Imagine a world where elders lived happily at home into their late 80s and 90s, independent and connected with their communities, but also helped by programs and services that ensured their well-being, assisted with medications, provided transportation, and maybe did the laundry.
If they got too sick or too frail to stay at home, they could choose from an array of residential options – assisted-living facilities, nursing homes – without worrying about the cost, because government or private insurance would cover it all.
Seifert Systems Invests in Energy Efficiency to Strengthen Operations
For manufacturers, energy is more than just another operating expense. It plays a critical role…
Learn More
And they wouldn’t have to worry about waiting lists, or about being treated badly, because the system as a whole would be of high quality, with plenty of resources for all.
For the very wealthy, to a great extent, this is already the case.
Now, a national commission is trying to help make long-term care better for all elderly Americans – and for the growing number of people who will live into their 80s, 90s and even 100s in the coming decades.
The National Commission for Quality Long-Term Care, co-chaired by former U.S. Sen. Bob Kerrey and former House Speaker Newt Gingrich, is preparing a report – due to be released soon – that aims to draw a “roadmap” for improving long-term care nationwide.
The report will focus on six key areas: “culture transformation” within the long-term care system; empowering individuals and families; improving work conditions within the system; leveraging technology to enhance independence and improve care; improving the regulation of the system and aligning it with quality improvement efforts; and improving the public and private financing systems, to ensure all Americans have access to care.
To help guide its work, the commission enlisted researchers Vincent Mor and Edward Allan Miller at the Center for Gerontology and Health Care Research at Brown University. This month, Mor and Miller shared their findings with the commission and the public, offering a glimpse of where national policy may be heading.
“We’ve been talking about the aging of the population for a long time, and now it’s starting to happen,” Miller said in an interview. Most baby boomers won’t start turning 85 – the height of long-term care use, the researchers say – for another three decades. But “policy change takes a long time,” Miller said, “so you’ve got to start early.”
There are also “serious problems with the current system,” he noted, so it’s important to make changes for today’s elders. And there’s a growing recognition of these issues, he said, as baby boomers watch their parents age.
“This is something that’s becoming very real to people,” Miller said, “and maybe they can see themselves in their parents’ shoes.”
Mor’s and Miller’s findings are outlined in a 100-page report, “Out of the Shadows,” that is available online at www.chcr.brown.edu. And while recent public policy discussions of long-term care in Rhode Island have focused on regulation, inspections or, at the other end of the spectrum, controlling Medicaid costs, this report’s priority is elders’ quality of life.
It begins by noting the “growing recognition that loneliness, helplessness and boredom plague the provision of long-term care in the United States.” It also notes the frustration that elders and their caregivers feel about the “disjointed array of federal and state policies that reimburse, regulate and stimulate the development of long-term care services.”
Elders and their families are frustrated by the limited choices available, the report notes, and they fear entering a nursing home, “with the loss of control and individuality associated with these institutions,” so they’d much rather have better community-based services.
The report does not, by any means, prescribe all the answers, but it does point in general directions.
In long-term care financing, for example, it notes that while one-third of adult Americans think they have private insurance coverage for long-term care, fewer than 10 percent of the elderly actually have such coverage – and private insurance plans paid for only about 4 percent of all long-term care costs in 2004.
The reports also notes that the policies of Medicare and Medicaid – which cover nearly two-thirds of nursing home residents – can get in the way.
There are positive signs of change, Miller said: States have gotten Medicaid waivers to provide community-based services to elders who would otherwise go into costlier nursing homes; and the U.S. Deficit Reduction Act of 2005 has taken that concept further, establishing monetary incentives to provide community-based care and allowing the states to offer such support, with no waiver required, to anyone up to 150 percent of the poverty line.
The system is also beginning to get better at raising public awareness of long-term care issues, of the need to prepare financially, and of the options available – which helps empower elders and their families, Miller said. In that vein, the report says it is important to increase options for respite care, which provides some rest for unpaid caregivers.
One particularly tricky area, Miller said, is information technology. Long-term care providers are far behind the hospital industry in adopting health care IT, he said, and so far, they haven’t been invited to be part of larger-scale health-information networks (Rhode Island is working to develop a statewide network that is to include hospitals as well as individual doctors’ practices and outpatient facilities, such as labs).
Since most nursing home residents come from hospitals, and many return to hospitals, it makes a lot of sense to share information among those facilities, Miller said, but even hospitals with their own long-term care facilities have found it difficult to integrate networks.
