Anyone interested in aging in America should see Rest, a new play by Samual Hunter, about residents and staff in a northern Idaho assisted living facility, being performed at Chicago’s Victory Gardens Theatre. On Sunday afternoon, after a matinee performance of the play, I was honored to moderate a town hall meeting themed around senior healthcare in America.
“Welcome everyone to tonight’s conversation on Senior Healthcare in America. Before I introduce our panel of speakers, I would like to frame our conversation by expanding the topic. If we think of aging in America as a road, then one guardrail on that road would be health care and the other guardrail is broadly known as long-term services and supports (LTSS). Accessing affordable and quality healthcare and LTSS for today’s population of older adults and for the baby boomers is the challenge we now face.
We cannot discuss healthcare or older adults without understanding Medicare. We have come a long way. In 1963 only 50% of Americans over the age of 65 had medical coverage and much of that coverage was very poor. Today, Medicare is the program that provides health insurance to 93% of older adults. Almost everyone who worked long enough to be eligible for social security, or whose spouse qualified for social security may enroll in Medicare at age 65.
Medicare has four basic components: Part A (hospital insurance), Part B (medical insurance for physician and outpatient services), Part C (Medicare Advantage Plans) and Part D (prescription drug benefit). Make note, Medicare does not pay for long term services in supports.
Accessing Long-Term Services and Supports
LTSS include a broad range of services that meet the needs of older adults, often frail, who have functional limitations. The services range from assisting with activities of daily living like bathing, dressing and grooming, to activities associated with maintaining a household, like balancing a check book or meal preparation. Care is provided in a variety of settings, ranging from home and community based services, to institutional settings (e.g. assisted living or skilled nursing facilities).
Last year, an estimated 44 million American families and friends provided unpaid care to an older adult. These caregivers provide about 80% of the long-term care in the United States.
About 58,500 regulated providers provide long-term services and supports and in 2012, about 8 million people paid privately for their LTSS.
Paid LTSS are expensive and when received over an extended period of time, can be financially catastrophic. Individuals and families rarely have sufficient resources to pay for extended LTSS. As a result, older adults ultimately rely on publicly funded LTSS, provided largely though Medicaid, a state-administered program partially funded by federal dollars. Medicaid accounts for 66% of paid LTSS in the United States today. Accessing Medicaid reimbursement for home and community based services differs from state to state, resulting in inequalities based on where the older adult lives.
The Silver Tsunami
The population aged 65 and older continues to grow more rapidly than the population under age 65. With the first baby boomers turning 65 in 2011, the older population s expected to more than double from 40 million in 2010 to 84 million in 2050 (when I will be 87), or 21% of the US population (up from the current 13%. The 90-and over population is projected to more than quadruple from 2010 to 2050. By 2050, 27 million older adults will require LTSS.
It is important to remember that although, when we talk about older populations, we generally are referring broadly to those who are over age 65, we must remember the important differences that exist within that broad category. For example, People aged 90 are more likely to lived in nursing homes than younger age groups within the 65-and-over population.”
It was an honor to share the stage with my fellow panelists Melanie Chaven, Daniel Winship M.D., and Jean Schmidt Winship and Melissa Kahn. I also want to thank Isaac Gomez and the Victory Gardens organization for creating these public programs that allow the audience to delve deeper into the reality of the issues, so well dramatized by Victory Gardens.
Learn more at @aginginchicago