TABLE OF CONTENTS


CHAPTER 1. INTRODUCTION…………………………………1


Statement of the Problem………………………………………..2


Purpose of the Study ………………………..……………………3


Importance of the Study …………………………………………3


Scope of the Study………………………………………………. 4


Rationale of the Study…………………………………………… 4


Definition of Terms………………………………………………. 5


Overview of the Study…………………………………………… 5


CHAPTER 2. REVIEW OF RELATED LITERATURE…………6


CHAPTER 3. METHODOLOGY…………………………………14


Approach………………………………………………………… 14


Data Gathering Method………………………………………… 14


Database of Study………………………………………………. 15


Validity of Data…………………………………………………….. 15


Originality & Limitation of Data………………………………… 15       


Summary…………………………………………………………  16


References…………………………………………………………16


 


 


 


CHAPTER 1


INTRODUCTION


 


Introduction


Approximately thirty four million people over the age of 65 are currently living in the United States. For this reason, the health care system is facing new challenges in caring for this growing population. Assisted living facilities have emerged as one of many solutions in combating this overwhelming demand on the health care system by elderly patients. As time progresses the elderly population grows at a continuous rate. Thereby the need for facilities to accommodate their needs is a growing concern for the health care industry. Many elderly patients are seeking alternative forms of care without needing continuous specialized nursing care.


Therefore the industry of assisted living plays a vital role. This paper presents the research proposal on the future of health care of the elderly in the United States. Specifically, the research will focus on how the elderly can afford assisted living. In this proposal, the background, context and theme of the study are presented; the objectives of the study and the research statements are formulated. Here, vital concepts, questions and assumptions are stated. Finally, the scope and limitation of the study, methodology to be used and the significance of the research are discussed.


Statement of the Problem


Since the American demographic is aging at a much higher rate the demand for health care becomes a major issue on prescription drugs, health insurance, and especially on assisted living. Though there are facilities available affordability becomes an increasing and an urgent issue. As a result, the future of the elderly seems uncertain. The health care system in the United States continues to be in crisis. The US is the only industrialized country in the world that has not established universal health coverage. The loss of health coverage and delays in care has resulted in thousands of deaths (Himmelstein & Woolhandler, 1994). Social workers in the health care industry are witnesses to the suffering that results from not having access to assisted living.


 


Assisted Living is a market-responsive option that has literally changed the landscape of the senior living continuum. But from affordability perspective, the concept serves only about one third of the seniors that should benefit from this delivery system. So what are the possible pathways to afford assisted living? What must be done to ensure that seniors can afford appropriate care? What different approaches to financing maybe possible?


 


Purpose of the Study


 


The main purpose of this study is to show how the elderly can afford an assisted living and how we can show them that they still have financial opportunities and access to assisted living.


 


Importance of the Study


This study will be a significant endeavor in promoting awareness in assisted living facilities for elderly awareness. The study will critically examine different health care services and how they benefit (or not benefit) elderly. With this, the researcher hopes to find significant findings and provide important recommendations that will be helpful for authorities in designing health care programs. It shall suggest a call for concerned authorities to have an awareness program for older adults before they reach 65 so that they know what and when to take care of things and be prepared and make decisions before going out of hand so that they can have access to proper health care. Moreover, this study will be useful for researchers on elderly and assisted living.


Scope of the Study


This research study will only attempt to discuss issues on assisted living. The outcome of this study will be limited only to the data gathered from books and journals about health care for the elderly in the US.


 


Rationale of the Study


In the current health care environment, which is driven by the pursuit of profit not patient need (Riffe, 1998), access to health care in the US is not a right but instead a commodity to be bought and sold. If you cannot afford it, you cannot have it. Worse, if one is sick, if she/he has a “pre-existing condition”, she/he can be denied insurance coverage. If an aged person need health care she/he is less likely to get it. This is the perverse logic at the center of for-profit health care provision–insurers do not want to insure groups that are considered “high-utilizers” which include elderly people. This categorization of patients is dehumanizing and stigmatizing.


 


Definition of Terms


Elderly- For the purpose of this study, elderly individuals refer to those 65 year-olds and above.


Health care – It is a general term referring to the delivery of medical services by specialist providers.


Insurance It is the business of providing protection against financial aspects of risk, such as those to property, life and health.


Medicare – It is a publicly funded health insurance scheme for the elderly and disabled only.


Medicaid This program provides health insurance for the poor.


 


Overview of the Study


This research will use the descriptive approach. It will be divided in five chapters. The first chapter discusses the background of the study and the nature of the problem. The second chapter provides a review of related literature, followed by a chapter that discusses the methodology that will be used. The fourth chapter presents the findings based on the collated materials. The last chapter concludes the study by summarizing findings and providing recommendations. 


 


CHAPTER 2


REVIEW OF RELATED LITERATURE


Changes in the age structure of the American population are challenging in planning, providing, and paying for health care services for individuals over 65 years of age. According to the American Society on Aging (1988), the group 85 years and older is growing three to four times faster than the general population and is in particular need of health, social, and personal care services due to physical or mental limitations which hinder independent functioning. According to the United States Administration on Aging (1997), there are 34 million American elderly. The number of Americans aged 65 and older has increased from 3.1 million in 1900 to 33.9 million in 1990. Since 1900, the percentage of older Americans has more than tripled, from 4.1% in 1900 to 12.8% in 1996 (USAA, 1997).


The fastest growing segment of the U.S. population is those over 85 years of age, growing 31 times larger since 1900. In 1996, Americans reaching age 65 had an average life expectancy of an additional 17.7 years, 19.2 years for women and 15.5 for men. By 2030, the number of Americans 100 years old and older is expected to increase up to 8 times (USAA, 1997). Longer life expectancy and aging of the population in general suggest the number of elderly with long-term care needs is increasing dramatically.


The Unites States health care system has come a long way from where it used to be. It has also created a lot of problems for itself as well as causing some citizens to lose faith in it.  The Unites States is at the top of the list when it comes to technological advances, possibly due to the fact that in 2000 over $ 1,299.5 trillion were spent of general health care expense.


Compared to other developed nations in the world, the Unites States spends the most money on health care, however at the same time receiving the lowest quality of services. This problem is based upon the fact that so many Americans are uninsured, whereas approximately 15%of the population lacks health insurance completely.  This among other factors has some people to believe that the United States needs to change drastically to a “Universal” health care system. However most Americans are against this theory that Health care becomes a free good, which could inevitably lead to “unlimited demand”. When that happens, the only way to control costs is to simply limit the supply (Michael McCarthy 621). Because there are immense amount of doctors, health care administrators and insurers are unable to solve the problem.


 


There is little consensus on exactly what the assisted living describes or what it encompasses. Some arrangements include very few personal services; others involve rather extensive health care. Assisted living facilities (ALFs) are usually more home-like than nursing homes. Often, they provide private suites or small apartments that typically include private baths. Residents usually bring along their own furniture. Consumers usually pay for assisted living on their own, since neither Medicaid nor other government programs cover assisted living.


As the population ages, the concept of assisted living is gaining new currency. In the US, ALFs is experiencing an annual growth rate of 15 percent to 20 percent. Hawes, Rose and Phillips (1999) estimate that over 600,000 elderly people reside in assisted-living communities. However, relatively little research has been conducted in these facilities, as most of the research conducted in ALFs focused on organizational and structural components of assisted-living communities (General Accounting Office [GAO], 1999).


Assisted-living facilities emerged rapidly in the late 1980s in response to pressing demographic and economic demands. The assisted-living industry has emerged so rapidly that the states licensing ALFs and the businesses developing these facilities have not reached consensus on a precise definition. There is general agreement, however, that assisted living constitutes a special type of housing, not licensed as a nursing home, that offers supportive and health care services for individuals who require help with daily activities. According to the American Seniors Housing Association (1998), ALFs constitute 75 percent of all new housing construction for elderly people.


States have a strong incentive to support housing strategies to delay the transition of older adults to nursing homes. Nursing home costs account for 45 percent of all Medicaid expenditures (Hooyman & Kiyak, 1996). Research suggests that senior housing with supportive services can be a cost-effective alternative to nursing home care (Leon, Cheng, & Neumann, 1998). Indeed, the Assisted Living Federation of America (ALFA) (1998) states that the average daily rate for assisted living in a private room is , whereas the daily rate for nursing home care is 7.


According to the American Association of Retired Persons (AARP) (1999), the ultimate goal of assisted living is to maintain or enhance the ability of frail elderly people to remain as independent as possible in a home-like environment and to age in place. In response to this goal, nearly all ALFs provide or arrange for 24-hour staff, three meals a day, and housekeeping. The vast majority also provide assistance with taking medicines and with some activities of daily living (ADLs), such as dressing, bathing, and grooming (AARP).


Literature shows that most elderly prefer to remain in their own homes for as long as possible (Rowland & Lyons, 1991). Community-based long-term care is increasingly viewed as the most appropriate alternative to enable an aging population to maintain their independence (Kane & Kane, 1987). Paid home care is one means of helping individuals with routine and often repetitive tasks of daily living. Paid home care can range from social services (homemaker/chore, assistance with bathing and toileting) to more health-related services (nursing and nurses aides, monitoring medication).


According to Feder (1991) and Rivlin (1988), there has been a great deal of research on health care expenditures for acute care (physician or hospital) and institutionalized long-term care (nursing homes), but much less is known about the costs of maintaining elderly in the community through noninstitutionalized care. A majority of long-term care expenditure data has focused on skilled care, such as nursing services; few sources of data beyond Medicare and Medicaid records have been available to examine the full range of home care use, sources of financing, or out-of-pocket expenditures. Given the many gaps in current public and private programs, when paid home care is utilized the elderly and their family members typically bear the costs (Feder 1991).


Potentially, the elderly individual has access to multiple resources to meet the costs of health care services. According to Health Care Financing Administration (2000), out-of-pocket spending on prescription drugs increased 411 percent between 1970 and 1997; prescription drug expenses represent the single largest component of out-of-pocket spending on health care. Prescription drug expenses account for as much as those spent on physician care, vision care services, and medical supplies combined (Gibson, Brangan, Gross, and Caplan, 1999). Jackson (1999) states that many seniors with low income and multiple health problems are forced to choose between health care and other consumption needs. According to the American Enterprise Institute (1999), more than 10 percent of seniors spend up to ,000 annually on prescription drugs and nearly one-fourth of Medicare beneficiaries are living on less than 0 per month.


For most of the elderly seeking health care, the resource of first resort is Medicare. Medicare finances health care for 38 million people and pays 20 percent of the U.S. health care bill (McFall & Teitelman, 1999). Although it provides basic medical coverage for virtually all of the US’s seniors who are aged 65 and older and for those under age 65 with certain severe disabilities, it does not pay for prescription medication. As a result, seniors often turn to other insurance sources to defray costs of prescription drugs and other medical expenses. About 1 in 10 seniors have assets and income low enough to qualify for Medicaid (Rogowski, Lillard, and Kington, 1978).


About one-third of Medicare beneficiaries do not have coverage for prescription drugs and, among those who do, coverage is often inadequate relative to expenses (Gibson et al., 1999). Furthermore, prescription drug coverage is becoming increasingly expensive to obtain because both public and private insurers have shifted costs to the ultimate consumer in the form of higher premiums, deductibles, and co-payments.  Some insurance providers have cut-back or eliminated coverage for prescription drugs.  


Generally, studies on out-of-pocket spending on prescription drugs find that seniors are heavy users of medical care, accounting for more than 35 percent of all health care expenditures, 34 percent of all prescriptions dispensed, and 42 percent of prescription drug expenditures (Rubin, Koelln, and Speas, Jr., 1995). Consumers aged 65 and older devote a larger proportion of total health expenditures to health insurance, prescription drugs, and medical supplies, as compared with the proportion for consumers aged 64 and younger (Rubin and Koelln, 1993). In a study by Families USA, the cost of the top 50 prescription drugs used by seniors increased at four times the rate of inflation during 1998 (Hall, 1999). When public and private insurers shift the costs of health care goods and services to the ultimate consumers, such cost increases for prescription drugs can represent a major financial burden for seniors.


 


 


CHAPTER 3


METHODOLOGY


 


Research Approach


This study will employ the descriptive research method using observation. In this method, it is possible that the study would be cheap and quick. Nonetheless, it would be very hard to rule out alternative explanations and especially infer causations. Descriptive research is a type of research that is primarily concerned with describing the nature or conditions and degree in detail of the present situation (Creswell, 1994). The emphasis in this type of research is to describe rather than to judge or to interpret.


Data Gathering Method


The data will come from published articles from journals, books and studies on health care, assisted living, and related issues on insurance, prescription drugs and housing. For this research design, the author will gather data, collate published studies and make a content analysis of the collected documentary and verbal material.  Afterwards, the author will summarize all the information, make a conclusion provide insightful recommendations on the dealing with organizational management.


 


Database of the Study


            The researcher will gather data, collate published studies from different local and foreign authors, and articles from social science books and journals on health care for the elderly, specifically assisted living.


 


Validity of Data


As regard to the validity of the study, the author will try to treat materials objectively. The presentation and discussion of issues will be based solely on the content of the data gathered.


 


Originality and Limitation of Study


The originality of this study lies on its pursued capacity of being one of the few sources of specific information focused on assisted living facilities provided for the US’s elderly population. This study will also recommend pathways to affordable assisted living. The absence of interview and survey serves as the major limitation of this study. With this, the author will try to relate previous studies to the current situation.


 


Summary


The research will be a descriptive study using previous studies as bases for the conclusion and recommendation. The database of study will be social sciences books and journals on health care. The major limitation of the study lies in its methodology, in which no survey or interview will be conducted.


 


References


American Enterprise Institute (1999). Should Medicare’s basic benefits include prescription drugs? Available at [www.aei.org/ra/rahelms.htm]. Accessed [03/02/04].


                                  


Brenner, E. (1999). As HMOs flee, the elderly wonder, Who pays now? New York Times, February 28, Section 1, 1.


 


Creswell, J.W. (1994) Research design. Qualitative and quantitative approaches. Thousand Oaks, California: Sage.


 


Feder, J. (1991). Paying for Home Care: The Limits of Current Programs. In Financing Home Care: Improving Protection for Disabled Elderly People, D. Rowland and B. Lyons (eds.), Baltimore, MD: Johns Hopkins University Press: 27-50.


 


Gibson, M. J., Brangan, N., Gross, D. and Caplan, C. (1999). How much are Medicare beneficiaries paying out-of-pocket for prescription drugs? Washington, DC: AARP Public Policy Institute.


 


Hall, D. J. (1999). Drug prices put squeeze on the elderly. Wisconsin State Journal, November, 4, A1, A3.


 


Health Care Financing Administration (2000). National Health Expenditure Projections 1998-2008. Available at [www.hcfa.gov/stats/NHE/-Proj/]. Accessed 03/02/04].


 


Himmelstein, D., and Woolhandler, S. (1994). The national health program book. Monroe, ME: Common Courage Press.


 


 


Jackson, B. (1999). Paying for prescription drugs worries Medicare recipients.  Available at [www.enn.com/ ALLPOLITICS/stories/1999/03/16/jackson.prescriptions]. Accessed [03/02/04].


 


Kane, R. and Kane, R. (1987). Long Term Care: Principles, Programs and Policies. New York: Springer Publishing.


 


McFall, N., & Teitelman, A. (1999). The rise of managed care: The impact on consumers, community-based organizations, and social workers. Social Work Networker, January, 8.


 


Riffe, H. (1998). The managed care experience: The social worker’s perspective. Social Work in Health Care, 28, 1-9.


 


Rivlin, A. and Wiener, J. (1988). Caring for the Disabled Elderly: Who Will Pay? Washington, DC: Brookings Institute.


 


Rogowski, J., Lillard, L. A. and Kington, R. (1978). The financial burden of prescription drug use among elderly person. The Gerontologist, 1978, vol. 37 no. 4, pp. 475-82.


 


Rowland, D. and Lyons, B. (1991). The Elderly Population in Need of Home Care. In Financing Home Care: Improving Protection for Disabled Elderly People, D. Rowland and B. Lyons (eds.), Baltimore, MD: Johns Hopkins University Press: 3-26.


 


Rubin, R. M. and Koelln, K. (1993). Out-of-Pocket health expenditure differentials between elderly & nonelderly households. The Gerontologist, 333(5), 595-602.


 


Rubin, R. M., Koelln, K. and Speas, Jr., R. K. (1995). Out-of-pocket health expenditures by elderly households: Change over the 1980s. Journal of Gerontology: Social Sciences, 50B(5), 291-300.


 


United States Administration on Aging. (1997).A Profile of Older Americans. In Citymeals Quick Facts: The Growing Elderly Population in the United States. Citymeals. Available at [http://www.citymeals.org/get_meals/elderly_population.html]. Accessed [13/01/04].


 


 


 


 


 



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