The Demographics & Economics

of

Our Aging Society:

THE CASE FOR A NATIONAL MOVEMENT

August 2016

The country is

unprepared To meet the needs and desires of

an aging population and their families.

But there are unprecedented opportunities for

aging services organizations

and providers

Risk of Frailty-Associated Need is 50 Percent

> 5 years

2-5 years

1-2 years

< 1 year

0 years

47%

14%

12%

8%

Half of Older Americans Will Experience High Need

Favreault, Melissa and Judith Dey. Long-Term Services and Supports for Older Americans: Risks and Financing Research Brief. Office Of the Assistant Secretary of Planning and Evaluation, U.S. DHHS, Revised February 2015

Data pulled from the Avalere Long-Term Care Policy Simulator, June 25, 2013

A Lot of People Needing a Lot of Care

48%

6%

10% 10% 12%

15%

None $1-$9,999 $10,000-$49,999 $50,000-$99,999 $100,000-$249,999 $250,000 or more

A Quarter Face Costs of At Least $100,000

Favreault, Melissa, Gleckman, Howard and Richard W. Johnson How Much Could Financing Reforms for Long-Term Services and Supports Reduce Medicaid Costs? The Urban Institute. February 2016.

Personal Savings Finance Over Half of Spending

Individuals Turning 65 in the Next 5 Years

Will Pay Over ½ of the Average

Lifetime Cost Out of Savings

Favreault, Melissa and Judith Dey. Long-Term Services and Supports for Older Americans: Risks and Financing Research Brief. Office Of the Assistant Secretary of Planning and Evaluation, U.S. DHHS, Revised February 2015

Medicare Gap-Fills - Pays More for High Need

Annual Per Capita Medicare Spending in 2006,

by Number of Chronic Conditions & Presence of Frailty

Source: Data from Avalere Health, LLC analysis of 2006 Medicare Current Beneficiary Survey (MCBS) Cost and Use file. Prepared for: The SCAN Foundation. DataBrief No.22: Medicare spending by functional impairment and chronic conditions.

Medicaid Moving to Constrain Per Capita LTSS

Taken From: Medicaid Expenditures for Long-Term Supports and Services in FFY 2012,

by Steve Eiken et al., CMS and Truven Health Analytics, April 28, 2014

LTSS as a % of Total Medicaid Expenditures, FFY 1995-2012

Very Little $$ in System

to Reward Rapid Deployment of Capital

In the

Delivery System Innovation

We Need to Meet Demand

“We are fighting over crumbs”

Home is Where We Want to Be – Even When Frail

Source: Data from the 2011 National Health and Aging Trends Study, Accessed Through Freedman, Vicki A and Spillman, Brenda C.

Disabili ty and Care Needs Among Older Americans, The Milbank Quarterly, Vol. 92, No. 3, 2014 (pp. 509-541)

14% 1.1 m

13% .97 m

73% 5.63 m

70 Percent of Individuals with High Need Live at Home

Living in a Nursing Home Living in Residential Care Living in the Community

Total: 7.7 million

But, It’s Dangerous to Live at Home if You’re Frail

60% 3.38 million

Living in the Community

36% 0.35 million

Living in Residential Care

Source: Data from the 2011 National Health and Aging Trends Study, Accessed Through Freedman, Vicki A and Spillman,

Brenda C. Disability and Care Needs Among Older Americans, The Milbank Quarterly, Vol. 92, No. 3, 2014 (pp. 509-541)

Adverse Consequence Rate

Among Older Adults Who Pay for Some Help

And, More Expensive

$18,3082

$14,0012 $14,5942

$0

$3,000

$6,000

$9,000

$12,000

$15,000

$18,000

$21,000

Community

Residents with

Moderate or Severe

Disability

Residential Care

Residents with

Moderate or Severe

Disability

Nursing Home

Residents

Community Medicare Per Capita Spending

“I Can’t Believe I am Managing This!”

And Needs Go Unmet

Frail Older

Adult

Complex

Medical

Need

Long-Term

Services &

Support

Need

Home

Care

Senior

Housing

Nursing

Home

Doctors

Hospital

Post-

Acute

Care

FAMILY:

Management

Coordination

Unpaid

Caregiving

Legal

Financial

“I Can’t Find What I Need”

Information is too disperse and/or hard to trust

Most “finders” produce long lists

Many “Free” referral sources are biased sources of information

• A Place for Mom

“Home Care Is Challenging”

Commodity Service

• Delivered by “private duty agencies”

Business model design is around scheduling service,

not delivering service

Low paid workers

Service is too bundled

Highly variable quality

Too expensive

Seize the Opportunity

Connect to Customers Up and Downstream

Livable,

Connected

Communities

Medical

Management

In-home

Technology

Trusted Hands-

on In-Home Care

Providers

Supplemented

With Tech

Service

Coordination

and

Management

Home

Modifications/R

enovations

Create Products that Revolve Around Client and Family

Needs

Individual

Consumer and

Family

Manage Complex

Medical Needs

Support Safety AND

Independent Living

through Assistance

with Daily Tasks

Life Management

INNOVATIVE

HOUSING

MODELS

Home Care

Care Mgmt

Tech Solutions

Housing

SNFs

CLINICAL/

MEDICAL

INTEGRATION

Hospitals

Doctors

Form Partnerships

Leverage Innovation and Technology

Aging 2.0 Supporting Innovation-Oriented Incubators

Attempts at New Home Care Business Models

(Honor, Hometeam)

• Take out overhead of massive scheduling operations in traditional home

care business model

Senior Housing with Lower Price Point, More Individual Design

Elements and Integration of Medical

Providers Operating Risk-Based Fully Integrated Models of

HealthCare Delivery for the Long-Term Care Population

$220 $256

$468

$624

$0

$10 0

$20 0

$30 0

$40 0

$50 0

$60 0

$70 0

20 30 20 40

Status Quo

Insurance

Advocate for Financing

Combined Out of Pocket and Insurance LTC Spending

Increases When Everyone is Insured

Dollars in Billions

Favreault, Melissa, and Richard W. Johnson Microsimulation Analysis of Financing Options for Long-Term Services and Supports The Urban Institute Research Report November 2015

It’s Time

To Start

A

Movement

“Your Efforts Are Good Enough”

Creating Content and Communities

that Inform and Inspire

WHAT IS

DAUGHTERHOOD?