Nov 222013

The last few weeks have included a flurry of excellent articles, books, and ideas to review and ponder as we continue to explore ways to improve systems of care for frail older adults. To our mind, of course, chief among these was the November 12 Critical Issues edition of JAMA, which featured a “Viewpoint” by Dr. Joanne Lynn, Director of the Center for Elder Care and Advanced Illness [now the Program to Improve Eldercare] at Altarum. In her article, “Reliable and Sustainable Care for Frail Elderly People,” Lynn outlines the structure for a MediCaring model that would re-balance medical treatment with social services and supports, that would build care plans based on careful assessment of individuals, and that would anchor management in local authorities. The entire article can be accessed at the JAMA Website.

On November 21, The Washington Post featured an editorial by former U.S. Senator Tom Daschle and former Governor and former Secretary of Health Tommy Thompson, describing a new project underway at The Bipartisan Policy Center, which Daschle co-founded. The two will co-chair the Long-Term Care Project with  former Senate majority leader Bill Frist (R-Tenn.) and former White House Office of Management and Budget director Alice Rivlin. Their article, “Who Will Care for America’s Aging Population” notes four key issues that “stand out”:

First, we must figure out how to build a more integrated, efficient, person- and family-centered system of long-term care that ensures that people can access quality services in the settings they choose.

Second, the huge burdens on family caregivers must be more widely shared.

Third, more and better financing tools must be established to help people pay for services.

Fourth, Americans must be educated about how to make smart financial and health-care decisions earlier in life so that the odds of postponing a long-term-care event are increased and the odds of being financially ruined by such an event are decreased.

The December issue of The Atlantic features an essay by Jonathan Rauch, The Hospital Is No Place for the Elderly. The information will not surprise those immersed in these issues, but it provides a clear and compelling story that might attract others, and provide a basis for understanding what is wrong with the current system, and how it might change. Rauch quotes Dr. Lynn, who describes the “frailty course.”

And finally, yesterday’s [11/21/13] New York Times included Dr. Pauline Chen’s take on a new book, The American Health Care Paradox, by Dr. Elizabeth H. Bradley and Lauren A. Taylor on how it is that America can spend so much money on health care–and come up with less-than-remarkable outcomes. As Chen writes:  “the reason the richest country in the world doesn’t have the best health is because it takes more than health care to make a country healthy.”  Chen writes, “…the most thought-provoking writing focuses on America’s previous attempts to integrate social services and health care delivery. It is a sobering list of near-misses and “what-if’s,” testimony to the intractable power of cultural attitudes.”

It is all worth considering. Share your thoughts, too, on what you make of this work, and where we need to head.

key words: Joanne Lynn, Jonathan Rauch, Pauline Chen, Elizabeth Bradley, Lauren Taylor, frail elders,