The Risk of Needing LTSS: DYNASIM Projections. Key Definitions

07/30/2015

  • Most results today are for adults turning age 65 between 2015 and 2019
  • We project formal care, which includes the following:
    • nursing home care
    • paid home care
    • residential care
  • We focus on HIPAA level of need -- formal focus
    • need help with two or more ADLs, or
    • severe cognitive impairment
  • We project present discounted value of costs at age 65, in 2015 constant dollars
    • finances required to cover all expected future costs, given assumed interest rate

Context: Much home care is informal and provided to individuals not meeting HIPAA criteria, especially at older ages…

Bar chart: Aged 65-84--Formal (1.3), Informal (4.6), All (8.4); Aged 85 plus--Formal (9), Informal (17.7), All (22.4).

At HIPAA disability level, care is more prevalent… and typically more intensive

Bar chart: Aged 65-84--Formal (18.9), Informal (49.6), All (55.3); Aged 85 plus--Formal (33.7), Informal (59.8), All (73.5).

About half of adults surviving to age 65 can expect to use formal HIPAA LTSS before they die

Bar chart: All (47%); Men (42%); Women (52%); Married at age 65 (46%); Unmarried at age 65 (50%).

On average, formal LTSS lasts about one year

Bar chart: All (1.1); Men (0.7); Women (1.3); Married at 65 (0.9); Unmarried at 65 (1.2).

The average masks a lot of variation

Bar chart: None--Men (58), Women (48); <1 year--Men (22), Women (23); 1-1.99 years--Men (9), Women (10); 2-4.99 years--Men (8), Women (11); 5+ years--Men (3), Women (8).

Expected present discounted value of formal LTSS costs ($2015) at age 65 (HIPAA level)

Bar chart: All--Entire Population ($69,500), LTSS users ($133,700); Men--Entire Population ($47,400), LTSS users ($101,000); Women--Entire Population ($90,300), LTSS users ($159,000).

Lifetime costs vary widely over the full population

Bar chart: none--Men (53), Women (43); <10k--Men (8), Women (7); 10-24.9k--Men (7), Women (6); 25-49.9k--Men (9), Women (10); 50-99.9k--Men (11), Women (10); 100-249.9k--Men (8), Women (11); less than or equal to 250k--Men (5), Women (12).

Payers Vary Sharply by Setting

Stacked Bar chart: Nursing home--Private inurance (?), Out of Pocket (35), Other Public (?), Medicaid (50), Medicare (12); Community, all residential care--Private inurance (?), Out of Pocket (67), Other Public (?), Medicaid (20), Medicare (10); Community, residential care nonrental--Private inurance (?), Out of Pocket (49), Other Public (?), Medicaid (31), Medicare (15).

Medicaid Pays a Larger Share of LTSS Costs for Women than Men

Stacked Bar chart: All--OOP (52%), Private insurance (?), Other Public (?), Medicare (11%), Medicaid (35%); Men--OOP (55%), Private insurance (?), Other Public (?), Medicare (12%), Medicaid (29%); Women--OOP (50%), Private insurance (?), Other Public (?), Medicare (10%), Medicaid (36%).

Those disabled for a long time account for a large share of total formal LTSS expenditures

Bar chart: <1 year--Men (19), Women (12); 1-1.99 years--Men (17), Women (12); 2-4.99 years--Men (31), Women (28); more than or equal to 5 years--Men (33), Women (48).

Most LTSS expenses are incurred within two years, but an important share occur later

Bar chart.

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