G. Lawrence Atkins, Ph.D. executive director, Long-Term Quality Alliance and president, National Academy of Social Insurance, reviewed key lessons from the Federal Commission on Long-Term Care and aging services innovations to frame future care delivery.
Atkins is the former chair of the commission, which issued a comprehensive report in 2013 calling for more funding and services for care and caregivers of older adults. About 78 percent of adults over age 65 has some type of unmet care need, requiring help with independent household activities of daily living. More than a quarter of older adults rely on outside help; 75 percent turn to family members to help meet their needs.
The number of older adults requiring some type of long-term care is projected to double by 2050, presenting “a major challenges to the financing and delivery of services,” Atkins said. Nearly one-third (30 percent) of people currently residing in the community or assisted-living facilities receive a combination of paid and unpaid care, and nearly two-thirds (65 percent) get help only from family members.
Atkins spoke during a web briefing on Thursday for policy stakeholders, aging experts and journalists. The session was sponsored by the Gerontological Society of America.
“Older adults and caregivers need more support to handle the growing complexities of arranging for and providing long term services and supports and what can be frequent care transitions,” he said. There’s a need for service delivery reform. Financial pressure from new payment models, like ACOs, and challenges of Medicaid’s long term services financing are driving a search for savings and efficiencies.
“We need to eliminate duplication, unnecessary cost and poor results of siloed care,” Atkins said. Better integration of LTSS with medical and health-related care, including effective management of care transitions, is critical to cost- effective improvement of quality and care delivery.
Medicaid finances over 60 percent of LTSS today, according to Atkins. A substantial portion is for the “dual eligibles,” those seniors who qualify for both Medicare, (which does not pay for most long-term care) and Medicaid. As demographics shift, the Medicaid burden on state budgets — including LTSS — will grow substantially as family caregiving becomes less available.
Additionally, “most people reaching age 65 today are not prepared to finance an expensive or lengthy period of long-term care, and future generations will be no better prepared,” Atkins said.
While individual responsibility to plan and save for the future remains the the core component of long-term care services, Atkins cited a real need for public programs to step in and provide a safety net. “We also have to improve support for family caregivers and keep them in the game.”
He called for an affordable, national catastrophic insurance plan to address those at greatest risk, along with a plan for those at intermediate risk which integrates long-term services and supports as a first step to enable health plans to provide the necessary services to better manage complex patients and lower acute care costs.
Long-term services is one of four main topics that the White House Conference on Aging will address. The others are elder justice, healthy aging and retirement security. Policy briefs for each topic are available on the conference’s website.
According to Michele Patrick, director of communications, White House Conference on Aging, who also participated in the briefing, three main themes about long-term care emerged from hundreds of listening sessions and town halls held by conference organizers and aging experts over the past year.
“There’s a need for greater support of formal and informal caregivers, to create a sustainable long-term care financing model and to provide a greater focus on person-centered care that maximizes independence,” she said.
Most older people just hope to maintain their quality of life for as long as possible and to grow old in their community, with a little assistance, Atkins said. Family caregivers remain the foundation of that and they need more support.
The president’s 2016 budget continues to emphasize the importance of caregiver supports, allocating nearly $50 million in new funding for aging programs that provide essential help and supports to older adults and their caregivers, such as respite and transportation assistance. The president’s budget also provides $15 million to a family support initiative focused on assisting family members supporting older adults and/or individuals with disabilities.
Reporters may want to look at how their state budgets and Medicaid programs align with the WHCOA goals, highlight any public and private programs that support aging in place or those that assist family caregivers to help loved ones age in their community.