Policy and
Research Needs to
Maximize Independence
and Support Community Living
WORKSHOP SUMMARY
Joe Alper and Sarah Domnitz, Rapporteurs
Forum on Aging, Disability, and Independence
Board on Health Sciences Policy
Institute of Medicine
Division of Behavioral and Social Sciences and Education
THE NATIONAL ACADEMIES PRESS
Washington, DC
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by the Administration for Community Living (Contract No. HHSP233201400020B/HHSP23337027); Alliance for Home Health Quality and Innovation; Consumer Technology Association Foundation; The Gerontological Society of America; Health Resources and Services Administration (Contract No. HHSH250201500001I/HHSH25034002T); The John A. Hartford Foundation; LeadingAge; National Institute on Disability, Independent Living, and Rehabilitation Research (Contract No. HHSP233201400020B/HHSP23337036); Paraprofessional Healthcare Institute; Qualcomm Incorporated (Contract No. NAT-301711); U.S. Department of Defense (Contract No. HU0001-15-1-0007); and U.S. Department of Veterans Affairs (Contract No. VA268-12-P-0014). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-39106-1
International Standard Book Number-10: 0-309-39106-7
Digital Object Identifier: 10.17226/21893
Additional copies of this workshop summary are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.
Copyright 2016 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2016. Policy and research needs to maximize independence and support community living: Workshop summary. Washington, DC: The National Academies Press. doi: 10.17226/21893.
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PLANNING COMMITTEE FOR A WORKSHOP ON POLICY AND RESEARCH NEEDS TO MAXIMIZE INDEPENDENCE AND SUPPORT COMMUNITY LIVING1
TERRY T. FULMER (Co-Chair), President, The John A. Hartford Foundation
FERNANDO TORRES-GIL (Co-Chair), Professor and Director, Center for Public Research on Aging, Luskin School of Public Affairs, University of California, Los Angeles
JAMES C. APPLEBY, Executive Director and Chief Executive Officer, The Gerontological Society of America
MARY BRADY, Consultant, Home Use Devices and Medical Device Labeling
MARGARET L. CAMPBELL, Senior Scientist for Planning and Policy Support, National Institute on Disability, Independent Living, and Rehabilitation Research
THOMAS E. EDES, Director, Geriatrics & Extended Care Operations, U.S. Department of Veterans Affairs
ROBERT ESPINOZA, Vice President of Policy, PHI
STEVE EWELL, Executive Director, Consumer Technology Association Foundation
ROBERT HORNYAK, Director, Office of Performance and Evaluation, Administration for Community Living
ROBERT JARRIN, Senior Director, Government Affairs, Qualcomm Inc.
TERESA L. LEE, Executive Director, Alliance for Home Health Quality and Innovation
LARRY MINNIX, President and Chief Executive Officer, LeadingAge
MATT QUINN, East Coast Managing Director, Healthcare and Life Sciences, Intel Corp.
JACK W. SMITH, Director, Health Services Policy and Oversight, Office of the Assistant Secretary of Defense for Health Affairs, U.S. Department of Defense
MICHELLE M. WASHKO, Deputy Director, National Center for Health Workforce Analysis, Health Resources and Services Administration
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.
Project Staff
SARAH DOMNITZ, Program Officer
TRACY A. LUSTIG, Senior Program Officer
Y. CRYSTI PARK, Senior Program Assistant
ANDREW M. POPE, Director, Board on Health Sciences Policy
Consultant
JOE ALPER, Consulting Writer
FORUM ON AGING, DISABILITY, AND INDEPENDENCE1
TERRY T. FULMER (Co-Chair), The John A. Hartford Foundation
FERNANDO TORRES-GIL (Co-Chair), University of California, Los Angeles
JAMES C. APPLEBY, The Gerontological Society of America
MARGARET L. CAMPBELL, National Institute on Disability, Independent Living, and Rehabilitation Research
THOMAS E. EDES, U.S. Department of Veterans Affairs
ROBERT ESPINOZA, PHI
STEVE EWELL, Consumer Technology Association Foundation
ROBERT HORNYAK, Administration for Community Living
ROBERT JARRIN, Qualcomm Inc.
TERESA L. LEE, Alliance for Home Health Quality and Innovation
LARRY MINNIX, LeadingAge
JACK W. SMITH, U.S. Department of Defense
MICHELLE M. WASHKO, Health Resources and Services Administration
Forum on Aging, Disability, and Independence Staff
SARAH DOMNITZ, Forum Co-Director
TRACY A. LUSTIG, Forum Co-Director
Y. CRYSTI PARK, Senior Program Assistant
GOOLOO WUNDERLICH, Senior Program Officer
ANDREW M. POPE, Director, Board on Health Sciences Policy
RICK ERDTMANN, Director, Board on the Health of Select Populations
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.
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Reviewers
This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published summary as sound as possible and to ensure that the summary meets institutional standards for clarity, objectivity, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary:
ERIN ITURRIAGA, National Heart, Lung, and Blood Institute
LISA McGUIRE, Centers for Disease Control and Prevention
WENDY NILSEN, National Science Foundation
MICHELLE PUTNAM, Simmons College
RENÉ SEIDEL, The SCAN Foundation
Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this summary was overseen by RONALD T. ACKERMANN, Northwestern University. He was responsible for making certain that an independent examination of this summary was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this summary rests entirely with the rapporteurs and the institution.
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Contents
2 THE IMPORTANCE OF COMMUNITY LIVING AND MAXIMIZING INDEPENDENCE TO INDIVIDUALS AND SOCIETY
Federal Efforts to Support Community Living and Independence
American Perceptions and the Realities of Aging, Disability, and Independence
3 HOME AND COMMUNITY SETTINGS: SERVICES AND SUPPORTS FOR COMMUNITY LIVING AND PARTICIPATION
Overview of the Population Needing Long-Term Services and Supports
Reducing Reliance on Institutional Care
Policies to Support Community Living and Participation
4 WORKFORCE NEEDS TO SUPPORT COMMUNITY LIVING
Progress in Changing Workforce Culture in an Aging America
Enhancing and Supporting the Direct-Care Workforce
Drivers of Workforce Change in the Health Care System
5 FINANCING TO SUPPORT COMMUNITY LIVING
Options for Financing to Support Community Living
Approaches and Challenges to Financing Coverage for People with Disabilities
The Future of Financing Long-Term Services and Supports
6 TECHNOLOGY TO SUPPORT INDEPENDENCE
Future Possibilities for Technology to Help Maximize Independence
Technology for Health—Changing the Location of Clinical Care