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Long-term Care

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Disability and Care Needs Among Older Americans (Article)
Vicki Freedman, Brenda C. Spillman

Estimates from the new National Health and Aging Trends Study indicate that nearly half of Medicare enrollees age 65 or older had difficulty or received help in the last month with daily activities in 2011. Of those receiving help, 10% were in a nursing homes, 15% were in alternative supportive care settings, and the rest lived in the community (75%). Persons with low incomes were a disproportionate share of those receiving help with at least 3 self-care or mobility activities in settings other than nursing homes. Informal care, primarily from family members, was substantial—164 hours monthly for older persons receiving help in the community and 50 for those in alternative supportive settings. Adverse consequences related to unmet need affected nearly a third of persons with difficulty or help in all settings other than nursing homes and nearly twice that proportion of persons receiving paid help in the community. Results suggest that policies to improve services and supports and reduce unmet need could benefit both older adults and those who care for them.

Posted to Web: September 25, 2014Publication Date: September 09, 2014

The Future of Long-Term Care Policy: Continuing the Conversation: Testimony Before Special Committee on Aging, U.S. Senate (Testimony)
Judy Feder

In testimony before the US Senate Special Committee on Aging Feder speaks about a path forward for long-term services and supports. She establishes that there is much work to be done. Although policymakers are grappling with the challenges of assuring Americans affordable access to quality health care, they have yet to seriously tackle the equally important issue of long-term services and supports.

Posted to Web: December 19, 2013Publication Date: December 18, 2013

Behavioral Adaptation and Late-Life Disability: A New Spectrum for Assessing Public Health Impacts (Article)
Brenda C. Spillman, Additional Authors

Only about a third of Americans ages 65 and older are fully able to manage all daily activities independently, according to new research from the 2011 National Health and Aging Trends Study (NHATS). Another 30 percent are able to accommodate declining health or functioning by using assistive devices or scaling back their activities, 18 percent have trouble managing even with any devices they may use, and 21 percent receive help. These findings are based on innovative data NHATS collected for a nationally representative sample of 8,077 older Medicare beneficiaries. The data allow a more nuanced look at late life function than previously has been possible and can contribute to better understanding of ways older adults adapt to disability and to development of public health policies to maximize the quality of life for older Americans.

Posted to Web: December 16, 2013Publication Date: December 12, 2013

Income and Wealth of Older Adults Needing Long-Term Services and Supports (Testimony)
Richard W. Johnson

In his testimony before the federal Commission on Long-Term Care, Richard Johnson reports that most older adults who receive Medicaid-financed nursing home care have low incomes and very little wealth, both while on the program and for at least a decade before entering a nursing home. These results suggest that efforts to promote individual saving for long-term care may not move many people off Medicaid or reduce program costs because most Medicaid nursing home residents haven’t had the means to save much.

Posted to Web: August 21, 2013Publication Date: August 01, 2013

Financial Preparedness for Long-Term Care Needs in Old Age (Research Report)
Brenda C. Spillman

There is little evidence that the first of the baby boom generation or the retirees to follow are financially prepared for the risk of potentially catastrophic costs of disability-related long-term care. Both the high cost of insurance and uncertainty about its value are widely thought to account for the lack of preparedness. This chapter reviews evidence on the risk of long-term care, types of long-term care, financial risks, and consumer knowledge of these risks. Common and not-so-common options for private financing of long-term care and barriers to their widespread adoption are discussed. A final section briefly reviews policies in place or proposed for increasing private preparation.

Posted to Web: October 31, 2012Publication Date: October 31, 2012

Housing as a Platform for Improving Outcomes for Older Renters (Series/What Works Collaborative)
Brenda C. Spillman, Jennifer Biess, Graham MacDonald

This policy framing paper is one of three that explores the potential for housing combined with support services to create better outcomes for vulnerable populations. The aging of the U.S. population will have profound implications for society, the economy, and the health care system. This paper focuses on mitigating the impacts on low-income older renters and on how housing can provide a platform for supporting their independence and well-being. The authors establish a theoretical basis and empirical evidence that shows a link between favorable housing and positive life outcomes. They propose research that can inform policymakers and practitioners in meeting the housing and service needs of this at-risk group. This framing paper is part of a series of field-building research agendas produced under the What Works Collaborative. More information can be found on the What Works Collaborative web page

Posted to Web: May 07, 2012Publication Date: May 07, 2012

Drivers of Housing Demand: Preparing for the Impending Elder Boom (Research Report)
Kathryn L.S. Pettit, Chris Narducci, Additional Authors

The aging of the baby boomers represents a demographic tidal wave that will profoundly affect housing needs and living arrangements in the coming years. The authors examine three possible scenarios for the projected number and mix of households in New Orleans in 2020. But regardless of the scenario, the increase in households headed by elderly will greatly surpass the increase in any other household type. This report concludes with strategies for attracting new residents to the city and ensuring we meet the housing needs of aging residents, including the desire of many seniors to stay in their homes as long as possible.

Posted to Web: November 23, 2011Publication Date: November 16, 2011

Refocusing Responsibility For Dual Eligibles: Why Medicare Should Take The Lead (Policy Briefs/Timely Analysis of Health Policy Issues)
Judy Feder, Lisa Clemans-Cope, Teresa A. Coughlin, John Holahan, Timothy Waidmann

At 40 percent of Medicare's and of Medicaid's costs, the 9 million dual eligibles who receive benefits from both programs, are a focus of efforts to slow growth in entitlement spending. But, given the two programs' responsibilities, policy-makers are relying far too heavily on states to find the solution. Dollars spent on dual eligibles are overwhelmingly federal; potential savings come from better management of Medicare-financed acute care services; and enhanced state, rather than federal, responsibility for overall spending increases the risk of cost-shifting to Medicare and may undermine quality of care for vulnerable beneficiaries.

Posted to Web: October 04, 2011Publication Date: October 04, 2011

Improving Care for Dual Eligibles through Innovations in Financing (Commentary)
Lisa Clemans-Cope, Timothy Waidmann

Health care for over 9 million elderly and disabled people enrolled in both Medicare and Medicaid ("dual eligibles") is complicated by an inefficient and fragmented system. In each program, dual eligibles account for about one sixth of enrollment but almost 40% of spending. Despite health-care costs exceeding $315 billion in 2011, of which Medicare pays about 55%, both Medicaid and Medicare have shown a striking lack of leadership in coordinating care for dual eligibles. We suggest ways in which the CMS's recently proposed models could be modified to improve both the quality and cost-effectiveness of care for this population.

Posted to Web: August 31, 2011Publication Date: August 31, 2011

Who Purchases Long-Term Care Insurance? (Series/Older Americans' Economic Security)
Richard W. Johnson, Janice Park

Most Americans will eventually need long-term care, which is often expensive and not usually covered by public programs until recipients have nearly exhausted their savings. In 2009, 5.2 million Americans age 65 and older not living in institutions had long-term care needs. Yet, only about 1 in 10 Americans age 55 and older had private long-term care insurance in 2008. Coverage rates were nearly twice as high among those with annual incomes in excess of $100,000. Private insurance covered only 7 percent of the $240 billion in U.S. long-term care costs in 2009. Nearly a fifth were paid out of pocket.

Posted to Web: April 06, 2011Publication Date: March 28, 2011

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