The Future of Care for Older Americans
A Conversation with Chuck W. Gould about the Future of Health Care and Services for Seniors
What does it mean to age successfully in America today?
Most people have an idealized view of aging. They imagine themselves bouncing their grandchild on their knee, taking up a new sport or hobby, or maybe traveling the world. Unfortunately, in many cases, life's realities set in and older Americans realize they may not have enough savings to do many of the things they had planned. More importantly, they also realize they haven't enough finances to deal with the medical care they may need down the road. It is no secret that later in life, many people start to develop a variety of chronic health problems. In some cases, individuals have to cope with several chronic diseases at the same time. How they manage those conditions is part of the reality of successful aging.
Another stark reality is that Medicare is paying out more in benefits than it brings in, and in all likelihood, will be insolvent by 2017―just eight years from now. The Social Security trust fund also is in trouble and is expected to be insolvent by 2037. Simply put, successful aging means adapting to all of these changing realities and living a good life despite the challenges.
I believe these health and income challenges can be met where older Americans most want to be―in their own homes. I believe this is possible by broadening what is available to them to make their lives more comfortable. This belief is in sharp contrast to the commonly accepted view about aging―that when an elderly loved one starts showing signs of dependency or weakness, the family caregivers must immediately consider moving them into a care facility like a nursing home. One of our goals at Volunteers of America is to expand our current in-home programs and services for seniors, and establish new and innovative programs so older Americans may receive all the care they need while living independently for as long as possible. The goal is to provide them with choice and support throughout the aging process without them having to go bankrupt in the process.
How is the current system of providing health care and services to older Americans broken?
As I mentioned before, the current system of providing health care services is driven toward acute care provided in nursing homes. What we need is to provide integrated care in a home setting and more preventive care. These are far more cost effective and appealing to older Americans.
The Medicaid system now in place to care for older Americans is not sustainable. Medicaid will not be able to pay for our nation's long-term care needs. Our nation's broken Medicaid system poses a bigger problem today than the broken Medicare system. I believe now is the time for us to radically rethink the way we care for older people in this country.
Support for long-term care must be part of the current health care debate in Congress. Substantial changes to the current senior care system need to be made this year or else the clock will run out before we reach a time of true crisis.
What are the greatest barriers affecting the quality of life for older Americans today?
Accessing long-term care services at home has become the biggest barrier. Aging services are fragmented and difficult to navigate. This makes successful aging challenging even for those with a wealth of resources and knowledge. Long-term care can cost up to $70,000 a year, but most people don’t plan for it.
Another harsh reality is that seniors have to impoverish themselves in order to qualify for the long-term care provided by Medicaid. To be Medicaid eligible, you can’t have more than $2,000 in assets, and Medicare does not include long-term care, which most people don’t realize. Proud and independent seniors, who have worked hard all their lives, should not be forces into this situation just to receive the care they need.
There is a bias in the current senior care system that favors institutional care and sends many seniors to nursing homes prematurely. The current Medicare system is acute-care focused, so it does not effectively provide for the management of chronic care or preventative care. Under the current system, nursing home care is considered to be an entitlement, while care and support in the home is not. This is a sad situation, but one that can be changed. Often, home care is much less costly than nursing care, but people are forced out of their home and into a more expensive institution in order for their care to be covered. I believe there is a better way and it can be done. We at Volunteers of America are working hard to provide more options for an aging America.
Where will the money come to fix this broken system?
If you can manage someone's chronic conditions earlier, you can reduce their health care expenses later on. Today, 11 percent of health care dollars go to long-term care. The more money we spend up front on things like preventive care, the more we will save in the future on chronic long-term care.
This is where I believe home-care or programs like PACE – Programs of All-inclusive Care for the Elderly – are more cost efficient. We can take acute-care money, move it into preventative care and save money while also allowing people to stay at home longer. The PACE programs are a great alternative to the premature institutionalization of people. They provide a support system for not only the one being cared for, but for the caregiver as well.
One possible solution comes in the form of the CLASS Act proposed by Sen. Edward Kennedy, which would provide some of the funds we need to reshape our current health care system. It is a modest investment over time, but we must plan and put money aside now. We are never going to be able to fund long-term care if we wait until we need it.
I believe the CLASS Act is one solution that shows promise in fixing the current long-term care system. Participants would have the option to pay $65 per month collected from pay roll deduction. The program would then pay out $50 a day if you develop two or more disabilities and require long-term care. No one would be excluded from participating. If passed by Congress, this voluntary program would pay for 50 percent of the cost of long-term care in the future.
What do older Americans have to offer society that other age groups might not?
Volunteers of America believes that seniors are a vital resource and an asset to their communities. That is why we strongly believe in providing as many services and programs to help keep older Americans fit and healthy and living at home or wherever they call home, for as long as possible.
We are poised to have more seniors than we ever have in the history of our nation. This unprecedented 71.5 million people who will be age 65 or older by the year 2030―almost twice the number of seniors today―will need to be cared for and Volunteers of America is planning on being there for them. This is a once in a lifetime opportunity and should be seen as an asset, not a health care drain. Seniors have both the invaluable experience and time to contribute positively in their communities; and we need to find new ways to harness the many talents they so graciously offer.
This generation of older Americans values the idea of neighbors helping neighbors. They have worked hard, sacrificed much and are always willing to go the extra mile. I believe one way to engage this new army of older Americans is by opening up opportunities for them to volunteer and help other seniors who might need a helping hand. They could help fellow seniors around the house from time to time, doing things like assisting with household chores or checking in on someone when they are sick. "Volunteer banks” have shown great potential in helping seniors connect with other seniors. This “village” concept has many advantages, but most important is the community is brought together in a common cause with each other's needs at the heart.
What are some of the emerging trends or innovations affecting older Americans future?
The culture of nursing home care is evolving. It is moving more toward smaller facilities designed with “neighborhoods” that feature dedicated care workers specialized in certain types of care. At Volunteers of America, most of our nursing facilities today are divided into different areas, each designed to address a certain set of needs. Transitional care units are for those who need temporary care and have an average stay of about 14 days; memory units care for those with conditions like Alzheimer's and have an average stay of about one year; and traditional long-term care units, which are funded by Medicaid. The new wave of older Americans on the horizon is fiercely independent and looking for ways to remain that way for as long as possible. Nursing homes will remain an alternative, but not as we have come to think of them.
I think it is important to note that there already has been a sharp decline in the number of older Americans relocating to dedicated retirement communities. The average age of new senior housing/independent living residents has increased significantly and today is age 82.
This is one of the reasons Volunteers of America already has invested heavily in technology that allows seniors to live independently longer. One such technology is called WellAware, which uses a suite of sensors that non-intrusively monitor the health status of seniors living in eldercare facilities or in their own homes. The technology provides caregivers with information about the physical status of those being monitored, and flags any variances in patterns of daily living so caregivers can respond quickly.