1. LONG TERM CARE The Aging of America Assisted Living - Nursing Homes

2. The Aging of America

3. ELDERLY AMERICANS ARE JUST ABOUT THE ONLY GROUP OF U.S. CITIZENS WHOSE HEALTH CARE IS UNIVERSALLY INSURED AS AN ENTITLEMENT.

4. HOWEVER, ELDERS WHO NEED LONG-TERM CARE HAVE MUCH LESS PROTECTION.

5. MEDICARE, THE FEDERAL PROGRAM FOR THE ELDERLY AND DISABLED, COVERS MANY OF THE COSTS OF ACUTE MEDICAL CARE BUT ONLY TANGENTIALLY COVERS SOME LONG CARE SERVICES.

6. MEDICAID, THE FEDERAL/STATE HEALTH PROGRAM, COVERS LONG- TERM CARE BUT ONLY FOR PEOPLE WHO ARE POOR OR WHO BECOME POOR PAYING FOR LONG-TERM CARE OF MEDICAL CARE.

7. MORE THAN TWELVE MILLION PEOPLE IN THE UNITED STATES, ABOUT HALF OVER AND HALF UNDER AGE 65, NEED SOME KIND OF LONG TERM CARE. ABOUT A THIRD OF THESE PEOPLE HAVE CARE NEEDS THAT ARE SUBSTANTIAL.

8. SUPPORT FOR CARE FALLS LARGELY OUTSIDE MEDICARE’S SCOPE. MOST LONG-TERM CARE IS PROVIDED BY FAMILIES AND FRIENDS IN THE COMMUNITY.

9. MEDICAID IS A DIFFERENT STORY. 7% Medicaid Beneficiaries utilize 52% of all Medicaid spending.

10. One half are elderly One third are disabled and under age 65 The rest are adults or children not classified as disabled

11. PEOPLE WHO NEED LONG-TERM CARE OFTEN DO NOT GET THE CARE THEY NEED OR PREFER, AND FAMILIES’ CAREGIVING AND FINANCIAL BURDENS ARE OFTEN HEAVY.

12. CHANGING DEMOGRAPHICS POSE A FURTHER CHALLENGE. CURRENT ESTIMATES SUGGEST THAT THE DEMAND FOR LONG-TERM CARE AMONG THE ELDERLY WILL MORE THAN DOUBLE IN THE NEXT THIRTY YEARS.

14. AGING DEMOGRAPHICS

15. Projection of U.S. Population, by age, 1995-2050

18. GENERAL PROFILE:  CURRENTLY, THERE ARE 34 MILLION AMERICANS AGED 65 AND OVER, ALMOST 13% OF TOTAL POPULATION.  BY 2030, THIS NUMBER WILL GROW TO 69 MILLION WHICH WILL REPRESENT 20% OF THE POPULATION.  BY 2050, THERE WILL BE 80 MILLION AMERICANS 65 AND OLDER.

19. GRAYING OF AMERICA

20.  THE ELDERLY POPULATION INCREASED 11-FOLD FROM 1900- 1994.  THE NON-ELDERLY POPULATION INCREASED 3-FOLD.  FROM 1995 TO 2030 THE AMERICAN POPULATION WILL INCREASE BY 50%.

21.  IN THE SAME TIME PERIOD, THE 65+ AGE GROUP WILL INCREASE BY 135%.  PEOPLE OVER 85 WILL BE THE MOST LIKELY TO HAVE CHRONIC NEEDS.  THERE ARE CURRENTLY 3 MILLION AMERICANS OVER 85.

22.  THIS NUMBER IS EXPECTED TO REACH 8 MILLION BY 2030.  BY 2050 THE NUMBER OF AMERICANS OVER 85 IS EXPECTED TO BE 28 MILLION.

23.  SOME 75 MILLION AMERICANS WERE BORN IN THE YEARS 1946-1964.  FROM 2010 TO 2030 THE POPULATION OF ELDERLY AGED 65 TO 84 IS EXPECTED TO GROW 80%.

24.  THE POPULATION OVER AGED 85 WILL GROW 48%.  THE POPULATION UNDER AGE 65 WILL INCREASE ONLY 7%.

25. WHERE DO OLDER AMERICANS LIVE?

26. Living Arrangements of Older Men and Women

27.  67% OF ALL OLDER NON- INSTITUTIONALIZED PERSONS LIVE IN A FAMILY SETTING.  ABOUT 9.9 MILLION AMERICANS LIVE ALONE. 70% OF THOSE ARE WOMEN.

28.  21 MILLION AMERICAN HOUSEHOLDS ARE HEADED BY OLDER AMERICANS, USUALLY WOMEN (78%).  78% OWN THEIR HOMES AND 22% PAID RENT.  1.6 ELDERLY AMERICANS LIVE IN NURSING HOMES.

29. FINANCIAL STATUS  IN 2004, SOCIAL SECURITY WAS THE MAJOR SOURCE OF INCOME FOR 89% OF OLDER COUPLES AND INDIVIDUALS.  PROVIDED 40% OF TOTAL HOUSEHOLD INCOME.

32.  FOR 63%, SOCIAL SECURITY PROVIDED AT LEAST HALF OF HOUSEHOLD INCOME.  FOR 26%, SOCIAL SECURITY PROVIDED ALMOST ALL OF THE INCOME.

33.  FOR 14%, SOCIAL SECURITY WAS THE ONLY SOURCE OF INCOME.  IN 2006, MEDIAN INCOME WAS $21,784 FOR MEN AND $12,495 FOR WOMEN. MEDIAN INCOME FOR FAMILIES HEADED BY AN OLDER PERSON WAS $37,765.

34.  ABOUT 3.4 MILLION ELDERLY PERSONS ARE BELOW THE POVERTY LEVEL.  ANOTHER 2.4 MILLION ARE CONSIDERED NEAR-POOR.

35.  9.4% OF ELDERLY WHITES ARE POOR.  25.3% OF ELDERLY AFRICAN- AMERICANS ARE POOR.  24.4% OF ELDERLY HISPANICS ARE POOR.

36. OBSERVATION  THE OLDEST BABY BOOMERS ARE NOW IN THEIR SIXTIES, AND THE ABILITY OF OUR PUBLIC AND PRIVATE INCOME SECURITY AND HEALTH PROGRAMS TO MEET THEIR EVENTUAL RETIREMENT NEEDS IS DRAWING INCREASED ATTENTION.

37. WASHINGTON — The baby boomers' stampede for Social Security benefits has begun.

38. The nation's "first" baby boomer, a retired teacher from New Jersey, applied for Social Security benefits Monday, signaling the start of an expected avalanche of applications from the post-World War II generation. Social Security Commissioner Michael Astrue called it "America's silver tsunami."

39. An estimated 10,000 people a day will become eligible for Social Security benefits over the next two decades. The Social Security trust fund, if left alone, is projected to go broke in 2041.

40.  THE COMING DECADES ARE LIKELY TO SEE A SIGNIFICANT INCREASE IN THE DEMAND FOR LONG TERM CARE SERVICES, PARTICULARLY AT THE FIRST BOOMERS REACH 85 IN 2030!

41. WHO NEEDS LONG-TERM CARE? DEFINITION:  LONG-TERM CARE REFERS TO A BROAD SET OF PAID AND UNPAID SERVICES FOR PERSONS WHO NEED ASSISTANCE BECAUSE OF A CHRONIC ILLNESS OR PHYSICAL OR MENTAL DISABILITY.

42.  ADL – PERSONAL ASSISTANCE WITH THE ACTIVITIES OF DAILY LIVING. EATING, BATHING, DRESSING, GETTING INTO AND OUT OF BED OR CHAIR, AND USING THE TOILET.

43.  IADL - INSTRUMENTAL ACTIVITIES OF DAILY LIVING. ADDITIONAL ACTIVITIES NECESSARY FOR INDEPENDENCE SUCH AS PREPARING MEALS, MANAGING MEDICATIONS, AND SHOPPING FOR GROCERIES.

44. ASSISTED LIVING  THE AMERICAN ASSOCIATION OF HOMES AND SERVICES FOR THE AGING DEFINES ASSISTED LIVING AS A PROGRAM THAT PROVIDES AND/OR ARRANGES FOR THE PROVISION OF DAILY MEALS, PERSONAL AND OTHER SUPPORTIVE SERVICES, HEALTH CARE AND 24-HOUR OVERSIGHT TO PERSONS RESIDING IN A GROUP RESIDENTIAL FACILITY WHO NEED ASSISTANCE WITH ACTIVITIES OF DAILY LIVING.

45.  MORE THAN ONE MILLION SENIORS LIVE IN ASSISTED LIVING RESIDENCES.  ASSISTED LIVING RESIDENCES MOSTLY SERVE RESIDENTS WHO ARE IN THEIR MID-EIGHTIES AND REQUIRE ASSISTANCE WITH THREE ACTIVITIES OF DAILY LIVING…DRESSING, EATING, OR BATHING.

46. THE “RESIDENT” IS AN 83 YEAR-OLD WOMAN WHO IS WIDOWED OR SINGLE.

47. TYPES OF SERVICES  PROVISION OF MEALS, HOUSEKEEPING, MEDICATION ASSISTANCE, INCONTINENCE CARE, AND LIMITED NURSING SERVICES.

48. THE INDUSTRY  IN 1998 THERE ARE CLOSE TO 11,800 ASSISTED LIVING FACILITIES IN THE UNITED STATES.  THE ASSISTED LIVING INDUSTRY IS THE FASTEST GROWING SEGMENT OF THE SENIOR HOUSING INDUSTRY.

49.  OF ALL NEW SENIOR HOUSING, 75% IS DEVOTED TO ASSISTED LIVING FACILITIES.

50. THE VALUES OF ASSISTED LIVING  ALLOWS INDIVIDUALS TO REMAIN AS INDEPENDENT AS THEY PREFER AND STILL RECEIVE NECESSARY SERVICES.  SENIORS ARE ABLE TO AGE WITH MORE DIGNITY.

51.  COST-EFFICIENT, CONSUMER- DRIVEN, AND FLEXIBLE WHICH ACCOMODATES MANY TYPES OF RESIDENTS.  RESIDENTS ABLE TO RECEIVE INDIVIDUAL ATTENTION.

52.  WHAT IS THE COST OF ASSISTED LIVING?  RATES RANGE FROM UNDER SEVERAL HUNDRED DOLLARS A MONTH TO MORE THAN $3,000 A MONTH.

53. FOUR BASIC MODELS:  ALL-INCLUSIVE RATE MODEL: ALL SERVICES ARE INCLUDED IN A FLAT MONTHLY FEE. THE RESIDENT PAYS THE SAME RATE REGARDLESS OF THE AMOUNT OF SERVICES USED.

54.  BASIC/ENHANCED: A CORE SET OF SERVICES IS OFFERED FOR A FLAT MONTHLY FEE. A LA CARTE/FEE-FOR-SERVICE: ALL SERVICES ARE PRICED AND CHARGED SEPARATELY. IN THIS MODEL, THE RESIDENT PAYS FOR ONLY THOSE SERVICES RECEIVED

55.  SERVICE LEVELS: RESIDENTS ARE ASSESSED ACCORDING TO A NUMERICAL RATING SYSTEM AND ASSIGNED TO ONE OF SEVERAL LEVELS OF CARE. –EACH LEVEL OF CARE REPRESENTS MORE INTENSE SERVICE NEEDS WITH A HIGHER FEE ATTACHED.

56. OTHER SOCIAL SERVICES AVAILABLE – COMMUNITY BASED ORGANIZATIONS

57. PROGRAMS OF INTEREST: SOCIAL SUPPORT (IN HOME SERVICES, CASE MANAGEMENT) CAREGIVING (EDUCATION, RESOURCE AND SUPPORT, RESPITE

58. CHRONIC DISEASE SELF MANAGEMENT (INFORMATION, CLASSES, SUPPORT GROUPS. MANAGE CHRONIC DISEASES) PHYSICAL ACTIVITY

59. PROGRAM TYPE

60. SOCIAL SUPPORT SERVICES

61. SOCIAL SUPPORT PROGRAMS GENERALLY SERVE FRAIL OR VULNERABLE OLDER ADULTS, OFTEN IN THE HOME OR IN AN ADULT DAY CENTER.

62. CAREGIVING SERVICES

63. CAREGIVING PROGRAMS ARE TARGETED TOWARD A FAMILY MEMBER OR OTHER “INFORMAL” CAREGIVER. ADDRESSES THE ISSUE OF DEMENTIA AND TAKING CARE OF THE VERY FRAIL.

64. DISEASE SELF-MANAGMENT

65. HEALTH PROMOTION PROGRAMS WORK WITH OLDER ADULTS TO PROMOTE HEALTH LIFE STYLES AND SELF-CARE SKILLS.

66. PHYSICAL ACTIVITIES

67. PHYSICAL ACTIVITY PROGRAMS OFFER MIXTURES OF EXERCISE AND HEALTH EDUCATION TARGETED AT IMPROVING BALANCE, FLEXIBILITY, STRENGTH, AS WELL AS OVERALL HEALTH.

68. QUALITY OF ACCESS

69. IMPROVING QUALITY OF LIFE

70. TYPES OF ORGANIZATIONAL PARTNERS

71. BARRIERS TO EXPANSION

72. End End of Lecture for October 27 th 2010, 6 th period. Questions?

73. Assisted Living – Nursing Homes

74. NURSING HOMES  ALMOST 1.5 MILLION PEOPLE CURENTLY LIVE IN NURSING HOMES.  A 65-YEAR-OLD HAS A 43% CHANGE OF ENTERING A NURSING HOME AT SOME TIME IN HIS OR HER LIFE.

75.  OVER 52% OF ELDERLY WOMEN AND 33% OF ELDERLY MEN WILL USE A NURSING HOME BEFORE THEY DIE.

76.  HOW MANY NURSING HOMES ARE IN THE UNITED STATES?

77.  ACCORDING TO RECENT STATISTICS, THERE ARE OVER 17 THOUSAND NURSING HOMES WITH MORE THAN 1.8 MILLION BEDS.

78. GOVERNMENT: 7% NONPROFIT: 28% FOR PROFIT: 65%

79. WHO ARE NURSING HOMES FOR?

80.  AN OLDER PERSON IS MORE LIKELY TO NEED NURSING HOME CARE IF THE FOLLOWING FACTORS EXIST:

81. ADVANCED AGE CHRONIC DISABILITY DETERIORATING MENTAL AND PHYSICAL CAPACITIES

82. LIVING ALONE, OR LACK OF FAMILY MEMBERS TO PROVIDE HELP. TIME SPENT IN A HOSPITAL OR OTHER HEALTH FACILITY.

83. 76% NEED HELP IN USING THE TOILET 71% NEED HELP WHEN MOVING FROM BED TO CHAIR 46% NEED HELP WHEN EATING.

84. HOW MUCH DOES IT COST?  CMS DATA SHOWS THAT THE COST OF CARE IN FREE-STANDING NURSING FACILITIES AVERAGE $127 PER DAY OR OVER $46,000 A YEAR.  JACKSONVILLE = $63,875  ORLANDO = $68,620  MIAMI = $82,125

85. AVERAGE LENGTH OF STAY  65 AND OVER IS 838 DAYS  65-74 IS 1,064 DAYS  75-84 IS 864 DAYS  85+ IS 713 DAYS

86. –NURSING HOME FUNDING  MEDICARE: 9%  PRIVATE INSURANCE: 3%  MEDICAID: 50%  INDIVIDUALS OR FAMILIES 38%

87. NURSING HOME EXPENDITURES

89. WHO PAYS?

90. –WHAT IS THE FUTURE FOR NURSING HOMES?

91.  NURSING HOMES AND PERSONAL CARE FACILITIES EMPLOY ABOUT 1.6 MILLION WORKERS AT 21,000 SITES.  BY 2005, EMPLOYMENT LEVELS WILL RISE TO AN ESTIMATED 2.4 MILLION WORKERS.

92.  CENSUS BUREAU PREDICTS THAT THE NUMBER OF NURSING HOME RESIDENTS WILL INCREASE TO 2.2 MILLION BY THE YEAR 2000, 2.6 MILLION BY 2010, AND 3 MILLION BY 2020.

93. End of Lecture for 7 th Period, October 27 th, 2010 Questions?