AARP's PROFILES OF LONG TERM SERVICES AND SUPPORTS

AMERICAN ASSOCIATION FOR RETIRED PERSON'S 

PROFILES OF LONG TERM SERVICES AND SUPPORTS

9th Edition, 2012

     In 2012, I was absolutely delighted to obtain a copy of the AARP's Profiles of Long Term Services and Supports (LTSS) with Older Americans represented by this illustrious voluntary sector, non-profit organization in areas from US legislation to health care financing. Are you invited to join AARP as an Older American? Yes you are!

     In its American Public Policy Institute, AARP concluded:

* 4  Many older Americans live below 250 percent of the poverty line, and are likely to qualify for need-based long-term services and supports and other publicly funded services.

* 5  The bulk of Medicaid long term services and support dollars still go to nursing facilities rather than home and community-based services.

* 2  The older population is racially and ethnically diverse and is projected to become even more diverse as our multicultural society grows.

     Now, what did this author find as critically, relevant statistics "for use with legislative, executive and financing" bodies? 

* AARP states that "In 2010, one out of every five people 65+ was nonwhite or Hispanic, a percentage that is increasing and will continue to do so in the future. By 2060, it is projected that 46% of the age 65+ population will be people of color." The reasons for such demographic changes, according to Julie Ann Racino of the American Society for Public Administration, typically are differential birth rates among the populations and immigration policies, and that these changes vary by region and migration patterns in the USA.

* Very popular home health services are reported as part of LTSS by states in the Nation

(e.g., Alabama, Colorado, Maine, Mississippi), together with "similar workers" as personal and home care aides, assisted living and residential care units and facilities, health maintenance task delegation, and congregate and home delivered meals. These services and workers are called home and community-based resources. In contrast, nursing facilities (beds, facilities, occupancies) are reported with quality and oversight on physical restraints, residents with dementia, high risk and low care need residents with ombudsman programs.

* Long Term Services and Supports are still Long Term Care Financing, similar to the Public Policy Institute hosted by President Obama. In particular, the state-by-state analyses indicate a marked increase in Medicaid LTSS spending through MR/DD waivers (plus 54%) between 2004-2009 with growth in personal care services and other HCBS services (67%), nursing facilities (12% growth), HCBS 1915 waivers (77%), and intermediate care facilities for mental retardation (8%); aged and disabled waivers varied by state (e.g., plus 58% in Alabama; 89% increase in Idaho; 1,237% in Tennessee), including decreases (minus 5%, Maine; minus 56%, New York). The charts indicate in intellectual disabilities either a transfer of Medicaid packages to this reporting for older Americans, or indeed a marked new increase in funds toward this population group (may or may not include dementia; marked increases over age 85).

      This author recommends use of this document to review your own state (e.g., exorbitant institutional costs), to compare to others (why not in our state?), to increase "service typologies" for homes and communities (e.g., we like more hours available in home health instead of large nursing facilities), to obtain information on family caregiving and its economic costs (AARP at state legislatures for funds for family caregiving), and information on "living arrangements" including care for grandchildren and those over age 75 who may live alone. On the latter, few of us are truly alone, though increasingly families may have relocated out-of-state, and plans may involve neighborhoods or governments of "birthplaces" (e.g., institutions, had "place of origin"). In particular, the tables indicate a need for awareness on "cognitive difficulty" and "self care difficulty" which may be reasons a home health aide, a personal care aide or home care may be contacted or requested post-age 65 versus adult ages (18-64). The US has new disability and aging coordinators which are to be there to assist in decisions and resources.

        For those who wonder about the "formal and informal support" studies, the findings were that "instrumental support" is provided by neighbors and friends (e.g., coffee or lunch; "check in"; "voluntary telephone calls"), and broadly speaking, "more difficulty caregiving" (e.g., bathing, "toileting") does indeed "fall" to families (e.g., of birth), spouses (yes, gay marriages, too) and newly created families (e.g., children). Independent living has long supported a system of independence from families in living in homes and communities, and have advocated for the aides (e.g., see, also, US Direct Support Workforce, 2014, e.g., "psychiatric aides", "home aides"), income, decision making and supports to do so. The report also describes Long Term Care Insurance which is a new marketplace product.

      Thank you to the authors of the AARP report on Long Term Services and Supports, Ari Houser, Wendy-Fox-Gage and Kathleen Ujvari. AARP is on the web at www.aarp.org and has state offices throughout the US (e.g., Oklahoma, South Dakota, South Carolina, Rhode Island). The Public Policy Institute report was from 601 E. Street, NW., Washington, DC 20049.

By Julie Ann Racino, September 7, 2017