Aging and Health Care Trends

Aging, Health, and Long-Term Care

• The population 65 years and older will significantly increase by 2030.
• More services will be needed to treat chronic and acute conditions, along with disabilities.
• Medicare beneficiaries with multiple chronic conditions, especially the frail elderly with functional or cognitive impairments, will need care coordination.
• Since 2011, the number of older people has substantially increased.
• By 2034, older adults are projected to outnumber children under 18.
• By 2060, nearly one in four Americans will be at least 65 years old.
• The population is aging due to increasing life expectancy and decreasing fertility rates.
• The old-old (85 and older) segment of the population is growing the fastest.
• The percentage of people aged 65 and older is projected to grow more slowly after 2030.
• In 2050, 53% of the population will be non-white, compared to 21% in 2014.

Common Health Problems in an Aging Population

• Chronic diseases last for one year or longer and require ongoing medical attention, limiting daily living activities.
• Common chronic diseases among the elderly include arthritis, stroke, diabetes, chronic lower respiratory diseases, dementia, and Alzheimer's disease.
• Pre-existing health problems such as alcoholism, substance abuse, mental illness, and developmental disabilities may be associated with chronic diseases.

Basic and Complex Activities of Daily Living

• Loss of functional ability with aging, including limitations in vision, hearing, mobility, communication, cognition, and self-care.
• Inability to perform complex tasks requiring more complex thinking and organization.
• Examples of IADLs include managing money, shopping, preparing meals, and taking medications.
• ADLs involve basic skills needed for independent self-care, such as eating, bathing, dressing, maintaining hygiene, and mobility.
• Chronic disease and a loss of ability to perform ADLs and IADLs lead to the need for long-term care.
• In 2016, about 69% of people aged 85 and older had at least one type of disability, compared to 9% of the population under 65.
• Stroke and dementia are significant causes of functional impairment in older adults.
• Alzheimer's disease is the most common type of dementia, characterized by a decline in cognitive function affecting memory, language, and problem-solving.

Medicare for Older Adults

• Medicare-covered benefits mostly apply to treatment of patients with acute illnesses requiring hospitalization and short-term skilled nursing care.
• Medicare covers rehabilitation centers, nursing homes, home healthcare, and is divided into four parts (deductible and copayments).

Medicaid for Older Adults

• Medicaid covers a broad range of services not covered by Medicare, acting as supplemental insurance for the elderly and disabled.
• Medicaid pays Medicare premiums and covers prescription drugs.
• The Medicaid program is the primary payer for long-term services and supports (LTSS).
• Medicaid spousal impoverishment provisions protect a certain amount of the couple's combined resources for the spouse living in the community.

Long-Term Services and Supports (LTSS)

• LTSS help people of any age unable to complete basic ADLs due to physical or mental impairments.
• LTSS include preadmission screening and resident review (PASRR).
• LTSS cover intermediate care facilities for individuals with intellectual disabilities (ICF/ID).
• LTSS include inpatient psychiatric services for individuals under 21, services for older adults in institutions for mental diseases, nursing facilities (NF), and skilled nursing facilities (SNF).

Community Long-Term Care Services

• Include privately funded providers regulated by federal and/or state governments and include adult day care, residential care communities, home health agencies, and hospice.

National Study of Long-Term Care Providers

• A study conducted by the National Center for Health Statistics (NCHS) in 2016.
• 65,000 long-term care service providers serving more than 8.3 million people annually.
• Main types of long-term care services and providers include residential care communities, nursing homes, home healthcare agencies, adult day care services, and hospice.

Health Literacy

• Limited health literacy affects people of all ages, races, incomes, and education levels.
• Health literacy disproportionately impacts lower socioeconomic and minority groups, those with low English proficiency, and older adults.
• Health literacy includes understanding instructions on prescription drugs, appointments, medical information, directions, consent forms, and negotiating complex healthcare systems.
• Limited health literacy is associated with worse health outcomes and higher costs.

Personnel Needs

• Healthcare practitioners will routinely serve older people in the future as part of their regular duties, making up approximately one-third to two-thirds of healthcare personnel workload.
• The current workforce will not be enough to meet the growing need.
• Future education for health professions and interprofessional education (IPE) is vital.
• Health professionals need broader understanding and competence in geriatrics.
• Health literacy factors and knowledge of different ethnic, racial, and socioeconomic groups including recent immigrants are important.

Nonmedical Care Facilities

• Include residential care communities/assisted-living facilities that provide room, meals, housekeeping, medication management, assistance with ADLs, and recreational activities.
• Some may include transportation for shopping or doctor visits.
• Often part of a retirement community, nursing home, senior housing complex, or a stand-alone facility.

Home Health Agencies

• Provide part-time nursing and medical care in patients' homes.
• Offer additional services such as physical, speech, and occupational therapy, social services, and medical supplies.

Hospice

• Hospice care manages pain and symptoms associated with dying when conventional treatment is no longer beneficial.
• Provides emotional, psychological, and spiritual support for patients and families.
• Offers bereavement counseling for surviving families and friends.
• May include necessary medications, medical supplies, and equipment.

Adult Day Care Services

• Supplement home care services, or provide less costly alternatives to residential/nursing care facilities.
• Provide supervision, therapeutic treatment to maintain functioning, social/recreational activities, meals, and snacks.
• Often include medical services and transportation.

Program of All-Inclusive Care for the Elderly (PACE)

• Encourages states to provide a single delivery system for Medicaid and Medicare benefits to improve care coordination, reduce administrative burdens, and provide comprehensive care to older adults with chronic care needs.
• Allows older adults to live in the community.

The Aging Network

• A system of federal, state, and local entities supporting older Americans in living independently.
• Includes the Administration on Aging, state aging units, Area Agencies on Aging, and Native American aging programs.
• Senior centers are the focal point of services, accounting for 60%.

Demographic Trends and Projections

• There are expected shifts in the U.S. population with a decrease in the Caucasian population and an increase in other racial groups.
• Many measures of disease and disability differ significantly by race and ethnicity.
• The racial and ethnic makeup requires health professionals to address cultural competence to serve specific population groups.