US demand to be driven by demographic changes
Through 2018, growth in US elder care service revenues will be stimulated by demographic changes, especially by the large “baby boom” generation entering retirement years and longer life expectancies. Both of these trends will contribute to the rising size of the older population. Growth in elder care services will be further spurred by modified regulations, as improved coverage of these services, especially through Medicare, allows for greater flexibility and more choices for patients. Elder care service providers compete functionally with informal caregivers, typically family members; however, a growing number of older adults either do not have family members who are able to care for them or simply prefer using professional care.
Home healthcare will be fastest growing segment
In 2013, skilled nursing facilities, with 45 percent of the total, accounted for the largest share of elder care service revenue. However, home healthcare is projected to exhibit faster growth. Advances will be driven by the shift in preference among the older population to age in place, remaining in their homes as long as possible, as well as by regulatory changes that improve coverage of these home-based services. The ability of more seniors to utilize home-based services rather than institutional care will be further aided by advancements in medical technology, such as remote monitoring and a new generation of personal emergency response systems.
Continuing care retirement communities (CCRCs) will also see growth, as housing markets improve and housing values increase, boosting the ability of elderly individuals to raise money for the steep entry fees at CCRCs. More seniors appreciate the less institutional feel and convenience of lifetime care from independent living as opposed to skilled nursing care at a single location.
Social services (e.g., senior centers, adult day care, companion services, non-medical home care or homemaker services, respite care, and group support services) will also see increased demand. Such nonmedical care can postpone or negate the need for more expensive skilled nursing facilities or other institutional care services. The growing availability of home and community based Medicaid waivers will further benefit the market. Assisted living provides similar non-medical care, but in an institutional setting.
Government programs will remain leading pay source
Government programs remain the leading payment source for the elder care service industry, despite efforts to rein in expenditures. In 2013, Medicaid and Medicare combined to account for more than half of payments for elder care services. This dominance makes elder care service industry highly reliant on and reactive to government reimbursements; changes in reimbursement rates, coverage, or eligibility can have a significant impact on the industry.
Out-of-pocket expenditures continue to be essential for continuing care communities and assisted living facilities, as many non-medical care costs are not covered by Medicare or Medicaid. Private insurance usage will see aboveaverage gains in light of both the longterm care insurance industry maturing as more seniors have coverage and consumer concerns over the governments’s ability to pay for future elder care needs. Other payment sources include charitable donations, private grants, and other government resources such as the US Veterans’ Administration.