hsc 6636: long term care 1 dr. lawrence west, health management and informatics department,...

HSC 6636: Long Term Care

1Dr. Lawrence West, Health Management and Informatics Department, University of Central Floridahttp://systems.cohpa.ucf.edu/lwest

Topics

• Demographics of LTC• LTC Needs—A Starting Point• Financing LTC• LTC Goals• LTC Providers• Issues and Trends

“All to often, the public equates LTC with care in a nursing home or another institution. However, LTC is a broad constellation of services provided in diverse settings to a heterogeneous population with many different needs.”

Text, p. 240



Demographics of Long Term Care

• What are the changes of the last 100 years that affect Long Term care?– Family structure and location?– Population distribution by age?– Medical care?

• Or, how was Long Term care provided in 1900?



LTC Needs

• Table 9.1—Range of LTC Services– Housekeeping and daily living support– Companionship & social support– Transportation (including to medical care)– Personal care– Nursing and healthcare procedures– Rehabilitative services– Palliative care– Care management



LTC Needs (cont.)

• Who Needs LTC?– Those disabled from birth– Victims of injury or disease– The elderly

• Adults 85+ seven times more likely than adults 65-74 to need LTC

• This age group growing “exponentially”• Evidence is that the group will be healthier than

their predecessors



Financing LTC

• Consider the activi-ties from Table 9.1– What are typical

sources of payment for each?– What is the special burden Medicaid

places on recipients of these services?– How might Medicaid spending change

as states face continuing budget problems?• Why is measuring LTC expenditure

levels so difficult?

• Housekeeping and daily living support• Companionship & social support• Transportation (including to medical care)• Personal care• Nursing and healthcare procedures• Rehabilitative services• Palliative care• Care management

Table 9.1 List



Financing LTC (cont.)

• Spending sources on Home Health Care *– Medicaid: $15.5 billion (32.6%)– Medicare: $17.9 billion (37.7%)

• Out of Pocket Nursing and Home and Community Services *: – $37.4 billion– 22% of total spending

* Note that different services are compared



Financing LTC (cont.)

• LTC Insurance– What does it cover?– Staggered premium structure depending on age

when purchased– Is $1,000 - $7,000 / yr too much to spend for piece

of mind?• Should you charge your kids for the coverage?



Goals of LTC



Goals of LTC (cont.)

• See Table 9.2– Who pays?– Who benefits?– Who decides?– What do terms such as “_____” mean to a policy

maker?• “Needs” • “Adequate”• “Long as possible” • “Efficient”• “Acceptable” • “Maximize”



LTC Providers

• The multidimensional nature of LTC(Table 9.1) results in a multidimensional collection of LTC providers– Unpaid caregivers– Home care agencies– Hospice services– Nursing homes– Adult day services– Community-based residential alternatives– Continuing care retirement communities

Q: Is a taxicab driver a LTC provider

if he/she takes a patient to

an

appointment?



LTC Providers (cont.)

• Unpaid Care– Primarily family and friends– Valued at $7.5 - $11.2 billion / year

• But no systematic data collection– What are the costs of unpaid care?– What could be done to improve the unpaid care

environment?– What are the social costs and benefits of

supporting unpaid care providers?




• Paid Care Providers—Overview – Growth industry but what has fueled the growth?

• Government programs• Dual income families• Aging population

– What are social and individual costs and benefits?– What future trends will we see?– How could government entitlement changes affect

the industry?– Would you want to work in this field?




• Home Care Agencies– Provide medically related services to patients at

home– Provide nonmedical personal services– Recipients of government subsidies subject to

both medical and needs tests for eligibility– Industry responds (fairly quickly) to changes in

funding and eligibility rules– What is the career potential in this field?




• Hospice Services– Relatively new service

• Recognized by Medicare in 1983– Dramatic growth in use of services– What issues does Hospice care face?– What are the costs and benefits

• Individual?• Aggregate?

– What is the career potential in this field?




• Nursing Homes– Best known of LTC services– Heavily regulated

• But data gathering is difficult• Almost all data is self-reported

– Increasing variety of treatments and programs– Some interesting changes in enrollment rates

• How might these patterns look going forward?– What is the career potential in this field?




• Adult Day Services– What is the market niche for these services?– Why do you think that 78% of these services are

nonprofit?– What are the implications of an unmet need for

5,500 more centers?– Service orientations may differ

• Medical services• Social services• Mixed

– What is the career potential for these services?




• Community-Based Residential Alternatives to Institutional Care– Let’s define these facilities by how they differ from

other alternatives– Note the wide range of service packages that

come under this heading– Also note differing regulatory environments

• Different state rules• Different rules for different types of services

– Again, what is the market niche these facilities address?




• Continuing Care Retirement Communities– A relatively new concept with exciting potential– Many work on a healthcare condominium model

with resident ownership interests– Different fee schedules depending on

• Ownership model– May incorporate an insurance function

• Pricing structure



Issues and Trends

• Cost vs. Access– LTC incorporates almost all of the HC costs and

cost trends of other HC• As overall costs grow so do LTC costs

– Also include non-HC costs for those not able to perform tasks themselves

– Approaches• Improve use of LTC insurance• Control supply of beds to control use of

services• Alternatives to more expensive options



Issues and Trends (cont.)

• Quality Assurance– Quality difficult to assure

• Multitude of facilities and types makes inspection programs difficult

• Field relies heavily on self-reporting• Split responsibility for enforcement• Serious flaws routinely found when inspections

are performed– The government is taking a market-based

approach by providing quality reports online




• Quality Assurance (cont.)– Home care even more difficult to supervise than

institutional care




• Increasing Consumer Choices– “…there is wide agreement that consumers should

have significant choice regarding their long-term care arrangements.” (p. 260)

• How will these choices be created?• Who will pay for them?

– Who should manage LTC for a specific patient?– Who decides when the patient’s wishes

• Conflict with medical advice?• Conflict with program rules?




• Financing Trends– What should be the role of insurance in LTC

financing?– What should be the role of the government?– Can universal LTC insurance such as Germany or

Japan have be politically practical in the U.S?

hsc 6636: long term care 1 dr. lawrence west, health management and informatics department,...

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