BuildingMaking
Bridges:a Making
a Difference
in
Building Bridges:
Difference
in Long-Term
Care
Care
2010Long-Term
Policy Seminar
Rhonda Richards
Senior Legislative Representative, Federal
Government
Relations
Nora Super
Health
and
Long-Term
Care
Director,
Federal
Government
Relations
Health and Long-Term
AARP Care
March 23, 2010
February 10, 2010
AARP 1
Improving Long-Term Services and
Supports: An AARP Priority
• Throughout the health care reform debate, AARP has insisted that
improving LTSS be part of any final package.
• The vast majority (89%) of Americans age 50+ want to live in their
homes and communities as long as they can. This also resonates
personally with our members who help care for their aging parents.
• AARP supports multiple and complementary provisions that have
the promise of:
–
–
–
–
–
Increasing personal choice and independence
Helping people live in their homes and communities
Bending the cost curve on Medicaid
Reducing caregiver stress
Offering financing options to middle class families paying out-of-pocket
for long-term care needs
AARP 2
Personal Stories
I am a single woman, who worked in medical transcription for eight years and have been
laid off due to company going electronic. I only draw unemployment weekly and a small
social check. I am trying to care for my mother who is 90 years old with Lewy Body
dementia, macular degeneration, and VRE colonized. The government will pay a nursing
facility $6,000. per month and I have been unable to get very much help at all by caring
for her at home. The system is not as it should be. I can take better care of her and
cheaper with some help, which is almost impossible to get. Home health will come in and
help a little, but very little. So I have no way of leaving her to go on errands, grocery
store, etc. I would really like an answer to some of these problems. I am certainly not
alone in this situation. Please help me! My mom does not have long term insurance. She
draws a small social security monthly. No savings. Is there help out there anywhere for
someone trying to care for an elderly person? Please help us older citizens who have
worked a lifetime and been good citizens. I have looked many places for work and feel
that I am not being hired because of my age, then what will happen to my mother if I do
find job. She cannot be left alone. It is like taking care of a baby.
Sharon P., Evansville, IN
AARP 3
Personal Stories
My parents had worked very hard and had a lot of saving; then my dad got ALS Lou
Gehrigs disease. Luckily he had VA insurance, through the Railroad, and Medicare -HOWEVER -- IT WAS NOT ENOUGH FOR A 10 YEAR BATTLE. My mom was not yet
old enough to get Medicare. Luckily they had a bit left. However, 15 months later she had
a stroke. It was a right sided stroke so she recovered most of her mind and speech,
however the fall on her hardwood floors left her with a unrepairable broken shoulder, a
broken arm, a broken hip that required replacement. Unfortunately she was never able to
walk due to her shoulder, so was wheelchair confined. I had to leave my job, leave my
kids with their dad and come care for her -- as she was in the hospital for almost 6
months straight --- she used all her insurance, and eventually Medicare -- even some of
her life days as she could not get out of the hospital for 30 days. She went on to rehab
which at least prepared her to go to a Nursing Home, namely as she did not want to
move, could not afford a sitter 24 hours a day, so could not stay at home. She died a
year later in a nursing home -- which although was from pneumonia and cardio
pulmonary disease (rheumatic heart disease from childhood) -- I really believe she died
of a broken heart ! Not being able to get back home.
Jacque M. , Shreveport, LA
AARP 4
Need for Long-Term Services is
Growing
• This year about 9 million Americans over the age of 65 will need
long-term care services. By 2020, that number will increase to 12
million.
• While most people who need long-term care are age 65 or older, a
person can need long-term care services at any age.
• Forty percent of people currently receiving long-term care are adults
18-64 years old.
• About 70 percent of individuals over age 65 will require at least
some type of long-term care services during the lifetime. While
about one-third of today’s 65-year-olds may never need long-term
care services, 20 percent will need care for more than five years.
(Source: National Clearinghouse for Long-Term Care Information)
AARP 5
Projected Growth in the Older Population in United States as a
Percentage of 2000 Census, by Age Group, 2000-2030
Source: AARP Public Policy Institute calculations using data from
U.S. Census Bureau, Population Division
Population (% of 2000 Census)
240%
220%
200%
180%
85+
160%
140%
50-64
65-74
120%
75-84
100%
80%
2000
2005
2010
2015
2020
2025
2030
From 2007 to 2030, the population age 65+ is projected to grow by more
than four times as fast as the population as a whole
AARP 6
CLASS Program
• CLASS is a personal responsibility program designed to
provide an affordable, accessible and fiscally solvent
way to ensure millions of Americans who are elderly or
disabled receive the services they need without draining
the federal budget.
AARP 7
CLASS Program
• CLASS is a voluntary insurance program totally funded
by participants’ premiums and earned interest, not tax
dollars. In fact, the Senate health reform bill prohibits
using federal tax funds to pay for benefits.
• The bill also mandates that CLASS charge premiums
sufficient to assure that the program is solvent for at
least 75 years from day one and is kept that way.
• The Congressional Budget Office and other analysts
have extensively modeled CLASS and found that the
program meets this requirement.
AARP 8
CLASS Program
• The CLASS provisions would help to provide individuals
a basic level of coverage for LTSS without them
depleting their assets or being denied coverage due to a
pre-existing condition.
• The cash benefit is also an important feature, because it
gives individuals choice and control over the services
and supports they need to help them live independently
in their homes and communities.
• Individuals could also receive the benefit as long as they
remain eligible.
AARP 9
Benefits of CLASS
• Importantly, CLASS would also help family caregivers
caring for their loves ones. CLASS could help pay for
services, such as adult day care, that help give
caregivers a break and let them work or attend to their
own needs. The CLASS benefit could help pay family
caregivers who work part-time or not at all because of
their caregiving responsibilities.
AARP 10
Participation in CLASS
• CLASS premiums are based on maintaining 75 year
program solvency and individuals will be automatically
enrolled in the program, unless they choose to opt-out.
The aim is a large pool to spread the risk and help keep
premiums affordable. The auto enrollment design would
help increase the number of individuals who participate
in the program.
AARP 11
Impact of 401(k) Auto Enrollment
Default is nonparticipation
Participation %
100
Default is participation
86
80
75
80
60
40
35
19
20
13
0
Females
Hispanic
Under$20k
$20kininearnings
earnings
Under
Actual results for employees with between 3 and 15 months tenure. Study by Professor
Source:
Madrian
and Shea
Brigitte
Madrian,
University of Pennsylvania’s Wharton School, and Dennis Shea, United
Health Group.
AARP 12
www.retirementsecurityproject.org
CLASS one part of the
Solution
• CLASS would help provide a foundation of basic coverage for LTSS.
It would not cover all the services and supports that some
individuals need and it is not meant to do so.
• Individuals could build on their CLASS benefit and together with
private insurance, personal savings, other public programs and care
from friends and loved ones, the CLASS program would help offer
peace of mind to individuals and their families.
• An extensive outreach and education component will need to be part
of the CLASS program. AARP stands ready to help with that effort.
AARP 13
Medicaid HCBS Spending
Source: AARP Public Policy Institute calculations based on date from Brian Burwell, Kate Sredl,
and Steve Eiken, “Medicaid Long Term Care Expenditures FY 2007” Thomson Reuters, 2008
AARP 14
Medicaid HCBS
• There are also individuals who may need HCBS in the
short-term and long-term who are no longer working and
who would not be able to pay into CLASS and who rely
on Medicaid.
• Medicaid is the largest payer of LTSS in the country but
it is historically biased towards institutional care. While
an individual is entitled to institutional care, the state may
limit the number of people they serve in HCBS.
• Currently, we spend approximately 73 percent of
Medicaid long-term care resources devoted to older
people and adults with physical disabilities on
institutional care, even though most individuals prefer the
often less expensive and more cost effective HCBS.
AARP 15
Medicaid HCBS
•
•
•
•
AARP’s Public Policy Institute found that Medicaid dollars can support
nearly three older people and adults with physical disabilities in home- and
community-based settings for every person in a nursing facility. (PPI, 2009)
A study published in Health Affairs found that states that invested in
HCBS, over a relatively short period of time, were able to slow their rate of
Medicaid spending on long-term care. (Kaye, 2009)
That is why AARP strongly supports the inclusion of the State Balancing
Incentives Payments Program, the Community First Choice Option,
improvements in the Medicaid HCBS state plan option and spousal
impoverishment protections for HCBS, as well as provisions to extend
the Money Follows the Person Rebalancing Demonstration and to
allocate resources Aging and Disability Resources.
A SCAN Foundation survey released in July 2009 found that nearly 8 out of
10 people surveyed would be more likely to support health reform if it
improved coverage of home- and community-based services.
AARP 16
Family Caregivers:
The Backbone of the LTC
System
AARP 17
Middle Class Task Force Proposals to
Help Family Caregivers
The Middle Class Task Force, led by Vice President Biden,
put forward two proposals to help family caregivers:
1.
2.
AARP 18
A $52.5 million increase in caregiver support programs and a $50
million increase for services such as transportation, in-home services,
adult day care, etc.
A modification of the child and dependent care tax credit (CDCTC) to
allow more individuals to claim a larger tax credit. The CDCTC
provides a tax credit for a percentage of child and dependent care
expenses for a qualifying individual paid by a taxpayer so that s/he
could work or look for work.
Conclusion
• AARP believes there is no “single” solution to address
the long-term care needs of Americans.
• What it is clear is that today’s system is too costly, falling
far short of the needs and desires expressed by
consumer and their families.
• The CLASS program, private insurance, personal
savings, other public programs and care from friends
family, and other loved ones, are all necessary building
blocks to create a system that better meet needs and
desires of older Americans and people with disabilities.
AARP 19