Older People and Long-Term Care: Issues of Access

Chapter Five

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 of those over 75 will greatly increase.

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The Growing Population Needing Care

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

The most common disability is physical.

In addition, the nursing home population is expected to 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 meet certain criteria.

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 growth 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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