be a wasted opportunity. Instead, the current care delivery system requires significant reform in order to improve the care of this population.

This chapter begins with the committee’s vision of how best to deliver health services to older adults in the future. The vision represents a major departure from the current system, and its implementation will require shifts in the way that services are organized, financed, and delivered. After this vision has been detailed, the chapter continues with a discussion of models of health care delivery that hold promise for moving closer toward the committee’s vision. The chapter examines the evidence on several models as well as the challenges that will likely be encountered in disseminating these models. Although better models can lead to better care, dissemination of improved models has generally proved to be limited, in part due to financial disincentives to implementing these better models. Thus the committee offers its recommendation for how to foster dissemination of new models. Finally, the chapter discusses shifts in the workforce that may be required to support these new models, such as new roles for providers, increased delegation of responsibilities, greater use of interdisciplinary teams, and increased involvement of patients and their families.


The committee identified three key principles that need to form the basis of an improved system of care delivery for older Americans (Box 3-1). These principles are in alignment with the six aims of quality defined in Crossing the Quality Chasm (IOM, 2001).

First and foremost, the health needs of the older population need to be comprehensively addressed, and care needs to be patient-centered. For most older adults care needs to include preventive services (including lifestyle modification) and coordinated treatment of chronic and acute health conditions. For frail older adults social services may also be needed in order to maintain or improve health. These social services need to be integrated with health care services in their delivery and financing. Furthermore, ef-

BOX 3-1

Principles of Care

  • The health needs of the older population need to be addressed comprehensively.

  • Services need to be provided efficiently.

  • Older persons need to be active partners in their own care.

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