Improving Care for Dual Eligibles through Innovations in Financing (Commentary)
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.
Who Purchases Long-Term Care Insurance? (Series/Older Americans' Economic Security)
|Posted to Web: August 31, 2011||Publication Date: August 31, 2011|
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.
State Implementation of National Health Reform: Harnessing Federal Resources to Meet State Policy Goals (Research Report)
|Posted to Web: April 06, 2011||Publication Date: March 28, 2011|
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.
Living Up to Its Name: How to Fix the Class Act (Video / Event)
|Posted to Web: March 30, 2011||Publication Date: July 01, 2010|
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.
The Size and Characteristics of the Residential Care Population: Evidence from Three National Surveys (Research Report)
|Posted to Web: March 24, 2011||Publication Date: March 24, 2011|
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.
Does High Caregiver Stress Predict Nursing Home Entry? (Research Report)
|Posted to Web: July 22, 2010||Publication Date: January 01, 2006|
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.
Does High Caregiver Stress Lead to Nursing Home Entry? (Research Report)
|Posted to Web: July 17, 2010||Publication Date: June 01, 2009|
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.
Staying the Course: Trends in Family Caregiving (Research Report)
|Posted to Web: July 14, 2010||Publication Date: January 01, 2007|
Informal caregiving—unpaid help primarily provided by spouses and children—remains the most common source of long-term care for older persons with disability in the U.S. This report updates previously published trends in formal and informal care from the 1984 and 1994 National Long Term Care Survey. The earlier study found a significant decline in the number of family caregivers, accompanied by a significant increase in use of formal care from paid workers, especially in combination with informal care. Data for 1999 indicate that, contrary to the previous trend, formal care use fell dramatically between 1994 and 1999, while the rate at which spouses and children provided care remained stable. Increased reliance on only assistive devices or informal care accompanied the decline in formal care. In general, the greatest increase in use of assistive devices without help occurred among older persons with fewer informal resources and lower levels of disability.
Beyond Cash and Counseling: The Second Generation of Individual Budget-based Community Long-Term Care Programs (Research Report)
|Posted to Web: July 14, 2010||Publication Date: November 01, 2005|
States are increasingly interested in the individual budget model for older Medicaid beneficiaries as a mechanism to improve responsiveness of benefits to beneficiaries' needs and preferences and to increase their ability to remain outside or leave nursing homes. The "individual budget" model is a service option that originated in the Cash and Counseling Demonstration in three states in the late 1990s. As of January 2006, the model had been implemented for elderly Medicaid beneficiaries in some form by an additional seven states, and 12 other states were in the process of implementing programs. This report describes the 10 operating individual budget model programs serving older persons, identifies four areas of program design that are of particular importance to the success of the model, and provides more detailed profiles of programs in three states.
How Will the Patient Protection and Affordable Care Act Affect Seniors? (Policy Briefs/Timely Analysis of Health Policy Issues)
|Posted to Web: July 14, 2010||Publication Date: January 01, 2007|
The Patient Protection and Affordable Care Act will affect seniors in a number of ways. They will benefit from reductions in cost sharing for prescription drugs and for preventive services. There will however be reductions in current benefits some seniors now gain from Medicare Advantage plans and increases in premiums for high income people. Provider payment rate cuts if extended for several years could have implications for access to care. Many new provisions that will affect payment and delivery system reforms and most likely benefit seniors but could also potentially harm access to care.
|Posted to Web: July 07, 2010||Publication Date: July 01, 2010|