Disabilities

The United States spent an estimated $635 billion on the chronically ill and disabled in 2010; about half of this was spent on those dually eligible for Medicare and Medicaid. Recently, there has been a series of innovative chronic care management programs that have shown considerable promise in reducing hospital admissions, readmissions, specialty care and prescription drug use. Considerable savings could be achieved if these programs could be expanded broadly. In this paper, we argue that this should primarily be a Medicare initiative because most of the current expenditures and savings from these programs would accrue to Medicare. We estimate potential savings of close to 1% of national health expenditures.

The aging of the baby boomers represents a demographic tidal wave that will profoundly affect housing needs and living arrangements in the coming years. The authors examine three possible scenarios for the projected number and mix of households in New Orleans in 2020. But regardless of the scenario, the increase in households headed by elderly will greatly surpass the increase in any other household type. This report concludes with strategies for attracting new residents to the city and ensuring we meet the housing needs of aging residents, including the desire of many seniors to stay in their homes as long as possible.

At 40 percent of Medicare's and of Medicaid's costs, the 9 million dual eligibles who receive benefits from both programs, are a focus of efforts to slow growth in entitlement spending. But, given the two programs' responsibilities, policy-makers are relying far too heavily on states to find the solution. Dollars spent on dual eligibles are overwhelmingly federal; potential savings come from better management of Medicare-financed acute care services; and enhanced state, rather than federal, responsibility for overall spending increases the risk of cost-shifting to Medicare and may undermine quality of care for vulnerable beneficiaries.

Health care for over 9 million elderly and disabled people enrolled in both Medicare and Medicaid ("dual eligibles") is complicated by an inefficient and fragmented system. In each program, dual eligibles account for about one sixth of enrollment but almost 40% of spending. Despite health-care costs exceeding $315 billion in 2011, of which Medicare pays about 55%, both Medicaid and Medicare have shown a striking lack of leadership in coordinating care for dual eligibles. We suggest ways in which the CMS's recently proposed models could be modified to improve both the quality and cost-effectiveness of care for this population.

The Community Living Assistance Services and Supports (CLASS) Act, a provision of the landmark 2010 health law, would create a government-run, voluntary long-term care insurance program. To its supporters, CLASS is a major step toward a sustainable financing system for the care of both the frail elderly and younger adults with disabilities. But many experts believe the act's design is deeply flawed. They fear that few consumers will buy the insurance and the program will fail. Can CLASS be fixed? What changes are needed? Our panel of experts will debate various proposals.

This paper examines the health and economic status of those who collect Social Security retirement benefits prior to the full retirement age. It uses a propensity score reweighting method to estimate the fraction who use early retirement benefits as a safety net against deteriorating health and who might be induced to apply for disability benefits (SSDI) or retire without income replacement if the generosity or availability of early retirement benefits were reduced. About one in five early retirees have health characteristics similar to SSDI beneficiaries, and thus might not be able to replace losses in benefit income with labor income.

The Ohio Department of Rehabilitation and Correction and the Corporation for Supportive Housing Ohio Office developed a pilot program that provides permanent supportive housing to individuals released from several Ohio prisons. The Pilot intends to reduce recidivism and homelessness/shelter usage and decrease the costs associated with multiple service system use. The Urban Institute is evaluating the Pilot to determine whether it is meeting its intended goals. This Interim Report discusses the results of a re-arrest analysis, comparing the outcomes of individuals who received permanent supportive housing to those who did not. Implications from the analysis are also discussed.

After accounting empirically for methodological differences, three national population-based surveys from the period between 1999 and 2002 provide similar estimates of the size and characteristics of the older residential care population: About 2.2 million persons age 65 or older (6.5 percent) live in supportive settings, about 1.45 million of them in nursing homes and nearly 800,000 in alternative residential care. Depending on survey definitions of "facility" versus community settings, however, the estimated proportion of the residential care population in “community” settings ranges from about half to three-quarters. Elders in community residential care appear to have less severe disability and are far more likely to report no ADL or IADL disabilities than those in “facility” alternatives to nursing homes. The age and gender distribution of persons in residential care alternatives and nursing homes is similar, but those in residential care alternatives more likely to be white and less likely to have extremely low incomes.