Publications by James Lubitz for Health Policy Center

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This article attempts to resolve previously published inconsistencies across national surveys in trends in activity limitations among the elderly. The authors prepared estimates from five national surveys from 1982-2001, and investigated sources of the inconsistencies. The panel found consistent declines of 1%-2.5% per year for two commonly used disability measures: difficulty with, and help with daily activities. Mixed evidence was found for the use of help or equipment. The panel found that the period, definition of disability, treatment of the institutionalized population, and age standardizing of results affected results. The implications of the findings for policy, national survey efforts, and further research are discussed. (Freedman, VA, E Crimmins, RF Schoeni, B Spillman, H Aykan, K Land, J Lubitz, K Manton, L Martin, D Shinberg, T Waidmann. 2004. "Resolving Discrepancies in Old-Age Disability Trends Across National Surveys: Report From a Technical Working Group." Demography 41(3):417-441.)

This study finds that the percent of elderly decedents who ever had used a nursing home rose modestly between 1986 and 1993, with increased use before the last year of life. There was no change in the length of use among users. Projections indicate that a 65-year-old’s risk of ever entering a nursing home will rise to 47 percent over the next 20 years. With increases in the number surviving to age 65, the number ultimately entering nursing homes will double. The findings suggest that changing disability rates and Medicare policy had little net impact on patterns of nursing home use. Barring more dramatic health or policy changes, nursing home costs will be a growing share of national health spending as the population continues to age. (Medical Care 2002 October; 40(10):965-975).

This study explores the implications of the aging of the Baby Boom generation and increased longevity after age 65 for Medicare and long term care costs. Estimates show that Medicare spending increases at a decreasing rate with age, while long term care costs rise at an increasing rate. End of life Medicare costs actually decline with age, while nursing home costs rise sharply. Projections suggest that the impact of the increased longevity after age 65 of current and future elderly on Medicare spending will be small, and, although the impact of longevity on long term care spending will be larger, the dominant factor increasing future spending for both types of care will be the sheer number of persons turning age 65. (The New England Journal of Medicine 2000 May; 342(19); 1409-1415).

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