• Healthier and Wealthier Oldest Old –the poverty rate for individuals age 85 and over dropped by 28 percent, from 18.7 percent in 1985 to 13.4 percent in 2005, while the poverty rate for all persons age 65+ declined from 12.6 percent to 10.1 percent (about a 20 percent decline).  People with higher incomes have greater ability to choose preferred services.
  
  
• Changes in the Patterns of Nursing Home Use –  The focus on post-acute stays and shorter custodial stays resulted in a decline in average length of stay from 2.9 years in 1985 to 2.4 years in 2004, while median length of stay declined from 1.7 years to about 1.3 years.
  
  
• Alternatives to Nursing Homes Continued to Developed – Over the last decade, alternatives to nursing homes grew substantially: 1) residential facilities, such as assisted living, now boast approximately one million residents with an average age over 80; and 2) more home-based services became available through state funded and Medicaid home and community-based (HCBS) waiver programs targeting those at risk of nursing home entry.  Families also continue their large role in providing unpaid care to frail older adults.
  
  
• Increased Availability of Private Long Term Care Insurance – In the 1980s, the long term care insurance market just had launched and today around 10 percent of adults age 65 and older own a long term care insurance policy.  This coverage provides a small group of policyholders the resources to choose where they want to live and receive care.
  
• Active Efforts by States -- Many states actively tried to reduce the number of Medicaid recipients in nursing homes by providing more home and community-based services and intervening in critical pathways to nursing homes with pre-admission screening or by establishing single entry point systems (such as Aging and Disability Resource Centers (ADRC)) in order to divert people away from nursing homes.  

Nursing home use in Arkansas has declined; however, at least 23 states have fewer nursing home residents per 100 individuals age 65 plus than Arkansas.  Rather amazingly, the report found that states with already low nursing home use continue to reduce their census even further.  Oregon, which in 1995 was among the top ten states with the lowest nursing home residents per 100 population age 65+, also had the greatest percentage decline in the country between 1995 and 2005 going from 2.74 to 1.79 residents per 100 elderly (a 35 percent decline).

In 2005, 42 states — Arkansas included — had nursing home residents per 100 population age 65+ above Oregon’s 1995 level of 2.74.  This begs the question:  What has Oregon done that other states haven’t?

One of Oregon’s keys to success is combining housing and services.  They have both a strong assisted living and adult foster care system serving both Medicaid and private pay residents.  Assisted living is relatively new to Arkansas and is growing. Adult Foster Care is not readily available in our state.  Adult Foster care is a home setting in the community for adults who are unable to live independently due to physical, emotional, or other impairments.  A workgroup is currently developing standards for Medicaid supported Adult Foster Care in Arkansas.

Nationally 75% or nursing home residents are female and 83% are without a spouse.  Lack of a caregiver clearly puts one at risk for institutionalization.  Adult Foster Care and Assisted Living are attractive options for those who need some help to stay independent, but lack a caregiver.  Oregon also makes sure families understand their options and what support is available.

The report underscores the fact that family and friends care for their loved one.   Despite more women working and more families living in different parts of the country, family and friends of older adults with disabilities continue to play a critical role in supporting these individuals in the community.  Approximately two-thirds of older adults with functional impairments received all or most of the assistance they needed from unpaid caregivers, typically family and friends, while living in the community.  The proportion supported by unpaid care has remained fairly consistent over the past 20 years.”

Those that are cared for in nursing homes look different than those cared for in 1985.  As more individuals are cared for in the community, nursing homes are serving individuals with higher acuity and more complex medical needs according to Lewin.

The baby boom generation will represent twice as many older adults in 2030 as today’s cohort of older adults.  However, the report states that if the demand for nursing homes continues to decline at just half the rate of the national average over the past 20 years, the use rate among older adults would drop from a projected 3.2 percent to 2.5 percent in 2030.  This 0.7 percentage point decline represents a similar level of decline as occurred between 1997 and 2004 and would result in only 320,000 more older nursing home residents rather than 830,000 more in 2030.

The report states a continued decline seems feasible given the wide variation in the use of nursing homes across the country today.

The missing elders?  Apparently they are in your neighborhood.

A full copy of the report can be obtained at the Lewin website:  http://www.lewin.com

Division of Aging and Adult Services
Herb Sanderson, Director
PO Box 1437 - Slot S-530
Little Rock AR 72203-1437
Telephone: (501) 682-2441
Fax: (501) 682-8155