The Aging Network and the Future of Long-Term Care
Kleyman, Paul, Aging Today
As the elderly widow regained her ability to communicate following her stroke, she demanded that the nursing home staff return her home-to live alone at her rustic log cabin in the north woods of Wisconsin. There she could continue pursuing her passio ns for painting and gardening. Doctors and social workers urged her to stay in the facility, to move, to assisted living or at least to move into an apartment in town. But the rural woman held her ground.
Staff from Wisconsin's Community Options Program (COP), the state's home and community-based waiver program, were called in to help the resolute elder. They arranged for home, modifications, had raised flowerbeds built and obtained assistive technology to enable her to paint. To sustain her at home initially, a personal care worker and a homecare worker moved into the woman's home, rotating periods there. Rather than make the long drive home after each shift, they offered to stay overnight, despite being paid for only eight hours, until the client's care needs decreased. Eventually she could manage with only a few visits front a personal care worker and a nurse and she got daily help from her neighbors.
"These homecare workers valued this old and her tenacity, but they also loved her the house and the rustic beauty and tranquility of the setting," said Donna McDowell, director of the Wisconsin Bureau of Aging Long-Term Care, in describing the idyllic outcome. McDowell spoke on a panel with Josefina Carbonell, U.S. assistant secretary for aging, and other experts at the 2003 Joint Conference of the National Council on the Aging and the American Society on Aging in Chicago in March. Their general session was titled "The Aging Network and the Future of Long-Term Care."
WHAT EVERYONE WANTED
Most important, McDowell said, were that the care manager and service providers achieved what the woman wanted; the professionals got the outcome they wanted, her reasonable health and safety; and the system got the outcome it wanted, cost-effective care. McDowell explained that this woman was one of about 20 elders per month whom COP helps to return home from Wisconsin long-term care institutions under a federal nursing home transitions grant. Among them, she noted, is a 100-year-old woman moved to an assisted living facility in March.
However, McDowell continued, not every older adult in Wisconsin has such a satisfactory outcome. The program currently has a waiting list of 3,000 older people. Underlining the public's desire for more care at home, she said, is that Wisconsin now has 8,000 vacant nursing home beds, and units with 2,500 more such beds have been closed in the past two years. And as elders are rejecting costly and undesirable institutional care, their families are doing the best they can to care for their loved one and find community-based services, she explained.
"What can the aging network do to move the ideal long-term care system into reality? That's the hard question. We know what it should look like, but how do we get there?" Essential for change, she said, is that the nationwide network of services in aging should "exercise our fundamental role under the Older Americans Act (OAA), and that is advocacy," McDowell noted that agencies and organization in aging need to advocate for change in concert. "I can't think of anything that we do in Wisconsin that doesn't involve partnership among the state unit on aging, the area agency, the local providers, older people and volunteers," she said.
A MAJOR EFFORT
"Changing the direction of long-term care will not be easy," said Carbonell, who heads the U.S. Administration on Aging (AoA). "It will require a major effort in most states and communities across this nation. The task, however, will not be as difficult politically or fiscally as trying to maintain the intuitionally biased status quo for another 20 years. We really need to work together and take advantage of the opportunities created by growing societal preferences for home and community-based care. …