Industry trends and financial considerations
We are an aging society. In fact, 20% of the population in the U.S. is currently 65 or older. And, although the Centers for Disease Control estimate the average life expectancy to be 76.5 years, the truth is that people are living longer, healthier lives and by all accounts, this is a good thing.
As part of the Wilmington Trust Philanthropic Speaker Series, we invited Tara A. Cortes, Ph.D., RN, FAAN, Executive Director, The Hartford Institute for Geriatric Nursing, and NYU Rory Meyers College of Nursing, to explore Health Care for the Aging Population to discuss:
- trends in health care for older adults
- impacts of entitlements and financings on their health care options
- legislation and policy for the expanding aging population
Drivers of healthy aging
Dr. Cortes began with the factors contributing to people living longer. One factor is the transformative paradigm shift to focus on disease prevention as people are more self-aware of the food they eat, the benefits of exercise, rest, moderation, etc. In addition, medical and pharmaceutical advancements have all but eradicated the risk of death due to infectious or parasitic diseases and have dramatically increased the longevity of those living with diagnoses such as cancer.
While the physical advances over the past century are astounding, Dr. Cortes pointed out that we are still falling short in several areas. A critical issue is the integration of behavioral health where older adults are at increased risk due to their tendency to have at least one chronic condition. Even more concerning is the frequency at which they are misdiagnosed or go untreated.1 An assessment for depression is often not part of an annual wellness visit, if one actually takes place. This leads to another compounding issue which is the vast number of elderly who do not have ready access to medical care. Dr. Cortes discussed the severe need for more home health options including remote consultation, particularly in rural areas.
Dr. Cortes introduced the notion of a ‘person-centric’ healthcare system, which is a way of thinking and doing things that sees the people using health and social services as equal partners in planning, developing and monitoring care to make sure it meets their needs. Instead of the patient fitting into the routines and practices that are already established, the services change to more flexibly meet the needs of the patient.2
This concept is illustrated in an article entitled Age-Friendly Health Systems: The 4Ms. Written by experts from The John A. Hartford Foundation and The Institute for Healthcare Improvement, the 4Ms were designed to address the gap between the evidence-based models of health care for older adults and the care that our systems put into practice. The 4Ms include:3
- What Matters: Know and act on each patient’s specific health outcome goals and care preferences
- Mobility: Maintain mobility and function and prevent/treat complications of immobility
- Medication: Optimize use to reduce harm and burden, focusing on medications affecting mobility, mentation, and what matters
- Mentation: Focus on delirium and dementia and depression
The Institute for Healthcare Improvement has implemented a movement to encourage healthcare providers of older adults to become an Age-Friendly Healthy System, with a goal of having the 4M framework in 1,000 U.S. hospitals by December 2020.
Challenges of healthy aging
There is a lot of dialogue around planning financially for retirement or the “golden years.” Not many people envision themselves in those years dealing with dementia, chronic diseases, long-term, or end of life care. Dr. Cortes explained that many find themselves in these scenarios and, when they do, the cost often exceeds what they had planned.
Many aging adults have too many assets to qualify for Medicaid while Medicare doesn’t provide sufficient coverage requiring supplemental insurance through Medicare Supplemental Insurance also known as Medi-gap. Dr. Cortes used an example of how a typical 55-year old adult earning a middle-income of $65k with no savings has only a 50% chance of not out-living his assets.
And, before we think of turning to Social Security for help, according to a recent New York Times article, due to the changing demographics in the U.S., by 2034, the Social Security Fund will continue to deplete resulting in payments decreasing by 21%. With a projected growth of the number of those aged 65 or older expected to rise within the next five years, without new legislation, it is likely that the number of working-aged people feeding into Social Security will not be able to compensate for the demand.
Fortunately, there is progress being made to put more programs and opportunities in place for aging adults. Those with financial means could opt to buy into a continuing care retirement community well in advance of when they may need it. These communities often have continued nursing care as an option, if the need arises.
Dr. Cortes mentioned that The Centers for Medicare & Medicaid Services (CMS) are experimenting with what they are calling the Emergency Triage, Treat, and Transport (ET3) Model. ET3 is a voluntary, five-year payment model that will provide greater flexibility to ambulance care teams to address emergency health care needs of Medicare beneficiaries following a 911 call.4 Providers will transport an individual to a hospital ER or other an alternate location such as a primary care doctor’s office or an urgent care clinic. If transport is not necessary, treatment can be by a qualified health care practitioner, either on the scene or via telehealth. While currently experimental, this is a significant step forward to providing a more ‘person-centric’ health model.
Also, in a positive direction, New York, Massachusetts, and Colorado have been recognized by the AARP as age-friendly states meaning they have committed to providing communities with walkable streets, housing and transportation options, access to key services, and opportunities for residents to participate in.
Where do we go from here?
Dr. Cortes passionately spoke about the need to recognize ageism in our country. Education and health care are the United States two largest commodities that are significantly underinvested. We have come a long way and still have a long way to go. To continue to make a difference, we need to encourage and support legislation that provides quality care to our aging population that they deserve.
The Healthcare for the Aging Population discussion marks the 58th event in the Wilmington Trust Philanthropic Speaker Series. These events were started in 2011 by Walter Dillingham for the benefit of clients and professional committed to the betterment of the community through philanthropic, health care, and not-for-profit organizations.
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1 CDC.gov Healthy Brain Initiative.
3 Institute for Healthcare Improvement. (2017). The 4Ms Age-Friendly Frame¬work. Available at: http://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Pages/default.aspx
This article is for informational purposes only and is not intended as an offer or solicitation for the sale of any financial product or service. It is not designed or intended to provide financial, tax, legal, investment, accounting, or other professional advice since such advice always requires consideration of individual circumstances. Please consult with the professionals of your choice to discuss your situation.