Chapter Five Older People and Long-Term Care: Issues of Access 1 2 Why the new interest in long-term care? The Baby Boomers are adding to the growth in the population over 65. There is increasing fear of dependency on long-term care. Adult children of the elderly having to find care for their parents. Healthcare reform promises great changes that are not well understood. 3 3 The Growing Population Needing Care The need for ADL and IADL assistance continues to grow. Table 8-1 presents the broad range of services needed by the disabled. Most of the population needing long-term care do not live in nursing homes. Many factors contribute to the inability to predict the exact number needing services in the future. 4 4 The Growing Population Needing Care Future populations may be better educated which is associated with lower levels of disability. Ethnic composition suggests a greater need for care and government support. Boomers will bring greater numbers of people needing services. The number of those over 75 will greatly increase. 5 5 The Growing Population Needing Care Disability rates will increase among those who are not in nursing homes. The most common disability is physical. In addition, the nursing home population is expected to have profound increases until it triples by 2030. The number of younger persons with disability has also increased. 6 6 Issues of Access The current system is far from ideal. There is not an adequate supply particularly for the poor. The system itself continues to be so fragmented that many are not aware of what is offered. Financing is an underlying problem. 7 7 The Costs of Care Expenses for this care are sizable and will increase in the future. Private insurance only pays for a small percentage of the care. Medicaid pays for over 85% of nursing home care. 8 8 The Costs of Care Annual costs of nursing home care can average $58,000 per year and may exceed $100,000. For many, the costs of this care is just not affordable. With the addition of the Baby Boomers, costs will most certainly increase in the future. The effects of reform are not currently known. 9 9 The Care-giving Role of Families About 74% of dependent community-based elders receive care from family members. The majority of caregivers are women. The number and willingness of family caregivers may decline as the Boomers become in need for assistance. 10 10 The Role of Private Insurance Private insurance for long-term care is a relatively new product. Improvements in coverage are being made, but only an estimated 20% of the population will use it. CCRCs and LCAHs hold promise for the future. 11 11 The Role of Medicaid Medicaid is changing under PPACA to include more eligible adults who will receive benchmark coverage. Medicaid is used for those elders who meet certain criteria. Medicaid does not pay for the full range of services including home-based care. Some states are using a waiver to offe.

1. Chapter Five
Older People and Long-Term Care: Issues of Access
1
2
Why the new interest in long-term care?
The Baby Boomers are adding to the growth in the population
over 65.
There is increasing fear of dependency on long-term care.
Adult children of the elderly having to find care for their
parents.
Healthcare reform promises great changes that are not well
understood.
3
3
The Growing Population Needing Care
The need for ADL and IADL assistance continues to grow.
Table 8-1 presents the broad range of services needed by the
disabled.
Most of the population needing long-term care do not live in
nursing homes.
Many factors contribute to the inability to predict the exact
number needing services in the future.

2. 4
4
The Growing Population Needing Care
Future populations may be better educated which is associated
with lower levels of disability.
Ethnic composition suggests a greater need for care and
government support.
Boomers will bring greater numbers of people needing services.
The number of those over 75 will greatly increase.
5
5
The Growing Population Needing Care
Disability rates will increase among those who are not in
nursing homes.
The most common disability is physical.
In addition, the nursing home population is expected to have
profound increases until it triples by 2030.
The number of younger persons with disability has also
increased.
6
6
Issues of Access
The current system is far from ideal.
There is not an adequate supply particularly for the poor.

3. The system itself continues to be so fragmented that many are
not aware of what is offered.
Financing is an underlying problem.
7
7
The Costs of Care
Expenses for this care are sizable and will increase in the
future.
Private insurance only pays for a small percentage of the care.
Medicaid pays for over 85% of nursing home care.
8
8
The Costs of Care
Annual costs of nursing home care can average $58,000 per year
and may exceed $100,000. For many, the costs of this care is
just not affordable.
With the addition of the Baby Boomers, costs will most
certainly increase in the future.
The effects of reform are not currently known.
9
9
The Care-giving Role of Families
About 74% of dependent community-based elders receive care
from family members.

4. The majority of caregivers are women.
The number and willingness of family caregivers may decline as
the Boomers become in need for assistance.
10
10
The Role of Private Insurance
Private insurance for long-term care is a relatively new product.
Improvements in coverage are being made, but only an
estimated 20% of the population will use it.
CCRCs and LCAHs hold promise for the future.
11
11
The Role of Medicaid
Medicaid is changing under PPACA to include more eligible
adults who will receive benchmark coverage.
Medicaid is used for those elders who meet certain criteria.
Medicaid does not pay for the full range of services including
home-based care.
Some states are using a waiver to offer non-medical home-care
services.
12
12
The Role of Medicaid
Some elders qualify for Medicaid once they are institutionalized

5. and have used all of their assets.
Other elders are trying to shelter their assets so that they can be
poor without really being poor.
Healthcare reform requires an office within CMS to address the
issue of dual edibility.
13
13
Forces for Improving Access
Advocates for Alzheimer’s disease patients and for others have
worked for changes.
The Pepper Bill and other legislation recommended changes.
Attempts to limit the growth of Medicaid are part of the
national health care debate.
14
14
Future Prospects
Baby Boomer numbers and healthcare reform will result in
changes to the system.
Government involvement will increase as demand increases
without the funding for access.
Government involvement may not be the only or best answer.
15
15

6. Future Prospects
Future elders are concerned about what their care will be like
under healthcare reform.
The political climate must be willing to address future concerns.
Ethical questions such as beneficence, autonomy, and justice
need to be part of policy discourse.
16
16
Future Prospects
Issues of the elderly and non-elderly disabled need to be
addressed.
Given the cost and complexity, the medical model is not the
only one to be considered.
Long term care needs to be part of health care.
17
17
Update from a Practitioner’s View
Even with healthcare reform the trends and issues for long-term
care are the same.
Barriers to real change are driven by the political climate that
controls funding.
What will be America’s legacy about the treatment of its
elderly?
18
In Summary…
19

7. 19
Florida National University
PHI1635 Biomedical Ethics: Assignment Week 3
Case Study: Chapter 5
Objective: The students will complete a Case study tasks that
contribute the opportunity to produce and apply the thoughts
learned in this and previous coursework to examine a real-world
scenario. This scenario will illustrate through example the
practical importance and implications of various roles and
functions of a long-term care settings. As a result of this
assignment, students will be better able to comprehend,
scrutinize and assess respectable superiority and performance
by all institutional employees.
ASSIGNMENT GUIDELINES (10%):
Students will critically measure the readings from Chapter 5 in
your textbook. This assignment is planned to help you
examination, evaluation, and apply the readings and strategies
to your of a long-term care settings
You need to read the PowerPoint Presentation assigned for week
3 and develop a 3-4 page paper reproducing your understanding
and capability to apply the readings to your long-term care
settings. Each paper must be typewritten with 12-point font and
double-spaced with standard margins. Follow APA style 7th
edition format when referring to the selected articles and
include a reference page.
EACH PAPER SHOULD INCLUDE THE FOLLOWING:
1. Introduction (25%) Provide a brief synopsis of the meaning
(not a description) of each Chapter and articles you read, in

8. your own words that will apply to the case study presented.
2. Your Critique (50%)
A CASE STUDY: THE LONG TERM CARE OF OLDER
PEOPLE
1. INTRODUCTION
In December 2017 a Royal Commission was appointed by the
present Labor government to exam the options for a supportable
system of financing the long-term care of older people. The
forms of care considered included care in the community, in a
person's own home, and care in residential or nursing homes.
Older people receiving long-term care in these settings may also
require acute medical care so it was relevant to also look briefly
at the general health provision for older people. Since the
creation of the NHS older patients have been seen as a drain on
resources diverting services away from other patient groups
(Wilkinson and Hughes, 2006). Elderly care has always been
one of the Cinderella services within the NHS, receiving less
than adequate resources despite repeated attempts to ensure it
was given priority in resource allocation (Ibid.). Numerous
studies have focused on the social deprivation and abuse
suffered by people in elderly care homes (Barton, 2009; Biggs
et al., 2005; Robb, 2007; Townsend, 2002). The current debates
about health care and older people focus on rationing, and on
standards of care for the old both in hospitals and in residential
and nursing homes. Evidence exists that older people are denied
access to treatments provided for younger patient. (Aaron and
Schwartz, 2004; Age Concern, 2007). The continuing poor
quality of care for older people within the NHS has been the
focus of considerable media attention (Abrams, 2008; Brindle,
2007; Evans 2007). In October 2007 The Observer newspaper
launched a campaign to ensure that older people in hospital are
treated with dignity, following reports of neglect. In the same
month The Sunday Times launched a campaign for better care
for the elderly in long-term care and highlighted abuse and

9. indignity routinely suffered by people in residential and nursing
homes. Both campaigns generated a large public response. It is
important to note that long-term care is not free, but is means
tested, the state paying only for those who cannot pay for
themselves.
1.1 The Findings of the Royal Commission
According to the Royal Commission Report, With Respect to
Old Age: A Report by the Royal Commission on Long Term
Care (2009), the present system of long term care is
characterized by complexity and unfairness. The diversity of
providers and funders may operate against the interests of R. ter
Meulen, W. Arts, and R. Muffels (eds.), Solidarity in Health
and Social Care in Europe, 417-422. © 2001 Kluwer Academic
Publishers. 418 A. CAMPBELL AND S. JONES individual
clients. More importantly the Commission found evidence of
bewilderment, 'a strong sense of loss of control, a sense of
actually losing a loved individual to a system that is beyond
understanding and which makes individuals feel beyond help.
No amount of statistics or cool analysis can take away the
human despair which individuals feel when confronted with the
system as it is' (PA2). Although the Commissioners recognize
that the Welfare State has considerably improved the lot of
older people, they claim that as a society we have ceased to
value old age. Many older people now live twenty to thirty
years beyond retirement. The financial position of pensioners is
variable but many are considerably poorer than those in other
groups are, and this is a threat to their security in old age. The
present NHS is performance led, resulting in earlier discharges.
Discharge from hospital is a critical point for many older
people, which, along with other crises can result in the
perceived need for residential care. Older people can be forced
to sell their homes and cut off their links with local
communities by decisions, which are often hastily taken.
Although residential and nursing homes may be caring and

10. supportive, older people are then removed from sight and from
society. The result is social exclusion of a whole section of
society.
1.2 The Commission's Recommendations
The Commission Report sets out in the first chapter the values
that have guided its deliberations. The recommendations begin
from the position that old age should not be seen as a problem,
but as a time of life with fulfilment of its own. According to the
Commissioners older people do continue to play a positive role
in society by acting as careers, supporting families, by
providing wisdom and advice and by playing an active part in
society. However, these positive images are often over
shadowed by negative ones. Underlying much of the political
language about old age is assumption that old age is a problem.
With the expected rise in the numbers of elderly and the rise in
their proportion of the population this is thought to be a
problem which will become increasingly insoluble in future
years. However, such an approach treats the old as a
homogenous group, which clearly they are not, and fails to
recognize people as individuals with their own needs aspiration
and perceptions. Moreover the Commission found that for the
UK there is no 'demographic timebomb' as far as long-term care
is concerned, and as a result costs of care would be affordable.
Against these negative images, the Commission suggests a new
understanding: older people should not simply be seen as the
passive recipients of welfare, rather society should recognize
the value inherent in older people, and the value in helping
them to continue to realize their potential. The department of
Education and Employment's commitment to lifelong learning
should mean learning for life beyond work and into the
retirement years. Old age should be seen as a special time when
we have the gift of time to develop interests.
CASE STUDY CHALLENGE:

11. 1. Why is Long Term Care important to our overall health care
system?
2. What is long term care for the elderly?
3. What percentage of elderly live in nursing homes?
4. What percentage of individuals over 65 will require long term
care?
3. Conclusion (15%)
Briefly summarize your thoughts & conclusion to your critique
of the case study and provide a possible outcome for Long-term
Care setting for elderly. How did these Chapters influence your
opinions about Health Economics in a Health ethics Context?
Evaluation will be based on how clearly you respond to the
above, in particular:
a) The clarity with which you critique the case study;
b) The depth, scope, and organization of your paper; and,
c) Your conclusions, including a description of the impact of
these Case study on any Health Care Setting.
ASSIGNMENT DUE DATE:
The assignment is to be electronically posted in the
Assignments Link on Blackboard no later than noon on Sunday,
March 22, 2020.
ASSIGNMENT RUBRICS
Assignments Guidelines
1 Points
10%
Introduction
2.5 Points
25%
Your Case Study Critique
6 Points
50%

12. Conclusion
1.5 Points
15%
Total
11 points
100%
ASSIGNMENT GRADING SYSTEM
A
90% - 100%
B+
85% - 89%
B
80% - 84%
C+
75% - 79%
C
70% - 74%
D
60% – 69%
F
50% - 59% Or less.
Dr. Gisela Llamas