Out-Of-Pocket Cost

Even with the substantial contribution of public funds, the elderly bear a considerable financial burden for health care out of their own pockets. Direct out-of-pocket health costs for the elderly averaged 15 percent of their income in 1984- the same as before Medicare and Medicaid were enacted. Direct out-of-pocket health expenses for the elderly averaged $1,059 per person by 1984. The majority of these expenses are for nursing home care, physician visits and services, and health aids not covered by Medicare, Medicaid, or private insurance.

Chart 2

Where The Out-Of-Pocket Dollar For The Elderly Goes: 1984

Medicare

In 1984, Medicare was responsible for 49 percent of all personal health care expenditures. Costs for hospitals, which account for over 69 percent of all dollars Medicare spends for health care, are fueling Medicare's growth. The Congressional Budget Office has estimated that only 2 percent of the projected annual average 13.2 percent growth in hospital reimbursements from 1984 to 1985 will be due to the aging of the population.

SOURCE: Health Care Financing Administration, Office of Financial and Acturial Analysis

Medicaid

Medicaid pays about 13 percent of personal health care expenditures for the elderly, the great majority of which is for that small portion of the population using long-term care. The gap between funding by Medicare, Medicaid, and out-of-pocket costs for health care for the elderly is covered by private insurance, foundations, and other Government sources such as the Veterans Administration, Department of Defense, Indian Health Service, States, and counties.

In Mississippi, according to the Division of Medicaid report, July 1, 1984 - June 30, 1985, skilled/dual nursing homes rendered 1,678,342 days of care to 7189 Medicaid patients. The cost of this care was $54,589,709, or an average of $32.53 per day. By the same report, Intermediate Nursing Homes rendered 2,191,251 days of care to 8,592 Medicaid patients, at a cost of $58,307,676, an average of $26.61 per day.

In its community based long term care program, the Council on Aging utilizes Social Services Block Grant Funds (SSBG) to support the following array of services (FY 86):

Total: $4,907,680 (includes administration, state and local match and program income)

Under the Medicaid Home and Community Based Waiver Program, now a reality in Mississippi, approximately $478,000 is budgeted for a two county demonstration project in FY 87. Waivered services include case management, day care, homemakers, health aides, and respite care.* The intent of this program is two-fold: 1) to test cost effectiveness of community based services; and 2) to determine appropriate service level of community based programs for long term care clients.

"...Older Mississippians are confronted with a myriad of problems, including a declin-
ing state economy, over which they have little control."

• The Medicaid Waiver Program is administered by the Medicaid Division in agreement with the Council on Aging.

Elder Mississippians and Their Needs

The number of Mississippians 60+ will grow by 15 percent by the end of the century and reach almost one half million. This is a 140 percent increase since 1950. The "graying" of Mississippi will continue to reflect national trends with a population increase of 183 percent in the 75+ population from 1950-2000. This latter group, as has been pointed out, comprise the most frail, at risk group to whom long term care services are targeted.

Poverty Among the Elderly

Approximately 32 percent of all Mississippians 60+ live below sanctioned national poverty guidelines. This represents a population of approximately 140,000 older adults. The incidence of poverty increases with age among all elderly and at an even higher rate among minority elderly. Minority females and individuals living alone constitute the poorest segment of the older population. Priorities among this poverty group are medical bills, food stamps, purchase discounts, repair services, utility bills and transportation.

Life Satisfaction

Among the major findings in the MCOA Needs Assessment* is a critically strong relationship between socio-economic status (SES) and life satisfaction. Those reporting inadequate incomes, serious health problems, lower education levels and social isolation, report significant levels of life dissatisfaction. These elderly report significant disabilities in social relationships, lack of awareness of services and entitlements, more serious emotional problems, high stress and high levels of loneliness and boredom. This latter correlate is of particular significance in levels of life dissatisfaction, thereby indicating that community programming which stresses social interaction and collegial activities of a group or communal nature may significantly enhance levels of life satisfaction. Such programs are likely to be less costly and, therefore, more available than services focused more narrowly on health or physical needs. The point to be made, is that programs which ensure ongoing social relationships rapidly need to be enhanced in support of needed health care modalities.

However, for the group depicted above, disabilities are multiplied at an exponential rate, i.e., a disability in one area, isolation for example, leads to other disabilities. A profile of high life dissatisfaction elderly is: female, minority, lives alone, has unattended medical problems, and inadequate nutrition. This is, additionally, a population which is highly socially isolated, has few or no social contacts, and engages in little or no volunteer activities.

Highly Demanded Services

MCOA's needs assessment has documented the following as highest priority programs as reported by elderly along with a number of professionals such as agency directors, and human and health services executives.

High priority services are those dealing with public education regarding consumer protection against various frauds and/or "con" games which prey particularly upon the elderly, coupled

*The sampling ratio of the needs assessment is 1:242 people 60+