Long Term Care, Family Caregiving and the Law of Succession

Part One

Josephine Gittler

The Aging Population, Alzheimer’s and Other Dementias: Law and Public PolicyUniversity of Iowa College of Law

March 29, 2012

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The Aging Populationand Long Term Care

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Needs of Aging PopulationChronic Diseases & Disabilities

Functional Limitations

Long Term CareServices & Supports

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The Aging Population:Chronic Diseases & Disabilities Most older people have at lest one chronic

disease, e.g. heart disease, cancer, or diabetes.

Physical disabilities increase with age, e.g. vision, hearing, and mobility impairments.

Older persons, particularly the “oldest old” are at risk for Alzheimer’s Disease and other dementias.

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The Aging Population:Functional and Cognitive Limitations As a result of chronic diseases

and disabilities, a substantial proportion of the aging population, especially the “oldest old” have functional and cognitive limitations.

Functional and cognitive limitations may result in an inability to perform or difficulty in performing activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

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The Aging Population:Long Term Care

Older persons with functional and cognitive limitations frequently need long term care (LTC).

Estimated 70% of persons 65+ will need LTC at some time, for average of three years.

Persons 85+ are 4 times as likely to need LTC.

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The Aging Population:Long Term Care

Home-based: Personal care Home health care Friendly visitor from senior services Emergency response services

Community-based: Adult day care Senior centers Meals programs Transportation service

Facility-based (institutional): Nursing homes Assisted-living facilities

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Family Caregiving

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Extent of Informal Family Caregiving

Informal family caregivers are the most important source of unpaid LTC.

An estimated 1 in 6 adults provide unpaid LTC to older adult relatives (or friends).

It is estimated there were 54.6 to 68.6 million caregivers providing care to predominantly older adult family members in 2009.

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Nature of Family Caregiving

Family caregivers predominantly provide assistance with ADLs and IADLs.

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Characteristics of Family Caregivers

The typical caregiver is: a woman age 49 employed outside the home providing care to widowed mother

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13From: 2012 Alzheimer’s Disease Facts and Figures

Burden of Family Caregiving

According to a 2009 national survey:

over 50% of caregivers reported a medium to high level of

burden

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Family Caregiving: Health & Psychosocial Consequences

Caregiving more likely to have poor physical and mental health than non-caregivers.

Caregiving may adversely affect family relationship and lead to social isolation.

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Family Caregiving: Economic Consequences

Caregiving often has negative impact on employment status of caregiver, leading to lost earnings and diminished social security and pension benefits and retirement savings.

Caregivers often incur out of pocket expenses in connection with caregiving.

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Family Caregiving: Economic Value

Estimates of economic value of unpaid family caregiving in 2009 range from $199 billion to $450 billion.

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Formal Paid Caregiving

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Cost of LTC ProvisionBy Paid Formal Caregivers

In 2011, the Medicare annual rate was:

$77,745 for private nursing home room$70,445 for semi-private nursing home room$39, 135 for assisted-living facility$43,472 for home health aide services$41,184 for homemaker services

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Sources of LTC Financing

Federal/State Medicaid program

Federal Medicare program

Out of pocket expenditures by care recipient

LTC insurance

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Medicaid LTC Expenditures Federal/State Medicaid is single largest source of

funding for formal paid LTC, accounting for 40% of all LTC expenditures.

LTC is a major component of overall Medicaid spending

Medicaid spending is growing at annual rates exceeding state revenues and national economic growth.

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Rationale for Proposal

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Public policy and law should recognize and support contribution that families make to meeting growing need for LTC.

Without unpaid family caregiving, already strained state and federal budgets would have to increase enormously to cover costs of LTC.