The Future Supply of Family Caregivers

   Shakespeare declared, “What’s past is prologue.” This statement captures the demographic trends that predict the future supply of family caregivers in the United States. The past may be prologue, but the future ability of families to care for their aging members who encounter disabilities will be a “brave new world,” to quote the Bard again. In a recently released paper, we defined a “caregiver support ratio” as the number of potential caregivers ages 45-64 for each person age 80 …

Medicare Does Not Pay for Long-Term Care

Many consumers and policymakers mistakenly believe that Medicare – the federal health insurance program for people age 65 and older and some younger people with disabilities – pays for long-term care. It does not, as stated in the official Medicare handbook. Millions of Medicare enrollees must pay for long-term care services (such as personal assistance at home, assisted living, and nursing home care) entirely from their own income and savings. Confusion often stems from misinterpretation of coverage provided by Medicare’s …

Home and Community-Based Services: The Right Place and the Right Time

As evidenced at a recent hearing of the federal Commission on Long-Term Care, broad support is building: It’s time to end Medicaid’s “institutional bias.” It’s not rational that Medicaid entitles eligible individuals to be placed in nursing homes, while limiting their ability to receive services at home. On average, the Medicaid program can serve about three older people or adults with physical disabilities with home- and community-based services (HCBS) for the cost of putting one in a nursing home. Moreover, …

Transition to Medicaid Managed Long-Term Services and Supports: How Is It Going?

States are rapidly moving from fee-for-service to managed care for Medicaid long-term services and supports (LTSS). An inventory conducted for the federal government found that the number of states using Medicaid Managed LTSS grew from 8 in 2004 to 16 in 2012, and an AARP Public Policy Institute study  shows 11 states planning to develop new Medicaid Managed LTSS programs in 2013. Pros and Cons There are advantages as well as concerns about moving to capitated, risk-based managed care for Medicaid enrollees with LTSS needs. …

Health Homes: Who Knew?

A new model of care called “health homes” is quietly spreading through many states, as Medicaid programs work to improve care for people with chronic conditions. The problem: Few people know what health homes are – or worse, they confuse them with home health services. What are health homes? Health homes are not a place (even though “home” is in the term). They represent an approach in which providers or health teams coordinate care across settings for people with chronic …

Just How Valuable Is Family Caregiving?

A welcome recognition of the value of family caregiving came in a recent report by the Congressional Budget Office (CBO), which estimated the economic value of caregiving for older persons in 2011 to be $234 billion. This estimate vastly exceeds the total amount of paid care from all sources (Medicaid, Medicare, private pay and others) for both institutional care ($134 billion) and home and community-based services ($58 billion). The AARP Public Policy Institute has made similar estimates of family caregiving …