1. Reducing the Need and Costs of Long- Term Care October 8, 2004 Hal Freshley MINNESOTA BOARD ON AGING

2. THREE APPROACHES l Things that individuals can do to reduce their own risk and costs l Things that providers can do to increase efficiencies and reduce costs l Things that communities can do that reduce service needs

3. Why even bring this up? The NUMBERS By 2050 the population over 85 in Minnesota will increase by almost 400%

4. Why bring this up? U.S. savings rate is declining...

5. Why bring this up? Current role of informal supports...

6. Why bring this up? Loss of “traditional” informal supports? Boomers in 2030 l More than double the number living alone. l Average number of children per couple down from 3.2 to 1.9 l 18% are childless l Blended and “non-traditional” families the norm.

7. Why bring this up? 58% of all paid long-term care is publicly financed Most of these funds are paid through the federal/state Medicaid program. State of Minnesota spent $1.05 billion on long-term care for the elderly (FY2003).

8. Why bring this up? Growing gap between needs and public resources for long-term care

9. Why bring this up?

10. What can individuals do? Prepare for aging l It’s inevitable so make the best of it: Live Well, Age Well. l Maximize health: eating and exercise habits make “all the difference in the world” l The Third Age: prepare for what you’ll do in life’s next stage. People who stay actively engaged in their families and/or communities live longer and feel better.

11. What can individuals do? Prepare for retirement l Increase personal savings. l “Buy smarter” – get educated about Medicare and Medigap insurance --what’s covered (and not covered), long-term care insurance, annuities and other financial tools. l It’s not just financial. Think housing accessibility, community resources, family and friend proximity, transportation...

12. What can individuals do? OR Continue to work

13. What can families do? Caregiver training and supports reduce “caregiver burden” and reduce personal costs Occupational Therapist or Physical Therapist review for accessibility and/or assistive devices Buy services “strategically” – respite, housekeeping, day care

14. What can families do? More people are buying services Percent of frail elderly getting “paid help” for ADLs in 2000... Chores/heavy housekeeping = 30% Light housekeeping = 18% Personal care = 22%

15. What can providers do? Redesign services to reduce costs Streamline operations: Contract out for specialty services, simplify procedures, adopt management information systems Expand scope: Serve multiple target groups (including fee-for-service), enlarge service area to spread fixed costs

16. What can providers do? Rethink labor/personnel: More efficient use of paid staff, use of telehealth or other technologies, integrate volunteers, educate/support caregivers Focus on outcomes: evidence based practices result in better outcomes (lower costs), improve stability (prevent crises)

17. What can communities do? l Age-friendly communities Physical: Housing choices, transit, community design, general accessibility Social: Faith communities & volunteer networks, community participation, inter-generational trust Services: Simplify, accommodate older residents

18. What can communities do? l Housing options for the whole lifecycle Starter-apartments to mother-in-law apartments More attention to maintain and adapt current single family homes l Ramps, railings and benches in public places l Better lighting, clearer signage l Safer highways and roads

19. What can communities do? l Ensure a strong local economy Roles for business--understand the older market Develop strategies for youth retention Expand civic and contributory roles and expectations for older people

20. Resources For individuals... http://minnesotahelp.info/en/mn/cgi-bin/location.asp For providers... http://www.dhs.state.mn.us/main/groups/aging/documents/p ub/dhs_id_005733.hcsp For communities... http://www.gov.calgary.ab.ca/community/publications/elder_ friendly_communities/ http://www.van.umn.edu/advocate/index.asp