1. Long Term Care The Continuum of Care

2. What is Long Term Care? Health, mental health, social and residential services provided to temporarily or chronically disabled person over extended period of time

3. Characteristics of LT Care Physical or mental, temporary or permanent Need based on functional disabilities Promotes or maintains health and independence in functional abilities and quality of life To enable us to die peacefully and with dignity Multiple services and multiple professions spanning broad spectrum Multifaceted Designed around unique needs of the individual Service can change over time

4. Who needs LT Care Chronic – permanent or indefinite period of time Impaired – a decrease in or loss of ability to perform Disabled – short or long term; varies by age group Functional ability – person’s ability to perform the basic activities of daily living

5. Understanding demand for LT Care Patient represent “mosaic of sub- segments” of the population. Often co- morbid conditions Services can be organized across dimensions of users Some users of LT care have significant differences from other users

6. Organization of LT Care Informal organization – most LT care is provided by family and friends Each community may be different regarding availability of services Ideal system – client oriented continuum of care.

7. What is Continuum of Care? Matches resources to patient’s condition Monitors the client’s condition and changes services as needs change Coordinates care across disciplines Integrates care in a range of settings Enhances efficiency, reduces duplication, streamlines patient flow Maintains comprehensive record keeping

8. Categories of Continuum of Care Extended care Acute inpatient care Ambulatory care Home care Outreach Wellness Housing NOTE: Not all LT care clients get this full range of care. This is ideal that may offset or delay chronic illness.

9. Providers of LT Care Hospitals Nursing homes Home health agencies Hospices Adult day service programs Housing organizations

10. Types of LT Care Services (Source: http://www.medicare.gov/LongTermCare/Static/CommunityServices.asp Help with activities of daily living Help with additional services Help with care needs Range of costs Community-Based Services Yes NoLow to medium Home Health Care Yes Low to high In-Law Apartments Yes Low to high Housing for Aging and Disabled Individuals Yes NoLow to high Board and Care Homes Yes Low to high Assisted Living Yes Medium to high Continuing Care Retirement Communities Yes High Nursing Homes Yes High

11. Paying for LT Care Nursing home care represents approximately 8% of personal health care expenditures Home health care about 2% of expenditures though this is trending higher Since LT care is provided mostly by family and friends, these figures don’t represent full cost Medicare, Medicaid cover much of the cost Out of pocket costs for LT care are significant Little private insurance currently pays for LT care though incentives have been implemented to cover that area

12. Financing Option Only Availa ble for Long- Term Care Costs Remai ning Funds Availa ble to Heirs Rate of Asset Accu mula tion Eligibil ity Requir ement Risk of Insufficient FundsCost Family Support and Caregiving No NoneNo Moderate -- Family members may be unable/unwilling to provide care You pay for services that family members are unwilling to provide Personal Savings NoYes Variabl e No High -- Long-Term Care costs can exceed your personal savings You are responsible for creating private savings Long-Term Care Insurance YesNoFixedYes Moderate to Low -- Long-Term Care costs could exceed original coverage amount Monthly premiums for the life of the policy Limited Long- Term Care Insurance YesNoFixedYes Moderate to Low -- Long-Term Care costs could exceed original coverage amount Large one-time or short-term monthly premium Accelerated Death Benefit YesNoFixedYes Moderate to Low -- Amount received from benefit may not pay all long-term care costs None Reverse Mortgages NoYes Variabl e Yes Moderate -- Amount received from benefit may not pay all long-term care costs -- Home maintenance costs still exist Processing and origination fees to establish mortgage

13. Continuing Care Retirement Community Yes Variabl e Yes Low -- Additional care provided as needed in CCRC assisted living or nursing facility High purchase price and fixed monthly payment required of CCRC property Veterans Benefits No NoneYes Moderate to High -- Amount received from benefit may not pay all long-term care costs None Medicare No NoneYes Moderate to High -- Amount received from Medicare may not pay all long-term care costs Co-payments and deductibles Medicaid No NoneYes High -- Amount received from Medicaid may not pay all long-term care costs -- Recovery of Medicaid may be made against estate You pay for services not covered by Medicaid Financing Option Only Availab le for Long- Term Care Costs Remain ing Funds Availab le to Heirs Rate of Asset Accum ulatio n Eligibility Requirem ent Risk of Insufficient FundsCost