The expected impact that the ‘baby boomers’ will have on the delivery and distribution of health and long term care is substantial. And as life expectancy has lengthened, so too have the number of chronic conditions that the oldest have to contend with. Many seniors find challenges in coordinating long term care with gaps in services, staffing difficulties within both home-based and residential-based services, and funding.
All along, ‘baby boomers’ have demanded better. What is unclear is how we will get to better considering the pressures facing the current system. Payers and regulators are working to get to better as well – betterexperiences, better outcomes, at lower cost. The IHM Triple Aim continues although the current leadership at CMS may have different ideas about how to get there.
We all understand that people will want to be at home when they can. Home and Community Based Service programs have experienced increases in funding (now supporting more than half of the costs of long term care nationally – although lagging a bit less than that in Michigan). Nursing Home occupancy is contracting, and in some areas assisted living is noted to be over-bedded.
How will the mission of not-for-profit providers be sustained in this new and very uncertain environment? That topic rose often during last week’s LeadingAge Michigan Annual Leadership event at Crystal Mountain. How will we ensure promotion of independence, control, and choice for the consumers of care who are faced with decreasing family and paid workforce, lack of funding, and escalating medical cost?
Estimations for nursing home sales and closures in the next five-ten years have been cited as high as 30%, while the number of Skilled Nursing Facilities in Michigan is at an all-time high. And if home is the venue of choice, how will we ensure that seniors who have little support are protected? As residential care evolves, who will survive, and who will pay for services?
One thing for sure is that funding will become more complex – through Managed Medicaid payments and new Medicare reimbursement structures or some other mechanism. The survivors – home health care, home based care, and residential providers as well – will likely have some common characteristics:
- They will be truly consumer based and not facility- or program- based. They will create solutions that work for the consumer and not try to fit the consumer into their view of service.
- They will have a mechanism that allows close to real-time understanding of their performance – using data and deep understanding to improve care and services on a daily basis.
- They will listen – not only to the needs of consumers, but also of their staff and the community. They will engage with the community to address senior needs all around them.
- They will keep trying – they will not be satisfied with mediocre performance and will drive toward greater efficiency and effectiveness every single day. They will let go of the past and focus on what works for today.
- They will partner – if needed to obtain necessary support and resources, or with payers and health systems in a collaborative effort to provide the highest level of outcomes. And to do this, they must have internal systems that continually support high performance. Performance must and will be at the core of our mission and our success.