Table of Contents
ONE: EXECUTIVE SUMMARY
U.S. LONG TERM CARE INDUSTRY
SCOPE AND METHODOLOGY
OVERALL MARKET SIZE
LONG TERM CARE
DEMOGRAPHICS
Geographic Concentrations
Activities of Daily Living
Chronic Illness
Income
QUALITY OF CARE
CONSUMER PREFERENCES AND LIFESTYLE ISSUES
FEES AND PAYMENT
Public Payments
Long Term Care Insurance
PREPARING FOR THE FUTURE
NURSING HOMES
Number of Facilities
Resident Population
Issues and Trends
Market Size and Forecast
Competitor Analysis
Market Analysis
HOME CARE
Number of Facilities
Resident Population
Issues and Trends
Market Size and Forecast
Competitor Analysis
Market Analysis
HOSPICES
Number of Facilities
Resident Population
Issues and Trends
Market Size and Forecast
Competitor Analysis
Market Analysis
ASSISTED LIVING
Number of Facilities
Resident Population
Issues and Trends
Market Size and Forecast
Competitor Analysis
Market Analysis
TWO: LONG TERM CARE INDUSTRY, ISSUES AND TRENDS
THE U.S. HEALTH CARE INDUSTRY
LONG TERM CARE
Nursing Homes
Home Care
Hospices
Assisted Living
DEMOGRAPHICS
U.S. Population
Aging of the Population
Racial Trends
Obesity
Marital and Living Arrangements
Geographic Concentrations
Activities of Daily Living
Chronic Illness
Addiction
Mental Illness
Income
HEALTH CARE REFORM
QUALITY OF CARE
Certification and Accreditation
U.S. HEALTH EXPENDITURES
CONSUMER PREFERENCES AND LIFESTYLE ISSUES
The Elderly
Caregiver Issues
FEES AND PAYMENT
Medicare
Medicaid
Long Term Care Insurance
Numbers of Insured
Cost of Coverage and Affordability
Hybrid Plans
Effect of the Economy
THE MANAGED CARE ENVIRONMENT
PREPARING FOR THE FUTURE
Staffing and Human Resources
Information and Education Initiatives
Medicaid Reform
Building of New Facilities
Information Technology
THREE: NURSING HOMES
DESCRIPTION OF FACILITIES
Services
Number of Facilities
RESIDENT POPULATION
Demographic Data
Functional Data
Length of Stay
Insurance Coverage
ISSUES AND TRENDS
Reimbursement Cuts
Health Care Reform
Reform of Requirements for Long-term Care Facilities
Patient Dumping
Quality of Care
Staffing Issues
Federal Quality Improvement Initiatives
State Quality Improvement Initiatives
Legal Actions
Safety
MARKET SIZE AND FORECAST
Cost of Care
Size of the Market
COMPETITOR ANALYSIS
MARKET ANALYSIS
FOUR: HOME CARE
DESCRIPTION OF FACILITIES
Services
Number of Facilities
RESIDENT POPULATION
Demographic Data
Functional Data
Insurance Coverage
ISSUES AND TRENDS
Medicare Reimbursement
Medicaid Reimbursement
Medicare and Medicaid Co-payments
Home and Community Based Services
State Service Reductions
Improper Payments
Quality of Care
Disease Management
Caregiver Burnout
Technology and Telemedicine
MARKET SIZE AND FORECAST
Cost of Care
Size of the Market
COMPETITOR ANALYSIS
MARKET ANALYSIS
FIVE: HOSPICES
DESCRIPTION OF FACILITIES
Services
Number of Facilities
RESIDENT POPULATION
Demographic Data
Functional Data
Insurance Coverage and Hospice Profitability
ISSUES AND TRENDS
Fraud and Abuse
Health Care Reform
Proprietary Technologies
Profitability
MARKET SIZE AND FORECAST
Cost of Care
Size of the Market
COMPETITOR ANALYSIS
MARKET ANALYSIS
SIX: ASSISTED LIVING
DESCRIPTION OF FACILITIES
Services
Number of Facilities
RESIDENT POPULATION
Demographic Data
Functional Data
Length of Stay
Insurance Coverage
ISSUES AND TRENDS
Health Care Reform
Quality of Care
Federal Quality Improvement Initiatives
State Quality Improvement Initiatives
Safety
Mergers and Acquisitions
Consumer Knowledge and Information
MARKET SIZE AND FORECAST
Cost of Care
Size of the Market
COMPETITOR ANALYSIS
MARKET ANALYSIS
SEVEN: MARKET SUMMARY
OVERVIEW
ISSUES AND TRENDS
Continuum of Care
Reimbursement and Regulatory Changes
Specialty Care
Competitive Bidding
Mergers, Acquisitions and Divestitures
MARKET SIZE AND FORECAST
COMPETITOR ANALYSIS
EIGHT: PROFILES
AMEDISYS, INC.
History and Lines of Business
Long-Term Care Business
Financial Information
Mergers and Acquisitions
Corporate Strategies
AMERICAN HOME PATIENT
History and Lines of Business
Financial Information
Mergers and Acquisitions
Corporate Strategies
APRIA HEALTHCARE GROUP INC/ BLACKSTONE GROUP
History and Lines of Business
Long-Term Care Business
Financial Information
Mergers and Acquisitions
Corporate Strategies
ATRIA SENIOR LIVING
History and Lines of Business
Long-Term Care Business
Financial Information
Mergers and Acquisitions
Corporate Strategies
BROOKDALE SENIOR LIVING
History and Lines of Business
Long-Term Care Business
Financial Information
Mergers and Acquisitions
Corporate Strategies
EXTENDICARE, INC.
History and Lines of Business
Long-Term Care Business
Financial Information
Mergers and Acquisitions
Corporate Strategies
GENESIS HEALTHCARE
History and Lines of Business
Long-Term Care Business
Financial Information
Mergers and Acquisitions
Corporate Strategies
GENTIVA HEALTH SERVICES (now part of KINDRED AT HOME)
History and Lines of Business
Long-Term Care Business
Financial Information
Mergers and Acquisitions
Corporate Strategies
GOLDEN LIVING
History and Lines of Business
Long-Term Care Business
Financial Information
Mergers and Acquisitions
Corporate Strategies
HCR MANOR CARE, INC.
History and Lines of Business
Long-Term Care Business
Financial Information
Mergers and Acquisitions
Corporate Strategies
KINDRED HEALTHCARE, INC.
History and Lines of Business
Long-Term Care Business
Financial Information
Mergers and Acquisitions
Corporate Strategies
LIFE CARE CENTERS OF AMERICA
History and Lines of Business
Long-Term Care Business
Financial Information
Mergers and Acquisitions
Corporate Strategies
LINCARE
History and Lines of Business
Long-Term Care Business
Financial Information
Mergers and Acquisitions
Corporate Strategies
SUNRISE SENIOR LIVING INC.
History and Lines of Business
Long-Term Care Business
Financial Information
Mergers and Acquisitions
Corporate Strategies
VITAS HEALTHCARE
History and Lines of Business
Long-Term Care Business
Financial Information
Mergers and Acquisitions
Corporate Strategies
LIST OF EXHIBITS
ONE: EXECUTIVE SUMMARY
Table 1-1 The Overall U.S. Long Term Care Market 2011 – 2020 (Nursing Home Care, Home Care, Hospice Care, Assisted Living, Total)
TWO: LONG TERM CARE INDUSTRY, ISSUES AND TRENDS
Table 2-1 Projected U.S. Resident Population, by Age, Selected Years, 2015-2050 (Under 18 years, 18-64 years, 65-84 years, 85-99 years, 100 and over, Total Population)
Table 2-2 U.S. Expectation of Life at Birth, by Sex and Race, 2015 (White women, Black women, White men, Black men)
Table 2-3 U.S. Life Expectancy Projections in Years, 2015 – 2060 (Men, Women, Average)
Table 2-4 U.S. Resident Population, by Gender and Age, 2013 (Male Population, Female Population; 65 to 69 years, 70 to 74 years, 75 to 79 years, 80 to 84 years, 85 to 89 years, 90 years and over, Total 65 and older)
Table 2-5 U.S. Resident Elderly Population, by Age, Hispanic Origin, and Race, Selected Years, 2012, 2030, 2050 (Hispanic origin: 65 and over, 65 to 84 years, 85 and over; Non- Hispanic White: 65 and over, 65-84 years, 85 and over; Non-Hispanic Black: 65 and over, 65-84, 85 and over; Non-Hispanic American Indian, Eskimo, Aleut: 65 and over, 65-84, 85 and over; Non-Hispanic Asian, Pacific Islander: 65 and over, 65-84, 85 and over)
Table 2-6 U.S. Resident Elderly Population, by Age, Hispanic Origin, and Race, Selected Years, Percent (%), 2012, 2030, 2050 (Hispanic origin: 65 and over, 65-84 years, 85 and over; Non-Hispanic white: 65 and over, 65- 84 years, 85 and over; Non-Hispanic black: 65 and over, 65- 84 years, 85 and over; Non-Hispanic American Indian, Eskimo, Aleut: 65 and over, 65-84 years, 85 and over; Non-Hispanic Asian, Pacific Islander: 65 and over, 65-84 years, 85 and over)
Table 2-7 Characteristics of U.S. Household Population of Persons 65 and Older, 2013
Table 2-8 Marital Status of U.S. Residents Age 65 and Older, 2013 (Male: 65 to 74 years, 75 to 84 years, 85 years and over, Total; Female: 65 to 74 years, 75 to 84 years; 85 years and over, Total)
Table 2-9 Marital Status of U.S. Residents Age 65 and Older, by Percent, 2013 (Male: 65 to 74 years, 75 to 84 years, 85 years and over, Total; Female: 65 to 74 years, 75 to 84 years; 85 years and over, Total)
Figure 2-1 U.S. Senior Population in Top 10 States, 2013 (California, Florida, Illinois, Michigan, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Texas)
Table 2-10 U.S. Resident Population, by State and Age, 2013
Table 2-11 Estimated Number of Nursing Home Residents by State, 2013
Table 2-12 Disability Prevalence by Age, 2013 (Under 15 years, 15 to 24 years, 25 to 44 years, 45 to 54 years, 55 to 64 years, 65 to 69 years, 70 to 74 years, 75 to 79 years, 80 years and over)
Table 2-13 Frequencies of Selected Diseases among Older U.S. Persons, 2013 (Diabetes, Ulcers, Kidney disease, Liver disease, Arthritis, Chronic joint symptoms; Under 65 years, 65 to 74 years, 75 years and over)
Table 2-14 Frequencies of Selected Diseases among Older U.S. Persons, by Percent, 2013 (Diabetes, Ulcers, Kidney disease, Liver disease, Arthritis, Chronic joint symptoms; Under 65 years, 65 to 74 years, 75 years and over)
Table 2-15 U.S. Median Income by Householder Age, 2014 (15–24, 25–34, 35–44, 45–54, 55–64, 65 and over)
Table 2-16 Funding Sources for National Health Expenditures, 2011 – 2020 (Total, Out-of-Pocket Payments, Private Health Insurance, Medicare, Medicaid, Other Health Insurance Programs, Total Insurance Paid, Other Third Party Payers)
Table 2-17 Funding Sources for Home Health Care Spending, 2011 – 2020 (Total, Out-of-Pocket Payments, Private Health Insurance, Medicare, Medicaid, Other Health Insurance Programs, Total Insurance Paid, Other Third Party Payers)
Table 2-18 Funding Sources for Nursing Home Spending, 2011 – 2020 (Total, Out-of-Pocket Payments, Private Health Insurance, Medicare, Medicaid, Other Health Insurance Programs, Total Insurance Paid, Other Third Party Payers)
Table 2-19 Selected State Budget Shortfalls in Fiscal 2015 (Alabama, Alaska, Arizona, Connecticut, Illinois, Indiana, Kansas, Louisiana, Maryland, Massachusetts, Michigan, Nebraska, New Hampshire, New Jersey, North Carolina, Pennsylvania, Rhode Island, Vermont, Virginia, Washington, West Virginia, Wisconsin)
THREE: NURSING HOMES
Table 3-1 Primary Payment Sources for Nursing Home Residents, by State, 2013 (Medicaid, Medicare, Private/Other, Total)
Figure 3-1 Medicaid Nursing Home Payment Freezes and Cuts, by State, 2010 – 2012 (Payments Delayed (for SFY 12), Undecided (for SFY 12), Instituted rate freeze, Instituted rate cut, Neither cut nor froze rate)
Table 3-2 U.S. Nursing Home Deficiencies by State, 2012 (Number of Facilities, Average Number of Deficiencies, % of Facilities with Deficiencies, % of Facilities with Serious Deficiencies)
Figure 3-2 Nursing Home Customer Satisfaction for Long Term Residents (Family, Resident; Highest satisfaction: Respectfulness of staff, RN/LVN/LPN care, Safety of facility; Lowest satisfaction: Adequate staff to meet needs, Quality of meals, Security of personal belongings)
Table 3-3 The U.S. Nursing Home Market, by Revenues, 2011 – 2020
Table 3-4 Leading Competitors in the U.S. Nursing Home Market, by Revenues and Market Shares, 2015
FOUR: HOME CARE
Table 4-1 Medicare Home Care Patients and Visits, by State, 2011 (Total Persons Served in Thousands, Persons Per 1,000 Medicare Enrollees, Visits in Thousands, Visits Per Person Served, Visits per 1,000 Medicare Enrollees, Total Charges in $ Thousands)
Table 4-2 Medicare Fee-for-Service Home Health Outlays, Visits, Clients, Payment/Client, and Visits/Client, Calendar Years 1996-2011
Table 4-3 The U.S. Home Health Care Market, by Revenues, 2011-2020 Exhibits
Table 4-4 Leading Competitors in the U.S. Home Health Care Market, by Revenues and Market Shares, 2015
FIVE: HOSPICES
Figure 5-1 Services Offered to Hospice Patients’ Family and Friends (Bereavement, Spiritual, Medication Management or administration, Patient activities of daily living, Safety training, Equipment use, Caregiver health or wellness, Dietary, Referral or resource information, Dealing with difficult behaviors)
Table 5-1 Number of Medicare-certified Hospices and Program Payments, by State, 2010 (# of Hospices, # of Hospice Patients, # of Covered Hospice Days, Covered Hospice Days per Hospice Patient)
Figure 5-2 Proportion of Hospice Patients by Length of Service, 2012 (<7 days, 8-29 days, 30-89 days, 90-179 days, 180+ days)
Table 5-2 Mean Length of Hospice Stay, According to Disease Category (Alzheimer’s disease, Nervous system diseases except Alzheimer’s, Dementia, Organic psychosis, Chronic airway obstruction, Nonspecific symptoms or signs, Debility, Heart failure, Circulatory disease except heart failure, Other cancer, Lung cancer, Other disease, Respiratory disease, Digestive disease, Genitourinary disease, All)
Figure 5-3 Drugs Prescribed to U.S. Hospice Patients in the Last Week of Life (Narcotic analgesic, Antiemetic, Laxative, Antipsychotic, Diuretic, Proton pump inhibitor, Bronchodilator, Antidepressant, Antacid, Antiarrythmic, Corticosteroid, Antidiabetic, Antianginal, Antihyperlipidemia, Nonsteroidal anti-inflammatory drug, Baby aspirin or Plavix)
Table 5-3 Average Medicare Reimbursements for Hospice Care, FY 2015 (Routine home care (per day), Continuous home care (per day), Inpatient respite (per day), General inpatient care (per day))
Table 5-4 The U.S. Market for Hospice Care, by Revenues, 2011-2020
Table 5-5 Leading Competitors in the U.S. Hospice Market, by Revenues and Market Shares, 2015
SIX: ASSISTED LIVING
Table 6-1 The U.S. Market for Assisted Living, by Revenues, 2011-2020 Exhibits
Table 6-2 Leading Competitors in the U.S. Assisted Living Market, by Revenues and Market Shares, 2015 SEVEN: MARKET SUMMARY
Table 7-1 The Overall U.S. Long Term Care Market, 2011 – 2020 (Nursing Home Care, Home Care, Hospice Care, Assisted Living, Total)
Table 7-2 Long Term Care Industry Revenues by Sector, Selected Years, 2011 – 2020 (Nursing Home Care Share, Home Care Share, Hospice Care Share, Assisted Living Share, Total)
Figure 7-1 Long Term Care Industry Revenues by Sector, Selected Years, 2011, 2015, 2020 (Nursing Home, Home Care, Hospice, Assisted Living)
Figure 7-2 Long Term Care Industry Revenues by Year, 2011, 2015, 2020
Table 7-3 Long Term Care Industry Revenues by Major Player, 2015 (Nursing Home Care, Home Care, Hospice Care, Assisted Living, Total)
