1. Posted 5/31/05 Module 1: The Basics of Long-Term Care

2. 2 Key Questions What is long-term care (LTC)? How do people receive LTC assistance? How likely is it that a person will need LTC? How much does LTC cost? Who pays for LTC services?

3. 3 Definition of LTC Activity: What words and phrases come to mind when you think about LTC?

4. 4 Definition of LTC Bathing Dressing Eating Using the toilet Transferring Continence Activities of Daily Living (ADLs) Instrumental Activities of Daily Living (IADLs) Cognitive Impairment: loss in intellectual capacity Grocery shopping Laundry Preparing meals Housework Managing medication Transportation

5. 5 Levels of LTC Skilled Care: medical care, nursing care, or therapy usually delivered by a nurse or other trained professional Personal Care: assistance with ADLs Supervisory Care: monitoring and supervision, a safe or controlled environment, and assistance with ADLs, usually for individuals with cognitive impairments

6. 6 LTC Settings: Informal Care Informal care: unpaid LTC assistance that is usually provided by family members, friends, or local organizations In 1998, nearly one in four Americans provided unpaid LTC services Providing this care can take a significant toll on the caregiver Source: Kaiser Family Foundation, Survey of Long Term Care from the Caregiver’s Perspective. 1998.

7. 7 LTC Settings: Formal Care Adult Day Care Nursing Home Assisted Living Continuing Care Retirement Community Skilled Care Personal Care IADL Assistance Home Care Residential Care Community - Based Care

8. 8 Workforce Issues Critical shortage of LTC workers throughout the nation Factors contributing to the shortage include: – High staff turnover rates – Fewer informal caregivers available – An aging population Source: Stone, Robin, and Joshua Weiner. Who Will Care For Us? Addressing the Long-Term Care Workforce Crisis. October 2001.

9. 9 Workforce Issues: Rural Areas Especially severe shortages in rural and underserved areas Factors compounding shortages in rural areas include: – Lower wages – An aging workforce

10. 10 Lifetime Risk of Needing LTC Risk for needing LTC is 60 percent Risk for needing nursing home care is 43 percent Sources: Long-Term Care Insurance, Baby Boom or Bust? Conning & Company, 1999. B.C. Spillman and J. Lubitz, 2002.

11. 11 Risk Factors There are many factors that may increase a person’s risk of needing LTC: *Age* Marital Status Gender Lifestyle Health Family History Source: General Accounting Office. “Long-Term Care: Current Issues and Future Directions,” April 1995.

12. 12 Risk of Needing LTC by Age (during a 12-month period) Source: Urban Institute, Long-Term Care: Consumers, Providers, and Financing. 2001.

13. 13 Risk of Needing Nursing Home Care by Age (during a 12-month period) Source: Urban Institute, Long-Term Care: Consumers, Providers, and Financing. 2001.

14. 14 Cost of LTC (2001) Nursing home care: $56,000 per year Assisted living care: $22,500 per year Part-time home care: $12,000 - $16,000 per year Source: U.S. Department of Labor, National Center for Assisted Living, and U.S. Census Bureau.

15. 15 Payment for LTC (1999) Source: CMS, National Health Accounts, 1999.

16. 16 Payment for Nursing Home Care (1999) Source: CMS, National Health Accounts, 1999.

17. 17 Case Study 1: Sam An 82 year-old man requiring nursing home care Care paid for by several sources, which change over time Medicare Medicaid Personal $ Medicare Personal $

18. 18 Case Study 2: Margaret An 85 year-old woman who needs LTC services to stay in her home Uses a combination of formal and informal care to meet her LTC needs Meals Home Health Aide Senior Family Church Wheels on Center