Experts offer solutions for improving the long-term care system
About 10,000 baby boomers turn 65 each day – a trend that is expected to continue until 2029, according to Dr. Bruce Chernof of the SCAN Foundation. When the last of the baby boomers turns 65 in 2030, about one in five Americans will be 65 and older, he says, and most of them will require roughly three years of long-term care at a cost of $72,000 annually, or $216,000. Yet, only about 35 percent of Americans have set aside enough money to address this issue, he points out, and fewer still have even discussed their preferences with their families.
Recently, a group of long-term-care experts participated in the PBS-hosted forum, “Global and Regional Models for Long-term Care: Can They Work Nationally?” All people want to age with dignity, independence and choice, according to Chernof, in an address to the forum. For some, this means residing in a nursing home. But, for many, it means continuing to live in their homes and communities, near friends and family. “That’s a really different mindset when it comes to providing and planning for long-term care services and supports,” he said.
Following is a list of six “tips” compiled by PBS based on insights from six panelists at the forum:
Tip #1. Howard Gleckman, author of Caring for our Parents.
“I would suggest community and bottom-up solutions. One of the real problems we have had in this country is trying to find the single answer. In truth, there are probably many different answers, and different communities are going to come up with different solutions. To the degree that we can, government can at least try to stay out of the way of these solutions, and perhaps even take the next step and encourage them. There’s a lot you can do in terms of helping people stay at home. [Friends and neighbors can provide transportation, visits and meals.] Some communities have created villages within their community through different models: There are villages that require membership and pay dues; there are some that have a professional staff; some are all-volunteer; and some are related to faith-based organizations. I have even seen hospitals and nursing homes doing outreach into their communities to achieve similar goals. The one issue that concerns me a little bit about the village model is that, for the most part, it seems to be working for upper-middle-class, highly educated white people. For some reason, we haven’t found the key to make this particular design work in lower-income minority communities. So that’s why I say those local organizations should figure this out for themselves, and the role of government, the role of nonprofits, should be to support those solutions.”
Tip #2. Dr. Mark McClellan, senior fellow and director of the Health Care Innovation and Value Initiative at the Brookings Institution, former FDA commissioner and former CMS administrator.
“One important way to make long-term-care work better in the United States is to move our financing away from silos, where we have separate funding for Medicaid, separate funding for out-of-pocket costs, separate funding for acute healthcare costs. We need to put it together and let people control how that money is spent on their behalf. That’s what’s behind our ‘Money Follows the Person’ initiatives around the country, that’s what’s behind integrated care approaches in states like Minnesota. All of those steps are important for getting to better long-term care at a more sustainable cost. These programs get implemented at the local level, but they depend a lot on federal and state funding, and traditionally, our funding has gone to institutions like long-term-care facilities, and not to the individuals who use those institutions. So putting more of those dollars under the control of individuals can lead to better outcomes and lower costs. People can use those resources to stay in the community. They can use those resources to help get coordination of services to prevent avoidable hospitalizations. They can stay out of the nursing home and avoid other very costly outcomes that otherwise we’d have to pay for on the healthcare side.”
Tip #3. Dr. E. Percil Stanford, president of Folding Voice and the KIND Corporation, a San Diego, Calif.-based group that provides housing for low-income older people.
“During the past several decades, long-term care policies and programs have gained significant momentum at the state and federal levels. Unfortunately, considerable attention has focused primarily on the middle and upper classes. Personal savings and private insurance are not impact areas that reform or vastly improve the quality of long-term care for millions of poor older people. According to some sources, the percent of poor people 65 and older has been as high as 23 percent during the past three years. To ensure that current and emerging millions of poor and near-poor individuals, particularly the aged, have equal access to long-term care services and supports, existing federal, state and local agencies and organizations should be charged with having a laser-like focus on this burgeoning wave of potential long-term care recipients.”
Tip #4. Debra Whitman, executive vice president for policy, strategy and international affairs, AARP.
“The United States is vastly unprepared to meet the long-term-care needs of our rapidly aging society. While some states and local communities are developing innovative systems, we need a comprehensive national strategy to help people remain in their homes as they age, including:
- Concrete steps to ease the burden on family caregivers.
- More resources in public programs like Medicaid steered toward care in one’s home and away from institutions.
- New ways of thinking about local communities and the supports they offer to optimize independence, including developing more houses, apartments and transportation systems that are accessible and affordable.
- Better integration with healthcare services and expanded use of technology to help people live independent, secure and engaged lives as they age.
- A more effective, seamless financing system that enables individuals and families to pay for services they need without having to impoverish themselves.”
Tip #5. Jennie Chin Hansen, CEO, American Geriatrics Society.
“Current research shows that seven of 10 of us will require longer-term assistance, sometimes modest but often significant over a period of years (even longer for women, given their greater longevity). We need to dip our toes in that conversation, covering topics as to who can and will provide support, where we hope to reside, how much we might need to live on and what is most important to us along the way, but especially when life becomes most challenging.”
Tip #6. Dr. Laura Gitlin, professor and founding member of the Center for Innovative Care in Aging, Johns Hopkins University School of Nursing.
“We need to grow a long-term care system based on multiple principles [one of which is] that long-term care is a basic right. Finland has a government-sponsored approach to long-term care, and it’s included in their equivalent of a Bill of Rights. From there, we need to expand on our understanding of what long-term care is and what long-term-care needs are. So, it’s not just about self-care and instrumental activities but it’s really about the entire gamut of needs that older adults have, particularly those with complicated conditions such as co-morbidities and functional limitations. So, it’s not just about enabling people to be able to stay at home and have their self-care and instrumental activities needs met, but also have other equally important needs met, such as engagement in meaningful activities and socialization and integration in the community. I also think that, in the United States, it isn’t going to be one system. One system does not meet all the different needs of individuals, whether they be very poor or the near-poor or those that can afford long-term care insurance. We are going to have to come up with mixed models and strategies and probably a lot of private-public partnerships and involvement in the community.”
Source: PBS NewsHour. For more information visit http://www.pbs.org/newshour/rundown/2013/11/6-tips-for-better-long-term-care-for-us-seniors.html.
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