The impact of the aging population on long-term and post-acute care services
The aging population is one of the most significant demographic trends in the world today. According to the United Nations, the number of people aged 60 years or over is expected to increase from 962 million in 2017 to 2.1 billion in 2050, and to 3.1 billion in 2100. This means that by 2050, one in five people will be over 60 years old, and by 2100, one in three people will be over 60 years old .
The aging population poses many challenges and opportunities for the health care system, especially for the long-term and post-acute care (LTPAC) services. LTPAC services are defined as “a range of health care and supportive services that are provided to individuals who have lost some capacity for self-care due to injury, chronic illness, or conditions associated with aging” . LTPAC services include home health care, hospice care, nursing home care, assisted living facilities, adult day care, and rehabilitation services.
The demand for LTPAC services is expected to rise as the aging population grows and faces more chronic and complex health conditions. According to a study by the U.S. Department of Health and Human Services, the number of Americans who will need LTPAC services is projected to increase from 15 million in 2000 to 27 million in 2050, an increase of 80% . Moreover, the average duration of LTPAC use is also expected to increase from 2.1 years in 2000 to 2.5 years in 2050 .
The supply of LTPAC services, however, may not be able to meet the growing demand. There are several challenges that affect the availability and quality of LTPAC services, such as:
– Workforce shortage: There is a shortage of qualified and trained workers who can provide LTPAC services, especially nurses, aides, therapists, and social workers. The shortage is caused by factors such as low wages, high turnover, poor working conditions, lack of career advancement opportunities, and insufficient education and training programs . The shortage is expected to worsen as the demand for LTPAC services increases and as the workforce itself ages.
– Financial constraints: The cost of LTPAC services is high and often exceeds the ability of individuals and families to pay. According to a report by Genworth Financial, the median annual cost of LTPAC services in the U.S. ranged from $19,500 for adult day care to $102,200 for a private room in a nursing home in 2019 . The cost is expected to increase further due to inflation, rising labor costs, and increasing acuity levels of patients. The public funding sources for LTPAC services, such as Medicare and Medicaid, are also limited and face budgetary pressures. Medicare covers only a small portion of LTPAC services, mainly for skilled nursing care and home health care for a limited period of time. Medicaid covers a larger share of LTPAC services, mainly for nursing home care and home- and community-based services for low-income individuals who meet certain eligibility criteria. However, Medicaid spending on LTPAC services varies widely across states and is subject to state budget constraints .
– Quality issues: The quality of LTPAC services is often compromised by factors such as inadequate staffing levels, lack of coordination among providers, lack of standardization of practices and protocols, lack of quality measurement and improvement systems, lack of patient-centeredness and cultural competence, and lack of patient and family engagement . The quality issues can lead to adverse outcomes for patients, such as infections, falls, pressure ulcers, hospitalizations, readmissions, functional decline, cognitive impairment,
and mortality .
To address these challenges and improve the delivery of LTPAC services for the aging population, there are several strategies that can be implemented by policy makers, providers,
payers, researchers, educators, and consumers. Some of these strategies are:
– Developing a comprehensive and integrated system of LTPAC services that can provide seamless transitions across different settings and levels of care . This can be achieved by enhancing communication and collaboration among providers; implementing electronic health records and health information exchange systems; developing standardized assessment tools and care plans; establishing accountable care organizations and bundled payment models; creating incentives for quality improvement; and promoting patient-centeredness
and shared decision making.
– Expanding the availability and accessibility of home- and community-based services that can enable older adults to remain in their homes and communities as long as possible . This can be achieved by increasing public funding for these services; expanding eligibility criteria for Medicaid waivers; providing tax credits or vouchers for family caregivers; supporting volunteer and informal networks; developing innovative models of care delivery, such as telehealth, mobile health, and remote monitoring; and improving the physical and social environment of communities.
– Enhancing the recruitment and retention of LTPAC workers who can provide high-quality and compassionate care for older adults . This can be achieved by increasing wages and benefits for these workers; providing career development and advancement opportunities; creating scholarships and loan forgiveness programs; expanding education and training programs; improving working conditions and safety; and fostering a culture of respect and recognition.
– Increasing the awareness and education of consumers and families about LTPAC services and their options, rights, and responsibilities . This can be achieved by providing information and counseling services; developing consumer guides and tools; creating online platforms and social media campaigns; conducting outreach and engagement activities; and empowering consumers and families to advocate for their needs and preferences.
The aging population is a global phenomenon that has profound implications for the health care system, especially for the LTPAC services. By implementing these strategies, we can ensure that older adults receive the LTPAC services that they need and deserve, and that they can enjoy a high quality of life in their later years.
References:
: United Nations. (2017). World population ageing 2017. Retrieved from https://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2017_Highlights.pdf
: Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.
: U.S. Department of Health and Human Services. (2016). Long-term services and supports for older Americans: Risks and financing research brief. Retrieved from https://aspe.hhs.gov/basic-report/long-term-services-and-supports-older-americans-risks-and-financing-research-brief
: Stone, R. I., & Bryant, N. (2013). The long-term care workforce: Can the crisis be fixed? Problems, causes, and options. Generations, 36(4), 52-61.
: Genworth Financial. (2019). Cost of care survey 2019. Retrieved from https://www.genworth.com/aging-and-you/finances/cost-of-care.html
: Kaiser Family Foundation. (2020). Medicaid home and community-based services enrollment and spending. Retrieved from https://www.kff.org/report-section/medicaid-home-and-community-based-services-enrollment-and-spending-issue-brief/
: Grabowski, D. C., & O’Malley, A. J. (2014). Quality in long-term care settings. In A. B. Auerbach, D. E. Cutler, & J. M. McGinnis (Eds.), The Oxford handbook of health economics (pp. 687-709). New York, NY: Oxford University Press.
: Mor, V., Intrator, O., Feng, Z., & Grabowski, D. C. (2010). The revolving door of rehospitalization from skilled nursing facilities. Health Affairs, 29(1), 57-64.
: Naylor, M. D., Aiken, L. H., Kurtzman, E. T., Olds, D. M., & Hirschman, K. B. (2011). The care span: The importance of transitional care in achieving health reform. Health Affairs, 30(4), 746-754.
: Reinhard, S., Kassner, E., Houser, A., Ujvari, K., Mollica, R., & Hendrickson, L. (2014). Raising expectations: A state scorecard on long-term services and supports for older adults,
people with physical disabilities, and family caregivers (2nd ed.). Washington, DC: AARP Public Policy Institute.
: Institute of Medicine. (2008). Retooling for an aging America: Building the health care workforce. Washington, DC: National Academies Press.
: National Council on Aging. (2020). Long-term services & supports: Helping older adults live at home longer with dignity & independence.Retrieved from https://www.ncoa.org/wp-content/uploads/NCOA-LTSS-Fact-Sheet.pdf
