The US is moving away from fee-for service to managed care, covering people rather than episodes of care, writes Katie Smith Sloan.
Aged care organisations in the United States are facing a shifting landscape. While we share the unprecedented demographic shifts of other countries, there are a number of factors that are accelerating the changes for providers here.
These include increased costs, pressures on wages, availability of a qualified workforce, regulatory complexities, demand for community services, technology, data and transparency. Individually and combined, these issues create significant challenges and opportunities for providers.
The vast majority of older adults remain in their own homes as they age. It is their strong preference, a fact that has remained unchanged for the last two decades or more. These individuals access services in the community as needed and rely on family and friends for support.
To meet this increasing demand, our real estate-centred ageing services field is expanding their services out into the community, taking their expertise on seniors’ needs and solutions, trained staff and good reputations to serve people in their home.
There is a rapid growth in home care services, providing personal support. There are home health agencies providing clinical support to people in their homes. And there are meal delivery programs, transportation and adult day programs.
There is also an increasing variety of more institutional service models: green houses, small houses and memory care, among them. Nursing homes are serving more and more short-term rehabilitation needs than ever before as people who might have previously moved to a nursing home can be served in other settings.
No matter the service, our challenge is to move towards a more integrated model of service so consumers and their families can more readily navigate what is currently a fragmented system.
The challenges are significant. The government payment model that has supported aged care for decades is changing. We are rapidly moving away from “fee-for service” to managed care, covering people rather than points of service or episodes of care.
While managed care is not new, its prevalence in covering the services and supports needed by older adults is a fairly recent development, driven by the desire to control costs and coordinate care. Providers are scrambling to adapt their business models to this reality.
The drive towards better care coordination demands a more integrated system of services and supports. As a result, stronger relationships must be formed among providers as well as between aged care providers and hospitals, clinics and physicians. These stakeholders are beginning to understand each other and to learn how to work best together.
Technology is an essential underpinning of effective care coordination and service integration. The good news is that there is considerable investment on the part of technology companies in developing solutions. LeadingAge’s Center for Aging Services Technologies has developed tools to help providers sort out options, including case studies of the application of various technologies in provider settings.
The nexus between technology and changing payment models is data, largely focused on quality and outcomes. No longer the domain of management or board directors, there is now an expectation that organisations will be transparent about their results. Therefore, providers must be increasingly sophisticated about determining metrics, collecting data and reporting outcomes.
One of the biggest challenges facing the field of ageing services in the US is the lack of a qualified workforce. Providers struggle to recruit people to all levels and positions, with the most acute shortages being nurses and nursing assistants.
The barriers are several fold: wages that can’t compete with hospitals and other businesses, demographics (fewer people in the cohort that has been attracted to these positions in the past), and a bias against working with the older population.
Providers are reaching out into schools and universities, making the case that careers in aging services and both valued and valuable. They are instituting creative strategies to retain the staff they have – career ladders, professional development, and a concerted focus on employee engagement. LeadingAge is launching an online platform to share promising practices so that providers can learn from one another.
There is a great deal of innovation and experimentation, driven by the understanding that the ways of working in the past will not sustain us.
We know consumer needs are changing, the number of older people is growing and the factors working against us – primarily funding and workforce – demand new ways of working. I am confident that organisations in the US are up to the task.
Katie Smith Sloan is president and CEO of LeadingAge, an association of community-based, non-profit aged care organisations.
This article appears in the current edition of Australian Ageing Agenda magazine.
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When are people going to grasp what being a sovereign currency nation with a fiat monetary system means… affordability is not a problem at the Federal Government level, as the sole creator and issuer of currency in sovereign currency nation is the Federal Government itand can pay for anything at anytime.