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Closing Remarks
In the closing session, Fernando Torres-Gil of the University of California, Los Angeles, provided his thoughts on workshop. In his view, he said, the collective goal is to develop a 21st-century model to guide the nation in bringing about the changes highlighted at the workshop in a way that makes sense for a future in which more Americans will be aging with various types of disabilities. The entitlement programs and aging network of the last century will provide a legacy upon which a new model will be built for this century, he said.
Torres-Gil said that in his opinion, the workshop laid out a clear thematic goal of moving toward a rational and substantive national strategy for the 21st century based on clearly stated conceptual frameworks and driven by data. Such a strategy will require the development of some kind of national standards for an integrated, coordinated system of community-based services for individuals and for developing a workforce capable of deriving the best outcomes from this system through a combination of training and health system reform, Torres-Gil said.
Torres-Gil also said he was of the opinion that there needs to be a national strategy that begins to address long-term care, integration, coordination, and workforce needs that also reflects the transformation of health care and the integration of technology into daily life that is already occurring in this century. The dialog to produce such a strategy will have to include the role of diversity, immigration, and foreign workers in the workforce of the 21st century and how that relates to what is happening in other countries and to how other countries are supplying members of the
U.S. workforce. The dialog, Torres-Gil said, will also need to include the role and impact of economic disparities on the provision of services to those in need, particularly given the projections that there is going to be an increase in poverty among older persons because of the lack of savings and defined-benefit plans. Money, said Torres-Gil, is a real determining factor for the choices and options an individual has with regard to access to services.
While there are many stakeholders who will need to have a seat at the table for this dialog, Torres-Gil said, those stakeholders must find a way to find common cause. Those stakeholders include disability and older adult advocacy groups as well as unions, the for-profit sector, and social movements. He also noted that too often caregiving is a “default option” rather than one that people seek, which raises the issue of who gets in the workforce and who is left out or leaves. The nation must figure out how to value the workforce of caregivers in a way that reflects relevant culture and ethnic traditions and practices. “How can we bring back a sense of nobility and prestige to working in this particular area?” asked Torres-Gil.
The impact that health care reform, the Patient Protection and Affordable Care Act, the spread of accountable care organizations, and the consolidation in the medical and hospital industries will have on workforce needs and integration is still unclear, said Torres-Gil. What is clear, he said, is the need for financial resources to rebuild the home and community-based system for long-term care services as well as the need for a vision of what kind of workforce the nation needs and how to train and develop that workforce. In some ways, he said in conclusion, it may be just as well that the national political mood is not ready for that yet. “It gives us time to think this through and try to put together a national strategy,” he said.