Elderly and long-term care

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  • Elderly and Long-term Care

    Yanita Simeonova, Maike Heiser, Roxana Arredondo, Ariana Papp,

    Nasar Khan CSULB-HAW-Summer School

    Summer School 2016


  • Contents

    1. Long-term Care Insurance in Germany2. Three Levels of Care3. Long-term Care Insurance in the USA 4. LTC Services5. Staffing6. Long-term Care in Pakistan 7. Discussion 8. Conclusion9. References 10. Register of illustrations 2

  • A nations greatness is measured by how it treats its weakest members.

    Mahatma Gandhi(Fig. 1)


  • 1. Long-term Care Insurance in Germany

    Available for all insured people depending on the extent of the need for care, but irrespective of age, income or wealth

    Similar to other insurance systems in Germany (health insurance, pension etc.)

    Contributions paid equally by employers and employees

    (Fig. 2)




  • 1.Long-term Care Insurance (LTCI) in Germany

    Statutory (90%) and private (9%)

    Entire population is insured (compulsory)

    For people in need (physical or mental handicap, psychological illness or disability etc.), who are unable to independently carry out normal daily activities over a period of at least 6 months.



  • 1. Long-term Care Insurance (LTCI) in Germany

    Provides basic security in form of supportive assistance

    Areas of needs: hygiene, nutrition, mobility, household help

    (Fig. 4)(Fig. 3)6


  • 2. Long-term Care System: 3 Levels of Care

    Care Level I considerable need of care

    Care Level II severe need of


    Care Level III extreme need of


    Help with personal care, nutrition, mobility

    at least 1x/day for at least 2 tasks in one or more areas

    at least 3x/day at different times of the day

    assistance around the clock

    Additional assistance (taking care of the household)

    several times a week several times a week several times a week

    Nursing staff needs at least 1.5 hours/day on the average

    at least 1.5 hours/day on the average

    at least 5 hours/day on the average

    Hardship cases Assistance at least 7h/day and 2h during the night Basic care that can be provided by several individuals together 7

    (2) (5) (9)

  • Available only for people who can meet the costs themselves (many have few options for coverage)

    No national system for insuring the individuals against the risk of having major LTC expanses

    Two types of LTCI: statutory (Medicare, Medicaid) and private

    Uninsured: 10% of the population Veterans Affairs benefits pays for service related

    disabilities regarding LTC, nursing homes and at home care.

    3. Long-term Care Insurance in the USA



  • Medicare (13% of the population) Medicaid (19% of the population)Federal Insurance Program Federal & State Assistance Program

    Paid for by a Trust Fund funded with Payroll Taxes Paid for by Federal, State and Local Taxes

    Same Program Nationwide Program differs State by State

    Benefits people over the age of 65 Benefits people with low incomes ($11,880 per year for a person/$24,000 per year for 4 family)

    Participants pay deductibles and for part of coverage Participants pay very little or no part of coverage

    Divided into 4 parts (A,B,C,D): Hospital Insurance, Medical Insurance, Advantage Plans, Prescription Drug Insurance,

    Participant receive regular Dental and Vision Exams

    Benefits people with disabilities

    Prescription Drug Coverage

    Outpatient Hospital Care

    Inpatient Hospital Care

    3. Statutory LTCI in the USA


  • 3. Private LTCI in the USA

    Through voluntary LTCI plans Too costly for many Americans Unavailable to people with health conditions or

    disabilities due to medical underwriting Based on the age of the individual (The older you

    are, the more expensive it is) Only 3% of the adult population are private





  • 4. LTC Services

    Germany USA No upper limit for the price of nursing

    homes (negotiated between providers and sickness funds)

    $81,000 per year on average

    The part paid by LTCI is constant (across federal states, nursing homes), depends on the care level

    The costs depend on the needs of the patient

    In case residents cant afford the price Social welfare covers the private share of the price

    Medicaid covers the cost of nursing homes as a whole

    Medicare covers only the first 100 days of staying in nursing home

    Quality monitoring in nursing homes (Quality standards Comparability of nursing homes is guaranteed)

    The often-poor quality of nursing homes has been a consistent issue of concern for consumers, government, and researchers

    The quality scale is extremely broad 11(5)(5) (7)

  • 3. U.S. Spending for LTC


  • 3. Spending for LTC as a % of GDP


  • 5. Staffing

    Germany USA The USA and Germany are facing major labor force shortages in meeting future

    demand for LTC services.BUT: U.S. population is much younger (higher rates of fertility and immigration)

    Germany has one of the oldest populations in Europe (by 2050: less than 2 people of working age for every person age 65)

    Women provide the overwhelming majority of caregiving

    special credential of elder care for nurses in the LTC sector

    much more training on issues of specific relevance to caring for older people is provided

    nursing degrees arent specific to LTC

    LTC work is low paid and with a lower prestige than work in other health sectors14


  • The elderly population will be 26.84 million in 2025

    No health care system exists for the health care of the elderly population

    Geriatrics is not accepted as a specialty Only a few centers in Pakistan give LTC: - Saint Josephs Hospice, Rawalpindi - Darul Kafala, Lahore - Edhi Center for Elderly, Karachi (11)

    6. LTC in Pakistan


    Fig. 7

  • A national health policy for health care of elderly in Pakistan was developed in 1999. The key policy recommendations are:

    - Focal point and health unit of elderly - Health care systems for the elderly - National Institute of Geriatrics (NIG) - Health Promotion, Disease Prevention (11)

    6. LTC in Pakistan


  • Family support system

    Family members are of paramount importance in providing care

    Social and cultural norms

    Economic value

    6. LTC in PakistanCaregivers


  • How to handle the shortage of skilled nurses? Caregiving Corps: trained volunteers that specialize in

    geriatric and long term care working in NP, public agencies and community organizations

    Increasing the amount of schools for nursing and medical professions (admitting every semester)

    Decreasing the discriminating of male nurses Reorganizing nursing care to reduce paperwork to

    increase the proportion of RN time spent on patient care

    7. Discussion(Fig.5)


  • More support for caring relatives 71% (DE) and 66% (USA) are looked after at home from relatives

    In contrast to the U.S. everyone in Germany who meets the criteria has the choice of benefits that will meet their needs, their homes or institutions.

    The U.S. trend is toward increasing use of home and community-based services and assisted living, with declining use of nursing homes. In Germany, use of institutional care has been growing modestly

    8. Conclusion


  • Thank you for your attention!


  • 9. References

    1. Arno PS, Levine C, Memmott MM (1999) The economic value of informal care giving. Health Aff 18: 1828

    2. Arntz, Melanie et.al (2007): The German social Long-term Care Insurance: Structure and Reform Options.

    3. Baig LA, Hasan Z, Iliyas M. (2000) Are the elderly in Pakistan getting their due share in health services? Results from a survey done in the periurban communities of Karachi. J Pak Med Assoc. 50(6):192-6

    4. Deutscher Berufsverband fr Pflegeberufe, (2015): Zahlen-Daten-Fakten Pflege. Berlin. 5. Gibson, Mary et.al (2007): Comparing Long-term care in Germany and the United States: What

    can we learn from each other?.6. Herr, Anika; Hottenrott, Hanna (2016): Higher prices, higher quality? Evidence from German

    nursing homes.7. Herr, Anika et.al (2015): Does quality disclosure improve quality? Responses to the introduction

    of nursing home report cards in Germany.8. Itrat A, Taqui AM, Qazi F, Qidwai W. (2007).Family Systems: Perceptions of elderly patients and

    their attendents presenting at a university hospital in Karachi, Pakistan J Pak Med Assoc.57:106;9. Schulz, Erika (2012): Determinants of institutional Long-term Care in Germany.

    10. Qidwai W, Rauf MU, Sakina S, Hamid A, Ishaque S, Ashfaq T. (2011).Frequency and Associated Factors for Care Giving among Elderly Patients Visiting a Teaching Hospital in Karachi, Pakistan. PLoS One. 6(11):e25873. Epub 2011 Nov 4.

    11. http://apps.who.int/medicinedocs/documents/s17305e/s17305e.pdf12. http://thumbnails-visually.netdna-ssl.com/MedicareversusMedicaid_545b8931036a7_w1500.png13. http://kff.org/other/state-indicator/total-population/ 21