A Good Death?Changing Expectations and Plans

Osher Lifelong Learning Institute

John Amson Capitman, PhD.Nickerson Professor of Health PolicyCentral Valley Health Policy Institute

California State University, Fresno

Day 2: Review of worksheets from Day 1Anticipating Long-term Care NeedsCaring for CaregiversLiving Will: the 5 wishesLong-term Care Insurance

A Good Death: Preliminary Outline

D-I-Y Obituary◦Anything learned or relearned◦Any new questions

Recipes for a good death---medical consensus◦Anything learned or relearned◦Any new questions

Review of worksheets from Day 1

Anticipating Long-Term Care Compression of Mortality? Morbidity? Because of epidemiological transition, more

people live to old age, and more people live to the natural limits of human life ===Smaller part of life course associated with most deaths====Compression of Mortality

BUT is there a compression of morbidity? Later onset of disability?

Lifetime Risk of Disability Risk of current disability increases with age: for a

person aged 85 (35 %) is more than 7x greater than for a person aged 74 (4.6 %).

The lifetime risk of developing a disability in at least two primary activities of daily living for at least 3 months or becoming cognitively impaired is 44% for males and 72% for females at age 65.

Women face a 64% higher risk than do men. Lifetime risk of developing a disability declines

slightly with age.

Anticipating Long-Term Care

1. Disability insurance and long term care (LTC) insurance cover the same things.

2. The average lifetime chance of needing long term care for an individual 65 years or older is more than 40%.

3. People have to spend all or almost all of their assets to get Medicaid benefits.

4. Medicare is not the primary funding source for most seniors’ long term care costs.

5. Most long term care is provided in a nursing home.6. Medicaid covers long term care services received at home.7. Nursing home expenses for Alzheimer’s Disease patients are

covered by Medicare.8. The average length of stay in a nursing home is more than four

years.9. Nearly 40% of the long term care population is under the age of

65.10. On average, a one-year stay in a nursing home costs about

$30,000.

Anticipating Long-Term Care

Over 7 million Americans provide 120 million hours of informal care to approximately 4.2 million severely disabled elders each and every week.

About 38 million adult caregivers (age 18 or older) provided unpaid care for ADL/IADL

Caregivers provided an average of 21 hours of care per week, or 1,080 hours per year.

An estimated $350 billion/year to replace informal caregiving

Out-of-pocket, lost wages, lost retirement income, lost productivity, costs associated with health effects

Caring for Caregivers

If you are run down, tiring more than usual, will you be able to provide good care?

If you have a cold or the flu, will your loved one catch it from you? If you become depressed will you be able to make good decisions, will life

become unbearable? If you are not well, who will fill your shoes, whether temporarily or

permanently?

BASIC TIPS

Take a daily vitamin supplement Get exercise — make it a priority for both your mental and physical well-

being. Get regular check-ups and do not ignore possible symptoms of ill health. Take a break from caregiving – respite time is crucial. Watch for signs of depression – more information Stay involved in hobbies Laugh with a friend

Caring for Caregivers

Educate yourself about the disease your family member is facing and how it may affect his or her behavior, pain level, etc.

Find sources of help for caregiver tasks. Contact family, friends, neighbors, church/synagogue, workplace, Area Agency on Aging or other organizations. Keep looking!

Protect your personal time for something you enjoy or something you need to get done. Try to find time for exercise, eating well and sleeping enough.

Watch out for symptoms of depression (such as crying more, sleeping more or less than usual, increased or decreased appetite or lack of interest in usual activities). Notify your doctor if symptoms of depression are present.

Consider how you will feel and what you will do after the caregiving ends.

Coping Tips for Caregivers

In-home supports (home health, homemaker, independent living aide)

Out-of-home, community care (adult day care, outpatient rehabilitation)

Supportive/Transitional Housing Board and care Assisted living CCRC Nursing homes

Caring for Caregivers

Figure up to $150k in long-term care costs if needed for average time/mix of in-home and facility

3 primary options1. Save money—dedicated savings2. Prepare to qualify for MediCal3. Purchase LTC Insurance

Financing Long-Term Care