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 TimeMinnesota 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.