Unlike a regular mortgage, a RAM loan is not repaid until the owner dies or the house is sold. The borrower receives monthly payments for five or 10 years. DSS also engages in outreach, provides the public with information on the program, and accepts applications.
The state ' s AAAs contract with three legal organizations to provide free legal help on elder law issues to people age 60 and older who cannot afford to hire a private attorney.
Priority is given to people with problems regarding health care access, nursing home issues, patient ' s rights, and federal and state benefit programs. The following organizations provide assistance:. Connecticut Legal Services, Inc. The hotline number is Adult Day Care—Alzheimer ' s Disease.
DSS provides funding through the state ' s AAAs to pay for adult day care program staff for people with Alzheimer ' s disease. Approximately 29 adult day care centers participate. The department ' s CHCPE program also subsidizes the attendance fees for people who qualify financially.
DSS funds a voluntary adult family living program for seniors who are inappropriately institutionalized or who might otherwise be placed in a nursing home. The program provides room, board, and personal care services in a host home or substantially equivalent environment. There are no income limits, but participants must contribute towards the program ' s costs according to a sliding fee scale. Currently, the program serves only two people and does not accept new applicants.
Alzheimer ' s Respite Program. Services provided under the program include homemaker services, adult day care, short-term medical facility care, home health care, and companion services. PA also added personal care assistant PCA services to this list. There is no age requirement for eligibility, but these diseases affect more seniors than younger people. Brain G.
Program to provide services to certain participants in the State Alzheimer ' s Respite program and 15 adult day centers. The program uses a two-tiered, non-pharmaceutical approach to address the needs of people with Alzheimer ' s disease. Its two primary interventions--computer exercises that target specific areas of cognition and hands-on cognitive training in a small group or workshop environment--are designed to maintain cognitive functioning levels in these individuals.
The CHCPE has both Medicaid- and state-funded components that pay for home- and community-based services for infirm elderly individuals who might otherwise require nursing home care. Services include care management, adult day care, adult foster care, homemaker services, transportation, meals-on-wheels, minor home modifications, and certain assisted living services.
Qualifying people in the higher income ranges must contribute to the cost of their care. Financial eligibility differs for the program ' s two portions. Elderly Personal Care Assistance Pilot. To be eligible, individuals must be at least age 65 and meet all of CHCPE ' s functional and financial eligibility requirements.
Participation is limited to individuals. Legislation enacted in removed the person limit, but because the law requires the program to operate within available appropriations, DSS has retained the cap.
The program permits clients to choose their own assistants to help with personal care and activities of daily living. The client employs, trains, supervises, and may fire the attendant, but a financial intermediary takes care of the paperwork.
DSS also provides consumer-directed PCA services under two Medicaid waivers, one for disabled adults and one for people with acquired brain injury. Both programs serve adults ages 18 to 64 and have only a limited number of program slots available. Removing the age cap also applies to working disabled people currently receiving PCA services because they are participating in the Medicaid for Employed Disabled program.
Homecare Option Program for the Elderly. The Home Care Option Program for the Elderly HOPE and a related trust fund helps people plan and save for the costs of services that are not covered by a long-term health insurance policy or supplement services that such a policy or Medicare covers.
This allows seniors to live in their homes or a non-institutional setting as they age. Participants can establish individual savings accounts and designate a beneficiary to withdraw account funds to pay for qualified home care expenses. It exempts interest the accounts earn from state income tax and makes any balance remaining when a beneficiary dies part of his or her estate. The program and trust fund are administered by the comptroller.
It expanded the people who can benefit from a HOPE account to include any designated beneficiary. Under prior law, only a person who enters the HOPE participation agreement or who is later designated as that person's spouse or civil union partner could benefit.
Money Follows the Person Demonstration Project. MFP is a five-year program that permits states to move people out of nursing homes or other institutional settings into less-restrictive, community-based settings.
To be eligible, individuals must have lived in a nursing home or other institution for at least six months and, if not for the community-based services provided under the demonstration, would have to remain in the institution. For the first 12 months the participant lives in the community, the program will pay an enhanced federal match compared to the usual Medicaid match. It also required the commissioner to develop a plan to establish and administer a similar home- and community-based services project for adults who may not meet the MFP institutionalization requirement.
Since December , the program has transitioned 31 individuals into the community. The National Family Caregiver Support Act, Title IIIe, of the federal Older Americans Act OAA , gives grants to states to provide information and referral, training, counseling, respite care, and other supportive services to 1 people caring at home for chronically ill, frail, elderly relatives or relatives with mental retardation or other developmental disabilities and 2 grandparents and other relatives caring for children at home.
Although the program ' s funding is entirely federal, it is distributed through the states. The states must provide the services through their AAAs. States must give priority to services to older people with the greatest social and economic need with particular attention to low-income seniors and to older people who are taking care of relatives with mental retardation or other related developmental disabilities.
The AAAs or their contractors provide the services, which include caregiver counseling, information about available services, help in accessing services, respite services, and limited supplemental services not available through other programs. Each AAA must coordinate its activities with community agencies and voluntary organizations providing similar services.
Nursing Facilities Transition Grant Program. This small program helps transition elderly and disabled people from nursing homes into community living and helps them obtain needed support services to do so successfully. The program was initially funded by a three-year federal grant in , but is now funded by the state.
Since December of , the program has helped 23 people transition to community living. The pilot ' s goals are to improve the quality of life for nursing home residents and provide nursing home care in home-like, rather than institutional, settings. DSS must develop design specification guidelines and other requirements for the homes and submit them to the legislature ' s Human Services Committee for approval.
In selecting proposals, DSS must give priority to proposals that use energy efficient technology, including fuel cells. And two of the proposals selected must be to develop a small-house nursing home in a distressed municipality with more than , people.
Any small-house nursing home participating in the pilot must comply with certificate of need requirements and processes. Pursuant to federal law, DSS operates 13 elderly nutrition projects that provide nutritionally sound meals to people age 60 and older and their spouses.
Programs must provide one meal per day, five days per week. Disabled people living in housing facilities that are congregate meal sites can also receive meals.
There is no charge for the meals, although voluntary contributions are encouraged. Both federal and state funds are used to pay the program costs. Senior Farmers ' Market Nutrition Program. In order to be eligible for the program, seniors must participate in a subsidized rental housing or congregate meal program that has applied for and been accepted into the program. Circuit Breaker. An applicant must 1 be 65 years of age or older, have a spouse who is 65 or older, or be at least 50 and a surviving spouse of someone who at the time of his or her death was eligible for the program; 2 occupy the property as his or her home; and 3 have lived in Connecticut at least one year before applying for benefits.
For the Network. The Home and Community-Based Supportive Services HCBS program, established in , provides grants to states and territories using a formula based primarily on their share of the national population aged 60 and over. The grants fund a broad array of services that enable older adults to remain in their homes for as long as possible.
These services include, but are not limited, to:. Each state uses an intrastate funding formula to allocate funds to its Area Agencies on Aging. Almost 75 percent of physician visits by the elderly are made to a doctor's office. The remaining visits are to hospital emergency rooms, outpatient offices, home and telephone consultations, and other places outside a hospital.
The aging of the population will affect the demand for physician care. That demand is expected to increase 22 percent by the year to million contacts per year, and percent by the year to million contacts per year, based on physician contact rates and projections of the noninstitutionalized population Special Committee on Aging, — Long term care refers to the array of medical, social, and support services for individuals in nursing homes or in the community who, for an extended period of time, depend on others for physical assistance GAO, More than 11 million Americans were estimated to need some form of long term care in Of this group, approximately 6.
Of the total elderly population needing long term care in , approximately 20 percent resided in nursing homes and other institutions GAO, Almost 40 percent lived in the community with their spouses. The other 40 percent were fairly evenly divided between those living with others and those living alone in the community.
The demand for nursing home care is increasing, although the lengths of stay, at least in skilled nursing facilities, are dropping Gornick and Hall, This pattern reflects an increase in shorter stays and a decrease in longer stays. Almost 90 percent of nursing home expenditures were for people age 65 and older Waldo et al. Despite the large amounts of funding for nursing homes, growth in the number of beds has evidently not kept pace with the growth of the elderly population Scanlon, This apparent discrepancy may, however, reflect a shift in the locus of care to other long-term-care settings, rather than a shortage of nursing home beds Gornick and Hall, ; NCHS, a.
Although expenditures for home health benefits represented only about 3. The number of Medicare-certified home health agencies grew from slightly over 2, in to almost 6, in Gornick and Hall, Home health services covered under Medicare include nursing care, physical, speech, and occupational therapy, home health aide services, and some medical supplies and equipment.
There is no limit to the number of covered visits for beneficiaries confined to their homes i. Following PPS implementation, the growth rate of home health expenditures and persons served has declined, as has the number of visits per person Table 3.
For example, from to , the number of persons served increased at an average annual rate of The slower rate of growth in the use of Medicare home health services since PPS may be the result of movement toward equilibrium following the growth spurt before PPS. For example, the percent of patients using covered home health services within 60 days of hospital discharge increased 55 percent from to , but increased only 27 percent between and Gornick and Hall, Further, the decline in short-stay hospital use among Medicare beneficiaries since PPS is often cited as a reason for the related decline in home health care, although the reduced lengths of hospital stay following PPS should in theory have had the practical consequence of a greater need for home health services.
Other factors in this leveling may be a strict interpretation of the homebound provisions and an inability of the home care market to expand sufficiently to meet the immediate demand.
A detailed examination of home health statistics Table 3. The proportion of females using home health services is 29 percent higher than that of males. In , 80 percent of the elderly who required assistance with activities of daily living ADLs lived at home. Women outnumbered men 2 to 1 in this population GAO, Formal community-based services help address the needs of persons with activity limitations and include a broad range of health and social services such as home health care, rehabilitation programs, homemaker and chore services, personal care services, adult day care, and meals on wheels.
Some nursing home patients do not require the level of care provided in an institutional setting and could remain at home assuming that appropriate services could be provided Rice and Estes, Community-based services, therefore, are intended to help the elderly among others cope with independent or community living, so as to improve the quality of individuals' lives and forestall institutionalization.
Most of these services are not covered by Medicare, and a significant number of noninstitutionalized individuals who need such services do not receive them. Of the dependent community-dwelling elderly in , almost 74 percent received all of their care from informal care givers; only a small percentage relied exclusively on formal sources of care of the sort previously mentioned Scanlon, As a result of legislative changes over the last several decades, federal spending has grown for income protection, health insurance, and other services designed to reduce high levels of poverty among the elderly.
The focus of this spending has also shifted. According to the Special Committee on Aging — , in , less than 15 percent of the federal budget was spent on the elderly; 90 percent was for retirement income and 6 percent for health care.
Retirement income accounted for approximately 67 percent, and Medicare and Medicaid benefits accounted for nearly 27 percent of these monies. The federal government also spends money on general benefit programs through the Older Americans Act social, nutritional, and employment services , the Social Services Block Grants, and research conducted through the National Institutes of Health.
Contrary to stereotype, most older persons view their health in a positive manner. In , almost 70 percent of elderly people living in the community described their health as excellent, very good, or good compared with others their own age Figure 3. The trends in life expectancy both at birth and at age 65 continue upward Table 3. The greatest gains in life expectancy at birth occurred at the beginning of the century, owing to reductions in deaths from infectious disease and in infant and childhood mortality.
Most of the increase in life expectancy in the later part of the century since has come from decreased mortality from chronic conditions among the middle-aged and the elderly populations. Life expectancy at birth differs by sex; in , life expectancy for males was Since , white females have had the highest life expectancy and black males have had the lowest NCHS, , Table The probability of surviving to age 65 has increased substantially for all race-sex groups since NCHS, b.
Life expectancy at age 65 is more pertinent to the elderly population since it estimates additional years of life anticipated after entering the elderly population. Although the differences in life expectancy at age 65 by race are small, the differences by sex are large. Males' life expectancy at age 65 ranks tenth among countries with at least one million population, and females share the rank of seventh. Age-specific death rates for the elderly have improved dramatically in the last several decades Table 3.
For example, declines in death rates have been more dramatic for those age 65 to 84 than for those age 85 and older. Additionally, decreases for older females are greater than those for older males. The top ten causes of death in the United States have changed since , the most striking change being the shift from infectious to noninfectious diseases. Today, heart disease, cancer, and cerebrovascular disease and stroke are the three leading causes of death for the elderly; two of three persons die of one of these conditions.
The death rate from stroke has been decreasing over the past 30 years, probably owing to improved control of hypertension and better diagnosis, management, and rehabilitation of stroke victims. The death rate from heart disease has also been decreasing over the last several decades, but the death rate from cancer has been increasing.
The greatest number of deaths still occur from heart disease, but deaths from cancer continue to rise relative to that number Table 3. Eliminating deaths from heart disease would add an estimated five years of life expectancy at age 65 NCHS, c. By contrast, if cancer were eliminated as a cause of death, the average life span would be extended by less than two years. Although many elderly experience declines in organ functioning and physiologic processes, this is not necessarily an inherent part of the aging process Manton, ; Guralnik and Kaplan, Since the elderly have experienced improvements in life expectancy and declines in mortality, an important issue to consider is whether these declines in mortality are accompanied by similar declines in morbidity, resulting in an elderly population with improved health status and physical functioning.
More than four of five older persons have at least one chronic condition, and many have several, although these conditions do not necessarily limit significant daily activities. The most prevalent chronic conditions expressed in terms of morbidity from these conditions in the elderly population include arthritis, hypertension, hearing impairments, and heart conditions Table 3.
Older women experience chronic conditions such as arthritis and osteoporosis more frequently than men, and older men experience acute conditions such as heart attacks more often than women. In general, the health situation of elderly blacks is poorer than that of elderly whites.
Most elderly people do not need long-term-care assistance, but many suffer from some form of impairment that limits their ability to perform basic activities of daily living ADLs Rowland et al. ADLs categorize levels of functional impairment and thus have many health care planning, research, and policy purposes, such as increasing our understanding of the population at risk of institutionalization or alternatively, in need of long-term-care services.
Functional impairment can be defined in many ways—ranging from difficulty with at least one ADL in the broad set e. Data from the National Health Interview Survey Supplement on Aging show that, of the population age 65 and older living in the community, 6 million 23 percent had difficulty with one or more personal care ADLs inventoried Table 3. Close to 1. Walking was the most frequently reported limitation, affecting 4.
The severity of ADL limitations is associated with age Table 3. Nevertheless, even at very high levels of impairment, a significant number of community residents with ADL limitations manifest long-term improvements in functioning Manton, Mental health problems of the elderly are significant in frequency and in their influence on the overall well-being of the individual. Between 15 and 25 percent of older persons have serious symptoms of mental disorders Special Committee on Aging, — , and the elderly make up a considerable fraction well beyond their proportion in the population of the institutionalized mentally ill.
For example, among all state mental hospital patients, 27 percent are age 65 and older Special Committee on Aging, — Depression is the psychiatric illness that occurs most commonly in old age; it is more prevalent than all forms of dementia and psychosis Frengley, Symptoms of depression have been described in as many as 15 percent of community residents Special Committee on Aging, — This rate may be misleading, however, because it represents primary depression, or depression that occurs for, reasons other than physical causes or drug side effects, rather than secondary depressions due to illness or drug side effects.
The elderly are more at risk for secondary depressions than any other age group. Alzheimer's disease is the leading cause of cognitive impairment in old age. Several studies have shown the prevalence of Alzheimer's disease in the older adult population to range from approximately 6 percent Special Committee on Aging to more than 10 percent Evans et al.
In addition, the prevalence rate is strongly associated with age. For example, one study of the prevalence of Alzheimer's disease in a noninstitutionalized community sample revealed that 3. Suicide is a more frequent cause of death among the elderly than any other age group owing to the high suicide rate of older white men. In , the suicide rate for white men age 65 and older was The United States will experience continued growth of the total population and the elderly population, especially among the oldest age groups.
The ratio of females to males in the elderly population will continue to rise. In addition, elderly women on average have a higher prevalence of limitations in activities of daily living, visit physicians more frequently, and are more predominant users of hospital and nursing home care than men. These trends have significant implications for demands on the Medicare program and the long-term-care system.
Because of increases in life expectancy and declining fertility rates, the ratio of elderly persons to working-age persons is increasing. This has significant economic implications, insofar as working-age persons support their own children, help support their own parents, provide for their own retirement and health care , and provide the tax base for that portion of Medicare services covered by payroll taxes and general revenues rather than those services covered by premiums.
The increase in life expectancy also manifests changes in the social circumstances of our population. For instance, there are now four generations of persons, and informal caregivers are themselves older. With more women in the work force, the demand for professional long-term-care services rather than hands-on, informal support is higher. Together these two phenomena may move health care towards a more formalized system of care. The incidence and prevalence of chronic illness increase with age, and chronic ailments are a major cause of disability requiring medical care.
The new elderly population, however, may be healthier than previous cohorts of elderly because they will have experienced a lifetime of different and better medical care.
These factors will have complex effects on future mortality rates, utilization of services, and health care expenditures.
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