1. Elderly and Long-term Care
Yanita Simeonova, Maike Heiser,
Roxana Arredondo, Ariana Papp,
Nasar Khan
CSULB-HAW-Summer School
Summer School 2016
1
2. Contents
1. Long-term Care Insurance in Germany
2. Three Levels of Care
3. Long-term Care Insurance in the USA
4. LTC Services
5. Staffing
6. Long-term Care in Pakistan
7. Discussion
8. Conclusion
9. References
10. Register of illustrations 2
3. “A nation’s greatness is measured by how it
treats its weakest members.’’
Mahatma Gandhi
(Fig. 1)
3
4. 1. Long-term Care
Insurance in Germany
▪ Available for all insured people depending on the
extent of the need for care, but irrespective of
age, income or wealth
▪ Similar to other insurance systems in Germany
(health insurance, pension etc.)
▪ Contributions → paid equally by employers and
employees
(Fig. 2)
4
(6)
(2)
5. 1.Long-term Care Insurance
(LTCI) in Germany
▪ Statutory (90%) and private (9%)
▪ Entire population is insured (compulsory)
▪ For people in need (physical or mental handicap,
psychological illness or disability etc.), who are
unable to independently carry out normal daily
activities over a period of at least 6 months.
5
(2)
6. 1. Long-term Care Insurance
(LTCI) in Germany
▪ Provides basic security in form of supportive
assistance
▪ Areas of needs: hygiene, nutrition, mobility,
household help
(Fig. 4)(Fig. 3)
6
(2)
7. 2. Long-term Care
System: 3 Levels of Care
Care Level I –
considerable
need of care
Care Level II –
severe need of
care
Care Level III –
extreme need of
care
Help with personal
care, nutrition, mobility
at least 1x/day for at
least 2 tasks in one or
more areas
at least 3x/day at
different times of the
day
assistance around the
clock
Additional assistance
(taking care of the
household)
several times a week several times a week several times a week
Nursing staff needs at least 1.5 hours/day
on the average
at least 1.5 hours/day
on the average
at least 5 hours/day
on the average
▪ Hardship cases
– Assistance at least 7h/day and 2h during the night
– Basic care that can be provided by several individuals together 7
(2) (5) (9)
8. ▪ Available only for people who can meet the costs
themselves (many have few options for coverage)
▪ No national system for insuring the individuals
against the risk of having major LTC expanses
▪ Two types of LTCI: statutory (Medicare, Medicaid)
and private
▪ Uninsured: 10% of the population
▪ Veterans Affairs benefits pays for service related
disabilities regarding LTC, nursing homes and at
home care.
3. Long-term Care
Insurance in the USA
8
(13)
9. Medicare (13% of the population) Medicaid (19% of the population)
Federal Insurance Program Federal & State Assistance Program
Paid for by a Trust Fund funded with Payroll Taxes Paid for by Federal, State and Local Taxes
Same Program Nationwide Program differs State by State
Benefits people over the age of 65 Benefits people with low incomes ($11,880 per year for a
person/$24,000 per year for 4 family)
Participants pay deductibles and for part of coverage Participants pay very little or no part of coverage
Divided into 4 parts (A,B,C,D): Hospital Insurance,
Medical Insurance, Advantage Plans, Prescription Drug
Insurance,
Participant receive regular Dental and Vision Exams
Benefits people with disabilities
Prescription Drug Coverage
Outpatient Hospital Care
Inpatient Hospital Care
3. Statutory LTCI
in the USA
9(5)(12)
10. 3. Private LTCI
in the USA
▪ Through voluntary LTCI plans
▪ Too costly for many Americans
▪ Unavailable to people with health conditions or
disabilities due to medical underwriting
▪ Based on the age of the individual (The older you
are, the more expensive it is)
▪ Only 3% of the adult population are private
insured
10
Fig.6
(5)
11. 4. LTC Services
Germany USA
▪ No upper limit for the price of nursing
homes (negotiated between providers
and sickness funds)
▪ $81,000 per year on average
▪ The part paid by LTCI is constant
(across federal states, nursing homes),
depends on the care level
▪ The costs depend on the needs of the
patient
▪ In case residents can’t afford the price
→ Social welfare covers the private share
of the price
▪ Medicaid covers the cost of nursing
homes as a whole
▪ Medicare covers only the first 100 days
of staying in nursing home
▪ Quality monitoring in nursing homes
(Quality standards → Comparability of
nursing homes is guaranteed)
▪ The often-poor quality of nursing
homes has been a consistent issue of
concern for consumers, government,
and researchers
▪ The quality scale is extremely broad 11
(5)(5) (7)
14. 5. Staffing
Germany USA
The USA and Germany are facing major labor force shortages in meeting future
demand for LTC services.
BUT: U.S. population is much ’’younger’’ (higher rates of fertility and immigration)
Germany has one of the oldest populations in Europe (by 2050: less than 2 people of
working age for every person age ≥ 65)
Women provide the overwhelming majority of caregiving
▪ special credential of ’’elder care’’ for
nurses in the LTC sector
▪ much more training on issues of
specific relevance to caring for older
people is provided
nursing degrees aren’t specific to LTC
LTC work is low paid and with a lower prestige than work in other health sectors
14
(5)
15. ▪ The elderly population will be 26.84 million in
2025
▪ No health care system exists for the health care
of the elderly population
▪ Geriatrics is not accepted as a specialty
▪ Only a few centers in Pakistan give LTC:
- Saint Joseph’s Hospice, Rawalpindi
- Darul Kafala, Lahore
- Edhi Center for Elderly, Karachi (11)
6. LTC in Pakistan
15
Fig. 7
16. ▪ A national health policy for health care of elderly
in Pakistan was developed in 1999. The key
policy recommendations are:
- Focal point and health unit of elderly
- Health care systems for the elderly
- National Institute of Geriatrics (NIG)
- Health Promotion, Disease Prevention (11)
6. LTC in Pakistan
16
17. ▪ Family support system
▪ Family members are of paramount importance in
providing care
▪ Social and cultural norms
▪ Economic value
6. LTC in Pakistan
Caregivers
17
18. ▪ How to handle the shortage of skilled nurses?
→ Caregiving Corps: trained volunteers that specialize in
geriatric and long term care working in NP, public
agencies and community organizations
→ Increasing the amount of schools for nursing and medical
professions (admitting every semester)
→ Decreasing the discriminating of male nurses
→ Reorganizing nursing care to reduce paperwork to
increase the proportion of RN time spent on patient care
7. Discussion
(Fig.5)
18
19. ▪ More support for caring relatives
→ 71% (DE) and 66% (USA) are looked after at
home from relatives
▪ In contrast to the U.S. everyone in Germany who
meets the criteria has the choice of benefits that
will meet their needs, their homes or institutions.
▪ The U.S. trend is toward increasing use of home
and community-based services and assisted
living, with declining use of nursing homes.
→ In Germany, use of institutional care has been
growing modestly
8. Conclusion
19
21. 9. References
1. Arno PS, Levine C, Memmott MM (1999) The economic value of informal care giving. Health Aff
18: 182–8
2. Arntz, Melanie et.al (2007): ’’The German social Long-term Care Insurance: Structure and Reform
Options’’.
3. Baig LA, Hasan Z, Iliyas M. (2000) Are the elderly in Pakistan getting their due share in health
services? Results from a survey done in the periurban communities of Karachi. J Pak Med Assoc.
50(6):192-6
4. Deutscher Berufsverband für Pflegeberufe, (2015): ‘‘Zahlen-Daten-Fakten „Pflege“. Berlin.
5. Gibson, Mary et.al (2007): ’’ Comparing Long-term care in Germany and the United States: What
can we learn from each other?’’.
6. Herr, Anika; Hottenrott, Hanna (2016): ’’Higher prices, higher quality? Evidence from German
nursing homes’’.
7. Herr, Anika et.al (2015): ’’ Does quality disclosure improve quality? Responses to the introduction
of nursing home report cards in Germany’’.
8. Itrat A, Taqui AM, Qazi F, Qidwai W. (2007).Family Systems: Perceptions of elderly patients and
their attendents presenting at a university hospital in Karachi, Pakistan J Pak Med Assoc.57:106;
9. Schulz, Erika (2012): ‘‘Determinants of institutional Long-term Care in Germany‘‘.
10. Qidwai W, Rauf MU, Sakina S, Hamid A, Ishaque S, Ashfaq T. (2011).Frequency and Associated
Factors for Care Giving among Elderly Patients Visiting a Teaching Hospital in Karachi, Pakistan.
PLoS One. 6(11):e25873. Epub 2011 Nov 4.
11. http://apps.who.int/medicinedocs/documents/s17305e/s17305e.pdf
12. http://thumbnails-visually.netdna-ssl.com/MedicareversusMedicaid_545b8931036a7_w1500.png
13. http://kff.org/other/state-indicator/total-population/
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