Publications by Brenda Spillman for Retirement Policy

More about Brenda Spillman's areas of expertise can be found on this Urban Institute expert's page.

Although the prevalence of late-life disability has been declining, how to promote further reductions has been unclear. We developed an analytical framework that compares the effects of different interventions on the prevalence of late-life disability. We considered three potentially high-impact intervention strategies: physical activity programs, depression screening and treatment, and fall prevention. We conclude that in the short run multi-component fall-prevention efforts have the greatest impact. At present, longer-term impacts cannot be assessed based on the current literature and may differ from short-run conclusions, since increases in longevity may temper the effect intervention strategies have on prevalence of late-life disabilities. (Milbank Quarterly 84(3): 493-520, 2006.)

This study explores the properties of an integrated income and disability annuity as an alternative framework for long-term care financing, demonstrating that pooling disability and mortality risks can reduce the need for medical underwriting, and discussing private and public implications. Specifically, a simulation indicates that pooling these competing risks can reduce the costs of both the income annuity and the disability coverage and expand the medically eligible population to 98 percent of 65-year-olds. Combining income and disability protection may be able to expand private markets for long-term care financing beyond what appears possible in the conventional long-term care insurance market, and is only one of multiple models that could be considered for long-term care financing. Public policy should foster innovation in financing mechanisms and avoid the distortion of choices created by exclusive policy focus on a conventional insurance model. (Journal of Aging and Health 15(1): 45–73, 2003.)

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 properties of a combined income and disability annuity in the context of the current long term care and retirement environment, particularly the trend toward defined contribution pensions and reduced annuity offerings through pension plans. Current tax policy obstacles to such a combined product and potential remedies for them are discussed. (In Innovations in Financing Retirement 2002; edited by Olivia Mitchell, Zvi Bodie, Brett Hammond, Stephen Zeldes; University of Pennsylvania Press).

This article examines the implications of the positive correlation of mortality and disability for the benefits of combining an immediate income annuity with long-term care disability coverage at retirement ages. It also investigates the value of such a combined benefit to various subgroups of prospective purchasers and the implications of possible errors and moral hazard in the reporting of disability status and making claims. (The Journal of Risk and Insurance, 2001, Vol. 68, No. 2, 225-254)

This study finds that the prevalence of informal, family care for the frail elderly declined between the mid 1980s and mid 1990s, while the use of formal, paid services increased. This pattern was more pronounced among those who had spouses and children, the dominant source of informal care. On the other hand, the decline in informal care appears to be entirely among those playing a secondary role. A larger proportion of those who were providing informal care were the primary source of care in the later year, and those who were receiving care were more disabled, suggesting that a smaller proportion of near kin may have been providing a greater level of care. The implications for public policy, informal caregiving, and the burden on families as the Baby Boom Generation ages into frailty are discussed. (The Milbank Quarterly 2000 Fall; 78(3):347-374)

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