Older Americans can live in comfortable health, without needless treatment – and we can save money in the process, but only if we change the way we think and talk about the issue, according to Joanne Lynn, M.D., from the Center for Elder Care and Advanced Illness at the Altarum Institute. Lynn spoke about the need for reliable and sustainable comprehensive care for frail elderly during yesterday’s media briefing from the Journal of the American Medical Association on critical issues in U.S. health care. Authors of several of the articles in this special issue, published today, spoke about policy, economic, and societal changes needed for a viable, quality health system.
In a follow up-call today, Lynn said that, although most frail elderly – those over age 85 or anyone 65+ with multiple chronic conditions – would prefer to live out their lives at home comfortably and with adequate function and quality of life, that’s not how our system is set up.
“We have an array of disjointed services, that don’t take patient values about what matters to them most, into account,” she said. “We have all kinds of metrics that measure clinical outcomes but we don’t evaluate metrics that put patient priorities first.”
A huge shift in focus is necessary to deliver the care that most older people want. Most people who live past age 65 have an average of three years of self-care disability – they may need help with activities of daily living, or visit several physicians for multiple chronic diseases, or be recovering from a fall or serious illness, requiring some in-home support services. Those over age 65 will represent 21 percent of the population by 2040. The 85+ population is projected to triple from 5.7 million in 2011 to 14.1 million in 2040 according to figures from the Administration on Aging.
What’s needed, according to Lynn, are more social services and supports to enable them to live at home or in their community, such as meals on wheels, or help with home repairs, or for someone to conduct a falls assessment to make their home safer. “Any physician can order a $100,000 drug but can’t order a substitute caregiver or home-delivered meal,” she said. Not only do we need to fix how we use and deliver care, but need to change our concept of what “appropriate” care means to the elderly.
Additional social services could be paid through shared medical savings, she said. In her JAMA paper, she described a “MediCaring-ACO” model that serves frail elderly in a defined geographic area, and which takes shared savings from more appropriate medical care to be used for supportive housing, personal care and other long term support services. “It requires significant structural changes in service delivery.”
The changing structure of family caregiving also must be considered. Right now, the average woman spends more years caring for aging parents than she does her kids. However, most baby boomers do not have adequate retirement savings and cannot afford to stop working, leading to tremendous stress and strain within the family. “How do they juggle all of this without being totally overwhelmed?” Lynn asked.
Change must come from both the top down and bottom up. Among Lynn’s suggestions are to link health care and social services more closely, as most other industrialized countries do, broaden the mandate for Area Agencies on Aging to include more community supports, and to fund more pilot projects that allow seniors access to hyper-local services such as help with home safety and repairs or grocery shopping in bad weather. “We can do this, but we have to accelerate the pace of change,” she said.
Lynn cited several programs, including an Elderly Service Program in Cincinnati funded by tax levies, and one in LaCrosse, Wis, that are successfully changing how communities deal with aging populations. She said there was no one “magic bullet,” or perfect program, but importantly, at least people were beginning to talk more about how the elderly can live out their lives in meaningful ways. With the most Americans now living longer, “we have to learn to live with longevity.”
Note: AHCJ members have free access to online versions of a number of useful journals, including JAMA.