Analysis: The new 'old-folks home'

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UPI Health Business Editor
WASHINGTON, Nov. 21 (UPI) — The so-called golden years — age 85 and older — no longer signal an inevitable trip to a nursing home to live out one’s remaining days completely dependent on others and shut off from the community where an octogenarian may have lived his or her whole life, suggests a new study released Tuesday.

The research, done by the healthcare consulting firm The Lewin Group, shows a sharp decline in nursing-home use by the “oldest old,” clear evidence, the study’s author says, of a seismic shift away from nursing-home care to “community based” — and significantly cheaper — options, like assisted living and retirement communities.

“The implications for the future are significant,” said study author Lisa Alecxih. “While future disability rates and income levels among older adults are difficult to forecast, the baby boomers could be expected to have preferences similar of those of the current group of older adults. That is, they would probably seek to avoid nursing home care if possible.”

The study suggests “we won’t see a major explosion in demand (for nursing-home care) from baby boomers,” she said Tuesday at a news briefing in Washington.

The study showed that, since 1999, the number of people aged 65 and older in nursing homes dropped more than 8 percent from 1.44 million to 1.32 million, but more dramatically, nursing-home use among the “oldest old” fell by a full two-thirds, from 21.1 percent in 1985 to 13.9 percent in 2004. Without this shift away from nursing-home care — which was the only long-term-care option 20 years ago — and toward community-based care, nearly 2 million seniors would be living in nursing homes today. But instead, the nursing-home population is dropping towards half that number, or 1.32 million residents as of 2004.

“Eighty-five is the new 65,” said Barbara Manard, vice president for long-term care and health strategies at the American Association of Homes and Services for the Aging, who commented on the findings at the briefing.

The study helps explode the “myth that we abandon families to nursing homes,” she said, and also suggests seniors “have gotten wealthier due to good public policy.”

But the trend toward independent living in the twilight years may not be only for the wealthy.

The transformation to assisted living has not been lost on government assistance agencies like state Medicaid programs, which are struggling with shrinking budgets and looking for ways to save money on long-term care.

Although the study didn’t include data on projected savings to Medicaid — which now picks up roughly 43 percent of the tab for a patient’s nursing-home care — some states are already banking on assisted living’s potential, Melissa Hulbert, with the Center for Medicare & Medicaid Services’ (CMS) Center for Medicaid and State Operations, told United Press International. Those states are using so-called home- and community-based waiver programs to provide Medicaid reimbursement for a part of beneficiaries’ assisted-living expenses, she said.

The federal government is also getting involved, Hulbert noted, with CMS having already granted $250 million to states to help them recraft their long-term-care programs to emphasize community-based care.

The role of the government in the assisted-living boon is “all about housing,” said Roger Auerbach, senior consultant with The Lewin Group and formerly with the Department of Human Services in Oregon, the state credited with essentially inventing the concept of assisted living.

“If a patient loses housing, it’s harder to get the government to help,” he told the briefing.

Oregon’s long-term-care program meshed government-assisted healthcare and housing via federal housing programs and low-income tax credits to create ‘affordable assisted living,'” he told UPI, a concept that is catching on in other states.

“Before, assisted living was only available to people with money,” he said. Auerbach told UPI that, after he left Oregon’s Department of Human Services in 2001, the state’s Medicaid program was paying for 40 percent of a beneficiary’s assisted-living bill.

“These services are cost-effective and proven to be less expensive than nursing homes,” he said. “They’re good for the government and good for the economy,” he said

The findings in The Lewin Group study “counter the ‘doom and gloom/sky is falling’ outlook for baby boomers,” noted John Rother, director of policy and strategy at AARP, adding that “we’re not off the hook.”

More focus is needed on the increasingly critical role home-based caregivers will play in tending to the swelling ranks of the “oldest old” but still independent, he said, and to push states still lagging behind to adopt long-term-care programs modeled on that of Oregon’s.

And what can health policymakers learn from the new study? “Flexibility is a very important part of it,” study author Lisa Alecxih told UPI. “Twenty years ago, we couldn’t have predicted this, so in policymaking, we need to be flexible to adapt to the new (healthcare) technology.”

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