A New Approach to Advancing Aging with Dignity, Choice, and Independence

Author: Bruce Chernof

Originally published: Tuesday, February 4, 2014

For all of us, the start of the new year brings an opportunity for reflection and the chance to chart a bold path forward. As we enter 2014, The SCAN Foundation celebrates its fifth year of working to improve the lives of older adults and their families. Our founding strategic plan set us on a course to raise public awareness, advance realistic policy options, and scale promising programs, all in support of aging with dignity and independence. We are honored to have worked with many talented partners in this work to bring leadership and visibility to the field of aging and long-term care.

The field in which we work is constantly in motion. The health care landscape has altered dramatically since the Foundation’s inception in 2008, and our role in this work requires a corresponding repositioning. Important progress has been made. The passage of the Patient Protection and Affordable Care Act, the creation of a federal Commission on Long-Term Care, major federal and state initiatives to better connect medical care and supportive services for high need populations, and new developments in federal and state policy on how to best pay for care signal tremendous steps forward in thinking about how we deliver care to older adults. Yet much work remains to be done to support older adults with chronic health conditions and functional limitations, as well as for the family members and loved ones who care for them. In response, the Foundation has used 2013 to take a thoughtful and measured look at our work, exploring the areas where we may be most bold, catalytic, and impact oriented in transforming the system upon which all older Americans eventually rely.

Working toward this ideal in the rapidly evolving health care sector requires adaptation to policy changes currently underway and responsiveness to new solutions yet to be imagined. To meet these evolving needs and to maximize what we can do for older adults and their families, we have developed a revised strategic framework that will guide our efforts over the next 5 years, incorporating our new vision, mission, and goals. This new strategic framework keeps us squarely in our sweet spot, transforming the financing and delivery of aging services. It also provides substantial new clarity about what we think are the greatest leverage points for change and what we hope to achieve over the next 5 years.

Our new vision is a society where older adults can access health and supportive services of their choosing to meet their needs.

Our new mission is to advance a coordinated and easily navigated system of high-quality services for older adults that preserve dignity and independence.

We will work to achieve our vision and mission by focusing our efforts on the following three goals:

1. Integrate care and financing for vulnerable, low-income older adults.
2. Support models of care that value dignity, choice, and independence by putting individuals and their families at the center of the decisionmaking process.
3. Create a viable set of options that will enable working families to pay for future long-term care needs.

Dual Integration: Integrate care and financing for vulnerable, low-income older adults.

Through this goal, the Foundation seeks to transform care for vulnerable, low-income older adults by integrating systems to improve quality while developing new ways of paying for their care. This work focuses on individuals who are eligible for both Medicare and Medicaid, often called “dual eligibles.” Currently, these individuals face a system of care that is fragmented, confusing, and expensive. The Foundation is advancing efforts underway in California to integrate the financing and delivery of care for these individuals, building on lessons learned from other states engaged in this work. The new dual integration goal aims to provide high quality, cost-effective care through an appropriate mix of medical services and community supports.

Person-Centered Care: Support models of care that value dignity, choice, and independence by putting individuals and their families at the center of the decisionmaking process.

This goal seeks to support models of care that value dignity, choice, and independence by putting older adults on Medicare and their families at the center of the care decisionmaking process. Successful person-centered care models make use of an interdisciplinary team that includes doctors, nurses, paid caregivers, and social service providers in tandem with individuals and their families to offer coordinated care that considers people’s full range of needs and preferences. Research shows that person-centered care enhances quality-of-life for the people served and frequently lowers costs of care by reducing unneeded or unwanted services.

LTC Financing: Provide working families with tools to help pay for their future care needs.

This goal seeks to help working families by providing a range of tools to help plan for and pay for their future care needs. Most Americans will need long-term care at some point in their lives, but few are adequately prepared to pay for it. When the need for assistance arises, individuals and families typically pay out of their own pockets, but costs far exceed the resources of most people, especially older adults and people with disabilities. Many Americans turn to Medicaid for support in time of need, however, in order to qualify they must have very few resources. Through this goal, the Foundation seeks to create new tools for working families that includes accessible, affordable long-term care financing options.

Successfully meeting our three new strategic goals will require a total system of care in which people receive the appropriate mix of medical services and community supports to meet their needs, values, and preferences. It will take a paradigm shift that puts quality of life on a level playing field with quality of care. It is dependent on the development of innovative new tools for working adults that enable them to plan and pay for their future care. Our hope is to make great, new strides over the next 5 years toward meaningful system transformation that enables aging with dignity, choice, and independence. We look forward to engaging with you in this work.