reducing the need and costs of long- term care october 8, 2004 hal freshley minnesota board on aging
TRANSCRIPT
Reducing the Need and Costs of Long-Term Care
October 8, 2004Hal Freshley
MINNESOTA BOARD ON AGING
THREE APPROACHES
Things that individuals can do to reduce their own risk and costs
Things that providers can do to increase efficiencies and reduce costs
Things that communities can do that reduce service needs
Why even bring this up?The NUMBERS
By 2050 the population over 85 in Minnesota will increase by almost 400%
0
50000
100000
150000
200000
250000
1990 2000 2010 2020 2030 2040 2050
Why bring this up?
U.S. savings rate is declining . . .
-10
0
10
20
30
PE
RC
EN
T O
F D
ISP
OS
AB
LE
IN
CO
ME
Savings
Source: U.S. Department of Commerce
Why bring this up?
Current role of informal supports . . .
Who Helps Older People with Activities of Daily Living?
9.1%
39.7%
52.8%
6.7%
5.2%
5.2%
0 10 20 30 40 50 60
other
formal agency
friend/neighbor
other relative
child/child-in-law
spouse
Why bring this up?
Loss of “traditional” informal supports?
Boomers in 2030 More than double the number living alone. Average number of children per couple down
from 3.2 to 1.9 18% are childless Blended and “non-traditional” families the norm.
Why bring this up?
• 58% of all paid long-term care is publicly financed
• Most of these funds are paid through the federal/state Medicaid program.
• State of Minnesota spent $1.05 billion on long-term care for the elderly (FY2003).
Why bring this up?
Growing gap between needs and public resources for long-term care
0
0.5
1
1.5
2
2.5
3
3.5
4
1990 2000 2010 2020 2030 2040 2050
Needs
Resources
Why bring this up?
Minnesota's Dependency Ratio 1920 - 2050
0
10
20
30
40
50
60
70
80
1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050
PE
R 1
00
PE
RS
ON
S 1
5-6
4
Youth Dependency Ratio Elderly Dependency Ratio
What can individuals do?
Prepare for aging It’s inevitable so make the best of it:
Live Well, Age Well. Maximize health: eating and exercise habits
make “all the difference in the world” The Third Age: prepare for what you’ll do in
life’s next stage. People who stay actively engaged in their families and/or communities live longer and feel better.
What can individuals do?
Prepare for retirement Increase personal savings. “Buy smarter” – get educated about Medicare
and Medigap insurance --what’s covered (and not covered), long-term care insurance, annuities and other financial tools.
It’s not just financial. Think housing accessibility, community resources, family and friend proximity, transportation. . .
What can individuals do?
OR Continue to work
Percent Working by Age, 2000
4.7%
18.8%
48.6%
69.3%
0.0% 20.0% 40.0% 60.0% 80.0%
75+
65-74
60-64
55-59
Age
What can families do?
• Caregiver training and supports reduce “caregiver burden” and reduce personal costs
• Occupational Therapist or Physical Therapist review for accessibility and/or assistive devices
• Buy services “strategically” – respite, housekeeping, day care
What can families do?
More people are buying services • Percent of frail elderly getting “paid
help” for ADLs in 2000 . . .Chores/heavy housekeeping = 30%Light housekeeping = 18%Personal care = 22%
What can providers do?
Redesign services to reduce costs• Streamline operations: Contract out for
specialty services, simplify procedures, adopt management information systems
• Expand scope: Serve multiple target groups (including fee-for-service), enlarge service area to spread fixed costs
What can providers do?
• Rethink labor/personnel: More efficient use of paid staff, use of telehealth or other technologies, integrate volunteers, educate/support caregivers
• Focus on outcomes: evidence based practices result in better outcomes (lower costs), improve stability (prevent crises)
What can communities do?
Age-friendly communities Physical: Housing choices, transit,
community design, general accessibilitySocial: Faith communities & volunteer
networks, community participation, inter-generational trust
Services: Simplify, accommodate older residents
What can communities do?
Housing options for the whole lifecycle Starter-apartments to mother-in-law
apartmentsMore attention to maintain and adapt
current single family homes Ramps, railings and benches in public places Better lighting, clearer signage Safer highways and roads
What can communities do?
Ensure a strong local economyRoles for business--understand the older
market Develop strategies for youth retentionExpand civic and contributory roles and
expectations for older people
Resources
For individuals . . .http://minnesotahelp.info/en/mn/cgi-bin/location.asp
For providers . . .http://www.dhs.state.mn.us/main/groups/aging/documents/pub/dhs_id_005733.hcsp
For communities . . .http://www.gov.calgary.ab.ca/community/publications/elder_friendly_communities/
http://www.van.umn.edu/advocate/index.asp