1. LONG TERM CARE A Community Based Approach Presented by: Lanette Gonzales Houston, Texas July 26, 2005

2. Population Profile Harris County: 252,895 residents 65 years of age or older (Texas State Data Center, 2004) Residents older than 65 years of age increased 28% Residents older than 85 years old or older increased 52% in the last decade

3. Socioeconomic Status  Median household income of older adults ages 65 to 74 years old – $33,431 in 1999  Median household income of older adults 75 years old and older - $25,375

4. Risk Factors for needing Long Term Care  Individuals age 85 years old and older  Multiple chronic health conditions: - arthritis, hypertension, heart disease, hearing impairment, cancer, diabetes, and stroke  Cognitive and/or multiple functional impairments

5. Harris County  Vulnerable older adults are defined as 75 years old and older or those 60 years of age and older who have at least one need of the following conditions:  help bathing  uses a cane, walker, or wheelchair  fair or poor health  afraid to be left alone more than two hours or  has a chronic illness

6. Risk Factors  Living alone  Limited to no support system  Living at or near poverty  Women  Minorities

7. Providers of Long Term Care Family Caregivers Female Baby boomer Works full-time Annual income of $35,000 Provides average 18 hours per week Support Systems Community organizations and agencies

8. Challenges Limited funding Waiting lists Shortage of direct care workers

9. Funding Major public and nonprofit sources of funding include Medicaid, Block Grant Funds, Older Americans Act Funds, United Way, and local foundations Self-pay (costs often prohibitive): Private pay can cost $15 per hour, can range up to $125 per hour

10. Shortage of direct care workers (Stone 2000) Low wages and benefits Hard working conditions Heavy workloads Job stigmatized by society Low or no recognition

11. Strategies (Better Jobs Better Care 2004) Recruit and retain high quality direct care workers Increase wages, fringe benefits, such as health insurance and payments Increase and improve training requirements Create opportunities for higher job levels with Career Ladder

12. Care for Elders Private-public partnership established in 2001 Strategy –Improve quality of long term care Collaboration with other direct care service providers

13. Care for Elders (continued) Four solutions: - Improve recruitment by promoting direct care work - Enhanced Screening to improve turnover rates - Increase retention with comprehensive orientation, training, and recognition - Test pilot wage supplementation to evaluate worker retention effects.

14. Sheltering Arms Senior Services 501©3 agency United Way agency State licensed, Medicare certified Over 200 employees Bonded and Insured Served over 79,000 seniors and their family caregivers in 2004 Fiscal agent for Care for Elders (2000)

15. Final Analysis Average life expectancy is 87 years old. Number of people purchasing care for relatives could place more demands on formal long-term care system.(BLS 1998) Personal and home care assistance is projected to be fourth-fastest growing occupation. (Stone 2001)

16. Final Analysis Reductions in Medicare payments may diminish the future growth rate of health care jobs available. By 2010, baby boomers will approach old age and begin to require assistance Smaller pool of middle-aged women available to provide low-skilled basic services

17. Medicare and Medicaid are the major sources of public funding for health care. Reimbursement policy plays a substantial role in determining workers’ wages, benefits, and training opportunities. Maintain payment rates to keep up with true cost of providing services, giving organizations ability to offer competitive wages and benefits.