Jul 162020
Anne Montgomery and Sarah Slocum

By Anne Montgomery and Sarah Slocum

Altarum’s Program to Improve Eldercare has designed a survey of nursing home residents on the impact of Covid-19.  We’d be grateful to have your help in regards to disseminating the survey link, along with a brief set of instructions, to interested nursing homes and to residents and their families.

Many thanks to Consumer Voice, AMDA, Leading Age Michigan, AHCA, the Pioneer Network, The Eden Alternative and ombudsman programs for helping to distribute the survey to as many residents as possible. We would be immensely delighted and grateful if it’s possible for others to post the instructions below, which include a link to the survey at the end. This is a survey of convenience, so it will not be fielded across a random set of respondents across the country. However, if we have help disseminating the link and receive a reasonable number of responses, we believe that this will help to generate a picture of residents’ experiences so far during the Covid-19 pandemic. Essentially, we are hoping to be able to use our survey expertise to help lift up residents’ voices during this difficult time.

The survey takes about 20 minutes, according to several residents who have tested it out. No personally identifying information is being collected. If they so wish, residents can choose to identify the home, their county, and state. The link to the survey will be active until August 31, 2020. If you have any questions, please be in touch: [email protected] .

Here is the core message that can be given to residents:


Thank you for taking the “COVID-19 Nursing Home Resident Survey,” which has been designed by Altarum’s Program to Improve Eldercare. We are grateful! This questionnaire at the link below is designed to be completed in 20 minutes or less.

  • Residents can take the survey on a computer, a tablet or a smartphone – either their own, or one that is lent to them.
  • We encourage residents to complete the survey on their own, if they are able
  • Residents who want to answer the questions and need help can choose to be assisted by a family member or friend.
  • If no family or friend can help, a member of the nursing home staff can assist.
  • Once the resident is done answering the questions, they just click Submit – no other action is needed.
  • We will be taking responses to the questions until Monday, August 31st.

A link to the survey is below. Thank you so much!


Jul 082020
Dr. Joanne Lynn Portrait. Photo credit Politico (used with permission)

By Joanne Lynn, MD

A colleague once sent me an obituary notice from a local paper in Arkansas which said, after noting that the 94-year-old woman had gone to live with Jesus, that she “had been troubled in her later years with heart problems and succumbed to the complications of a cold.” How true.  That characterizes how many of us will come to the end of life – we’ll be living with very little reserve and even a small thing will be enough to lead to death.  This is like walking a tightrope and waiting for a stumble or a breeze.  One might manage to keep going for a long time, or one might trip and be gone tomorrow.

The tenuous hold on life that this scenario calls to mind is commonplace among residents in nursing homes.  As an attending physician in nursing homes, I was often perplexed as to how to document a death certificate.  In so many cases, there are so many causes, the conjunction of which is what actually caused the death at this time in this way.  So, of course, COVID-19 will be one of the causes of death for many infected residents in nursing homes, and in many situations, that will be counted as “the” cause of death.

But it is relevant that the person was living in a fragile balance with life before COVID-19.  Life expectancy for nursing home residents varies among facilities and among regions of the country, but the median is mostly under one year.  It is still a loss to the human community to encounter a cause of death some months earlier than would otherwise have happened, but it is worth knowing that the foreshortening of life for nursing home residents is mostly measured in months. Social Security, for example, expects that deaths from COVID-19 will have an almost negligible effect upon their payouts for old age benefits.

The newsworthy tragedy arises with the sudden deaths of a much larger than usual number of residents of a particular facility.  Consider, for example, a nursing home with 240 long-term care residents, where the usual month will have around 20 deaths. In a COVID-19 outbreak in a nursing home that has reasonable staffing and support, it appears that about 20% die with COVID-19 over two months. That would yield 48 COVID-related deaths in that time. Remember, also, that another group of about the same size will have been very sick, whether on-site or in the hospital, which adds to the caregiving and grieving on the part of the staff. So, the situation quickly becomes dire.

However, it is important to consider a statistical perspective on this situation. Assume that this outbreak foreshortened the lives of half of these (and the other half would have died in these two months without COVID-19).  That would mean ½ x 48 = 24 excess deaths over two months. Thus, in two months, the facility would have had:

24 (who died early with COVID-19)

+ 24 (who would have died in about this time frame from their underlying illnesses, but they also had COVID-19)

+ (40-24=16, being those who died without COVID-19 playing a part, which is the background rate minus those attributed to COVID-19 but who would have died in this time frame)

= 64 deaths over two months.

That would be enough to be troubling to the staff and families, and probably to get a hostile story in the local paper.  The judgement is subtly different to realize that 40 deaths were expected before COVID-19.  Over the course of a whole year, the mortality of the residents at the start of 2020 might well be very nearly the same as expected, though 24 died more than a month or two early from COVID-19 infection.

Foreshortening lives by a few months is a real harm and would be better to have been avoided, of course, but it is different from the deaths of people who otherwise were healthy and would have lived for many years. I admit that it is very hard to find the language that acknowledges the pain and loss from deaths of a large number of nursing home residents in a short time while also recognizing that these were somewhat more tolerable than similar numbers of deaths of otherwise healthy people with longer lives ahead of them. Indeed, our culture has a difficult time finding the language or metaphors for death and dying.  Whether one adopts a stance of confidence in the afterlife, gratitude for the necessarily finite gift of life, or fury at that finitude, each of us will die.  Nursing home residents are mostly in a fragile balance with continued life, with multiple organs having little reserve and multiple identifiable chronic conditions.  We need to find a way to acknowledge their nearness to dying without discounting the merits of making the life that is left as meaningful and comfortable as possible.

Consider that the death certificate for the 94-year-old woman who “succumbed to the complications of a cold” will give her cause of death as her heart conditions, even though it was the upper respiratory infection that immediately led to her death.  In the case of COVID-19 affecting nursing home residents, the multiple actual causes of death will often include something like “advanced age with a tendency to a dysfunctional inflammatory response, multiple organ systems with greatly reduced function and no reserves, cognitive dysfunctions that yield self-care disabilities, and a last blow from infection by COVID-19.”  The death certificate and the tally of deaths on the television news will say, “death from COVID-19 infection.” We need to find a way to maintain awareness of the proportion of COVID-19 deaths that afflict persons who were living “in the shadow of death” – while still honoring, valuing, and supporting their opportunities to live.

Nov 132019
Dr. Lynn testifying before Congress.
Dr. Joanne Lynn, MD

The Ways & Means Committee of the U.S. House of Representatives heard testimony on “Caring for Aging Americans” on November 14. Dr. Joanne Lynn participated as an expert witness. A video of the hearing can be viewed at https://www.youtube.com/watch?v=20GgbnOMIn4.

Read Dr. Lynn’s comprehensive written testimony by clicking below.


Sep 182019
Portrait of Joanne Lynn
Dr. Joanne Lynn, MD

By Joanne Lynn

Within just a dozen years, the U.S. will have nearly double the current number of frail and disabled elderly people needing daily supportive services. Look around! What is being done to prepare for this expectable increase? Already most cities have long waiting lists for home-delivered meals, and no city in the U.S. has adequate affordable disability-adapted housing. We have all sorts of improvements “proven” to work in research or demonstrations, but we have no long-term plan. A recent Health Affairs article showed that most of the people who retired from “middle class” jobs will be unable to afford housing and health care within a decade.

America mostly deals with issues no more than a few years into the future. But private savings for supportive services in old age requires planning more than 30 years ahead – the person at age 50 has to plan for the risks at age 80 and beyond. And the nation has no real plan for how to arrange savings, taxes, and services to keep frail and disabled elders having food, shelter, and personal care. Indeed, even the Presidential candidates don’t debate these issues!

Delaying action until the suffering is so widespread and severe that taxes rise to support more of what is already haphazard and costly “care” would severely weaken the economy and curtail needed investments in other areas, such as childhood development and transportation infrastructure.

One clever proposal calls for federal coverage of long-term care after a period of need that depends upon the person’s lifetime earnings. If low-wage earners had to cover a year and high-wage earners had to cover 5 years, the cost would be less than 1% added to the Medicare tax. And we’d suddenly have long-term-care insurance vehicles that are affordable and widely purchased.

Well-proven improvements in medical care, preventive services, housing, and food delivery are easy to identify – they just need to be demanded and implemented.

In an editorial in the Journal of the American Geriatrics Society, I have called on all of us who serve frail and disabled elderly people to speak up – to push civic leaders for urgent planning and policy improvements. Click here to read the editorial – and then take action! Find a few other people willing to speak up! Get organizations to push for attention to these issues! It’s our future, claim it and make it better! Let us know how to help.

Apr 302019
Portrait of Sarah Slocum
Sarah Slocum

By Sarah Slocum

Across the U.S., we see more and more reports about a shortage of well-trained staff who are committed to providing in-home and other long term supports and services. The pinch of the shortage is apparent in many communities where it’s difficult to execute in-home service plans, and residential providers struggle to stay adequately staffed. We all see this problem, but what are we doing about it?

An upcoming Michigan Department of Health and Human Services Long Term Care Study, including Workforce, is described in legislation http://www.legislature.mi.gov/documents/2017-2018/billconcurred/Senate/pdf/2018-SCB-0848.pdf Altarum and PHI, will lead the workforce component of the study that will formally quantify the current workforce and its future and make recommendations for how to meet the growing need for recruiting new caregivers. Some have asked, “Why study this again? We already know it’s a problem.” By now, everyone agrees – it has become urgent to develop consensus around an action plan and move rapidly to implement solutions. That is the mission of our study – to analyze what causes shortages; to agree on what can make entry-level caregiving jobs economically competitive and to create a plan that outlines continuing education, training, promotion, and mentoring practices that can transform currently dead-end jobs into rewarding and sought-after careers.

One issue to tackle is inadequate pay. When entry-level caregiving jobs compete with retailers, it is no surprise that those less complicated and less personally stressful retail positions are filled first. So raising pay levels in stepwise increments is one obvious answer. But beyond pay, we can already see a need for skills-based, value-focused career ladders that motivate direct care staff to stay and advance as they gain experience, take extra training, and acquire new competencies. Proposals like Advanced Care Aides, Mentor Caregivers, and Lead Direct Care Workers (see a summary at: https://phinational.org/service/advanced-roles/) are gaining momentum as avenues for professionalizing the field of direct care into one that encourages entry-level employees to be part of larger care teams – to take partial responsibility for good patient outcomes that are in turn linked to the possibility of greater recognition and reward.

In California, the California Future Health Workforce Commission (https://futurehealthworkforce.org/) has a plan to eliminate the state’s shortage of care workers by 2030. A state investment of $3 billion over the next 10 years will support changes in education, training, and recruitment of workers, and includes strategies to address care worker shortages in rural areas with particular focus on the needs of people of color. California chose to take a hard look at the worker shortage and created a bold, multi-faceted set of solutions that can serve as a template for action in other states.

In Michigan and elsewhere, issues we already know about include the need for employee supports in areas like benefits, paid time off, childcare, transportation support and better training. How do we actually address these issues? Again, studies are an important first step – but they must be structured to lead to follow-up and implementation. Altarum and PHI (see PHI’s 2018 report on workforce at https://phinational.org/resource/the-direct-care-workforce-year-in-review-2018/) will collaborate to quantify typical benefits packages for direct care workers today and estimate costs for improving them. We’ll also focus on the costs and possible return on investment for employers opting to offer ongoing training programs to help their staff accumulate new skills. And we will endeavor to examine whether a case can be made that a well-trained and well-supported workforce can lead to better patient outcomes.

As one care worker in Michigan recently said, “It is my mission to care for people, and I don’t quit even though there are many hardships. Just a little help – a little more support, can keep me and my co-workers providing care. But we need the help now!”

Dec 182018
Portrait of Dr. Joanne Lynn
Dr. Joanne Lynn, MD

By Joanne Lynn

“Starting in 2020, we are going to be expanding that range of [Medicare Advantage] benefits…to include home modifications, home-delivered meals, and more.” — Alex Azar, Secretary of HHS [The Root of the Problem: America’s Social Determinants of Health, November 14, 2018, as prepared for delivery]

Aha! Medicare leadership is awakening to the fact that elderly people living with disabling conditions need comprehensive care that includes supportive services. Without those, frail elders run up unnecessary expenses for Medicare, particularly when the only way to get help is to go the emergency room. People who can’t get out and about need nutritious food delivered to their homes – and we need homes where wheelchairs can get into the bathroom, and from which disabled persons can escape during an emergency. When we can’t take care of our daily needs, we need help with meals, hygiene and transportation. Virtually all of us will need this help for at least a couple of years if we live to advanced old age, for ourselves or for those we love and honor. There are sound ways we can provide for this through policy and adaptation of current care systems. One way is through newly expanded MA supplemental benefits which enable MA plans to offer partial coverage for long-term services and supports (LTSS).

The CHRONIC Act, part of the Bipartisan Budget Act of 2018, frees Medicare to start allowing MA plans to offer supplemental benefits in conjunction with a personal care plan in calendar year 2020, which requires that the proposals be submitted to the Centers for Medicare and Medicaid Services (CMS) by the end of June 2019. Already, MA plans that chose to submit bids for 2019 including some LTSS services may offer a narrower range of supplemental benefits to all with designated conditions in a particular county. In general, MA plans can choose to offer supplemental benefits if they decide they can do so for less than the capitation that Medicare is expecting to pay. In the past, these benefits have been limited to services that are tightly tied to health care, including eyeglasses, and diabetes supplies, and those services had to be available to all beneficiaries in the plan.

Secretary Azar and others are pleased to point out the merits of avoiding hospitalizations and skilled nursing facility stays for beneficiaries who can be served at lower cost with additional support “at home.” It’s a good thing for Medicare to take note of the urgent need for the basics of daily living – food, hygiene, clothing, shelter, socialization, and mobility. People who need help with these basics in old age also need caregiving, and Medicare is making efforts to help caregivers, for example, by redefining respite and in-home support services to be included in permissible supplemental benefits. In addition, policy changes should allow Medicare to help volunteer and paid caregiving by including requirements for reasonable training and support for communities providing adequate back-up for caregivers.

Gaps are Wide Today

Yet there is still more we must do. How is it that this prosperous country can publish a study of home-delivered food that randomized 626 people in 8 cities who were on waiting lists longer than 6 months, needing home-delivered food? The three groups received
(1) 5 meals delivered daily on weekdays,
(2) 5 frozen meals delivered each week, or
(3) nothing
(Thomas KS, Dosa D. More than a Meal Pilot Research Study: March 2015. at https://www.mealsonwheelsamerica.org/docs/default-source/News-Assets/mtam-full-report—march-2-2015.pdf ) How does it not count as a scandal that one-third of the study participants were left without food? Indeed, how does it not count as a scandal that the study could readily find 8 cities with more than 6 months waiting for home-delivered food?

MA plan supplemental benefits might help reduce the inadequate supply of supportive services, but there are risks to using medical care to address social needs. To start, getting housing through a physician has to be an expensive way to provide housing. Perhaps more important, who will get supplemental services in a capitated medical care system? Surely, it will be people who are likely to spend less on medical care if they have the services. These will be enrollees who have established a track record of high-cost medical care, or who are reliably predicted to do so. But over time, many people will realize that the way to get urgently needed LTSS services is to go to the emergency room a few more times. Perhaps before that, they will sign up for MA plans that have these supplemental services. Inadequate risk adjustment may therefore pose a risk of adverse selection for plans, while promoting perverse behaviors on the part of beneficiaries.

Even more troubling is the moral question of feeding (or housing or otherwise supporting) people mainly because they are costly, rather than because they are very much in need. Imagine two neighbors, Ida and Emma, both 90 years old, hearing-impaired and visually limited, and who use wheelchairs to get around their small apartments due to failing hearts and bad hips. Ida is very nervous about her health and has a physician whose response to any urgent call is, “Go to the ER.” She ends up in the hospital every few months. Emma, on the other hand, believes that things will take their course and you should only use a hospital when there’s something specific that hospital care can fix. Her primary care physician also serves the local hospice program and does house calls when needed. She hasn’t been in the hospital since having her last child 50 years ago. Indeed, she has not seen her physician for some years, relying instead on telephone advice from the office.

Both women live on Social Security at just above the Medicaid income eligibility threshold, and they juggle the cost of rent, pills, co-pays, heat, and food. Neither has family nearby and all their old friends have died. Recently, both of them have become sufficiently disabled that they cannot shop for food and can only heat things up in the oven or microwave. Is it really acceptable that the supplemental benefits from the MA plan ensures that Ida gets home-delivered food regularly, but Emma does not, and that Emma’s life may be shortened due to lack of good nutrition (and socialization, as the More than a Meal study showed)? We don’t calculate the impact of a deficit of supportive services at this point: Rather, earlier death is attributed to age and various maladies. Not acknowledged are the months Emma spends hungry and alone. This is poor care, and we need Medicare to take additional steps to address LTSS – both for enrollees of MA plans, and the millions of Medicare beneficiaries who prefer to be in the fee-for-service system or other non-MA care arrangements.

In addition to supportive services, good eldercare arrangements make physician coverage much more reasonable. Both of these ladies are likely to need ongoing personal care at some point. MA plans are not likely to provide more than short-term help with in-home aides – it is just too expensive and doesn’t save hospital care much. Instead, good care at home saves on nursing home care, but that is not covered by Medicare. Ida and Emma are therefore likely to end up spending down quickly to Medicaid and having to move from their homes to a nursing home (and giving up all but a pittance of their income). Even in states with managed Medicaid LTSS for elderly persons, those plans are often not the same as the MA plans, and concern for spending down and nursing home placement is not often a pressing concern for the MA plan.

Things are even more challenging when it comes to family support. What should we expect of family? What if Ida had multiple attentive family members willing and able to bring in food, help with household repairs, provide transportation, and so on – while Emma had only the grudging support of a small group of elderly relatives living some distance away? What if the situation is even more complicated by a history of abuse? This country has had little discussion of what can reasonably be expected of relatives or neighbors when a person becomes disabled and needs help.

Another major issue that is rarely spoken about is this: how can we account for the effects of our choices on our lifespans, given that survival is expensive once you need near-constant help from another person? This and family support are among the elephants in the room, with too little honest discussion to shape good public policy.

How can we adopt a more useful and accurate vision of what it takes to ensure adequate supportive services for all elderly people? One way to do this is to start with the simple premise that individual people have varying needs that evolve over time, and addressing them requires that they be connected to local entities that have a mission of addressing those needs. In other words, services must be organized to be adequate by geographic community. No physician can conjure up housing that is affordable and adapted for a disabled elderly patient if that sort of housing is not available in the area where that elder lives. If there is a long waiting list for home-delivered meals, there is virtually no opportunity to ensure that what a particular person needs can be met. No one physician, nurse or other provider, or family member or friend, can generate the trained workforce needed, or convince area employers to have flexibility to enable family caregiving.

To get a handle on whether a particular community has adequate service capacity, we need metrics that can gather information about and publicly display what a local system’s overall performance is vis-à-vis eldercare, and its ability to improve. We also need examples of governance arrangements that develop into entities that can take on the responsibility of monitoring and managing the performance of a local eldercare system. This entity needs data and the authority to prioritize the use of some resources.

Some MA plans could do this, for example in areas where an MA plan dominates the local health care market or where the various providers and payers learn to cooperate in the public interest of better eldercare. Under current policy, an initial “demonstration” phase could take place in designated counties where payers, providers, and civic leaders are willing to measure and monitor their eldercare system’s performance according to selected dimensions and are able to establish an entity that is charged with setting priorities and taking action. If we can get a dozen counties to test this approach, we can quickly learn what reliable and effective eldercare looks like, and how efficient it can actually be. In a locally driven framework, the new MA supplemental benefit availability would become part of achieving better eldercare across the community.

Sep 252018
portraits of Anne Montgomery and Sarah Slocum
Authors Anne and Sarah

By Anne Montgomery and Sarah Slocum

On May 4, 2018, the Michigan State Legislature voted to “just do it:” to assemble a group of experts to craft a blueprint for taking the Wolverine State deep into the future of Michigan’s age wave – all the way through the mid-21st century.

Specifically, the language requires the Michigan Department of Health and Human Services (MDHHS) to contract for: “an independent feasibility study and actuarial model of public, private, and public-private hybrid options to help individuals prepare for, access, and afford long-term services and supports.” The study will take 9 months. It is meant to squarely address the fact that current options for individuals to fund their long term supports and services (LTSS) needs have been unworkable and have often resulted in impoverishment and bankruptcy for Michigan families.

Since Medicare doesn’t pay for LTSS and less than 10% of Americans have purchased private long term care insurance, most people have to pay out-of-pocket when they need in-home care, assisted living, or nursing home care. This continues until the disabled person qualifies for Medicaid, which picks up the cost of nursing home care. Or, if there is an available program for home and community-based services (HCBS) that doesn’t have a waiting list, families may be able to tap into Medicaid for in-home services and other types of assistance.

Along the way, thousands of formerly middle-class families in Michigan are forced to impoverish themselves every year in order to qualify for Medicaid LTSS coverage. This “spend down” process is anguishing for many, who would prefer to have more control over their lives and perhaps to leave some of their accumulated resources to children and grandchildren. Recognizing this, the Michigan legislature, led by Rep. John Hoadley (D-Kalamazoo) and Sen. Margaret O’Brien (R-Portage), went to work last year — along with a coalition of concerned organizations led by Michigan United and including Altarum’s Program to Improve Eldercare – to ensure that the study bill would become law.

The Michigan budget for fiscal year 2019, which begins in October, includes language directing the Department of Health and Human Services (MDHHS) to draw up a workable, practical plan that will make LTSS available to middle-class Michigan families. MDHHS has $100,000 in state funds that will be matched with at least that much in private philanthropic funds – and possibly far more — to take a hard look at LTSS financing possibilities, workforce development capacity and future needs. The study will assess the current landscape of long-term care needs including:

  • What private and public services exist;
  • What the costs for current services are;
  • Who is accessing them and who is not;
  • What are the challenges to accessing care, including the gaps in services;
  • The impact that care has on the care workforce and family caregivers.
  • The primary goal of this study is to assess the cost and impact of three main financing proposals:
  • o A long-term care benefit for all Michiganders;
    o A public-private risk-sharing insurance program that reimburses insurers;
    o A long-term care benefit for those who do not qualify for Medicaid.

Today, Michigan Medicaid spends almost $3 billion per year on LTSS — and the cost goes up each year. But Michigan families spend more. AARP Michigan reports that Michigan families provide $15 billion worth of uncompensated care each year. New options are needed to keep both the state budget and Michigan families healthy during the state’s “age wave” era.

On the workforce side, Michigan is already facing shortages of people able and willing to fill direct caregiving jobs. MDHHS will engage experts to examine what supports current workers need to remain in the LTSS workforce: e.g., career ladders, benefits and wages to make LTSS jobs more attractive, and workplace conditions to make LTSS jobs safer and valued to attract candidates and keep them. Overtime and turnover due to stressed staff are major cost centers and major causes of staff shortages. The LTSS study will examine all of these factors and create new solutions to make LTSS jobs a career option for many more people.

Similar studies in the states of Washington and Hawaii have resulted in major changes to how LTSS is delivered and paid for in those states. The AARP Long Term Supports and Services Scorecard ranks these states respectively first and seventh in the nation on an array of measures. Washington and Hawaii have used results of LTSS studies to develop much better options for individuals and workers. Michigan is overdue for a serious examination of issues in financing and staffing LTSS, and this opportunity will jump-start major innovations. In the absence of a national strategy or plan for affordable high quality LTSS, several additional states are pursuing state level action. The chart below provides some current examples:

The current environment of long term care in Michigan includes over 40,000 nursing home beds in about 430 facilities, another 40,000 beds in about 4,500 Adult Foster Care Homes, and 10,000 beds in about 190 Homes for the Aged. An unknown number of unlicensed Assisted Living facilities operate in Michigan, serving an unknown number of people. In addition, another unknown number of people are getting care through visiting nursing services, private duty home care, and other unlicensed businesses offering various services. Medicaid also funds 11,000 Medicaid HCBS beneficiaries through the “MI Choice” program, and over 3,000 beneficiaries (the vast majority are dually eligible) through 10 PACE organizations (Program for All Inclusive Care for the Elderly). Michigan is home to nearly 1.9 million Medicare beneficiaries, of whom almost 300,000 are also eligible for Medicaid.

Experts estimate that 50% of the Medicare population will need long term care at some point in their lives. In Michigan and around the country, elders are the fastest growing segment of our population – so the need for LTSS, which seems high today, is set to increase steeply over the coming years.

To put some financial parameters around this discussion, nursing home care costs Michigan’s Medicaid budget $1.7 billion dollars per year; private pay rates in nursing homes range from $9,000 to $11,000 per month. Adult Foster Care and Home for the Aged monthly rates range from $800 to $5,000 for those able to pay privately. Michigan spends another $350 million on MI Choice and PACE, both of which have lower monthly costs than nursing home care. Area Agencies on Aging and other community organizations provide supportive community services, but their budgets are quite limited and have not seen the significant budget increases needed to keep pace with the growing aging population.

The costs to individuals and families of unplanned, poorly coordinated LTSS are also very high: First there are substantial “out-of-pocket” costs associated with in-home services, equipment, medications and more medical procedures and visits; second are the high costs to family caregivers, who may face the loss of their jobs and their own livelihoods as care needs increase. Some families may also find it necessary to move to different housing that can accommodate an ill or disabled family member’s needs for disability access, thus incurring the costs of moving. Many families struggle and figure out how to cope for a while, and later give up – leading to costly nursing home admissions. Others simply go bankrupt.

Like other states, Michigan must devise ways to stretch publicly financed health care dollars further to support LTSS. For families, LTSS must be made more affordable and reliable – and delivery systems must shift to services that can readily be delivered at home. The workforce that delivers this care must be well-trained, supported, and paid a living wage to assure quality and continuity of services. With advocates, researchers, policymakers and funders at the table, the Michigan LTC study is a prime opportunity to create smart adaptations to existing programs, and to create new and more efficient initiatives. Both will serve as investments in the future.

Jan 232018
A photograph of a group of Zuni elders
Zuni Elders Community

On December 5, 2017 the “It Takes YOUR Community” symposium was hosted by Altarum’s Center for Elder Care & Advanced Illness in Washington, DC. This post provides an edited videocast of the event and the edited transcript with links to presentation slides as well as a Resource POD. The primary goal of this symposium was to bring together fellow stakeholders and interest groups involved in addressing the needs of the growing elder population at the policy and grassroots level, and to discuss possible strategies as to how we can stay engaged and think about building community-anchored care systems across the country.

Our diverse and dynamic group of speakers and panelists provided in-depth insight, as well as actionable and practical tools of advocacy models necessary to plan for the community-based health and long-term service and support (LTSS) needs of a growing older population.

The Symposium Transcript has been edited for clarity and readability and includes links the background resources that presenters provided [for additional resources see our Resource POD]. Additionally, here is the final agenda, for your reference.

The Full Videocast can be viewed or you can use the individual links to the agenda below (so you can select which panel discussions you wish to watch). Click on the discussion title [blue text] to link to start the recording of that discussion. You can navigate in the whole recording from any of the links below, for example you can view the entire session by clicking the opening link.

0:00 – 6:29 ~ Opening: Communities and the “Age Wave”
6:30 – 1:04:40 ~ Three Communities: What Are the Driving Factors?
1:04:41 – 1:52:52 ~ The Role of the Federal Government in Supporting Community-Anchored Care
1:52:53 – 2:31:46 ~ Panel Discussion: Drilling Down
2:31:47 – 3:10:04 ~ Financing Projections by Communities and Getting a Handle on Services and Costs: How You Can Approach This as a Community Planning Initiative
3:11:46 – 3:47:28 ~ Where Can Communities Go To Find Some Money to Get Started?
3:47:28 – 3:49:44 ~ Leveraging Action

Copyright © 2017 Altarum, All rights reserved.

Altarum is a national nonprofit whose mission is to create a better, more sustainable future through ideas and action that transform health and health care in America. Learn more at www.altarum.org

Jul 102017
Stages of Analysis graphic
Stages of Analysis

A new analysis from The Center for Elder Care and Advanced Illness lays out the key regulatory flexibilities that are central to allowing a greater number of Medicare beneficiaries to enroll in PACE, and includes links to relevant regulatory and statutory policy.

The Program of All-Inclusive Care for the Elderly is a highly promising model that can be adapted to meet the needs of large numbers of older adults who require a mix of medical care and long-term services and supports. These beneficiaries need reliable, well-coordinated, geriatrically competent, longitudinal services that are delivered in the community. These services must be affordable to participating older adults and to U.S. taxpayers.

Click Here to View PACE Flexibility Provisions That Would Help Medicare-Only Enrollees

May 242017
Poster showing elder and caregiver

The Center for Elder Care and Advanced Illness is proud to support CARE, a 65-minute documentary about the increasing importance of caregiving in our aging society; the passionate caregivers who often earn poverty wages; and the families who struggle to afford the care they desperately need. We hope you will join the CARE team in support of the work we all do to move towards a more just, and equitable care system for all!

How can you help?

Bring CARE to your church, community organization, campus, or workplace. Local screenings help to spread awareness of eldercare issues, create fundraising opportunities for local care networks, and empower and educate the public about efforts to improve our care system to better support both elders and caregivers. To learn more, reach out to the film team by visiting www.caredocumentary.com or contacting Denae Peters at [email protected].