Aging and healthcare: an impending crisis

A news article titled “Here come the seniors” caught my eye today. It describes the challenges for the health care industry as all of us boomers age and need more medical care.

More importantly, however, it outlined solutions. Here’s how it starts:

The silver tsunami. The age wave. The graying of America. Whatever cliché you want to use, the strain that the aging baby boomer population will place on the healthcare system in the near future has been well-documented and thoroughly discussed. Yet the industry as a whole remains surprisingly unprepared to care for a wave of new elderly patients who may fill as many as two-thirds of hospital beds in the next 30 years.

So that’s the problem, in a nutshell. Here are some of the recommended solutions:

Success Key No. 1: Look downstream
Tie in acute hospital care with other services like long-term care, hospice care, outpatient care and fitness programs.

Success Key No. 2: New models of care
The ACE program in Cleveland, OH, is a model for senior care that not only treats the whole person using an interdisciplinary approach, and incorporates principles of patient-centered care. It’s a program that is effective in reducing hospital and long term care stays – both things that seniors would applaud.

Success Key No. 3: Coordinate in the community

"One of the biggest challenges with the geriatric population is the handoff; the transition of care," says Barbara Looby, administrative director of senior health services at Crozer-Keystone Health System, a five-hospital system based in Drexel Hill, PA, covering 774 inpatient beds. "What happens when patients leave the inpatient hospital setting to go to an outpatient level of care, whether that's home care or another level of care such as nursing home or assisted living?"

Communication is vital, but so is training. The caregiver providing the care to the patient needs very specific training to ensure that the patient doesn’t end up right back in the hospital. Too often the elderly are discharged out of the hospital to untrained, inexperienced family members who are very willing, but not appropriately trained to provide quality follow-up care.

Success Key No. 4: Train physicians

Currently the US has a little over 7,000 geriatricians (specialists in geriatric medicine). It seems that med students see little reward in this field of practice and they’re right – it is one of the lowest paid specializations. The projected need for geriatric physicians to meet increasing demand is estimated at 36,000 by 2030. Making this more attractive to new, young physicians – and compensating appropriately – must begin happening soon for this need to be met.

Moving Home - the continuing journey

Many of you have been following my family's journey with our two sets of elderly parents. My mom's squared away in a perfect retirement village, happy and traveling with new companions following the loss of my father.

It's my in-laws that have been challenging the family lately. They have been reluctant to give up the home where they have lived for the past 55+ years. However, with their mobility diminishing (neither drive much anymore), loss of friends, neighbors and their social circle, and home repairs and maintenance that are simply too tough for them to handle any longer, the time has come for them to make a change.

Fortunately, my sister-in-law determined to make it her mission to convince them to move. She toured retirement communities with them until they located one very close to their home that they really like.

Three weeks ago, we all met at the retirement community for lunch and a tour. Walking through, we all commented on how much they will be gaining by this move - not giving up. They finally agreed, too.

The following weekend they put their home on the market. My mother-in-law threw a fit when the "for sale" sign went up on the lawn (she didn't want a sign), but a few days later a young couple, renting in the neighborhood, walked by and saw the sign. The papers have been signed and, even in this very slow market, the house sold in a matter of days.

Last week the in-laws went to a Hawaiian luau at their new community. They came home happy about the decision they've made, and really looking forward to the move.

Whew! It's been quite a journey for us all. Our one goal: to see the folks more active and more involved with others. In short, to see them happy again. They are both very social people by nature. My mother-in-law had at least 3 social groups she belonged to for more than 60 years - one composed of the other mothers whom she met in the hospital giving birth to my husband! One by one, her group members have died or moved away. My father-in-law loved to golf, go to the beach, and play cards. Over the past few years, their circle has gradually shrunk to their living room, with only each other for companionship.

They, as so many others today, have been blessed with a long life. My father-in-law is 96; my mother-in-law close behind. Living fully, right to the end of life, can mean tough choices and tough decisions.

But in the end, living fully, all the way to the end, is the difference between just existing, and truly gaining the richness and joy that life has to offer.

50 is the new 30 - of course!

I loved watching the Today show staff celebrate Ann Curry's 51st birthday this morning - but I loved even more knowing that Ann and I are only a month apart in age.

Ann makes 51 look fabulous - she's healthy, fit and beautiful. She is all the things that make people think that 51 isn't all that old - heck, it isn't really "old" at all, just ask any of us 51-year-olds!

As a part of Ann's birthday tribute other women who had done remarkable things in their 50s were featured.

What a wonderful time in our world's history to be 51! Thanks, Ann, for showing us how to do it in style!

Aging Tsunami Coming

In September a group of individuals came together for an “Aging Revolution Summit” – a look at how aging services providers will begin to address the coming changes in needs that the aging baby boomers will bring.

According to a story in the FutureAge magazine, the summit was kicked off by Wesley Enhanced Living’s president and CEO Jeff Petty, who said, “As ‘revolutionaries,’ we need not answer traditional questions, but begin questioning traditional answers.”

Keynote speaker David Walker, comptroller general of the US, shared a detailed analysis of coming costs and trends that the seismic demographic shift will bring. (See report.)

Walker notes that just the government liability for Social Security and Medicare benefits alone increased 197% between 2000 and 2006. In his presentation he notes that “GAO’s simulations show that balancing the budget in 2040 could require actions as large as 1) Cutting total federal spending by 60 percent or 2) Raising federal taxes to 2 times today's level.”

Clearly, we have not only a clue, but solid facts about what the future of this country will be with the dramatic increase in the aging population.

As senior care and services providers, our responses will need to be not just “more of the same,” but we will truly need to “question traditional answers” and explore ways to move beyond the current service and delivery method.

One traditional answer that we’ve been working hard to turn on its head is the traditional approach to training. More and more individuals will need to be trained to provide services to seniors in their homes, in assisted living and residential care settings and in skilled care settings.

Fewer and fewer resources will be available to train them. Introducing quality online training can not only increase the number of individuals that can be simultaneously trained, but it can also increase our output of trained individuals.

Once they’re trained, we need to figure out how to keep the goods ones in senior care. We know that ongoing training is a key element, but what other sorts of questions of traditional answers do we need to be asking?

Walker closes his presentation with a statement about the “Five Leadership Attributes that are needed for these Changing and Challenging Times: Courage, Creativity, Integrity, Stewardship and Partnership.”

It is time for real leadership. And that leadership will come through partnership as we work together, creatively, to solve these challenges.

'Round the world view

Yesterday was my first day back in the office following three weeks on the other side of the globe.

What an experience it was, to see first hand how people live in Singapore, Indonesia and Australia. The cultural differences couldn’t be more dramatic, especially between the remote islands of Indonesia (we spent 10 days on a small island group 600 miles east of Bali), the bustle of Singapore and the quiet beauty of South Australia.

We saw families transporting cows on the cabin roof of their small boat, visited a family’s home on stilts, carefully walking on the floor joists so we wouldn’t crash through the grass mats covering the floor, and stayed on a winery in picturesque McLaren Vale.

In one of the most remote villages we visited, age 50 looked ancient and the average life expectancy was very short.

In Singapore the government has recently decided to allow people a third day off each week, in addition to the weekend, in the hopes that they will procreate more freely and help offset the aging population. There, with the third oldest population in the world, the health and social needs of an aging population are at near crisis. With too few young workers, migrant laborers, mainly from India, are imported to provide the needed labor, raising cultural and social challenges of their own.

It’s always interesting to see how the rest of the world lives, and how they tackle some of the very problems we’ll soon be facing here.

On the other hand, it’s always good to be back home, too.

An Insider's View

I love a good story. I particularly love those stories that make me think, over and over, for a good, long time.

Celia Berdes, a researcher and author, reviewed the new book "Dancing with Rose" with such enthusiasm that I'm going directly to Amazon and ordering it:

Dancing with Rose: Finding Life in the Land of Alzheimer's (York: Viking, 2007), a new book by Lauren Kessler, is the best book yet written on the lives of old people in residential care and the people who care for them,

Celia writes in today's Quality Jobs/Quality Care e-newsletter.

Here's more of her review:

Dancing with Rose leads us to this inescapable conclusion: that caring aptitudes and attitudes of skilled direct care workers are the most important components of high quality care. In a call for systemic reform, Kessler asks us to think about our own aging: ''If I do need help when I get older, if it becomes impossible for me to live independently, how do I want to live? Do I want to be cared for by an overworked, underpaid woman with so many chores to accomplish on her shift that she can barely spare a minute to talk to me? The important question is whether I--whether any of us--have the gumption, foresight, creativity, fearlessness, imagination, whatever it takes to do something about eldercare before it's our turn.''

Let me echo this. My theme, and I'll repeat it every chance I get, is to simply say that this is a personal issue for all of us. Who will care for my mother - for yours - when the day comes? Who will, eventually, be caring for you and me?

That's about as personal as it gets.

Working Together for Change

This Sunday is the annual Race for the Cure event in my home town (Portland, Oregon). It’s an event I’ve been participating in for several years, and one I’ve encouraged my daughters to attend with me year after year.

The first time I attended the Race I spent the entire time in tears – what an emotional experience to see so many women, moving together with a force that only comes from joining together for one purpose and one goal. At the time, I wondered what incredible things we could achieve if we put that kind of effort into other needed changes in society.

I often reflect on this experience as I work with senior care providers, training the next generation of senior care administrators, managers and caregivers. What a force we can be when we join together to achieve a goal!

Too often in this profession, however, we tend to want to protect our turf, and focus only inward. Instead of tapping into each others’ skills and services, we try to “reinvent the wheel” by doing everything in house. We miss the tremendous benefits we can gain by going outside our own circle and sharing our expertise, asking advice, or standing together for a cause.

The folks in Hendersonville, NC know the power of joining together to solve a problem. Instead of protecting turf and hording resources, they’re joining forces to reach out to impoverished seniors who cannot afford to purchase medical equipment – equipment that may make the difference, for many, between the ability to live independent lives or becoming dependant, increasingly frail seniors.

Carillon Assisted Living (1550 Charles Rd Shelby, NC 28152) is at the head of the pack, collecting donated items 7 days a week and working together with the Salvation Army and other area non-profit organizations.

Associations like the American Association of Homes and Services for the Aging and the American Health Care Association provide a vehicle for providers to join forces for change on a national scale, and in that manner those organizations have achieved amazing things.

As those of us who are both senior care professionals and aging boomers know, however, change starts right here at home, in my town, in our state. Working to improve the quality of care provided to seniors right here is a cause we can support – together.