Elderly and Long-term Care

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

Nasar Khan CSULB-HAW-Summer School

Summer School 2016

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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 nation’s greatness is measured by how it treats its weakest members.’’

Mahatma Gandhi(Fig. 1)

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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)

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(6)

(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.

5

(2)

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)

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

Care Level I – considerable need of care

Care Level II – severe need of

care

Care Level III – extreme need of

care

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

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(13)

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

9(5)(12)

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

insured

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Fig.6

(5)

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 can’t 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

12(5)

3. Spending for LTC as a % of GDP

13(5)

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 aren’t specific to LTC

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

(5)

▪ 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 Joseph’s Hospice, Rawalpindi - Darul Kafala, Lahore - Edhi Center for Elderly, Karachi (11)

6. LTC in Pakistan

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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

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▪ Family support system

▪ Family members are of paramount importance in providing care

▪ Social and cultural norms

▪ Economic value

6. LTC in PakistanCaregivers

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▪ 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)

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▪ 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

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Thank you for your attention!

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9. References

1. Arno PS, Levine C, Memmott MM (1999) The economic value of informal care giving. Health Aff 18: 182–8

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 für 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

Fig. 1 http://www.biography.com/people/mahatma-gandhi-9305898/videos/mahatma-gandhi-a-legacy-of-peace-12169795858Fig. 2 http://knutsoncpa.com/2015/09/18/plan-today-for-future-long-term-care-costs/Fig. 3 http://www.insurancelifeblog.com/why-you-need-long-term-care-insurance-coverage/Fig. 4 http://www.sozialstation-giengen.de/index.php?id=26Fig. 5 http://www.b4bberlin-brandenburg.de/nachrichten/potsdam_artikel,-Potsdamer-STADTWERKE-FESTival-2012-noch-ungewiss-_arid,112174.htmlFig. 6 http://www.berzan.se/art.php?u=the-political-development-of-the-usaFig. 7 http://www.huffingtonpost.com/khwaja-khusro-tariq/post_11312_b_9481852.html

10. Register of illustrations

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