2011.03.

10

homes)

(nursing

GDP 33

OECD
OECD 2006 38

(
)

out-of-pocket payment
(Medicare,
Medicaid)

(
)
2008

28

(
)

private long-term care insurance

(
) Medicare
Medicare

65

65
Medicare

Medicare

Medicare

Medicare
21

119
21 21 100 (co-pay)

100

Medicaid
Medicaid

(
) Medicaid

Medicaid

19

19

Medicaid
Medicare
Medicare
Medicaid

Medicaid

Medicaid

2006

Medicaid

44%
28%

Medicaid
2015
Medicaid

50%

Medicaid

2006 3,000
5,500

50

15

27
66
Medicaid

Medicaid

57

43

 Medicaid

20




1935

(Social

Security)

1950

1965 Medicare Medicaid

1970

(
)
:

care providers)

(Health

Medicare Medicaid

(California Department of Public Health, CDPH)

(Licensing

and Certification Program, L&C)

Medicare and
Medicaid
Department of Health and Human Services Centers
(U.S.

for Medicare and Medicaid Services, CMS)

L&C CMS

Medicare Medicaid
C

(
)

(
Older Americans Act)

Adult Protect Services, APS

APS

50 100

13

(
)
programs)

(Ombudsman

1965

(Older
Americans Act)

1971

(The Office of
the State Long-Term Care Ombudsman , OSLTCO)

24

(
)

1987
Nursing Home Reform Act,

(The

NHRA)

NHRA

40



1990 NHRA

12

(
)

1.

Elder Justice Abuse Act

2010

2.

1987

NHRA
Medicare
Medicaid

(
)


2008
900 65

2020

1,200

65
40

10

(
)

1. (Skilled
nursing facilities, Nursing Homes)

24 (
)

2008

150 1 6,100

66

27
7




Medicare Medicaid

2008

190

94
Medicaid
84
Medicare

(Administrator)
(Medical
Director)

(Registered Nurses and Licensed Practical Nurses)

(Certified Nurse Assistants)
(Social
workers)

& Dietary Staff)
(Nutrition

(PT & OT)

Activities)

(Recreational/

& Facilities)

(Housekeeping/Plant

Medicare

Medicaid

Medicaid

2.
living facilities, ALF)
(Assisted

24

Aging in place

2008 100 2

2015

200

3,131

 75

:
National Center for Assist Living
3. (Home care services)

20

2010
9,000

65%

300

Medicare

6,500
66

3,540

1993



Family &
Medical Leave Act

12
12

15
40

4.

(Hospice care)

2008 145

2009 55

Medicare

24 /

Medicaid

2007

3.5%
2008
90

39%

30

2008 Medicare
100 4,000 Medicare

80%

2009 2
Buffalo News

2008 46.2%

49.6%

4.2%

4,850

The National Hospice and Palliative Care Organization

The National Hospice and Palliative Care Organization

The National Hospice and Palliative Care Organization

5.
care)
(Respite

5,000

940

Medicare

Medicaid

6.
day care Center)

(Adult

2008
4,000

80%

40 100

61

Medicare

Medicaid

living)

(Assisted

7. SWOT
1.
(1)

196
1965 Medicare
Medicare Medicaid

Ski
Skilled
lled Health
ealthcare
lthcare
Group 2009



6
7,700

(2)

Medicare
Medicaid
2010

23
Medicare Medicaid
d

(3)

2010 4,680 Medicare

900

2020
1,200

(4)

(Non For
Profit, 501c(3))

(5)

65

2.
(1)

Medicare Medicaid

Medicare

(2)

(Discharge Planner)

3.

Medicare
2010 4,600
2030
8,000
20

(1)

(2)

(3)

Health Promotion

(4)

call center

4.
(1) Medicare

Medicare

2008

7%

10%

GDP 2010

(
)
2010
Medicare

$4,680

13%

4,600
2030
8,000

2019

(2)

Medicaid
Medicare

Area Age
Agency

Medicare

Medicare
Medicaid
Medicaid

Medicare Medicaid

(3)

(
) (HCR Manor Care)

2007

500 6

Toledo

(
) Golden Living
Golden Living

2009 26.5
22
300

4 2000

(
) Life Care Centers of America
Life Care Centers of America 1970
L

 28

28 230

(Retirement Center)

Beverly Enterprises Inc.

Sava Senior Care LLC Sun Healthcare Group

(
) Kindred Health Care
2011 Kindred Health
ealth Care 9 Rehab Care
are6

118
226
226

121

(
) Sun Healthcare Group
Sun 200

25
2009
3 29

2009 Sun

Allegiance Hospice Group Inc

300

2007 Sun 3.75

Harborside Healthcare
Sun 2009 18.8

3 2 Medicare Medicaid

2007 10

Bn

HCR Manor Care

38,372

280

29

3.877

Golden Living

33,757

329

22

N/A

Life Care Centers

31,244

231

28

N/A

29,106

228

27

24,002

213

25

1.59

23,195

190

13

2.029

of America
4

Kindred Health
Care

Sun Health care

Group

Genesis Health

Care Corp
7

Sava Senior Care

22,948

185

19

N/A

Extendicare

13,110

181

12

1.132

13,710

N/A

N/A

N/A

9,183

74

0.644

Health
Services
9

The
Evangelical
Lutheran
Good
Samaritan
Society

10

Skilled
Healthcare
Group

one-stop-service,

(
)

stop service)

(one

(
)

(
)

(Naturally
Occurring Retirement Community, NORC

(
)

(
)

informal caregivers

(
)

Sun Health care Group 2009

Allegiance Hospice
Group Inc

300
2007 S 3.75

Harborside Healthcare

2011 2 Kindred Healthcare 9 RehabCare

6

(
)

deliver system

NGO

(
)

1993
7%

2025
2010 10.74%

99

1,053
5,566

9 4,099

7
2 1,701 65
65

29.4
4

78.2 79

(
)

Assistant living

5 10

(
)

(
)

(
)

(
)

CQC Assisted Living Homes CQC

Dr. Theresa Chang