Long-term services and supports (LTSS) are a system of accommodations for persons who cannot perform activities of daily living (ADLs) or instrumental ADLs for more than 3 months.
1 Activities of daily living are activities that are essential for fundamental functioning, such as grooming, dressing, and cleaning oneself. Instrumental ADLs are activities that allow one to live independently in a community, such as cooking, cleaning, and managing money and medication.
1,2 Therefore, these persons require assistance in the form of supportive care and supervision, adaptive technology, and housing. As of 2013, it is estimated that over 12 million people in the United States rely on LTSS.
1 In persons older than 65 years, approximately two-thirds will use these services during their lifetimes.
3 In this demographic group, it is predicted that by 2050, the population of people aged 65 and 85 years will double and triple, respectively, from 2012.
3
The most pressing problem elderly persons and their families face is the financing of LTSS. Most elderly persons exclusively receive care from some 42 million family members, the majority of whom are women.
4 The estimated value of the care that family members provide is $450 million per year in the United States, but family members receive no reimbursement.
4 Instead, because of the lost productivity from missed and shorter work days, our economy loses $34 billion annually, and family caregivers earn $300,000 less in their lifetime.
1 One could instead choose to place his or her loved one in a nursing home, but these costs can range from $41,000 to $100,000 annually, depending on the state of residence and the type of room (eg, shared vs private).
4 Community-based care with home health aides is another, less expensive option. A typical family pays close to $20 per hour for approximately 30 hours per week, which equates to an estimated $30,000 per year.
4 With the average total assets of a retired family being only $64,000,
4 and the anticipated growth in the number of elderly persons needing LTSS, the lack of affordable options for these vital services is a challenge. In this article, I review the current financing model and stakeholders for long-term care and offer guidance for osteopathic physicians toward a potential solution for LTSS.