Long Term Care Long Term Care

Nancy L. Wilson-Baylor College of MedicineHuffington Center on Aging-Department of MedicinePresentation to Citizen’s Health Care Working Group Houston Hearing July 26, 2005

Mission Statement: To improve long-term care and supportive services provided to vulnerable older adults and family caregivers in Harris County through collaborative problem solving and strategic planning that involves consumers, providers, funding organizations, and other major stakeholders of the long-term care system.

www.careforelders.orgRWJ Community Partnership Program for Older Adults

Key Issues and Strategies

Access to Needed Services

Availability of Affordable Services

Quality of Care: Major Workforce Issues Preparedness for Aging

Individual/Personal Organizational Community

Today’s Presentation: Population concerned with long-term care is very diverse in terms of

age and level of disability : physical, mental,

My Expertise and Experience Focused on Older Adults– (60-63%)

Who I think about:

My brother –in-law who has managed with functional limitations due to encephalitis : fiercely independent in his own apartment with an electric wheelchair and dependent on daily assistance

My neighbors: Mrs. H, 81 who has congestive heart failure and COPD as well as a closed head injury sustained from a fall. She would like to remain at home with her husband for the duration of her illness.

My niece who is 22-years-old who has mental retardation as a result ofcomplications during birth and has been diagnosed with autism. Her family would like her to live at home indefinitely , but they need help with her care, particularly with a program of supervised daily activities.

Think about the heroic families who support these individuals –and the workplaces who make accommodations for these families

Definition and Examples

LTC is difficult to define: boundaries among primary, acute, and long-term care have blurred. medication management for elders with

chronic disabilities ?Settings of care are confounded with services

Nursing homes provide acute care Home Health Care delivers medical treatment

Long-term care is primarily concerned with maintaining or improving the ability of elderly people with disabilities to function as independently as possible for as long as possible.

Long-term care also encompasses social and environmental needs and is therefore broader than the medical model that dominates acute care.

Long-term care is primarily low-tech, although it has become more complicated as elderly persons with complex medical needs are discharged to, or remain in, traditional long-term care settings, including their own homes.

Services and housing are both essential to the development of long-term care policy and systems.

R. Stone (2000) Milbank Memorial Fund

Key Issue: Chronic Disease and Disability

43.5% of Harris County elders report disability

55.5% report two or more disabilities

63,400 need help with basic daily living tasks

Key Issue: Disability and Long Term Care

Not Just Nursing HomesA range of services to address functional needs and support independence

Everything from a home delivered meal to institutionally based care

Escalating costsNational expenditures in long term care

expected to triple to $346 billion/year by 2040

Long-Term Care “Risk” The risk of nursing home placement

increases with age - 31% of those who are severely impaired and between the ages of 65 and 70 receive care in a nursing home compared to 61% of those age 85 and older.

Most people with long-term care needs (83 percent) live in their own home; among those living at home, the majority (78 percent) does not hire any help and only 8% depend only on paid help

Long-Term Care is Expensive

• In 2002, the average annual cost for a nursing home was $51,000 for a semi-private room and $61,000 for a private room.

• Four hours of home care daily costs $26,000 a year. (national average)

• The cost of assisted living can range from less than $10,000 a year to well more than $50,000 a year (depending on the kind of assisted living facility and type of services an older person chooses.) (DHHS:Administration on Aging, 2003))

$32

$83

$257

$0

$50

$100

$150

$200

$250

$300

Home Health Care Nursing HomeCare

Family & Friends

BIL

LIO

NS

OF

DO

LL

AR

S

Source: Expenditure data from HCFA, Office of the Actuary, Levit K. et all, Health Affairs 2002;21.

The value of the services family caregivers provide for

"free" is estimated to be $257 billion a year.

Economic reality

You can save for college—but most of us can’t “save” for long-term care

Need to Consider how to approach the individual and social risk Physical, emotional, and social burdens that

providing care impose on the caregiver and its economic costs to the caregiver and to society.

Caregiving can conflict with caregivers’ employment, creating economic losses for caregivers and society.

Individuals suffer from inadequate attention to basic needs

Best Practice Approaches with Potential to Reduce LTC Costs Integration of care for long-term care recipients:

PACE: Program of All-Inclusive Care for the Elderly (55+ Medicare/Medicaid population)

EverCare nursing home managed care (Use of NPs and PAs to deliver medical care)

Consumer-Directed Services: Cash and Counseling Demonstration

Public Policy Support of Private Insurance Plans and Consumer Education

Other Approaches

Incorporating Geriatric and Prevention Approaches to Chronic Illness

A Geriatric PerspectiveFinding the Appropriate Balance and the Right Plan

ProlongingLife

Optimizing Qualityof Life

Increasing age and frailty

A B C D

Examples of promising complements to primary care of senior populations

Brief GEM/disability prevention with attention to primary care adherence in community (HEP, Stuck) or clinic

Chronic Disease Self-management and other proven self-management support programs

Post-hospital transition care Linkage to community Alzheimer’s services and

supports Problem-solving therapy for depression Post-prescription drug monitoring Senior oriented physical activity(Ed Wagner, Seattle 2005)

Threats to Health and Quality of Life Physical inactivity Poor diet and nutrition, obesity Falls Alcohol and substance abuse Depression Smoking Infection (flu and pneumonia) Inability to self-manage chronic conditions Inattention to clinical preventive services Social isolation

Underlying Risk Factors – “The Actual Causes of Death”

Behavior % of deaths, 2000 Smoking 18% Poor diet & nutrition/ 17%

Physical inactivity Alcohol 4% Infections, pneumonia 3% Racial, ethnic, economic ?

disparities*Mokdad et al., Actual causes of death in the United States, 2000, JAMA, March 10, 2004.

Threats to Health and Well-being Among Seniors 37% women & 33% men aged 65 – 74 report no

physical activity 24% - obese 33% - fall each year 34% - no flu shot 45% - no pneumococcal shot 47% - no mammogram 88% - at least one chronic condition

37% experience some activity limitation

Evidence Based Health Promotion Programs

Administration on Aging and National Council on the Aging (www.healthyagingprograms.org)

Evidence Based Disease Self-Management National Demonstration Program

3 of 13 projects in Texas

HoustonCare for Elders/Sheltering Arms

Depression interventionNeighborhood Centers, Inc.& St. Joseph’s

Physical activity intervention

San Antonio and Other Projects NationallyChronic disease self management

DiabetesHeart disease

Nutrition and dietFalls preventionMedication management

Contact Information

Nancy L. WilsonHuffington Center on Aging Baylor College of Medicine One Baylor Plaza M-320Houston, TX. 77030-3498713.798-3850 nwilson@bcm.edu