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Long-term Care

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Housing as a Platform for Improving Outcomes for Older Renters (Series/What Works Collaborative)
Brenda 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

State Implementation of National Health Reform: Harnessing Federal Resources to Meet State Policy Goals (Research Report)
Stan Dorn

This report for the State Coverage Initiatives program of AcademyHealth explores how states could use resources provided by the Patient Protection and Affordable Care Act to achieve five goals:

- Increasing coverage and access to care;
- Reforming health insurance to function more like a traditional market;
- Holding insurers accountable;
- Reforming health care delivery to slow cost growth and improve quality; and
- Reduce state budget deficits.

The paper, "State Implementation of National Health Reform: Harnessing Federal Resources to Meet State Policy Goals," concludes that federal legislation gives states powerful new tools for making progress towards longstanding policy objectives.

Posted to Web: March 30, 2011Publication Date: July 01, 2010

Living Up to Its Name: How to Fix the Class Act (Video / Event)
Urban Institute

The Community Living Assistance Services and Supports (CLASS) Act, a provision of the landmark 2010 health law, would create a government-run, voluntary long-term care insurance program. To its supporters, CLASS is a major step toward a sustainable financing system for the care of both the frail elderly and younger adults with disabilities. But many experts believe the act's design is deeply flawed. They fear that few consumers will buy the insurance and the program will fail. Can CLASS be fixed? What changes are needed? Our panel of experts will debate various proposals.

Posted to Web: March 24, 2011Publication Date: March 24, 2011

The Size and Characteristics of the Residential Care Population: Evidence from Three National Surveys (Research Report)
Brenda Spillman, Kirsten Black

After accounting empirically for methodological differences, three national population-based surveys from the period between 1999 and 2002 provide similar estimates of the size and characteristics of the older residential care population: About 2.2 million persons age 65 or older (6.5 percent) live in supportive settings, about 1.45 million of them in nursing homes and nearly 800,000 in alternative residential care. Depending on survey definitions of "facility" versus community settings, however, the estimated proportion of the residential care population in “community” settings ranges from about half to three-quarters. Elders in community residential care appear to have less severe disability and are far more likely to report no ADL or IADL disabilities than those in “facility” alternatives to nursing homes. The age and gender distribution of persons in residential care alternatives and nursing homes is similar, but those in residential care alternatives more likely to be white and less likely to have extremely low incomes.

Posted to Web: July 22, 2010Publication Date: January 01, 2006

Does High Caregiver Stress Predict Nursing Home Entry? (Research Report)
Brenda Spillman, Sharon K. Long

This study estimates how informal care, paid formal care, and caregiver stress or burden relate to nursing home placement. Data came from the 1999 National Long Term Care Survey and were merged with administrative data. Results show that stress is a strong predictor of entry over follow-up periods of up to two years, and physical strain and financial hardship are important predictors of high levels of caregiver stress. The estimates indicate that reducing these stress factors would significantly reduce caregiver stress and, as a result, nursing home entry. We conclude that initiatives to reduce caregiver stress hold promise as a strategy to avoid or defer nursing home entry.

Posted to Web: July 17, 2010Publication Date: June 01, 2009

Does High Caregiver Stress Lead to Nursing Home Entry? (Research Report)
Brenda Spillman, Sharon K. Long

Understanding the role of informal caregiving in keeping chronically disabled elders out of nursing homes is increasingly important for policy. Demographic shifts are likely to increase the caregiving burden for a smaller number of caregivers per elder in the coming decades. This study examines how informal care, paid formal care, and stress or burden experienced by caregivers relate to nursing home placement. Data are from the 1999 National Long Term Care Survey and Informal Caregiver Survey merged with Minimum Data Set and other external data. Results from instrumental variables models indicate that stress is a strong predictor of nursing home entry over follow-up periods of up to two years, and that caregiving-related physical strain, financial hardship, and recipient behavior problems are important predictors of high levels of caregiver stress.

Posted to Web: July 14, 2010Publication Date: January 01, 2007

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