My adopted grandmother has it right--when asked her age, she is perennially 39. Even though she has faced serious medical problems, she still lives in the home she and her husband bought in the early 1950s, aging with vibrancy, with family, with community, and with as much independence as she can muster--and she loves it. This is what all our parents and grandparents want. This is what we all want for ourselves. Secretly we are all afraid that the goals of a meaningful quality of life and independence will elude us as we age. But when I am ready to be perennially 39, I want to follow the path of my adopted grandmother.
The current national health care reform debate provides an important opportunity to lay the groundwork for a better system of services and support for seniors. From a reform perspective, this simply makes good sense. Recent Medicare data shows that those with five or more chronic conditions generate roughly 75 percent of all Medicare spending. Within health care reform we have the opportunity to fundamentally improve the delivery system for those who use it the most and rebalance services so that seniors can remain at home. Given that the average hospital bed in the US now costs $2,714 per day,1 supporting seniors’ desires to remain independent should result in both better care and better use of dollars.
Health care for seniors has always figured into discussions about reform, but the sensitive issue of quality of life and continuums of care were thrust into the national spotlight recently when legislators sensationalized the issue of “end-of-life” care conversations to spotlight their objections to plans for reform. And that’s been just one example of the seemingly intractable nature of our differences on health care priorities for seniors.
Instead I’d propose we remember this very common thread--we are all someone’s children. Millions of Americans are facing very difficult decisions about how they will support their aging parents, particularly whether or not they will be able to help their parents remain at home in communities of their choice.
A recent survey commissioned by the organization I manage, The SCAN Foundation, found that 79 percent of respondents are concerned about their ability to pay for long-term care services. Caring for one’s aging parents has no political party or liberal/conservative agenda--majorities of Republicans, Democrats and Independents had the same concern. Furthermore, the vast majority of Americans, 92 percent to be exact, believe that it is important to improve health insurance coverage for services that help people remain in their own homes, instead of going to nursing homes.2
The SCAN Foundation recently released a report by Georgetown University that delineates several policy options to address the most pressing needs in long-term care financing reform, helps us achieve the goals of health care reform, and sets the nation on a path to a better long-term care system in the future. It is available here.
Sadly, long-term care concerns seem to have no end in sight. The senior population is expected to double by 2040.3 If you don’t have aging parents yet--you will. If you haven’t thought about how mom or dad may need just a little bit of help in the future--you will. If you’ve never toured a physical rehabilitation facility, nursing home, or other eldercare facilities in order to make the best decision for your loved ones--you may have to one day. For some with unique needs, nursing homes provide a necessary and appropriate choice for supportive living. Yet even in these environments, we all wish to make every effort for real choice in our living arrangements, daily activities, culinary preferences, and level and quality of social engagement regardless of our functional abilities--namely living like we are still 39. And, despite our ideological or political differences, it seems like we all understand this--the survey found that 80 percent of people are more likely to support a health care reform proposal that improves coverage for long-term care services for seniors.2
These polling numbers demonstrate that we must continue to advocate for policies that fundamentally improve care coordination for people with chronic health and mental health conditions, rebalance health care services to help make home and not institutions the default choice for seniors, and finally support new program models that give seniors opportunities to live with dignity and independence, at home and in the community, for as long as possible. These reforms will provide older adults of today and tomorrow with a higher quality of life and ultimately reduce the economic burden on our health care system.
Just as parents want the best for their children, every family wants the best for their parents and grandparents. We have the tools and emerging technologies to make life better for the ones we love as they navigate aging. Now we need the political will, quality legislation, and economic support.
Bruce Chernof, MD, FACP, is the President and Chief Executive Officer of The SCAN Foundation.
1Agency for Healthcare Research and Quality – Medical Expenditure Panel Survey, Statistical Brief #256 (August, 2009).
2These results come from The National Omnibus Survey on Long-Term Care, conducted by Lake Research Partners on behalf of The SCAN Foundation (July, 2009).
3U.S. Census Bureau (July, 2009).