# Presentation: 481458

## Slide 1

**Notes:**
Image of cover page of “Older Americans 2008:  Key Indicators of Well Being.”

## Slide 2

**Notes:**
Health Care Section divider page

## Indicator 29 – Use of Health Care Services

**Notes:**
This first chart for Indicator 29 - Use of Health Care Services – shows that between 1992 and 1999, the hospitalization rate increased from 306 hospital stays per 1,000 Medicare enrollees to 365 per 1,000. The rate then decreased to 350 per 1,000 enrollees in 2005. The average length of a hospital stay decreased from 8.4 days in 1992 to 5.7 days in 2005. Skilled nursing facility stays increased significantly from 28 per 1,000 Medicare enrollees in 1992 to 79 per 1,000 in 2005. Much of the increase occurred from 1992 to 1997. 

## Indicator 29 – Use of Health Care Services

**Notes:**
This second chart for Indicator 29 - Use of Health Care Services – shows that Between 1992 and 2005, the number of physician visits and consultations increased. There were 11,359 visits and consultations per 1,000 Medicare enrollees in 1992, compared with 13,914 in 2005. The number of home health care visits per 1,000 Medicare enrollees increased rapidly from 3,822 in 1992 to 8,227 in 1997. Home health care use increased during this period in part because of an expansion in the coverage criteria for the Medicare home health care benefit.40 Home health care visits declined after 1997 to 2,295 per 1,000 enrollees in 2001. The decline coincided with changes in Medicare payment policies for home health care resulting from implementation of the Balanced Budget Act of 1997. The visit rate increased thereafter to 2,770 per 1,000 enrollees in 2005. 

## Indicator 30 – Health Care Expenditures

**Notes:**
This first chart for Indicator 30 - Health Care Expenditures - shows that after adjusting for inflation, health care costs increased significantly among older Americans from 1992 to 2004. Average costs were substantially higher at older ages. 

## Indicator 30 – Health Care Expenditures

**Notes:**
This second chart for Indicator 30 - Health Care Expenditures - shows that hospital and physician services are the largest components of health care costs of the elderly. Long-term care facilities accounted for 14 percent of total costs in 2004. Prescription drugs accounted for 15 percent of health care costs. The mix of health care services changed between 1992 and 2004. Inpatient hospital care accounted for a lower share of costs in 2004 (25 percent compared to 32 percent in 1992). Prescription drugs increased in importance from 8 percent of costs in 1992 to 15 percent in 2004. “Other” costs (short term institutions, hospice and dental care) also increased as a percentage of all costs (4 percent to 8 percent). 

## Indicator 31 – Prescription Drugs

**Notes:**
This first chart for Indicator 31 - Prescriptions Drugs - shows that average prescription drug costs for older Americans have increased rapidly in recent years. Average costs per person were $2,107 in 2004. Average out-of-pocket costs also increased, though not as rapidly as total costs because private and public insurance covered more of the cost over time. Older Americans paid 60 percent of prescription drug costs out of pocket in 1992, compared with 36 percent in 2004. Private insurance covered 38 percent of prescription drug costs in 2004; public programs covered 25 percent.

## Indicator 31 – Prescription Drugs

**Notes:**
This second chart for Indicator 31 - Prescriptions Drugs - shows that the number of Medicare beneficiaries enrolled in Part D prescription drug plans increased from 18.2 million in June 2006 to 19.7 million in September 2007. In September 2007, two thirds of enrollees were in stand-alone plans and one-third were in Medicare Advantage plans. In addition, approximately 6.5 million beneficiaries were covered by the Retiree Drug Subsidy in both years. Beneficiaries who were not in Part D plans and not covered by the Retiree Drug Subsidy either had drug coverage through another source (e.g., Tricare, Federal Employees Health Benefits plan, Department of Veterans Affairs, or current employer) or did not have drug coverage. In September 2007, 5.9 million Part D enrollees were receiving low income subsidies. Many of these beneficiaries had drug coverage through the Medicaid program prior to enrollment in Part D. 

## Indicator 32 – Sources of Health Insurance

**Notes:**
This chart for Indicator 32 - Sources of Health Insurance – shows that Most Medicare enrollees have a private insurance supplement, approximately equally split between employer sponsored and Medigap policies. The percentage with Medicaid coverage has increased slightly over the last several years to about 12 percent in 2005. Enrollment in Medicare HMOs and similar health plans, which are usually equivalent to Medicare supplements because they offer extra benefits, varied between 6 percent and 21 percent. About 12 percent of Medicare enrollees report having no health insurance supplement. Enrollment in HMOs and similar health plans increased rapidly throughout the 1990s, then decreased beginning in 2000 as many HMOs withdrew from the Medicare program. The percent with Medigap policies decreased in the late 1990s as HMO enrollment increased. There was a slight increase in the percentage of Medicare enrollees without a supplement in 2002. 

## Indicator 33 – Out-of-Pocket Health Care Expenditures

**Notes:**
This chart for Indicator 33 - Out-of-Pocket Health Care Expenditures – shows that from 1977 to 2004, the percentage of household income that people age 65 and over allocated to out-of-pocket spending for health care services increased among those in the poor/near poor income category (from 12 percent to 29 percent).   The percentage of household income that people age 65 and over allocated to out-of-pocket spending among those in the other income category increased from 5 to 8 percent.

## Indicator 34 – Sources of Payment for Health Care Services

**Notes:**
This chart for Indicator 34 - Sources of Payment for Health Care Services – shows that Medicare paid for slightly more than one half (53 percent) of the health care costs of Medicare enrollees age 65 and over in 2004. Medicare finances most of their hospital and physician costs, as well as a majority of short term institutional, home health, and hospice costs. Medicaid covered 9 percent of health care costs of Medicare enrollees age 65 and over, and other payers (primarily private insurers) covered another 19 percent. Medicare enrollees age 65 and over paid 19 percent of their health care costs out-of-pocket, not including insurance premiums. In 2004, 48 percent of long-term care facility costs for Medicare enrollees age 65 and over were covered by Medicaid; another 45 percent of these costs were paid out-of-pocket. Fifty five percent of prescription drug costs were covered by third party payers other than Medicare and Medicaid, consisting mostly of private insurers. Thirty-two percent of prescription drug costs were paid out-of pocket. Seventy-six percent of dental care received by older Americans was paid out-of pocket. 

## Indicator 35 – Veterans’ Health Care

**Notes:**
This chart for Indicator 35 - Veterans' Health Care – shows that In 2006, approximately 2.4 million veterans age 65 and over received health care from VHA. An additional 1.1 million older veterans were enrolled to receive health care from VHA but did not use its services in 2006. 

## Indicator 36 – Nursing Home Utilization

**Notes:**
This first chart for Indicator 36 - Nursing Home Utilization – shows that In 2004, 9 people per 1,000 age 65–74 resided in nursing homes, compared with 36 people per 1,000 age 75–84 and 139 people per 1,000 age 85 and over. The total rate of nursing home residence among the older population declined between 1985 and 2004. In 1985, the age adjusted nursing home residence rate was 54 people per 1,000 age 65 and over. By 2004 this rate had declined to 35 people per 1,000. Among people age 65– 74, rates declined by 24 percent, compared with a 37 percent decline among people age 75–84 and age 85 and over. 

## Indicator 36 – Nursing Home Utilization

**Notes:**
This second chart for Indicator 36 - Nursing Home Utilization – shows that In 2004, the majority of nursing home residents age 65 and over received assistance with at least one activity of daily living (ADL). Levels of assistance provided for individual ADLs were high, from 94 percent for bathing to 73 percent for transferring. The only ADL for which the majority of residents received no assistance (65 percent) was eating. 

## Indicator 37 – Residential Services

**Notes:**
This first chart for Indicator 37 - Residential Services – shows that In 2005, 2 percent of the Medicare population aged 65 and over resided in community housing with at least one service available. Approximately 5 percent resided in long term care facilities. The percentage of people residing in community housing with services and in long-term care facilities was higher for the older age groups; among individuals age 85 and over, 7 percent resided in community housing with services, and 17 percent resided in long-term care facilities. Among individuals age 65–74, 98 percent resided in traditional community settings. 

## Indicator 37 – Residential Services

**Notes:**
This second chart for Indicator 37 - Residential Services – shows that People living in community housing with services had more functional limitations than traditional community residents, but not as many as those living in long term care facilities. Forty-six percent of individuals living in community housing with services had at least one activity of daily living (ADL) limitation compared with 26 percent of traditional community residents. Among long-term care facility residents, 82 percent had at least one ADL limitation. Forty percent of individuals living in community housing with services had no ADL or instrumental activities of daily living (IADL) limitations. 

## Indicator 38 – Personal Assistance and Equipment

**Notes:**
This first chart for Indicator 38 - Personal Assistance and Equipment – shows that Between 1992 and 2005, the age adjusted proportion of people age 65 and over who had difficulty with one or more ADLs and who did not receive personal assistance or use special equipment with these activities decreased from 42 percent to 35 percent. More people are using equipment only—the percentage increased from 28 percent to 36 percent. The percentage of people who used personal assistance only decreased from 9 percent to 7 percent. In 2005, nearly two-thirds (65 percent) of people who had difficulty with one or more ADLs received personal assistance or used special equipment: 7 percent received personal assistance only, 36 percent used equipment only, and 22 percent used both personal assistance and equipment. 

## Indicator 38 – Personal Assistance and Equipment

**Notes:**
This second chart for Indicator 38 - Personal Assistance and Equipment – shows that In 2005, more than three-fifths of people age 65 and over who had difficulty with one or more IADLs received personal assistance. The percentage of people receiving personal assistance was higher for people age 85 and over (74 percent) than it was for people age 75–84 (67 percent) or people age 65–74 (63 percent). There was no significant change between 1992 and 2005 in the percentage of people (in any age group) who had difficulty with one or more IADLs and who received personal assistance. Men and women were equally to receive assistance. 

## SPECIAL FEATURE - Literacy

**Notes:**
This special feature chart on Literacy shows that the majority of older Americans face literacy challenges. In 2003, 60 percent of people age 65 and over had below basic or basic document and prose literacy, and 71 percent had below basic or basic quantitative literacy. Only 3 percent to 5 percent of older Americans had proficient literacy in any component. Between 1992 and 2003, the percentage of older Americans that had below basic prose, document, and quantitative literacy decreased significantly, from 33 percent to 23 percent for prose, from 38 percent to 27 percent for document, and from 49 percent to 34 percent for quantitative.

## SPECIAL FEATURE – Health Literacy

**Notes:**
This special feature chart on Health Literacy shows that Older adults are proportionately more likely to have below basic health literacy than any other age group. Almost two-fifths (39 percent) of people age 75 and over have a health literacy level of below basic compared with 23 percent of people age 65–74 and 13 percent of people age 50–64. 

## Slide 21

**Notes:**
This chart is titled The Historical Experience of Three Cohorts of Older Americans: A Timeline of Selected Events 1923-2008.  The timeline lists the 1923, 1933, and 1943 cohorts.  Selected events include the year, historical events, and legislative events.