1. Long-Term Care and Aging HAS 4320

2. Aging Society Americans are living longer Chronic disease is taking a bigger toll Growing number of older adults Disability

3. Long-Term Care Acute hospital Rehab hospital Nursing home CCRC Skilled home care Personal home care Family/community

4. Paying for LTC Medicaid/Medicare Case-mix Reimbursement –ADLs –RUGs Long-term care Insurance

5. Long-Term Care Insurance Location Type Options of benefit Waiting periods Mental illness/Alzheimer’s

6. LTC insurance: not popular Incidence is less random Must be purchased earlier Medicaid is there Helps heirs more than patients

7. CCRCs Assisted care (apartments) and nursing home Big up-front fees Advantages Problems

8. Aging Population

10. Aging Population: Labor Supply Workers to retirees declines Output per capita and living standards will be lower

11. Health Care Expenditures

13. Health Care Expenditures (1996) Elderly in institutions = $38,906 Elderly in the community = $6,360 1% of Medicare beneficiaries incurred 13% of health care expenditures. Top 5% of enrollees with highest expenditures = 37% of total.

14. Components of Expenditures

15. Components (1996) 30% = hospital care 10% = skilled nursing care 46% = nursing home for 85 and older 7% = nursing home for 65 to 69 Lower income = higher cost No insurance = lower total drug expenditures, but higher costs on drugs

16. Out-of-Pocket Expenditures

17. Out-of-Pocket Expenses (1998) 9 to 16% of total Dollar expenditure increases with income Relative burden is much higher on lower income Share spent by all income groups has increased

18. Access to Health Care

19. Difficulties are down Delays due to costs are down Delays highest among non-Hispanic Blacks (10%) then Hispanic persons (7%) and non- Hispanic Whites (5%).

20. Use of Health Care

22. Use (1998) Physician visits have increased Home health visits have increased Hospitalizations has slightly increased Skilled nursing has increased Visits increased markedly with age

23. Nursing Home Utilization

24. Nursing Home Use

25. Nursing Home Use (1997) About half of residents are 85 or older Use has declined (assisted living centers) Women more than men Functional limitations have increased Rates of functional limitations higher among 65-74 year olds.

26. Home Care

28. Home Care (1994) Rates of home care declined Assisted care centers and other alternatives Percent receiving informal care declined Increase among most severe diabilities