Meeting the Needs of an Aging Population LeadingAge Ohio: Meeting the Needs of an Aging Population Kathryn Brod, President/CEO LeadingAge Ohio House Long Term Care Committee May 17, 2017

Who We Are

Aging in Ohio: Health Conditions and Behaviors, 65 + US US Ranking Diabetes 24 22 38 Arthritis 57 52 44 Hip fractures per 1000 6.2 5.9 33 Multiple chronic conditions 40 37 39 Skilled NF Admits per 1000 93 63 Health behaviors % Smoking 10.2 8.8 No leisure physical act 36 31 42

The national caregiver dilemma 1/2 as many caregivers will be available in 2050 ½ as many caregivers will be available in 2050 While the number of older people is going up, the number of people to care for them is decreasing. The supply of potential caregivers is not going to keep pace with the future need ½ as many caregivers will be available in 2050 Extra information: 1990 to 2010-Was marked by boomers aging into prime caregiving years 2010-2030- Will be a period of transition as boomers age into old age and are not replaced with younger potential caregivers 2030-2050-Remaining boomers age into high care risk ages of 80+ Ratio of Potential Caregivers to Those Needing Care1 1. Ratio of # people in most common caregiving age ( 45-64 ) to those at most risk for needing care (80+) AARP PPI “The aging of the baby boom and the growing care gap: A look at future declines in the availability of family caregivers

Unpaid caregivers provide most LTSS today Paid caregivers: 70-80% home health aides, certified nursing assistants, personal aides Unpaid Family Caregiving: $470 billion annually 40 million family caregivers 37 billion hours of care Averaging 20-22 hours per week This is a problem because paid care is expensive, so unpaid caregivers provide most LTSS today The SCAN Foundation estimates that 87% of care is provided by unpaid family and friend caregivers Unpaid caregiving valued at $470 billion per year; Lynn Feinberg, Susan C. Reinhard, Ari Houser, and Rita Choula, “Valuing the Invaluable, 2011 Update,” http://assets.aarp.org/rgcenter/ppi/ltc/i51-caregiving.pdf, and Lynn Feinberg, Testimony to the Long-Term Care Commission, Populations in Need of LTSS and Service Delivery Issues, July 27, 2013 Source: SCAN Foundation, Who Provides Long-Term Care in the US? October 2012; Feinberg, et.al, “Valuing the Invaluable, 2015 Update; 2015 Alzheimer’s Facts and Figures, Alzheimer’s Association

The financial burden of LTSS falls on two principal sources Half of costs are borne by people who use LTSS (and their families) through out of pocket expenditures, especially in early years One third of costs are borne by Medicaid. Medicaid is the default public LTSS payer for long duration LTSS need The financial burden of paying for LTSS falls on two principal sources Approximately half of costs are borne by people who use LTSS (and their families) through out of pocket expenditures Over one third of the costs are borne by the Medicaid program. Medicaid has become the default public LTSS payer even though it was not designed to do so Source: HHS ASPE Issue Brief: LTSS for Older Americans: Risks and Financing July 2015. http://aspe.hhs.gov/sites/default/files/pdf/106211/ElderLTCrb_0.pdf   HHS ASPE Issue Brief: LTSS for Older Americans: Risks and Financing July 2015.

Less than 1 in 5 Boomers have taken any action to prepare for LTSS care. In a Met Life study, only 1 in 5 Boomers have taken any steps to prepare for LTSS. One might think that this is because this is a morbid issue, but …..

Boomers are poorly informed regarding LTSS payment Boomers also are unsure of funding sources for LTSS 52% of boomers think Medicare will pay for LTSS-the next largest source is don’t know (26%) While they are not sure where funds will come from to pay for LTSS, Boomers are certain that their children will not pay for or provide for such care. This is concerning in light of the fact that unpaid family caregivers are such an important part of the funding equation. Perceived Methods for Funding Ongoing Long-Term Care Source: Retirement Care Planning: The Middle-Income Boomer Perspective, Bankers Life and Casualty Company Center for a Secure Retirement, August 2013. LTCi = Long Term Care Insurance

Sales of LTC insurance are declining There are fewer ways for middle income families to protect themselves financially given that private market insurance products are not affordable for them, these families are not eligible for Medicaid initially, and their financial assets are too limited to satisfy LTSS needs. This slide shows the decline in insurance sales. The long-term care insurance market is going thru a market consolidation Prominent carriers have left the market, unwilling to deal with uncertain risk and profit concerns The product, already expensive has seen significant price increases, consigning it to high-end niche status. Annual Sales of Individual LTC Insurance Decline Since 2002 Source: LifePlans. LifePlans analysis based on AHIP, LIMRA and LifePlans sales surveys, 2013. Beginning in 2009, LTC Partners data for annunitants included in counts.

So What Should We Do? Many countries that have tackled this issue have done so as a result of the culmination of these perfect storm conditions Building on a sense of urgency and clearly defining the problem moved them on a path to LTSS reform