Long g Ter erm m Ser ervices ices and Sup uppo ports ts (LTSS) SS) Landscape: ndscape: Are we heading into the Perfect Storm? 1
What are expected future needs for LTSS? 70% of People 65+ will need some LTSS 2 Source: Kemper , Komisar and Alecxih, 2005. Outputs of model using March 1993 and March 1994 CPS data.
What are the perfect storm conditions? Demographic imbalances Economic pressures Social norms Demographic Economic Absence of adequate options Imbalances Pressures to address needs Absence of Social Norms Adequate Options 3
The caregiver dilemma 1/2 ½ as many caregivers as many caregivers will be will be available in available in 2050 2050 Ratio of Potential Caregivers to Those Needing Care 1 1. Ratio of # people in most common caregiving age ( 45-64 ) to those at most risk for needing care (80+) 4 AARP PPI “The aging of the baby boom and the growing care gap: A look at future declines in the availability of family caregi vers
Unpaid caregivers provide most LTSS today Types of Paid Long-Term Care Providers: 20-30% Physicians, nurses, and therapists 70-80% Home health aides, certified nursing assistants, and personal care aides Unpaid Caregiving valued at $450 billion annually 5 Source: SCAN Foundation, Who Provides Long-Term Care in the US? October 2012; Feinberg, et.al, “Valuing the Invaluable, 2011 Update
Medicaid is beginning to crowd out other expenditures in state budgets Note: Figures are for total state expenditures, including both general fund spending and federal funds 6 Source: National Association of State Budget Officers (NASBO), State Expenditure Report, 2010
Less than 1 in 5 Boomers have taken any action to prepare for LTSS care. 7
More Boomers prepare for death than life Approximately 5x Approximately more Boomers 5x more have taken action Boomers have to prepare for taken action to death vs. life prepare for death vs. life Action Taken to Prepare for Life vs. Death Source: Retirement Care Planning: The Middle-Income Boomer Perspective, Bankers Life and Casualty Company Center for a Secure Retirement, 8 August 2013
Boomers are poorly informed regarding LTSS need Boomer Long-Term Care Expectations and Reality Source: Retirement Care Planning: The Middle-Income Boomer Perspective, Bankers Life and Casualty Company Center for a Secure Retirement, August 2013 9
Cost of paid care Median an Five-Yea ear Annual al Rate Annual al Growth Homemaker Services $ 43,472 1% Hourly Rates HOME Home Health Aide Services $ 45,188 1% Hourly Rates Adult Day Health Care COMMUNITY $16,900 3% Daily Rates Assisted Living Facility $42,000 4% (One Bedroom, Single Occupancy) Monthly Rates FACILITY Nursing Home (Semi-Private Room) $77,380 4% Daily Rates Nursing Home (Private Room) $87,600 4% Daily Rates 10
Boomers are poorly informed regarding LTSS payment Perceived Methods for Funding Ongoing Long-Term Care Source: Retirement Care Planning: The Middle-Income Boomer Perspective, Bankers Life and Casualty Company Center for a Secure Retirement, 11 August 2013. LTCi = Long Term Care Insurance
Sales of LTC insurance are declining Annual Sales of Individual LTC Insurance Decline Since 2002 Source: LifePlans. LifePlans analysis based on AHIP, LIMRA and LifePlans sales surveys, 2013. Beginning in 2009, LTC Partners data for annunitants included in counts. 12
The current LTCi situation = void for middle income consumers The Share of LTC Sales to the Middle Market Age 40-69 is Declining 13
Why does this matter and to whom? Current and future older Americans Caregivers Families Employers and employees States Federal government Taxpayers 14
How Might We Weather the Storm? 15
Define the problem Our country and its people cannot meet their long-term service and support needs. 16
Address the problem Pathways to LTSS Reform LeadingAge initiated Pathways to foster federal and state reform. 17
Pathways: overall initiative summary WHAT? Foster state and federal LTSS reform that helps our country and its people prepare and pay for LTSS. HOW? 1. Messaging/Mobilization 2. Federal Proposal Development 3. State Conversations and Action 4. Political Alignment DESIRED SIRED OUTCOMES COMES 18
Pathways: desired outcomes A federal LTSS reform package is signed 2017 into law. At least 5 states adopt LTSS reforms that foster preparing for and financing LTSS. 2016 19
Pathways: Federal Reform to Weather the Storm Foster Adoption of Federal LTSS Package 20
Federal Reform Pathways Status Quo Priv rivat Personal Responsibility ate-Pub Private Market Public Private Catastrophic lic Sp Spec Public Catastrophic ectrum Public Front End rum Public Comprehensive 21
From federal to state In addition to weighing in on LTSS Federal Reform Pathways: Build capacity in states to engage in LTSS 1 reform discussion If feasible, foster state level LTSS reform 2 with emphasis on middle class solutions 22
Pathways: State Reform to Weather the Storm Support State-Level Conversations Regarding LTSS Reform 23
Conversation approach Develop and offer a starter conversation for 1 a state If there is momentum, follow up with 2 2 additional conversations and technical assistance that may aid a state in getting traction for state level reform 24
Potential stakeholder involvement High Level State Support - Champion Organization – Governor, Legislators i.e. State Human Services Care Recipients Local Advocacy Orgs /Caregivers, Families State Budget Office Stakeholders Employers Consumers Insurance Carriers National LTC Policy State Insurance Medicaid/Medicare Expertise Dept. Expertise Actuarial State Aging Dept. LTC Experts Expertise 25
Potential state actions Awareness/Educat Awareness/ ion Education Re-energize LTCi and Other Private Market Re-energize Medicaid Options LTCi and Reform or Other Private Public Insurance Regulatory Market or Health Changes Options Insurance and Medicare Public Insurance Medicaid Reform or Health or Regulatory Insurance and Changes Medicare 26
Potential state actions Awareness/Education Awareness/ Education Re-energize Own Your Future Campaigns Medicaid LTCi and Reform or State-Employer joint education Other Private Regulatory Market LTCi counseling through Health Changes Options Exchanges Public Insurance or Health Insurance and Medicare 27
Potential state actions Re-energize LTCi and Other Private Market Options Awareness/ Education New private insurance options/or regulatory reforms Re-energize Medicaid Incent LTC purchase or savings LTCi and Reform or Other Private via tax policy Regulatory Market Changes Reinsurance pools Options Other insurance, savings, tax Public approaches Insurance or Health Insurance and Improve utilization of others Medicare consumer assets 28
Potential state actions Public Insurance or Health Awareness/ Insurance and Medicare Education Re-energize Medicaid Public catastrophic or front end LTCi and Reform or coverage Other Private Regulatory Market Changes Improve LTSS integration with Options health insurance, Medicaid and Public Medicare Insurance or Health Insurance and Medicare 29
Potential state actions Medicaid Reform or Regulatory Changes Awareness/ Education Re-evaluate spend down requirements Re-energize Medicaid LTCi and Reform or Evaluate impact of Other Private Regulatory tighter/looser eligibility Market Changes Options Evaluate impact of HCBS Public rebalancing Insurance or Health Develop earlier intervention Insurance and Medicare model to minimize NH stays 30
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