POLICY BRIEF:

Extended Care For Aging Adults

ISSUE STATEMENT

Latasha Robledo : March 2015

Medicare coverage is a problem now and will be a greater problem in the future. Rapid rising
numbers of older Americans are expected to continually increase as baby boomers reach age 65.
Traditionally, Medicare has been the health care insurance for elderly adults. However, Medicare does
not offer extended care such as home care costs,
personal care, companionship, post-op care or support
services, to decrease number of revolving patients.
(Edlund, 2003) The need for long-term care is growing
rapidly and costs are unmaintainable. Medicare was
never designed to pay for the 133 million Americans
with chronic disease (the most abundant illness in the
U.S) and longterm care (CDC, 2013). Medicare only
covers medically necessary care and focuses on medical
acute care, such as doctor visits, drugs, and hospital
stays. According to the DHHS, Medicare coverage also
focuses on short-term services for conditions that are
expected to improve, such as physical therapy to help
you regain your function after a fall or stroke. A
strategic method to improve health insurance for aging
adults we will see millions of older Americans suffer in health as health care cost continually increase.
Assessed Need after discharged from
Doctors care, an assessment will be conducted
individually to know what level of care if any is
needed.
Costs of annual long term care for chronic illness
without insurance coverage are a significant barrier to
access. On average, an elderly adult will pay an average of
$8,170 in medical expenses annually. Even after Medicare
pays (on average, according to the CDC) a 24 - 57%
portion, patients can see expenses, in a skilled nursing
facility, up to $140.00 per day.
Premium increases to provide insurance coverage for
long term care with lowered incurred hospital costs.
Patients in the ACE intervention program/study incurred
lower hospital costs, $9,477 versus $10,451, or a savings of
$974 per patient (Kim, 2012)
Home Care / Assisted Living Expenses. Health
Insurance Association of America (HIAA) notes that
assisted living facilities charge an average daily fee of $63 or
approximately $23,000 per year with some residents paying significantly more
based on their individual care needs (HIAA, 2002).

Option#1: A federal mandate for expansion of medicare, health care insurance of older adults,
would require medicare insurance companies to provide individualized post-care
services.Patients must be assessed by a physician or case management personnel and upon
individual needs will be assigned specific care package.
Advantages:Provides efficient coverage to all elderly patients, reducing long-term care
costs and allowing insurance companies to negotiate discounts for services. Also
decreases unnecessary health care costs and limiting any related home care costs
and retires any discrepancies between states.
Disadvantages:Increases
premiums for all covered Medicare patients, also treating some

without chronic disease.(NIH, 2011)

Option#2: A restricted federal mandate, similar to the above, would limit coverage only to
those with need for chronic illness or long-term care.
Advantages: Less costly than the above option federal mandate. Provides coverage for
aging adults with chronic illness and in need of long term care, which is limiting
costs. May encourage aging adults to consider an alternative to cost effective
prevention care and services. Insurance company support is more likely for limited
mandate.(NIH, 2011)
Disadvantages: Limits on treatment will encourage abuse of services. Would set
discrimination issues in place due to unclear restrictions to long-term care patients.
(Edlund, 2003) Patient savings would be small relative to total premiums.

Option#3: Optional State mandates programs where nurses offer strategic solutions to meeting
present and future needs by educating, increasing involvement, advocating, coordinating
using resources, and serving as activists; working on many levels to
influence care for older adults presently and in the future
(Edlund, 2003).
Advantages:Physicians, providers, and patients could be
encouraged to limit costs without government intervention; solely
on individual assessments. More individualized policies
depending on state demographics.Less argument from insurance
providers at a national level. (Edlund, 2003)
Disadvantages: Many current state policies have significant
restrictions on medicare coverage. Variety in state policies could
not address the problematic issue, lack of long term care, as
effectively.( NIH, 2011)State medicare companies who provide coverage in states
without mandate will pay high costs as more people enroll in their plans.

Policy Recommendation: With rising numbers of

baby boomers, along with the

necessity for long term care, quick reform is necessary to ensure elderly patients have access to
cost-effective, quality care. Although some prestigious insurance companies cover post care
services, medicare doesn't not provide quality care nor post care to all elderly patients (NIH, 2011).
A federal mandate without significant restrictions, streamlining care and providing consistency
between states, will increase access to many people in a short amount of time (Edlund, 2003). While
this option costs money, individual liability will be very minimal. Furthermore, the costs of chronic
illness and long-term care treatment have been proven to fall with rising use of extended care and
integrated care teams. An integrated care team is composed of different specialist comprised into a
cluster of teammates that work together for an individuals highest quality of care while keeping
costs minimal. This trend suggests long-term care costs will become more affordable as Medicare
coverage expands and through expanded insurance coverage will reduces necessary costs and
improve overall quality care for older adults.

Sources:

Edlund, RN, Barbara J., Lufkin, Sylvia R., Franklin, Barbara, Online Journal of Issues in
Nursing, Long-Term Care Planning For Baby Boomers: Addressing
anUncertain Future, 10913734, 2003, Vol. 8, Issue 2
Health Insurance Association of America. (2002). An Employer's Guide to Long-Term
Care Insurance. Washington, DC: Author.
National Institute on Aging/ NIH. (2011). Page Last updated (January 2015). Accessed
at Http://www.nia.nih.gov/research/publication/global-health-andaging/assessing-costs-aging-and-health-care
Kim, Leland,. Specialized hospital care elderly patients could significantly cut costs.
(2012). www.ucsf.edu/news/2012/06/12133/specialized-hospital-careelderly-patients-could- significantly-cut-costs
National Center for Health Statistics, Centers for Disease Control and Prevention.
(2013) Summary Health Statistics for the U.S. Population: National
Health Interview Survey, 2012. Accessed at http://www.cdc.gov/
nchs/data/series/sr_10/sr10_259.pdf