Academic journal article Generations

The Aging Services System-When It's 64

Academic journal article Generations

The Aging Services System-When It's 64

Article excerpt

A researcher's vision of the aging services network by the year 2030 encompasses a more person- and family-centered, coordinated, and integrated service system that offers quality care outcomes.

The aging services network was developed almost half a century ago, when we were a relatively youthful country, with the Older Americans Act in 1965 providing a framework for this initial development. As the Act reaches its half-century mark, the network is reshaping its roles and responsibilities. This is in response to demographic shifts, increased demand for person-centered and consumer-directed care, federal- and state-level healthcare reform emphasizing prevention, care coordination and service integration, the need for more competent, professional staff, and a focus on paying for performance based on improved quality outcomes at lower costs.

Over the next fifteen years, the rapid aging of the population and its increasing diversity-ethnic, racial, and economic-will create new challenges and opportunities for the aging services network. While there is no crystal ball to provide us with answers, I offer my vision of the aging services system as it turns 64.

A Vision for 2030

Given the range of factors that will influence the nature and scope of service delivery in the future, it is impossible to predict how the service system will evolve. A dramatic change in regulatory or reimbursement policy, for example, could significantly affect the types of services and approaches to delivery. A new financing mechanism for long-term services and supports (LTSS) would substantially increase the resources that middle-class individuals and families have to pay for services-particularly home- and community- based care. The speed of technological advances will influence how and where services are delivered. And major scientific breakthroughs, such as cures for Alzheimer's Disease or Parkinson's Disease, could obviate the need for some types of service delivery. With these caveats, my vision for 2030 assumes the evolution of a more person- and family-centered, coordinated, and integrated service system to meet the needs and preferences of people with disabilities across the age spectrum.

The role of family caregivers

Family caregivers will probably continue to play a pivotal role delivering services and supports and navigating between care settings. But to the extent that it is financially feasible and preferred, caregivers will augment their hands-on care and oversight by buying home- and community-based services (HCBS) and technology. Non-kin informal caregivers- including partners, neighbors, and friends- may assume more responsibility for those who lack close relatives or who do not live in close proximity to family members. Technological advances-including the development of Web-based social networks, personal devices, sensors, and electronic medication reminders- will support more long-distance caregiving, leading to a greater number of geriatric care managers and brokers to assist in these efforts.

Family caregivers will have access to more formal training, provided through an array of community-based organizations within the aging services network and offered through multiple modalities, including online. Increased demand for respite services will encourage the development of more adult day health centers that are open on weekends and evenings. The federal Family and Medical Leave Act, which requires employers of a certain size to grant unpaid leave to family caregivers, may follow the lead of states such as California and require employers to make paid leave available to employees with significant caregiver responsibilities.

The role of the nursing home

The primary role of the nursing home in 2030 will be to provide post-acute care to medically complex individuals being discharged from the hospital, or those who require significant rehabilitation following such events as a stroke or post-fall hip replacement. …

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