Number of elderly rising dramatically
Who Pays for Long-Term Care?
43% paid out of pocket
Medicaid pays for 46% after the people have depleated all their resources
$70 billion in 1991, average of $34,000/year for nursing home
Medicare Long-term Coverage
Covers "skilled" not "custodial" care
Covers postacute but not cronic
Medicaid Long-term Coverage
will not pay for 24-hour-a-day custodial services--must go to a nursing home
requiers you to spend down your assets and may put liens on your home
Private Long-term Care Insurance
only 2% of costs
too expensive to insure the elderly and the young don’t want this insurance
(you don’t sell insurance for somethign which is going to happen)
Who Provides Long-term Care?
Informal Care Givers
85% recieve long-term care services from family or friends
Community-based & Home Health Services
growing number of facilities--many for profit
hospice programs will not accept terminal illnesses
Nursing Homes
dominated by Medicaid
most of them are mediocre quality or worse
many demented patients
Improving Long-term Care
Financing Long-term Care
Pepper Commission (1990)--only way to pay for long-term care is to spread the cost over the whole population with a Medicare A type program
Providing Long-term Care
develop social insurance for long-term care
in home, not in nursing homes
trian family to support
On Lok program in San Francisco has been very sucessfull with an integrated home-based care system