Financing Long-Term Services and Supports for Individuals with Disabilities and Older Adults Workshop Summary (2014) / Chapter Skim
Currently Skimming:
2 The Challenge
2 The Challenge
Pages 7-18
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• A "care gap" is emerging as the population ages, and the work force for long-term services and supports continues to have serious capacity problems. (Stone)
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Lisa Iezzoni, director of the Mongan Institute of Health Policy at Massachusetts General Hospital and professor of medicine at Harvard Medical School, discussed the choices people with disabilities make and the need for society to respect those choices. THE FINANCING OF LONG-TERM SERVICES AND SUPPORTS: AN OVERVIEW Judith Feder Georgetown Public Policy Institute The vast majority of the 11 million people who need long-term services and supports are living at home and in the community, Feder said.
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Medicare and Medicaid By law, Medicare does not cover custodial care. Even in cases where Medicare does cover home health care and skilled nursing facility care,
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Health care reform is focused on improving primary care rather than on people who need long-term care. But the chronic conditions that create high costs in the health care system also create a need for long-term care, Feder noted.
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Some family caregivers are ruining their own health, and some cannot do an adequate job. WORKFORCE ISSUES Robyn Stone LeadingAge Center for Applied Research The workforce for long-term services and supports has serious capacity problems.
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Changes that could make this more likely include the development of technologies that help to retain older staff; the redesign of work, such as the introduction of job-sharing options; the use of retired providers as mentors or coaches for younger staff; and the use of retired geriatric professional caregivers as educators. Mental Health Issues About one in five older Americans -- more than 8 million altogether -- have some type of mental health or substance use condition, and older veterans are even more likely to fall into this category than the general older population.
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Stone asserted that the licensing and certification of health care providers should require the demonstration of competencies in basic geriatric care and that schools and training programs should expand geriatric and gerontological coursework. Appropriate content needs to be developed to teach needed competencies across all settings.
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TECHNOLOGY Laurie Orlov Aging in Place Technology Watch If successful aging is defined as the ability to do things for oneself, feel safe, and be healthy as one gets older, then successful aging in place includes the ability to remain in one's home of choice, whether a private home, an assisted living facility, a shared home, or some other option. Aging in place requires connected relationships among older adults, health care providers, and families and caregivers.
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Orlov agreed that efforts to commercialize promising research results are extremely limited, with just a few exceptions. Ph.D.s can be earned and technologies can be piloted in assisted living or nursing homes, yet they never get beyond the pilot stage.
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If the health care system is committed to personcentered care, it needs to find a way to accommodate such decisions. People who are born with disabilities or who become disabled early in life often have very low rates of employment and low incomes, which make it difficult for them to save, Iezzoni said.
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Confronting this issue will require political and public will.
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