Aging and the health care system
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Aging and the Health Care System. Board of Directors William H. Dunlap, Chair David Alukonis Eric Herr Dianne Mercier James Putnam Todd I. Selig Michael Whitney Daniel Wolf Martin L. Gross, Chair Emeritus Directors Emeritus Sheila T. Francoeur Stuart V. Smith, Jr. Donna Sytek

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Aging and the Health Care System

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Aging and the health care system

Aging and the Health Care System

Board of Directors

William H. Dunlap, Chair

David Alukonis

Eric Herr

Dianne Mercier

James Putnam

Todd I. Selig

Michael Whitney

Daniel Wolf

Martin L. Gross, Chair Emeritus

Directors Emeritus

Sheila T. Francoeur

Stuart V. Smith, Jr.

Donna Sytek

Brian F. Walsh

Kimon S. Zachos

New Hampshire House Long-Term-Care Commission

March 18, 2014

“…to raise new ideas and improve policy debates through quality information and analysis on issues shaping New Hampshire’s future.”

1

1


Major areas of consideration

Major Areas of Consideration

  • Aging

  • Service Demand

  • Service Supply

  • Financing

  • Responsibility and Authority for Policy

  • Flexible Systems (Peak Load)


Critical questions

Critical Questions

  • How will demand for different services change as a result of aging and new disease burden (e.g. dementia)?

  • Is the system of supports for aging sufficient to meet this growing demand (caretakers, institutions)?

  • Is a state solution the right answer? How do regional differences impact the questions being asked?

  • Does the growth of Medicare enrollment and changes in Medicaid (expansions to 55-64-year-old adults) provide opportunities?

  • What does a long-term-care accountable care organization look like?

  • How do these answers affect the state’s implementation of managed care for long term care services?

  • How do national policy changes (Affordable Care Act) and potential recommendations out of the long term care commission impact New Hampshire?

  • What role will the counties play in providing the services needed across the spectrum of long-term-care supports and services (Meals on Wheels to institutional care)?

  • Long-term-care expenditures are projected to grow more quickly then revenues. How will the state and counties finance these changes?


Are we old not yet but getting there

Are we old? Not yet, but getting there …

4


Aging and the health care system

Geography Matters

5


The new 60 significant growth of 75 79 population

The new 60? Significant growth of 75-79 population

6


Aging and the health care system

7


Aging and the health care system

The Geography of Elderly Poverty


Predicting the future in spending

Predicting the Future in Spending


Private pay tremendous growth in 45 64 y o range

Private Pay – Tremendous growth in 45-64 y.o. range


Aging has real impacts on medicare

Aging has real impacts on Medicare ….


Currently much of the medicaid spending is for those under the age of 65 2009

Currently, much of the Medicaid spending is for those under the age of 65 (2009)


A very different picture in 2030

A very different picture in 2030


Shifts in medicaid spending

Shifts in Medicaid Spending

14


Driven by age and shifts in demand for services

Driven by Age and Shifts in Demand for Services

Nursing Home Care

15


Can the current system support such demand for institutional and non institutional services

Can the current system support such demand for institutional and non-institutional services?

16


Large growth in spending

Large Growth in Spending


Medicare will play a growing role in driving the healthcare system

Medicare will play a growing role in driving the healthcare system


Workforce issues will become more acute

Workforce Issues will become more acute.


The workforce is aging as well

The Workforce Is Aging As Well!


Capacity questions

Capacity Questions

  • Home Health

  • Home and Community Based Care slots

  • Geriatric hospital services

  • Assisted Living Facilities

  • Alzheimer's Support (Hospital, Nursing Homes)

  • Prisons

  • Inpatient versus Outpatient services


What does a comprehensive assessment of the system of ltc supports look like

What does a comprehensive assessment of the system of LTC supports look like?


Aging and the health care system

Acute

Medical

Chronic

Medical

Community

Based LTC

Assisted

Living

Nursing

Home

What does a Long-Term-Care Accountable Care

Organization Look Like?


Support and information

Support and Information

Service Link (ADRC)

Legal Services

211 Calls

Other ?

24


Financial assistance 2012

Financial Assistance (2012)

TANF Grants for Lower Income Elderly

Household size of one must be under $712 per month and aged 65 or older; Average grant is $164.13 in July 2012

Property Tax Exemptions?

96% of cities and towns provide mandated base elderly exemption (94% provide additional value)

In 2006, 11,753 individuals received an exemption, average $1,727 for a total of $20.3 million across the entire state.

Local welfare expenditures?

25


Nutrition 2012

Nutrition (2012)

Food-stamps

Maximum grant is about $5.80 per day per person. Of a total 56,887 cases in July (2012), 5,944 or 5.1% are over age 65. Of these, 1,215 have a cash grant

Meals Programs (Title III)

11,454 individuals received home delivered meals.

17,192 received congregate meals

Local food kitchens

26


Other

Other

Housing

Section 8 housing?

Other efforts

Transportation

Title III – provided almost 19 visits per person over the age of 65 living in poverty in NH.

Medicaid provides transportation services

Acute Healthcare

Medicaid

Local Welfare

27


State or county based long term care supports

State (or county based) Long Term Care Supports

Public Health (support for falls, chronic conditions for those 55 to 64)

Medicaid Nursing Home

Home and Community Based Care

Title III

Adult Day Care – 654 individuals received support

Homemaker – 645 individuals received support

Personal Care Services – 523 received support

28


What about the impact of the budgetary changes from 2010 2013

What about the impact of the budgetary changes from 2010 – 2013?


The national long term care commission

The National Long Term Care Commission

  • The Commission identified the following problems with the current LTSS system:

  • Currently, family caregivers are providing most of the care, but their responsibilities can be very overwhelming. Their availability will decline as more of the population ages.

  • Many Americans approaching retirement are unaware of how costly paid LTSS are and are not prepared for these expenses.

  • There are training and retention problems within the direct care workforce that will affect the quality and accessibility of practiced employees in the future.

  • Paid LTSS are fragmented and difficult to access. They often lack the focus and efficiency that would result in the best outcomes, all the while remaining a financial burden.


Critical questions1

Critical Questions

  • How will demand for different services change as a result of aging and new disease burden (e.g. dementia)?

  • Is the system of supports for aging sufficient to meet this growing demand (caretakers, institutions)?

  • Is a state solution the right answer? How do regional differences impact the questions being asked?

  • Does the growth of Medicare enrollment and changes in Medicaid (expansions to 55-64-year-old adults) provide opportunities?

  • What does a long-term-care accountable care organization look like?

  • How do these answers affect the state’s implementation of managed care for long term care services?

  • How do national policy changes (Affordable Care Act) and potential recommendations out of the long term care commission impact New Hampshire?

  • What role will the counties play in providing the services needed across the spectrum of long-term-care supports and services (Meals on Wheels to institutional care)?

  • Long-term-care expenditures are projected to grow more quickly then revenues. How will the state and counties finance these changes?


Aging and the health care system

New Hampshire Center for Public Policy Studies

Board of Directors

William H. Dunlap, Chair

David Alukonis

Eric Herr

Dianne Mercier

James Putnam

Todd I. Selig

Michael Whitney

Daniel Wolf

Martin L. Gross, Chair Emeritus

Directors Emeritus

Sheila T. Francoeur

Stuart V. Smith, Jr.

Donna Sytek

Brian F. Walsh

Kimon S. Zachos

Want to learn more?

• Online: nhpolicy.org

• Facebook: facebook.com/nhpolicy

• Twitter: @nhpublicpolicy

• Our blog: policyblognh.org

• (603) 226-2500

“…to raise new ideas and improve policy debates through quality information and analysis on issues shaping New Hampshire’s future.”


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