Several contributors to THCB have commented that long-term care tends to get short shrift in healthcare discussions. New research might help to make a case for why we can no longer afford to demote this critical issue as we contemplate overarching healthcare financing strategies.
In the report, researchers looked at beneficiaries ages 65 and older who receive help with three or more activities of daily living (ADLs) — longhand for people who need long-term care — and found that, even though these individuals represent only 7% of the Medicare population, they account for nearly 25% of spending in Medicare Part A and B.
This is interesting because Medicare doesn't actually pay for extended nursing home stays, which is where long-term care is usually delivered, but it does pay for limited post-acute care. The implication here is that Medicare services that transition patients from acute to long-term settings might actually be filling a gap for long-term needs. And, given the size of the gap, it is equating to staggering levels of spending.
To put this in real numbers, the report — which was authored by Avalere Health on behalf of the SCAN Foundation — notes that, in 2005 — which is the most recent data available — these beneficiaries consumed $18,902 per capita in Medicare spending compared with $4,289 for beneficiaries without disabilities. This equates to 4.5 times more per capita Medicare spending.
Hospice trends help to illustrate this issue. Medicare covers palliative care and support services for beneficiaries who are terminally ill and have a life expectancy of six months or less. The new research shows that hospice lengths of stay from 2000 to 2005 took double-digit leaps for those suffering from Alzheimer's disease and senile dementia, suggesting that the Medicare hospice benefit may be addressing a shortfall in long-term care services.
As we enter into serious discussions on health reform, we must ensure that policymakers have a full understanding of the cost-drivers in our entitlement programs. They need to understand that long-term care cannot be categorized simply as a Medicaid or individual family problem and that more integrated solutions need to be considered.
Anne Tumlinson is a health policy consultant with nearly two decades of experience in long-term care financing policy. She is a senior advisor at Avalere Health and most recently directed the Post-Acute and Long-Term Care Practice at Avalere Health. In that role, she conducted and oversaw research and analysis on post-acute and long-term care policy for government, foundation, and commercial clients.