Long Term Care Research Paper

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L o n g -Te rm Ca r e Sy st em s Long-Term Care In The United States: An Overview A complex system of public and private funding often leaves elderly persons at risk of financial catastrophe and inadequate care. by Judith Feder, Harriet L. Komisar, and Marlene Niefeld PROLOGUE: Elderly Americans are just about the only group of U.S. citizens whose health care is universally insured as an entitlement. However, elders who need long-term care have much less protection. Medicare, the federal program for the elderly and disabled, covers many of the costs of acute medical care but only tangentially covers some long-term care services. Medicaid, the federal/state health program, covers long-term care but only for people who are poor or who…show more content…
Long-term care consists primarily of personal assistance with activities of daily living (ADLs) or instrumental activities of daily living (IADLs). ADLs are routine tasks of life, usually considered to include eating, bathing, dressing, getting into and out of bed or a chair, and using the toilet. IADLs are additional activities necessary for independence such as preparing meals, managing medications, and shopping for groceries. Long-term care also may include skilled and therapeutic care to treat and manage chronic conditions. Although the likelihood of needing long-term care rises with age, almost as many people who need such care are under age sixty-five as are above it—5.6 million persons under age sixty-five (including 0.4 million children) and 6.6 million elderly, in roughly 1995.5 About 13 percent (0.1 million nonelderly and 1.5 million elderly in 1996) reside in nursing homes. Of the remainder who live in the community, one-quarter (1.2 million ages eighteen to sixty-five and 1.5 million elderly) are severely impaired, needing personal assistance with three or more ADLs.6 Compared with the rest of the population, persons who need long-term care are disproportionately low-income, very old, and living alone or with relatives other than a spouse (Exhibit 1). They also incur substantial costs (out of pocket and Medicare financed) for acute care services.7 Virtually all elderly persons who need long-term care have health insurance through Medicare. Medicare covers disabled persons under age sixty-five, however, only after they have received Social Security disability benefits for two years. Only 33 percent of the home-dwelling population ages eighteen to sixty-four with longterm care needs have Medicare coverage (Exhibit 2). About half have either private health insurance (28 percent) or Medicaid (25

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