NURS 5462 Geriatric Issues Questions And
Answers| Updated
GLOBAL AGING TRENDS (2 of 3)
➢ In 2050, 80% of the global proportion of older adults will reside in less
developed regions • Individuals ≥80 yr are the fastest-growing age group in the
world ➢ Increasing at a rate of 3.8% per year
REGIONAL DISTRIBUTION OF THE OLDER US POPULATION
Half of people ≥65 yr live in 10 states, led by California, Florida, Texas, and New
York • Older adults disproportionately live in urban or suburban areas ➢ Just 1 in
5 lives in a non-metropolitan area. Between 2014 and 2050: ➢ The proportion of
adults 65 yr who are minorities will almost double, from 22% to 39%
SOCIOECONOMIC STATUS (1 of 2)
• About 10% of older adults are poor ― income below the federal poverty level •
About 41.4 million older adults are enrolled in Medicare • About 2.8 million older
adults are enrolled in both Medicare and Medicaid.
LIVING ARRANGEMENTS
,Approximately 57.4% of older adults live with a spouse • Living arrangements vary
dramatically by age, gender, and race/ethnicity subgroups ➢ For example, older
women are nearly twice as likely as older men to live alone (35.4% vs. 19.2% in
2014).
LEADING CAUSES OF DEATH
1 Diseases of heart 489,722 2 Malignant neoplasms 413,885 3 Chronic lower
respiratory disease 124,693 4 Cerebrovascular diseases 113,308 5 Alzheimer
disease 92,604
NURSING HOMES
In 2014, 1.3 million Americans lived in nursing homes • The nursing home
population has become older and more disable
OVERVIEW OF THE AFFORDABLE CARE ACT (ACA) (1 of 2)
The ACA established the Center for Medicare & Medicaid Innovation (CMI), CMI
has been tasked with developing, testing, and supporting new delivery models to
increase coordination of care and improve quality, along with new payment
systems to encourage more value-based care and move away from fee-for-service
payment
ACCOUNTABLE CARE ORGANIZATIONS (
,• Goal of coordinated care: Ensure that Medicare beneficiaries, especially the
chronically ill, get the right care at the right time, while avoiding unnecessary
duplication of services and preventing medical errors • ACOs are able to share in
the cost-savings it achieves for the Medicare program (get some savings back)
Medicare offers the following ACO programs:
➢ Medicare Shared Savings Program: Helps Medicare fee-forservice program
providers become an ACO ➢ Advance Payment ACO Model: Supplementary
incentive program for selected participants in the Shared Savings Program ➢
Pioneer ACO Model: Designed for early adopters of coordinated care
Fee For Service (FFS) Model:
Medicare makes separate payments to providers for each service they perform for
beneficiaries during a single illness or course of treatment ➢ Results in
fragmented care with minimal coordination across providers and health care
settings ➢ Rewards quantity of services, rather than quality
Bundled Payments for Care Improvement
Aligns incentives for providers (hospitals, post-acute care providers, physicians,
and other practitioners) ➢ Allows providers to work closely together across all
specialties and settings ➢ Introduced in 2013, by CMS to provide higher quality
and more coordinated care at a lower cost to Medicare, consists of 4 payment
models focused on financial and performance accountability for episodes of care
, BUNDLED PAYMENT MODELS
Services included in the bundle All Part A services paid as part of the MSDRG
payment All nonhospice Part A and B services during the initial inpatient stay,
postacute period, and readmissions All nonhospice Part A and B services during
the postacute period and readmissions All nonhospice Part A and B services
(including the hospital and physician) during initial inpatient stay and
readmissions
MEDICARE BASICS
Federal insurance program run by the Centers for Medicare and Medicaid Services
(CMS) • Pays for acute health care provided to Americans who are ages 65+,
disabled, or suffering from end-stage renal disease • As originally enacted,
comprises 2 FFS plans (Parts A and B), each of which pays predetermined amounts
for specified health-related goods and services • More than 47 million Americans
(15% of the US population) are covered by both plans
MEDICARE PART A
Coverage • Hospital, skilled nursing home, home-health, and hospice services
Does Not Cover • Routine dental or foot care, hearing aids, eyeglasses, orthopedic
shoes, cosmetic surgery, care in foreign countries, or custodial long-term care at
home or in nursing homes. Deductible for Part A : $1288 per benefit period, ie,
the first 60 days following an admission, every hospitalization
Answers| Updated
GLOBAL AGING TRENDS (2 of 3)
➢ In 2050, 80% of the global proportion of older adults will reside in less
developed regions • Individuals ≥80 yr are the fastest-growing age group in the
world ➢ Increasing at a rate of 3.8% per year
REGIONAL DISTRIBUTION OF THE OLDER US POPULATION
Half of people ≥65 yr live in 10 states, led by California, Florida, Texas, and New
York • Older adults disproportionately live in urban or suburban areas ➢ Just 1 in
5 lives in a non-metropolitan area. Between 2014 and 2050: ➢ The proportion of
adults 65 yr who are minorities will almost double, from 22% to 39%
SOCIOECONOMIC STATUS (1 of 2)
• About 10% of older adults are poor ― income below the federal poverty level •
About 41.4 million older adults are enrolled in Medicare • About 2.8 million older
adults are enrolled in both Medicare and Medicaid.
LIVING ARRANGEMENTS
,Approximately 57.4% of older adults live with a spouse • Living arrangements vary
dramatically by age, gender, and race/ethnicity subgroups ➢ For example, older
women are nearly twice as likely as older men to live alone (35.4% vs. 19.2% in
2014).
LEADING CAUSES OF DEATH
1 Diseases of heart 489,722 2 Malignant neoplasms 413,885 3 Chronic lower
respiratory disease 124,693 4 Cerebrovascular diseases 113,308 5 Alzheimer
disease 92,604
NURSING HOMES
In 2014, 1.3 million Americans lived in nursing homes • The nursing home
population has become older and more disable
OVERVIEW OF THE AFFORDABLE CARE ACT (ACA) (1 of 2)
The ACA established the Center for Medicare & Medicaid Innovation (CMI), CMI
has been tasked with developing, testing, and supporting new delivery models to
increase coordination of care and improve quality, along with new payment
systems to encourage more value-based care and move away from fee-for-service
payment
ACCOUNTABLE CARE ORGANIZATIONS (
,• Goal of coordinated care: Ensure that Medicare beneficiaries, especially the
chronically ill, get the right care at the right time, while avoiding unnecessary
duplication of services and preventing medical errors • ACOs are able to share in
the cost-savings it achieves for the Medicare program (get some savings back)
Medicare offers the following ACO programs:
➢ Medicare Shared Savings Program: Helps Medicare fee-forservice program
providers become an ACO ➢ Advance Payment ACO Model: Supplementary
incentive program for selected participants in the Shared Savings Program ➢
Pioneer ACO Model: Designed for early adopters of coordinated care
Fee For Service (FFS) Model:
Medicare makes separate payments to providers for each service they perform for
beneficiaries during a single illness or course of treatment ➢ Results in
fragmented care with minimal coordination across providers and health care
settings ➢ Rewards quantity of services, rather than quality
Bundled Payments for Care Improvement
Aligns incentives for providers (hospitals, post-acute care providers, physicians,
and other practitioners) ➢ Allows providers to work closely together across all
specialties and settings ➢ Introduced in 2013, by CMS to provide higher quality
and more coordinated care at a lower cost to Medicare, consists of 4 payment
models focused on financial and performance accountability for episodes of care
, BUNDLED PAYMENT MODELS
Services included in the bundle All Part A services paid as part of the MSDRG
payment All nonhospice Part A and B services during the initial inpatient stay,
postacute period, and readmissions All nonhospice Part A and B services during
the postacute period and readmissions All nonhospice Part A and B services
(including the hospital and physician) during initial inpatient stay and
readmissions
MEDICARE BASICS
Federal insurance program run by the Centers for Medicare and Medicaid Services
(CMS) • Pays for acute health care provided to Americans who are ages 65+,
disabled, or suffering from end-stage renal disease • As originally enacted,
comprises 2 FFS plans (Parts A and B), each of which pays predetermined amounts
for specified health-related goods and services • More than 47 million Americans
(15% of the US population) are covered by both plans
MEDICARE PART A
Coverage • Hospital, skilled nursing home, home-health, and hospice services
Does Not Cover • Routine dental or foot care, hearing aids, eyeglasses, orthopedic
shoes, cosmetic surgery, care in foreign countries, or custodial long-term care at
home or in nursing homes. Deductible for Part A : $1288 per benefit period, ie,
the first 60 days following an admission, every hospitalization
