Exam 3 - Long Term Care

What is Long-Term Care (LTC)?

Services designed to meet health or personal care needs when unable to perform everyday activities independently

How can LTC need begin?

May be sudden onset (Post-MI or CVA), but usually gradual

What are reasons LTC need increases?

More frail with age, develop serious ongoing illness, worsening health condition

Who are Baby Boomers?

Born 1946–1964, ~20% of population

When will the last Baby Boomers turn 65?

2029

What is life expectancy (2024 CDC)?

79.0 years

What % of Americans turning 65 will need LTC?

~56%

What % of those age 65+ have disabilities?

40%

What was US population age 65+ in 2020?

56 million

What is projected by 2030?

73 million

What is the “Silver Tsunami”?

10,000 people turning 65 daily with high costs and workforce shortages

Who is most likely to need LTC?

Age 75+ (>50% have disabilities)

What is the population age 85+?

6.5 million (2020) → 11.8 million (2035)

What % of population will be 65+ by 2050?

~22.8%

How many LTC facilities exist in US?

66,630 regulated facilities

How many individuals are served by LTC facilities?

6.9 million

Average LTC cost needed per senior (2022 study)?

$138,000

What does LTC provide?

Wide range of services and support for different needs

What are IADLs (instrumental activities of daily living)?

Low-level care: housework, laundry, transportation, finances, phone use, appointments, shopping, meal prep, meds

What are ADLs (activities of daily living)?

Higher-level care: eating, bathing, toileting, dressing, transfers, walking

What is the goal of LTC?

Help people live as independently and safely as possible

What % of men vs women need LTC?

49% men, 64% women

Average duration of LTC?

~3 years

Why are women more represented?

Longer life expectancy, 67% of LTC residents

Who is more likely to provide home care?

Women caring for male spouses

Average stay: women vs men?

Women 3.7 years, men 2.2 years

What are racial disparities in LTC?

89% White, 6% Black, 5% other

Where are assisted living facilities primarily located?

Primarily in White sectors (higher cost)

Where are adult day centers primarily located?

Communities of color (lower cost)

What contributes to disparities? x

Geographic distribution, mortgage lending, lower income, more debt

What are types of LTC facilities?

Nursing homes, hospice, residential care (assisted living), adult day care, home health

What is a nursing home?

24/7 skilled nursing facility for high acuity care

What is hospice care?

Final stage care focused on pain management

What are residential care communities?

Assisted living

What are adult day care centers?

Supervised group setting (personal care, transportation, medicine, meals)

What is home health?

Care at home for illness or injury

How many nursing homes exist?

14,700

Ownership type for nursing homes?

72.4% for-profit

Licensed beds in nursing homes?

1.6 million

Residents in nursing homes?

1.2 million

What % of adults 65+ will need LTSS?

~70%

What % of adults 65+need care >5 years?

~20%

How many unpaid caregivers exist for age 50+?

41.8 million

Cost of nursing home private room?

$116,800–$127,750

Cost of nursing home semi-private?

$104,000–$111,000

What % of admissions to nursing homes are mental disorders?

48%

What % of admissions to nursing homes are physical disorders?

43%

What % of admissions to nursing homes are social/emotional?

8%

What % of nursing home residents have cognitive impairment?

58%

Most common physical conditions in nursing homes?

• CV

• nervous system

• musculoskeletal

• diabetes complications

Why are facilities high risk?

Infections → require strict hygiene and vaccines

What is hospice care focus?

Comfort care for terminal patients

Top diagnoses in hospice?

• Cancer (24%)

• dementia/NS (24%)

• CV (21%)

When does Medicare cover hospice?

Prognosis <6 months

How many are served in hospice?

1.7 million

Average days of care in hospice?

92.1 days

What is assisted living?

Private or shared rooms with common areas

What are memory care units?

Units with closer supervision

What % in assisted living need bathing help?

75%

What services are provided in assisted living?

• Eating

• Mobility

• Dressing

• Hygiene

• Medication management

What do adult day care centers provide?

Meals, exercise, social activities, personal care, transportation

Additional services at adult day care centers?

• Meds

• Wound care

• Equipment help

• PT

• Trips

• Snacks

Cost structure for adult day care?

Variable: free or fee-based daily/weekly

What is home health care?

Care provided at home (“aging in place”)

Who are informal caregivers?

Family, friends, neighbors

What is personal care in home health care?

Help with ADLs and safety

Who are formal caregivers?

RN, aides, therapists providing paid services

What is total LTC spending?

$475.1 billion

Does Medicare cover LTC?

No, only short-term skilled care

What % of LTC does Medicaid cover?

54%

Who qualifies for Medicaid?

Low-income with limited assets

What % of Americans have private LTC insurance?

3-4%

Average length of LTC stay?

3.2 years

What % of LTC funding is public?

60.4%

What public & government agencies provide funding for elderly?

• Medicare

• Medicaid

• VA

What was % of public & government agencies pandemic assistance?

6.3% (2020–2021)

What has not dried up from public & government agencies pandemic assistance?

• Long covid assistance

• Vaccination support

What % of spending is out-of-pocket for elderly funding in US?

27.7%

What is largest private portion for elderly funding in US?

Out-of-pocket = 13.5%

Other sources of elderly private funding in US?

• Insurance

• Philanthropy

• Life insurance buyouts

• LTC insurance

• Reverse mortgage

• Annuities

• Trusts

• Bridge loans

• Savings

• Pensions

• Investments

• Home sales

What are alternative care costs?

• Home health $5,625/month

• Adult day care $1,847/month

• Assisted living $4,917/month

Does Medicare cover >100 days nursing home?

No

What do most long-term care places accept if resident qualifies?

Medicaid payment

Average claim coverage in long-term care insurance?

$54,019

What age files most claims for long-term care insurance?

>Age 70 (95%)

What is LTC planning?

Planning before need occurs

Why plan LTC early?

Learn services, costs, make decisions while able

Preferred option for elderly?

Aging in place (at home)

What support is available to plan for LTC?

• Counseling

• Healthcare professionals

• Agency on Aging

What are advance directives?

Legal documents for medical care instructions if unable to communicate

What is a living will?

Specifies desired emergency care

What is durable medical power of attorney?

Names healthcare proxy

What is a surrogate/agent?

Makes decisions for patient

When should directives be made?

Ahead of time (e.g., before MVA or CVA)

When are advanced directives needed?

Admission to hospital or LTC facility

What are strengths of LTC?

• Aging in place

• Reduced end-of-life costs

• Quality improvements

• Medicaid safety net

What are challenges of LTC?

• workforce crisis

• financial catastrophe

• broken insurance market

• fragmentation and inequality

• poor outcomes

What is the workforce crisis?

Loss of >400K workers, limited admissions

What is financial catastrophe?

Cost exceeds resources, need Medicaid

What is broken insurance market?

Rising premiums