Wanted: New Elder Care Model | Emphasis on Services, Not Surgeries

By Peters-Smith, Barbara | Sarasota Herald Tribune, August 10, 2016 | Go to article overview

Wanted: New Elder Care Model | Emphasis on Services, Not Surgeries


Peters-Smith, Barbara, Sarasota Herald Tribune


AGING SERVICES

ORLANDO -- The scary but inescapable question of how America will find the means to care for a massive wave of aging baby boomers may be inching closer to a workable answer. But it will require smashing and replacing the current "medical model" of addressing older adults' health needs only when they lapse into an expensive crisis mode that requires repeated hospital procedures.

It also means social service agencies that have historically supported elders must transform themselves from an endangered species into a vital driver of new community networks for healthy aging -- or get out of the way.

"During the next 10 to 20 years, things could go really well or really badly for old people," said Anne Montgomery, deputy director of the Center for Elder Care and Advanced Illness for Altarum Institute, a national nonprofit that conducts health research. "We know the systems we have today are not the ones we need."

After a decade of watching federal grants dwindle and private companies dominate the field of long-term care, nonprofits that serve Florida's elders heard Tuesday that the time is ripe for them to claim an equal partnership with health care providers in helping this

growing population thrive.

The money to do that, Montgomery suggested, could be siphoned from "high-cost, low-value" medical interventions and poured into outreach efforts that could make such drastic measures less necessary.

"We need to adapt policy models so they are deliberately designed to keep older adults out of the hospital," she said. "It sounds counterintuitive, but we have to spend more, not less, on social services."

Annual meetings of the Florida Council on Aging, a coalition of elder service organizations, have in recent years been mournful occasions where longtime professionals expressed dismay about budget cuts for meals and home care programs, along with the state Medicaid program's rapid transition into privatized managed care. Agency leaders, caseworkers and nutritionists accustomed to running tight ships in their communities have increasingly found themselves answering to for-profit companies placed in charge of spending smaller per-patient allotments of Medicaid dollars.

The council maintains a consistent drumbeat in Tallahassee, pointing out that nearly 58,000 frail, low-income, older Floridians pack the state's waiting list for essential services. The group is calling on Gov. Rick Scott and legislators to increase funding by $36 million to address just 6,000 of these elders.

But at the same time, its leaders are urging members to look for new revenue sources, entrepreneurial opportunities and radically more efficient ways to operate.

"People are still going through the stages of grief," observed Jeff Johnson, state director for AARP Florida. "There's still some denial and anger, and a lot of bargaining. But I think we're starting to see some acceptance that this is the way it is."

What comes next

Johnson presided over a panel discussion that was partly a funeral for "The Decline of the Traditional Aging Network," but mostly a look at what should come next.

Montgomery and other panelists agreed that the time to overhaul and reinvent the system is short, but the moment is opportune.

"To me it looks as though political populism in the 21st century is coinciding with the national and global age wave," Montgomery said. "It's not too late; we just have to move faster if we're going to succeed."

The Older Americans Act, which funds elder services, was renewed this year after a long political stalemate, said Bob Blancato, director of the National Association of Nutrition and Aging Services Program. But it was only accorded another three years of life, and panelists agreed that the next reauthorization should entail a "bold" rewriting of the law.

"The mainstream thinking in Washington is still around deficit reduction, the medical models," Blancato said. …

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