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Kathryn Roberts on Aging Services: Deliver The Right Care in the Right Place at the Right Time
Policymakers across the country are wondering what to do about rising health care costs and increased needs for aging services coming from the age wave. Ecumen CEO Kathryn Roberts discusses this in the article below, which appeared on the editorial page of yesterday’s Saint Paul Pioneer Press:
Deliver the Right Care in the Right Place at the Right Time
Minnesota spent $553 million on elder care last year. If the age wave and status quo continue on parallel tracks, we’ll soon hit unsustainable budgets and intergenerational conflict.
You get a flavor for that right now as state policy-makers do their biannual budget dance with the elephant in the room — aging services.
Gov. Tim Pawlenty’s budget proposal slices more than $130 million in aging services over the next eight years, most of it from nursing homes. The Senate would delay a 2 percent cost-of-living adjustment to homecare employees, while the House would make no cuts and give nursing home workers a 2 percent pay increase. Even with a budget deficit, cuts to government-funded nursing homes aren’t the right tactic now.
Most people don’t want to live in a government-funded nursing home. But 30,000 Minnesotans rely on their care. Because nursing home care is mostly paid for by government dollars that don’t cover the costs of care, many nursing homes have less than 10 days’ cash on hand. Choosing between payroll and innovation isn’t a choice. The silver tsunami requires transformative thinking, not shortcuts to a dead end.
Most people don’t need “long-term” care and million-dollar nursing home stays. But serious disconnects in our patchwork health system often lead to institutionalizing people, over-doctoring, draining will and devouring public dollars.
In a coordinated, localized short-term care system, people would move much more
easily and with greater confidence from the hospital to coordinated care and services. A nursing home would be a specialized medical respite center for rehabilitation and chronic care management, not an underfunded institution where someone recovering from a hip replacement shares a wing with an Alzheimer’s patient. It also wouldn’t have the overhead of hospitals’ emergency services, surgery suites and birthing centers. And it would pay providers based on the value we bring to the person and to coordinated health care.
This is all about delivering the right care in the right place at the right time. If you’re not at the hospital or respite center, you’re in your own home or an assisted living facility served by professionals. A coordinated short-term care system is also predicated on not turning assisted living into a mega-regulated nursing home that thwarts independence and suffocates people’s willpower.
In a paradigm-shifted approach, the respite center could be the medical home for chronic and elder care — the technologically connected hub that coordinates all therapy and services among settings.
That future is emerging in Duluth, where we’ve replaced an outdated nursing home with a short-term care center and independent, assisted-living and memory-care apartments. The focus is on getting people better so they can go home. If they need more care, it’s coordinated at an Ecumen-managed nursing home. Of 700 people we served last year at the short-term care center, only 30 went to the nursing home.
A short-term, coordinated care system would be efficient and proactive. And it would lead with self-empowerment, which today too often gets compromised.
Other states recognize this. In Oregon, you would spend less time in a government-funded nursing home than would nursing-home residents of any other state. Why? Oregon puts the biggest percentage of government dollars toward self-directed home care rather than institutional care.
Why can’t Minnesota seniors who qualify for government-paid care self-direct that care at home? They can, but few people know about the state’s initiative called Consumer Directed Community Supports. In fact, it has only about 400 enrollees. Many of the thousands eligible will likely have more expensive nursing home stays in today’s mouse-in-the-maze health system.
Minnesota had 69,000 seniors in 1950. We’re now approaching a million, many of whom will need some physical assistance. In the short term, we must forge a long-term strategy for growing old in Minnesota, not keep taking short cuts to a dead end.
Kathryn Roberts is president and CEO of Shoreview-based Ecumen, Minnesota’s largest nonprofit senior housing and aging services company. She was recently appointed to the Minnesota Veterans Health Care Advisory Council.
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This entry was posted on Tuesday, April 22nd, 2008 at 10:54 am and is filed under Innovation & Technology in the Age Wave, Leadership, baby boomers. You can follow any responses to this entry through the RSS 2.0 feed.
April 22nd, 2008 at 1:33 pm
I wholeheartedly agree with your article. I would like to add the suggestion that the Medicaid payment system MUST be scrutinized as it relates to coverage for long term care services. Many, many people are finding themselves in the situation where they must go to nursing homes rather than a lesser level of care environment (less expensive, better quality of living, as well) because Medicaid coverage is typically not available for care and services in these types of facilities. (Medicaid waiver programs have been instituted in some states, but if still in effect, (some have been placed on ‘hold’ status) wait lists can be several years long.)
April 22nd, 2008 at 1:34 pm
“Why can’t Minnesota seniors who qualify for government-paid care self-direct that care at home? They can, but few people know about the state’s initiative…”
Good news, right? We’re depending less on expensive nursing home care that most people don’t want anyway and more on home care which most people prefer.
Okay, but economically, this is a double-edged sword. Despite the change in venue of service, overall government costs continue to rise for several reasons. The more attractive publicly financed LTC is (home care instead of nursing home care), the more people come out of the “woodwork” to take advantage of it, the more attractive Medicaid planning (artificial self-impoverishment to qualify for public assistance) becomes and the less likely people are to use their home equity or buy private insurance to pay for long-term care.
In other words, as long as government programs pay for most long-term care, making the services those programs provide more attractive has the effect of driving up costs AND crowding out demand for alternative private funding sources that could otherwise relieve the fiscal burden on the public programs and make their more attractive service delivery systems affordable.
“In the short term, we must forge a long-term strategy for growing old in Minnesota, not keep taking short cuts to a dead end.”
Our problems in long-term care are self-inflicted by well-intentioned but perversely counterproductive public policy. The good news is that the problems are easy to fix. We can do it responsibly through public policy, or we can just stand by and let the existing social insurance and welfare house of cards collapse.
Anyone with eyes to see, a brain to think, and the will to reach obvious, albeit painful, conclusions can see the future of long-term care.
If current public policy is allowed to run its course, the public programs that pay for most LTC will implode. Poor people will get mediocre care if any. Home-owners (the vast majority of seniors) will have to use their home equity for LTC. But once home equity is at risk, everyone who is young, healthy and affluent enough to qualify will buy LTC insurance.
That’s how it’s probably going to shake out.
How about this idea? Instead of taking a short cut, perhaps we should start an extensive campaign to encourage individuals, families, and citizens is to take responsibility for their own long-term care. Plan early, and save, invest, or insure. Maybe you can’t solve the public policy problem alone, but you can protect yourselves and your families. Doing so is an important contribution. After all, as a wag once said: ‘The best way to help the poor is not to become one of them.’