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Explore the changing demographics and diverse needs of long-term care, including financing options and various providers in the industry.

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  1. Topics • Demographics of LTC • LTC Needs—A Starting Point • Financing LTC • LTC Goals • LTC Providers • Issues and Trends “All to often, the public equates LTC with care in a nursing home or another institution. However, LTC is a broad constellation of services provided in diverse settings to a heterogeneous population with many different needs.” Text, p. 240

  2. Demographics of Long Term Care • What are the changes of the last 100 years that affect Long Term care? • Family structure and location? • Population distribution by age? • Medical care? • Or, how was Long Term care provided in 1900?

  3. LTC Needs • Table 9.1—Range of LTC Services • Housekeeping and daily living support • Companionship & social support • Transportation (including to medical care) • Personal care • Nursing and healthcare procedures • Rehabilitative services • Palliative care • Care management

  4. LTC Needs (cont.) • Who Needs LTC? • Those disabled from birth • Victims of injury or disease • The elderly • Adults 85+ seven times more likely than adults 65-74 to need LTC • This age group growing “exponentially” • Evidence is that the group will be healthier than their predecessors

  5. Housekeeping and daily living support • Companionship & social support • Transportation (including to medical care) • Personal care • Nursing and healthcare procedures • Rehabilitative services • Palliative care • Care management • Table 9.1 List Financing LTC • Consider the activi-ties from Table 9.1 • What are typical sources of payment for each? • What is the special burden Medicaidplaces on recipients of these services? • How might Medicaid spending changeas states face continuing budget problems? • Why is measuring LTC expenditurelevels so difficult? GroupPresentation#1

  6. Financing LTC (cont.) • Spending sources on Home Health Care * • Medicaid: $15.5 billion (32.6%) • Medicare: $17.9 billion (37.7%) • Out of Pocket Nursing and Home and Community Services *: • $37.4 billion • 22% of total spending * Note that different services are compared

  7. GroupPresentation#2 Financing LTC (cont.) • LTC Insurance • What does it cover? • Staggered premium structure depending on age when purchased • Is $1,000 - $7,000 / yr too much to spend for piece of mind? • Should you charge your kids for the coverage?

  8. Goals of LTC

  9. Goals of LTC (cont.) • See Table 9.2 • Who pays? • Who benefits? • Who decides? • What do terms such as “_____” mean to a policy maker? • “Needs” • “Adequate” • “Long as possible” • “Efficient” • “Acceptable” • “Maximize”

  10. GroupPresentation#3 LTC Providers • The multidimensional nature of LTC(Table 9.1) results in a multidimensional collection of LTC providers • Unpaid caregivers • Home care agencies • Hospice services • Nursing homes • Adult day services • Community-based residential alternatives • Continuing care retirement communities Q: Is a taxicab driver a LTC provider if he/she takes a patient to an appointment?

  11. LTC Providers (cont.) • Unpaid Care • Primarily family and friends • Valued at $7.5 - $11.2 billion / year • But no systematic data collection • What are the costs of unpaid care? • What could be done to improve the unpaid care environment? • What are the social costs and benefits of supporting unpaid care providers?

  12. LTC Providers (cont.) • Paid Care Providers—Overview • Growth industry but what has fueled the growth? • Government programs • Dual income families • Aging population • What are social and individual costs and benefits? • What future trends will we see? • How could government entitlement changes affect the industry? • Would you want to work in this field?

  13. LTC Providers (cont.) • Home Care Agencies • Provide medically related services to patients at home • Provide nonmedical personal services • Recipients of government subsidies subject to both medical and needs tests for eligibility • Industry responds (fairly quickly) to changes in funding and eligibility rules • What is the career potential in this field?

  14. LTC Providers (cont.) • Hospice Services • Relatively new service • Recognized by Medicare in 1983 • Dramatic growth in use of services • What issues does Hospice care face? • What are the costs and benefits • Individual? • Aggregate? • What is the career potential in this field?

  15. LTC Providers (cont.) • Nursing Homes • Best known of LTC services • Heavily regulated • But data gathering is difficult • Almost all data is self-reported • Increasing variety of treatments and programs • Some interesting changes in enrollment rates • How might these patterns look going forward? • What is the career potential in this field?

  16. LTC Providers (cont.) • Adult Day Services • What is the market niche for these services? • Why do you think that 78% of these services are nonprofit? • What are the implications of an unmet need for 5,500 more centers? • Service orientations may differ • Medical services • Social services • Mixed • What is the career potential for these services?

  17. LTC Providers (cont.) • Community-Based Residential Alternatives to Institutional Care • Let’s define these facilities by how they differ from other alternatives • Note the wide range of service packages that come under this heading • Also note differing regulatory environments • Different state rules • Different rules for different types of services • Again, what is the market niche these facilities address?

  18. LTC Providers (cont.) • Continuing Care Retirement Communities • A relatively new concept with exciting potential • Many work on a healthcare condominium model with resident ownership interests • Different fee schedules depending on • Ownership model • May incorporate an insurance function • Pricing structure

  19. Issues and Trends • Cost vs. Access • LTC incorporates almost all of the HC costs and cost trends of other HC • As overall costs grow so do LTC costs • Also include non-HC costs for those not able to perform tasks themselves • Approaches • Improve use of LTC insurance • Control supply of beds to control use of services • Alternatives to more expensive options

  20. Issues and Trends (cont.) • Quality Assurance • Quality difficult to assure • Multitude of facilities and types makes inspection programs difficult • Field relies heavily on self-reporting • Split responsibility for enforcement • Serious flaws routinely found when inspections are performed • The government is taking a market-based approach by providing quality reports online

  21. Issues and Trends (cont.) • Quality Assurance (cont.) • Home care even more difficult to supervise than institutional care

  22. Issues and Trends (cont.) • Increasing Consumer Choices • “…there is wide agreement that consumers should have significant choice regarding their long-term care arrangements.” (p. 260) • How will these choices be created? • Who will pay for them? • Who should manage LTC for a specific patient? • Who decides when the patient’s wishes • Conflict with medical advice? • Conflict with program rules?

  23. Issues and Trends (cont.) • Financing Trends • What should be the role of insurance in LTC financing? • What should be the role of the government? • Can universal LTC insurance such as Germany or Japan have be politically practical in the U.S?

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