Long-Term Care and Aging

HAS 4320

Aging Society

• Americans are living longer

• Chronic disease is taking a bigger toll

• Growing number of older adults

• Disability

Long-Term Care

• Acute hospital

• Rehab hospital

• Nursing home

• CCRC

• Skilled home care

• Personal home care

• Family/community

Paying for LTC

• Medicaid/Medicare

• Case-mix Reimbursement– ADLs– RUGs

• Long-term care Insurance

Long-Term Care Insurance

• Location

• Type

• Options of benefit

• Waiting periods

• Mental illness/Alzheimer’s

LTC insurance: not popular

• Incidence is less random

• Must be purchased earlier

• Medicaid is there

• Helps heirs more than patients

CCRCs

• Assisted care (apartments) and nursing home

• Big up-front fees

• Advantages

• Problems

Aging Population

Aging Population

Aging Population: Labor Supply

• Workers to retirees declines

• Output per capita and living standards will be lower

Health Care Expenditures

Health Care Expenditures

Health Care Expenditures (1996)

• Elderly in institutions = $38,906

• Elderly in the community = $6,360

• 1% of Medicare beneficiaries incurred 13% of health care expenditures.

• Top 5% of enrollees with highest expenditures = 37% of total.

Components of Expenditures

Components (1996)

• 30% = hospital care

• 10% = skilled nursing care

• 46% = nursing home for 85 and older

• 7% = nursing home for 65 to 69

• Lower income = higher cost

• No insurance = lower total drug expenditures, but higher costs on drugs

Out-of-Pocket Expenditures

Out-of-Pocket Expenses (1998)

• 9 to 16% of total

• Dollar expenditure increases with income

• Relative burden is much higher on lower income

• Share spent by all income groups has increased

Access to Health Care

Access to Health Care

• Difficulties are down

• Delays due to costs are down

• Delays highest among non-Hispanic Blacks (10%) then Hispanic persons (7%) and non-Hispanic Whites (5%).

Use of Health Care

Use of Health Care

Use (1998)

• Physician visits have increased

• Home health visits have increased

• Hospitalizations has slightly increased

• Skilled nursing has increased

• Visits increased markedly with age

Nursing Home Utilization

Nursing Home Use

Nursing Home Use (1997)

• About half of residents are 85 or older

• Use has declined (assisted living centers)

• Women more than men

• Functional limitations have increased

• Rates of functional limitations higher among 65-74 year olds.

Home Care

Home Care

Home Care (1994)

• Rates of home care declined

• Assisted care centers and other alternatives

• Percent receiving informal care declined

• Increase among most severe diabilities