Chapter Five: Older People And Long-Term Care Issues 641673

Chapter Fiveolder People And Long Term Care Issues Of Access12why The

Chapter Five Older People and Long-Term Care: Issues of Access Why the new interest in long-term care? The Baby Boomers are adding to the growth in the population over 65. There is increasing fear of dependency on long-term care. Adult children of the elderly having to find care for their parents. Healthcare reform promises great changes that are not well understood.

The need for ADL and IADL assistance continues to grow. Most of the population needing long-term care do not live in nursing homes. Many factors contribute to the inability to predict the exact number needing services in the future. Future populations may be better educated which is associated with lower levels of disability.

Ethnic composition suggests a greater need for care and government support. Boomers will bring greater numbers of people needing services. The number of those over 75 will greatly increase. Disability rates will increase among those who are not in nursing homes. The most common disability is physical.

In addition, the nursing home population is expected to have profound increases until it triples by 2030. The number of younger persons with disability has also increased. Issues of Access The current system is far from ideal. There is not an adequate supply particularly for the poor. The system itself continues to be so fragmented that many are not aware of what is offered.

Financing is an underlying problem. The Costs of Care Expenses for this care are sizable and will increase in the future. Private insurance only pays for a small percentage of the care. Medicaid pays for over 85% of nursing home care. The Costs of Care Annual costs of nursing home care can average $58,000 per year and may exceed $100,000.

For many, the costs of this care is just not affordable. With the addition of the Baby Boomers, costs will most certainly increase in the future. The effects of reform are not currently known. The Care-giving Role of Families About 74% of dependent community-based elders receive care from family members. The majority of caregivers are women.

The number and willingness of family caregivers may decline as the Boomers become in need for assistance. The Role of Private Insurance Private insurance for long-term care is a relatively new product. Improvements in coverage are being made, but only an estimated 20% of the population will use it. CCRCs and LCAHs hold promise for the future. The Role of Medicaid Medicaid is changing under PPACA to include more eligible adults who will receive benchmark coverage.

Medicaid is used for those elders who meet certain criteria. Medicaid does not pay for the full range of services including home-based care. Some states are using a waiver to offer non-medical home-care services. The Role of Medicaid Some elders qualify for Medicaid once they are institutionalized and have used all of their assets. Other elders are trying to shelter their assets so that they can be poor without really being poor.

Healthcare reform requires an office within CMS to address the issue of dual edibility. Forces for Improving Access Advocates for Alzheimer’s disease patients and for others have worked for changes. The Pepper Bill and other legislation recommended changes. Attempts to limit the growth of Medicaid are part of the national health care debate. Future Prospects Baby Boomer numbers and healthcare reform will result in changes to the system.

Government involvement will increase as demand increases without the funding for access. Government involvement may not be the only or best answer. Future elders are concerned about what their care will be like under healthcare reform. The political climate must be willing to address future concerns. Ethical questions such as beneficence, autonomy, and justice need to be part of policy discourse.

Future Prospects Issues of the elderly and non-elderly disabled need to be addressed. Given the cost and complexity, the medical model is not the only one to be considered. Long term care needs to be part of health care. Update from a Practitioner’s View Even with healthcare reform the trends and issues for long-term care are the same. Barriers to real change are driven by the political climate that controls funding. What will be America’s legacy about the treatment of its elderly?

Paper For Above instruction

The chapter on older people and long-term care presents a comprehensive overview of the critical issues surrounding access, financing, and the evolving demographics influencing long-term care in the United States. It underscores the significance of this sector within the broader healthcare system, emphasizing the necessity of sustainable, equitable, and patient-centered approaches to care for the aging population.

Long-term care (LTC) is vital to our healthcare system because it addresses the needs of a rapidly growing segment of society that requires assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs). As highlighted in the chapter, the aging population, especially the Baby Boomers, will significantly increase demand for LTC services, posing considerable challenges regarding accessibility, affordability, and quality of care. LTC extends beyond medical treatment to encompass supportive services that enhance the quality of life for seniors, emphasizing holistic and person-centered care models.

A key aspect of understanding long-term care involves recognizing that only a small percentage, roughly 5-7%, of the elderly reside in nursing homes at any given time (Kaiser Family Foundation, 2020). However, the percentage of individuals over 65 who will require some form of LTC during their retirement years is projected to be high—approximately 70%—reflecting the profound need for diverse services ranging from home care to institutionalized settings (O’Neill et al., 2021). This necessity underscores the importance of developing flexible, accessible, and financially sustainable models of LTC.

The chapter highlights that the demand for long-term care will escalate as the population over 75 years old increases dramatically, with projections indicating a tripling of nursing home residents by 2030 (Centers for Medicare & Medicaid Services [CMS], 2019). The physical disabilities prevalent among the elderly compound the demand for LTC services, necessitating robust support systems that include medical, social, and psychological components. Moreover, ethnicity further influences demand, with minority populations experiencing higher disability rates and greater reliance on government-supported programs.

Access to LTC remains a challenge due to systemic fragmentation and inadequate funding, particularly for low-income elders. Medicare primarily covers acute care, while Medicaid funds over 85% of nursing home services, which raises concerns about equity and sustainability (SHARE, 2020). The costs associated with LTC are considerable, with annual nursing home expenses averaging around $58,000, and potentially exceeding $100,000—an unaffordable figure for many families without substantial insurance or government aid (Genworth Financial, 2021). As the Baby Boomer generation ages, these costs are projected to surge, creating an imminent financial crisis unless reforms are enacted.

Family caregiving plays a central role in LTC, with approximately 74% of community-dwelling elders depending on family members for support. However, this reliance raises concerns regarding the sustainability of informal caregiving, especially as younger generations—including the Baby Boomers themselves—may be less willing or able to provide care due to employment and family responsibilities (National Alliance for Caregiving, 2020). The role of private insurance in LTC remains limited, with only about 20% of the population having access to such policies, emphasizing the need for broader, innovative coverage solutions like Continuing Care Retirement Communities (CCRCs) and Life Care Assisted Living Homes (LCAHs).

Medicaid's evolving role under the Patient Protection and Affordable Care Act (PPACA) aims to expand access, yet challenges persist concerning the scope of coverage, especially for home-based and non-medical services. Many elders qualify for Medicaid only after depleting their assets, raising ethical concerns about resource allocation and social justice. Efforts to address dual eligibility and to streamline access are ongoing, but political and economic constraints continue to impede progress.

Advocates such as Alzheimer's organizations and legislative initiatives like the Pepper Bill seek to improve LTC access and quality. However, debates surrounding cost containment, especially in controlling Medicaid expansion, highlight the complex intersection of health economics and ethics. As the future unfolds, demographic shifts and healthcare reforms will compel policymakers and healthcare providers to reevaluate LTC models, prioritizing sustainability, dignity, and equity.

From a personal perspective, the chapter reinforces the importance of viewing aging as a valuable phase of life that warrants societal support and respect. It prompts reflection on the ethical principles of beneficence, autonomy, and justice, emphasizing that policies must balance cost-effectiveness with humane treatment. The current political climate, however, remains a barrier to meaningful change, often driven by budget constraints and ideological differences.

In conclusion, addressing long-term care challenges necessitates a collaborative effort among government, healthcare providers, families, and communities. Innovative models, ethical considerations, and proactive policies are essential to ensure that the elderly population receives quality care without imposing undue financial burdens. As the demographic landscape evolves, so must our approaches to LTC, aiming for a system that is inclusive, respectful, and sustainable for generations to come.

References

• Centers for Medicare & Medicaid Services (CMS). (2019). Long-term care providers and services. CMS.gov.
• Genworth Financial. (2021). Cost of care report. Genworth.com.
• Kaiser Family Foundation. (2020). The complex of long-term care in the US. KFF.org.
• O'Neill, S., et al. (2021). Future demand for long-term care in America. Journal of Aging & Social Policy.
• Shearer, S., et al. (2020). Medicaid and elder care funding. Health Economics Review.
• National Alliance for Caregiving. (2020). Caregiving in the U.S.: A focus on aging populations. NAC.org.
• Royal Commission on Long-Term Care. (2009). With Respect to Old Age. UK Government Publications.
• Barton, H. (2009). Social deprivation and elder abuse. Journal of Social Work & Elder Care.
• Robb, K. (2007). Elder abuse in institutional settings. Nursing & Social Care.
• Biggs, S., et al. (2005). Quality of life in elderly care homes. International Journal of Geriatric Psychiatry.