of nursing home residents.
• Long-term care is 35 of Medicaid budget.
• Medicaid is nations safety net provider for
  long-term care.
  
• Middle-income individuals must spend down assets
  and income to become eligible.
  
• Discuss.

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Long-term care policy issues

• Access to care
• Availability of providers to deliver care at low
  rates
  
• Repeal of Boren amendment may make things worse.
• State restrictions on nursing homes and nursing
  home beds.
  
• Access to community-based alternatives has been
  limited in most states. Medicaids institution
  bias.

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Long-term care policy issues

• Quality
• Long-standing concern
• Comprehensive nursing home reforms
• OBRA 1987
• Improvements in quality of care, reductions in
  restraints, increases in behavior management
  programs, hearing aids, psych therapy.
  
• Growing demand for Long-term care
• Baby boom.
• Financing
• Public programs remain liable.