Older Americans Month

According to the Population Reference Bureau (PRB) in its Fact Sheet: Aging in the United States, the population of those ages 65 and older is at an all-time high, driven by the Boomer generation (1946-1964). This creates a constellation of challenges and opportunities never encountered before in managing our economy, our institutions, and our infrastructure.

The Changing Face of Our Country

The U.S. population is getting older, and this shifting demographic is driving concurrent trends in health care and human services and how we manage them. The PRB reports:

The number of Americans ages 65 and older is projected to increase from 58 million in 2022 to 82 million by 2050 (a 47% increase), and the 65-and-older age group’s share of the total population is projected to rise from 17% to 23%.”

In its study on older adults, the National Council on Aging (NCOA), says that older people are healthier in general and living independently for longer. In fact, the NCOA reported that in 2022, an adult age 65 could expect to live, on average, for another nearly 19 years. By 2030, all Boomers will be over 65, and by 2040, just over 78 million people will be part of this demographic.

Still, most older adults are dealing with at least one chronic health condition, and some have several. In the same report, NCOA stated that in 2022, arthritis ranked first, affecting 44 percent of people 65-74. Heart disease, still the leading cause of death for all Americans, affected more than 24 percent, particularly those 75 and older, and slightly more than 20 percent of those 65+ had been diagnosed with diabetes. Being overweight was a prominent concern. Almost 42 percent of those aged 60+ were considered obese in 2022.

“These health care concerns, and the growing aging demographic will continue to make long-term care programs a primary focus for state Medicaid programs in the coming decades,” says Dave Halferty (senior manager).

Caring for Older Adults

NCOA also found that from 2021 to 2022, family caregivers, many of whom also held jobs and had children, provided care (unpaid) to a person 65 and older. Oftentimes, older adults were the ones providing care. In 2022, roughly one million grandparents ages 60+ provided care for minor grandchildren living with them. And in 2019, of the more than five million people with intellectual and developmental disabilities who were living with a family caregiver, 24 percent of those caregivers were over age 60.

Nursing Facilities

While home and community-based services or Programs of All-inclusive care of the Elderly (PACE) work to keep seniors thriving as they age in place in their own communities, nursing facilities (NFs) are essential for older adults who need more help than offered by assisted living facilities and for whom staying home is not an option.

NFs provide the highest level of care to individuals who need skilled nursing services and 24-hour monitoring and support. Typically, residents are medically stable and do not require hospitalization, but they cannot live at home due to chronic health issues.

According to data reported by the Kaiser Family Foundation (KFF), there were 14,827 certified nursing homes in the United States in 2024, which points to high demand and an essential need for these facilities and the services they provide. While NFs do provide support for activities of daily living, they provide services primarily for those with chronic conditions or who need palliative and/or rehabilitative care. The Centers for Disease Control reports that while one year is the average length of long-term care, 33 percent of today’s older adults will likely require care for more than two years.

Although most seniors will choose to use community-based services for as long as they can, NF services are a mandatory component of state Medicaid programs,” says Dave, “and demand will undoubtedly grow with the anticipated increases to the aging demographics. This will heighten the need for innovative reimbursement strategies as states strive to balance fiscal efficiency with provider access.”

Because NFs are expensive, provide complex care, and house residents who are even more fragile than their contemporaries, these programs require meticulous attention to several critical dimensions.

Cost
Data from KFF from July 2024, shows that 63 percent of residents used Medicaid as their primary source of payment, while another 13 percent relied on Medicare. Data from Genworth shows that a semi-private room cost an average of $9,277 per month, while a private room cost $10,646. Long-term care (LTC) coverage represents 32 percent of total Medicaid spending, and the average LTC total for older adults is $138,000.

Because of the high cost of these programs, it is critical that appropriate rate-setting methodologies and cost report attest work determine accurate rates. Similarly, reimbursement system design and ongoing maintenance must be the driver behind legislative and regulatory compliance for nursing facilities.
Transparency and Accountability
It is essential that provider payments conform to applicable state regulations and policies. This in turn ensures taxpayer dollars are not wasted, and that seniors are getting the services the Medicaid program funds. Ensuring accurate payment means ensuring proper financial stewardship alongside proper care. States can utilize many strategies to address the objectives including Claims audits (to detect fraud, waste, and abuse), minimum data set (MDS) assessment reviews (to ensure accurate resident assessment), and value-based payment programs (to incentivize quality outcomes).
Elder Abuse
The Nursing Home Abuse Center reports that roughly 1 in 10 NF residents are subject to some form of abuse. The National Library of Medicine reports that that figure might be even higher in long-term care facilities such as NFs.

The Cleveland Clinic identifies these types of abuse: Physical, sexual, emotional, or financial abuse, and neglect and/or abandonment. While physical and sexual abuse cause bodily harm and violation, emotional abuse can range from subtle (an ambiguous comment that is hurtful) to outright yelling and threats. In neglect, the caregiver intentionally denies basic needs such as food, warmth, shelter, or health care. Abandonment happens when the caregiver simply leaves the individual with no care at all.

Financial abuse/exploitation of older adults can come in the form of misuse, mishandling, or exploiting an adult’s asset of any kind. Various categories of financial exploitation are theft, fraud, lottery scams, romance scams, and real estate. Read more about these forms of abuse in June in our upcoming post on World Elder Abuse Awareness Day (June 15).

How Myers and Stauffer Can Help

Established in 1977, Myers and Stauffer is a nationally based consulting and certified public accounting (CPA) firm. For more than 48 years, we have worked exclusively with local, state, and federal government health and human-services agencies to help them accomplish their most critical goals for the nation’s most vulnerable people.

We are the national leader in NF acuity-based (case mix) rate setting system consulting and support. Our services include the development and maintenance of rate setting systems, evaluation of patient-driven payment model-based acuity system, regulatory and sub-regulatory language development, and the processing of large quantities of minimum data set data daily to support these systems and provide reporting to the state and provider communities.

We have helped many of our clients develop value-based payment programs to enhance their reimbursement systems and reward and encourage positive outcomes. We also provide MDS review services to many of our clients to help ensure the integrity of the MDS data used for their case mix reimbursement systems. In addition, Myers and Stauffer also has separate practice areas that provide benefit and program integrity, litigation support, and audit and attest services.