Aging in America - Findings
Research & Summary by Neel Homchowdhury September. 2019
Settings where elderly people move to in America:
Active Adult Communities:
Generally a series of houses/apartments that are created for the sole purpose of housing elderly individuals. There’s an age requirement of 55 or older in order to live there
Fully independent Residents, most individuals in these communities are able to properly care for themselves and manage day-to-day tasks within the home.
These communities often provide a series of activities for active older adults, providing opportunities for social involvement with other individuals in their age range
Independent Living Communities:
Otherwise known as retirement communities, these communities provide older adults with meals, housekeeping, laundry, and transportation.
The older individuals in these communities need no help with daily tasks, but often choose to live there in order to feel part of a community, and partake in daily socialization with others of their same age-group
Assisted Living Residences:
These communities are very similar independent living communities, yet they also offer personal care for residents
This type of facility is often utilized by elderly individuals that need help with day-to-day tasks, such as bathing and remembering to take medication
Nursing Homes:
These facilities often provide the services found in assisted living communities, while also providing medical care
These facilities generally include 24-hour medical care, with a full staff of nurses and additional health professionals.
Often times, the individuals that move to these locations are in need of full-time care following either a major medical procedure, a fall, or the discovery of a health condition requiring additional care. These facilities are sometimes covered by Medicare/Medicaid
Continuing Care Communities:
These often contain a series of residencies, allowing residents to choose between independent living, assisted living, or a nursing home depending on their circumstances
As their needs change over time, individuals are allowed to move to a residence that provides greater assistance or medical care
This is the most expensive senior living option, as it often forces individuals to sign contracts which force residents to pay for services upon on move in, depending on their need for use in the future
Reasons For Moving/Common Complications:
Often times, older individuals are forced to move due to complications in their health, inability to accomplish day to day task without assistance, or due to family-related complications.
Common causes for moving to specialized care communities include:
Falls
Cancer
Stroke
Syncope (Fainting)
Injuries resulting in reduced movement
Urinary/Incontinence related issues
Dementia
Mental Health Issues (Depression, Anxiety, Alzheimer’s, etc.)
Heart-Related Issues
Issues that decrease either visibility or hearing ability
Some individuals often choose to remain at their own home initially as they age, leading to complications. Often times, the most common occurrence for older individuals is experiencing a fall in which they are unable to recover from. Usually, either due to increased age/decreased physical mobility, home designs that prevent these individuals from easily accessing a communication device, or a solitary lifestyle, these individuals sustain injuries which lead them to be incapable of conducting their daily affairs without some form outside help.
Another main issue for elderly individuals living at home is their proximity to care facilities and emergency services. Depending on whether or not they live in a secluded area or a thriving suburban/urban area, the quality of the services around them in case of an emergency vastly differ, often leading to a difference in how they are cared for and ability to recover following an accident in the home.
Cost Implications:
The costs of elder care are very varied, mostly due to the necessary services required by the particular individual. The cost of having a home care individual can either be largely decreased or higher than that of an independent living community. Also, the necessity of care by the elderly individual in question can determine whether having a home-care agent come by several times a week for short visits would be worthwhile, or if moving them to a full-time facility would be more beneficial to their overall health and comfort. These costs have been outlined below, based on national averages:
|Type of Senior Care|Services Provided|Hourly Cost|Time Spent Daily| Monthly Cost|
|--------------|--------------|-----------------|-----------------|--------------|
|Non-Medical Home Care|Help with personal hygiene, laundry, cooking, and transportation.|$20|Generally 2-8 hours| $3,520( 22 work days per mo.)|
|Home Health Aide|Often skilled caregivers, check patients’ pulse, temperature, respiration, and assist with medical equipment (ex. ventilators)|$21|Generally 8 hours a day|$3,696( 22 work days per mo.)|
|Adult Day Care Cost|Provide elderly individuals with supervision and social activities in a structured setting during daytime hours|Flat rate - $71 per day|n/a| $1,562 ( 22 work days per mo.)|
|RESIDENTIAL CARE OPTION|COST|
|---------|-------|
|Independent Living Community |Market Rate to rent or buy a home, plus community fees from $400 - $2,000 per mo.|
|Assisted Living Community|$2,500 - $6,000 per mo.|
|Nursing Home|$4,500 0 $12,000 per mo.|
|Continuing Care Communities| Entrance fees are generally around $60,000 - $120,000, with monthly maintenance fees ranging from $500 - $3,000 per mo.|
- The 3 major programs that elderly individuals can receive assistance with the costs of their care as they age are Social Security, Medicare, and Medicaid.
_Social Security:_
- This is a federal program administered by the Social Security Administration, which provides retirement income for seniors who have paid into the program. The minimum age to collect Social Security is 62, but the benefit amounts increase the longer the individual delays collecting payments, until the age of 70 where benefits stop increasing. In order to collect this, individuals have to pay into the system for at least 10 years.
- The average check for a widowed, unmarried, or otherwise single retiree is $1,411 per mo.
- Maximum amount for a 62-year-old collecting the check is $2,158 per mo.
- Maximum amount for individuals collecting between ages 66 and 67 years old is $2,788 per mo.
- Maximum amount for individuals collecting at age 70 collecting benefits is $3,698 per mo.
_Medicare:_
- This is a federal health insurance program for the elderly aged over 65, consisting of 4 parts.
- **Part A (Hospital Insurance)**: Pays for inpatient hospital care, some skilled nursing, hospice, and home care (if prescribed). Part A is premium-free for 99% of beneficiaries, due to paying Medicare taxes while employed
- **Part B (Medical insurance)**: Covers outpatient physician and hospital services, some home health services, and durable medical equipment. For most seniors, Part B costs about $134.00 per mo.
- **Part C (Medicare Advantage Plans)**: Allows private companies like HMOs and PPOs to offer health insurance that provide at least the same benefits of Parts A & B, but usually more like dental and vision. Most also offer cover prescription drugs. To manage costs, they offer a limited choice of providers.
- **Part D ( Prescription Drug Plan)**: Offers prescription drug benefits through private insurance companies at the cost of additional monthly premiums. Monthly premiums range between $10 - $100.
_Medicaid_
- Jointly funded state and federal insurance program for low-income people of all ages. Via the state plan, Medicaid provides medical care (i.e. physician visits), and non-medical support services (i.e. in-home personal care assistance). Nursing home care is also provided via the state plan. If a senior is financially and medically qualified, Medicaid will pay nearly all of his or her long-term care costs.
- HCBS, 1915© , and 1115 Demonstration Wavers are state-specific programs that provide care and support to individuals outside of nursing homes. Services generally provided at home, assisted living facilities, adult foster care homes, or in adult day care.
- Medicaid Waivers are not entitlement programs, meaning that they have enrollment caps and once participant caps are filled, there are subsequent waiting lists
- Lastly, Cash and Counseling, the final program of Medicaid, allows recipients to receive funds for care and are given the flexibility to select their own care providers. The more accurate phrase that this program should be referred to as is “consumer-directed care”. This program often sees family members “hired” as care providers.
- The financial income limit for Medicaid is $2,250 per mo. as of 2018.
_Government Spending_
- In addition to federal programs, each state has a variety of elder-care related aid programs, with both Medicaid and Non-Medicaid options being instituted in order to cover as much of the older population as possible.
- The federal government also spends a large amount on elder care; A recent report by the Congressional Budget Office stated that 1/3 of its budget went to seniors in 2005, a figure that rose to 40%(or $1.5 trillion) in 2018, and is projected to rise to $2.7 trillion by 2029, with funds going solely into the programs of Social Security and Medicare.
**Global Elder Care**:
- International elder care is an interesting thing to note because other than most countries in Europe and East Asia¬, which have very strong social-welfare and public health programs, the rest of the world often doesn’t utilize nationally mandated elder care programs. As such, individuals in these regions are much more likely to have family members care for them than either live on their own or receive assistance from federally mandated programs.
- It’s seen, however, that countries such as Bolivia and Norway, which provide universal health care programs and universal pension programs for their elder populations often see the best care being delivered to their older populations
- One of the biggest signs that signals whether or not a country will have a successful elder care program is their ability to provide a strong pension program for their older population. This is why countries such as Russia and South Korea are less likely to receive positive care, as they are less likely to have any source of income to help support them post-retirement.
**Links**:
- https://www.cbo.gov/system/files?file=2019-01/54918-Outlook.pdf
- https://ghsm.hms.harvard.edu/programs/family-care-elderly
- https://www.fcihc.com/blog/challenges-and-complications-of-senior-care-at-home
- https://familydoctor.org/housing-options-for-seniors/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749707/
