(ADL) 4 and instrumental activities of daily living (IADL), 5 regardless of the physical location where such assistance is provided. 6 LTSS settings may include, among others, nursing homes, assisted living facilities, continuing care retirement communities, and the private home of the service recipient7 or that of the recipient’s family member(s) or friends. 8 LTSS may be delivered by many different types of individual, institutional, and agency actors, and LTSS service delivery among multiple actors may occur in either a coordinated or disjointed manner. 9 “About 70 percent of those aged 65 and older are likely to need long-term services and supports at some point in their lives, for an average of 3 years. Twenty percent will need that care for at least 5 years.” 10 Following this brief introductory section, the article outlines the basic nature and forms of consolidation currently in progress or active discussion among various healthcare providers and third-party payers, including long- term care insurers. The ensuing section delineates potential general impacts, both detrimental and salutary, of health industry consolidation, with a
4. Mary Grace Kovar & M. Powell Lawton, Functional Disability: Activities and Instrumental Activities of Daily Living, 14 ANN. REV. GERONTOLOGY & GERIATRICS 57, 61-63 (1994) (self-care tasks including functional mobility, bathing and showering, dressing, self- feeding, personal hygiene and grooming, and toilet hygiene). 5. M. Powell Lawton & Elaine M. Brody, Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily Living, 9 GERONTOLOGIST 179, 180-81 (1969) (activities that allow an individual to live independently in a community, including housework, preparing meals, taking medications, managing money, shopping, use of telephone or other form of communication, and transportation within the community). 6. Laura D. Hermer, Rationalizing Home and Community-Based Services Under Medicaid, 8 ST. LOUIS U. J. HEALTH L. & POL’Y 61, 61 n.2 (2014). 7. For purposes of the present discussion, I indulge my own bias and henceforth refer to persons who need and attempt to receive LTSS as LTSS “consumers.” Marshall B. Kapp, The Ethical Foundations of Consumer-Driven Health Care, 12 J. HEALTH CARE L. & POL’Y 1 (2009). I do this despite the controversy that sometimes attaches to the use of “consumer” in the health care context. See generally Carl E. Schneider & Mark A. Hall, The Patient Life: Can Consumers Direct Health Care?, 35 AM. J.L. & MED. 7 (2009); see also Mark A. Hall & Carl E. Schneider, Patients as Consumers: Courts, Contracts, and the New Medical Marketplace, 106 MICH. L. REV. 643 (2008); see also Kristin Madison, Patients as “Regulators”?, 31 J. LEGAL MED. 9, 9-10 (2010). 8. Graham D. Rowles & Pamela B. Teaster, The Long-Term Care Continuum in an Aging Society, in LONG-TERM CARE IN AN AGING SOCIETY: THEORY AND PRACTICE 3, 18 (Graham D. Rowles & Pamela B. Teaster eds., 2015); see generally ROBYN I. STONE, LONG-TERM CARE
FOR THE ELDERLY WITH DISABILITIES: CURRENT POLICY, EMERGING TRENDS, AND IMPLICATIONS FOR THE TWENTY-FIRST CENTURY (2000). 9. See Robert B. Hudson, The Aging Network and Long-Term Services and Supports: Synergy or Subordination?, 38 GENERATIONS 22, 28 (2014); see also W. Thomas Smith, An Overview of Long-Term Care Services and Support in America, 29 MISS. C. L. REV. 387, 387- 88 (2010). 10. U.S. GOV’T ACCOUNTABILITY OFF., GAO-15-190, OLDER ADULTS: FEDERAL STRATEGY NEEDED TO HELP ENSURE EFFICIENT AND EFFECTIVE DELIVERY OF HOME AND COMMUNITY-BASED SERVICES AND SUPPORTS 5 (2015).
