John Amson Capitman, PhD.
Nickerson Professor of Health Policy
Central Valley Health Policy Institute
California State University, Fresno
Day 2:
Review of worksheets from Day 1
Anticipating Long-term Care Needs
Caring for Caregivers
Living Will: the 5 wishes
Long-term Care Insurance
 D-I-Y
Obituary
◦ Anything learned or relearned
◦ Any new questions
 Recipes
for a good death--medical consensus
◦ Anything learned or relearned
◦ Any new questions
Compression of Mortality? Morbidity?
Because of epidemiological transition, more
people live to old age, and more people live
to the natural limits of human life
===Smaller part of life course associated
with most deaths====Compression of
Mortality
 BUT is there a compression of morbidity?
Later onset of disability?
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Lifetime Risk of Disability
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Risk of current disability increases with age: for a
person aged 85 (35 %) is more than 7x greater than
for a person aged 74 (4.6 %).
The lifetime risk of developing a disability in at
least two primary activities of daily living for at
least 3 months or becoming cognitively impaired is
44% for males and 72% for females at age 65.
Women face a 64% higher risk than do men.
Lifetime risk of developing a disability declines
slightly with age.
1. Disability insurance and long term care (LTC) insurance cover the same
things.
2. The average lifetime chance of needing long term care for an individual 65
years or older is more than 40%.
3. People have to spend all or almost all of their assets to get Medicaid
benefits.
4. Medicare is not the primary funding source for most seniors’ long term care
costs.
5. Most long term care is provided in a nursing home.
6. Medicaid covers long term care services received at home.
7. Nursing home expenses for Alzheimer’s Disease patients are covered by
Medicare.
8. The average length of stay in a nursing home is more than four years.
9. Nearly 40% of the long term care population is under the age of 65.
10. On average, a one-year stay in a nursing home costs about $30,000.
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Over 7 million Americans provide 120 million
hours of informal care to approximately 4.2
million severely disabled elders each and every
week.
About 38 million adult caregivers (age 18 or
older) provided unpaid care for ADL/IADL
Caregivers provided an average of 21 hours of
care per week, or 1,080 hours per year.
An estimated $350 billion/year to replace
informal caregiving
Out-of-pocket, lost wages, lost retirement
income, lost productivity, costs associated with
health effects
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If you are run down, tiring more than usual, will you be able to provide good
care?
If you have a cold or the flu, will your loved one catch it from you?
If you become depressed will you be able to make good decisions, will life
become unbearable?
If you are not well, who will fill your shoes, whether temporarily or
permanently?
BASIC TIPS
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Take a daily vitamin supplement
Get exercise — make it a priority for both your mental and physical wellbeing.
Get regular check-ups and do not ignore possible symptoms of ill health.
Take a break from caregiving – respite time is crucial.
Watch for signs of depression – more information
Stay involved in hobbies
Laugh with a friend
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Educate yourself about the disease your family member is facing and
how it may affect his or her behavior, pain level, etc.
Find sources of help for caregiver tasks. Contact family, friends,
neighbors, church/synagogue, workplace, Area Agency on Aging or
other organizations. Keep looking!
Protect your personal time for something you enjoy or something
you need to get done. Try to find time for exercise, eating well and
sleeping enough.
Watch out for symptoms of depression (such as crying more,
sleeping more or less than usual, increased or decreased appetite or
lack of interest in usual activities). Notify your doctor if symptoms of
depression are present.
Consider how you will feel and what you will do after the caregiving
ends.
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In-home supports (home health, homemaker,
independent living aide)
Out-of-home, community care (adult day
care, outpatient rehabilitation)
Supportive/Transitional Housing
Board and care
Assisted living
CCRC
Nursing homes
Figure up to $150k in long-term care costs if
needed for average time/mix of in-home and
facility
3 primary options
1. Save money—dedicated savings
2. Prepare to qualify for MediCal
3. Purchase LTC Insurance