LONG TERM CARE

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LONG TERM CARE

• The Aging of America
• Assisted Living - Nursing Homes

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• The Aging of America

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• ELDERLY AMERICANS ARE JUST ABOUT THE ONLY GROUP
  OF U.S. CITIZENS WHOSE HEALTH CARE IS UNIVERSALLY
  INSURED AS AN ENTITLEMENT.

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• HOWEVER, ELDERS WHO NEED LONG-TERM CARE HAVE MUCH
  LESS PROTECTION.

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• 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.

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• MEDICAID, THE FEDERAL/STATE HEALTH PROGRAM,
  COVERS LONG-TERM CARE BUT ONLY FOR PEOPLE WHO ARE
  POOR OR WHO BECOME POOR PAYING FOR LONG-TERM CARE
  OF MEDICAL CARE.

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• 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.

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• SUPPORT FOR CARE FALLS LARGELY OUTSIDE
  MEDICARES SCOPE. MOST LONG-TERM CARE IS
  PROVIDED BY FAMILIES AND FRIENDS IN THE COMMUNITY.

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• MEDICAID IS A DIFFERENT STORY.
• 7 Medicaid Beneficiaries utilize 52 of all
  Medicaid spending.

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• One half are elderly
• One third are disabled and under age 65
• The rest are adults or children not classified as
  disabled

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• 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.
  

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• 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.

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• AGING DEMOGRAPHICS

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Projection of U.S. Population, by age, 1995-2050
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• 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.

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• GRAYING OF AMERICA

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• THE ELDERLY POPULATION INCREASED 11-FOLD FROM
  1900-1994.
• THE NON-ELDERLY POPULATION INCREASED 3-FOLD.
• FROM 1995 TO 2030 THE AMERICAN POPULATION WILL
  INCREASE BY 50.

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• 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.

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• THIS NUMBER IS EXPECTED TO REACH 8 MILLION BY
  2030.
• BY 2050 THE NUMBER OF AMERICANS OVER 85 IS
  EXPECTED TO BE 28 MILLION.

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• 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.

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• THE POPULATION OVER AGED 85 WILL GROW 48.
• THE POPULATION UNDER AGE 65 WILL INCREASE ONLY
  7.

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• WHERE DO OLDER AMERICANS LIVE?

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Living Arrangements of Older Men and Women
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• 67 OF ALL OLDER NON-INSTITUTIONALIZED PERSONS
  LIVE IN A FAMILY SETTING.
• ABOUT 9.9 MILLION AMERICANS LIVE ALONE. 70 OF
  THOSE ARE WOMEN.

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• 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.

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• 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.

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• FOR 63, SOCIAL SECURITY PROVIDED AT LEAST HALF
  OF HOUSEHOLD INCOME.
• FOR 26, SOCIAL SECURITY PROVIDED ALMOST ALL OF
  THE INCOME.

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• 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.

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• ABOUT 3.4 MILLION ELDERLY PERSONS ARE BELOW THE
  POVERTY LEVEL.
• ANOTHER 2.4 MILLION ARE CONSIDERED NEAR-POOR.

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• 9.4 OF ELDERLY WHITES ARE POOR.
• 25.3 OF ELDERLY AFRICAN-AMERICANS ARE POOR.
• 24.4 OF ELDERLY HISPANICS ARE POOR.

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• 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.

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WASHINGTON The baby boomers' stampede for
Social Security benefits has begun.
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• 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."

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• 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.

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• 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!

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• 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.

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• ADL PERSONAL ASSISTANCE WITH THE ACTIVITIES OF
  DAILY LIVING.
• EATING, BATHING, DRESSING, GETTING INTO AND OUT
  OF BED OR CHAIR, AND USING THE TOILET.

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• IADL - INSTRUMENTAL ACTIVITIES OF DAILY LIVING.
• ADDITIONAL ACTIVITIES NECESSARY FOR INDEPENDENCE
  SUCH AS PREPARING MEALS, MANAGING MEDICATIONS,
  AND SHOPPING FOR GROCERIES.

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• 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.

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• 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
  LIVINGDRESSING, EATING, OR BATHING.

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• THE RESIDENT IS AN 83 YEAR-OLD WOMAN WHO IS
  WIDOWED OR SINGLE.

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• TYPES OF SERVICES
• PROVISION OF MEALS, HOUSEKEEPING, MEDICATION
  ASSISTANCE, INCONTINENCE CARE, AND LIMITED
  NURSING SERVICES.

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• 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.

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• OF ALL NEW SENIOR HOUSING, 75 IS DEVOTED TO
  ASSISTED LIVING FACILITIES.

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• 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.

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• COST-EFFICIENT, CONSUMER-DRIVEN, AND FLEXIBLE
  WHICH ACCOMODATES MANY TYPES OF RESIDENTS.
• RESIDENTS ABLE TO RECEIVE INDIVIDUAL ATTENTION.

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• WHAT IS THE COST OF ASSISTED LIVING?
• RATES RANGE FROM UNDER SEVERAL HUNDRED DOLLARS A
  MONTH TO MORE THAN 3,000 A MONTH.

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• 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.

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• 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

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• 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.

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• OTHER SOCIAL SERVICES AVAILABLE COMMUNITY BASED
  ORGANIZATIONS

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• PROGRAMS OF INTEREST
• SOCIAL SUPPORT (IN HOME SERVICES, CASE
  MANAGEMENT)
• CAREGIVING (EDUCATION, RESOURCE AND SUPPORT,
  RESPITE

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• CHRONIC DISEASE SELF MANAGEMENT (INFORMATION,
  CLASSES, SUPPORT GROUPS. MANAGE CHRONIC DISEASES)
• PHYSICAL ACTIVITY

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• PROGRAM TYPE

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• SOCIAL SUPPORT SERVICES

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• SOCIAL SUPPORT PROGRAMS GENERALLY SERVE FRAIL OR
  VULNERABLE OLDER ADULTS, OFTEN IN THE HOME OR IN
  AN ADULT DAY CENTER.

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• CAREGIVING SERVICES

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• CAREGIVING PROGRAMS ARE TARGETED TOWARD A FAMILY
  MEMBER OR OTHER INFORMAL CAREGIVER.
• ADDRESSES THE ISSUE OF DEMENTIA AND TAKING CARE
  OF THE VERY FRAIL.

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• DISEASE SELF-MANAGMENT

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• HEALTH PROMOTION PROGRAMS WORK WITH OLDER ADULTS
  TO PROMOTE HEALTH LIFE STYLES AND SELF-CARE
  SKILLS.

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• PHYSICAL ACTIVITIES

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• PHYSICAL ACTIVITY PROGRAMS OFFER MIXTURES OF
  EXERCISE AND HEALTH EDUCATION TARGETED AT
  IMPROVING BALANCE, FLEXIBILITY, STRENGTH, AS WELL
  AS OVERALL HEALTH.

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• QUALITY OF ACCESS

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• IMPROVING QUALITY OF LIFE

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• TYPES OF ORGANIZATIONAL PARTNERS

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• BARRIERS TO EXPANSION

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End

• End of Lecture for October 27th
• 2010, 6th period.
• Questions?

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• Assisted Living Nursing Homes

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• 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.

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• OVER 52 OF ELDERLY WOMEN AND 33 OF ELDERLY MEN
  WILL USE A NURSING HOME BEFORE THEY DIE.

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• HOW MANY NURSING HOMES ARE IN THE UNITED STATES?

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• ACCORDING TO RECENT STATISTICS, THERE ARE OVER 17
  THOUSAND NURSING HOMES WITH MORE THAN 1.8 MILLION
  BEDS.

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• GOVERNMENT 7
• NONPROFIT 28
• FOR PROFIT 65

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• WHO ARE NURSING HOMES FOR?

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• AN OLDER PERSON IS MORE LIKELY TO NEED NURSING
  HOME CARE IF THE FOLLOWING FACTORS EXIST

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• ADVANCED AGE
• CHRONIC DISABILITY
• DETERIORATING MENTAL AND PHYSICAL CAPACITIES

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• LIVING ALONE, OR LACK OF FAMILY MEMBERS TO
  PROVIDE HELP.
• TIME SPENT IN A HOSPITAL OR OTHER HEALTH
  FACILITY.

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• 76 NEED HELP IN USING THE TOILET
• 71 NEED HELP WHEN MOVING FROM BED TO CHAIR
• 46 NEED HELP WHEN EATING.

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• 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

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• 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

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• NURSING HOME FUNDING
• MEDICARE 9
• PRIVATE INSURANCE 3
• MEDICAID 50
• INDIVIDUALS OR FAMILIES 38

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• NURSING HOME EXPENDITURES

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• WHO PAYS?

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• WHAT IS THE FUTURE FOR NURSING HOMES?

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• 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.

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• 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.

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• End of Lecture for 7th Period, October 27th,
  2010
• Questions?