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Chapter 8

Older People and Long-Term Care: Issues of Access

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Why the New Interest in Long-term Care?

• The Baby Boomers are adding to the growth in the population over 65.

• There is increasing fear of dependency on long-term care.

• Adult children of the elderly having to find care for their parents.

• Healthcare reform promises great changes that are not well understood.

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The Growing Population Needing Care

• The need for ADL and IADL assistance continues to grow.

• Table 8-1 presents the broad range of services needed by the disabled.

• Most of the population needing long-term care do not live in nursing homes.

• Many factors contribute to the inability to predict the exact number needing services in the future.

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The Growing Population Needing Care

• Future populations may be better educated which is associated with lower levels of disability.

• Ethnic composition suggests a greater need for care and government support.

• Boomers will bring greater numbers of people needing services.

• The number those over 75 will greatly increase.

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The Growing Population Needing Care

• Disability rate will increase among those who are not in nursing homes.

• The most common disability is physical. • In addition, the nursing home population is

expected have profound increases until it triples by 2030.

• The number of younger persons with disability has also increased.

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Issues of Access

• The current system is far from ideal. • There is not an adequate supply particularly

for the poor. • The system itself continues to be so

fragmented that many are not aware of what is offered.

• Financing is an underlying problem.

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The Costs of Care

• Expenses for this care are sizable and will increase in the future.

• Private insurance only pays for a small percentage of the care.

• Medicaid pays for over 85% of nursing home care.

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The Costs of Care

• Annual costs of nursing home care can average $58,000 per year and may exceed $100,000. For many, the costs of this care is just not affordable.

• With the addition of the Baby Boomers, costs will most certainly increase in the future.

• The effects of reform are not currently known.

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The Care-Giving Role of Families

• About 74% of dependent community-based elders receive care from family members.

• The majority of caregivers are women. • The number and willingness of family

caregivers may decline as the Boomers become in need for assistance.

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The Role of Private Insurance

• Private insurance for long-term care is a relatively new product.

• Improvements in coverage are being made, but only an estimated 20% of the population will use it.

• CCRCs and LCAHs hold promise for the future.

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The Role of Medicaid

• Medicaid is changing under PPACA to include more eligible adults who will receive benchmark coverage.

• Medicaid is used for those elders who do not qualify for other assistance.

• Medicaid does not pay for the full range of services including home-based care.

• Some states are using a waiver to offer non- medical home-care services.

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The Role of Medicaid

• Some elders qualify for Medicaid once they are institutionalized and have used all of their assets.

• Other elders are trying to shelter their assets so that they can be poor without really being poor.

• Healthcare reform requires an office within CMS to address the issue of dual edibility.

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Forces for Improving Access

• Advocates for Alzheimer’s disease patients and for others have worked for changes.

• The Pepper Bill and other legislation recommended changes.

• Attempts to limit the grow of Medicaid are part of the national health care debate.

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Future Prospects

• Baby Boomer numbers and healthcare reform will result in changes to the system.

• Government involvement will increase as demand increases without the funding for access.

• Government involvement may not be the only or best answer.

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Future Prospects

• Future elders are concerned about what their care will be like under healthcare reform.

• The political climate must be willing to address future concerns.

• Ethical questions such as beneficence, autonomy, and justice need to be part of policy discourse.

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Future Prospects

• Issues of the elderly and non-elderly disabled need to be addressed.

• Given the cost and complexity, the medical model is not the only one to be considered.

• Long term care needs to be part of health care.

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Update from a Practitioner’s View

• Even with healthcare reform the trends and issues for long-term care are the same.

• Barriers to real change are driven by the political climate that controls funding.

• What will be America’s legacy about the treatment of its elderly?

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In Summary…

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