Is the health care industry's current approach to caring for older adults falling short?
We interviewed 13 executives from across the health care ecosystem and asked them that exact question. Overwhelmingly, the answer was yes. But, when we followed up to ask them why we are falling short, we received some interesting and different answers.
Here's a snapshot of what our conversations revealed:
We're working with a fragmented and archaic payment model
Our conversations highlighted that our current health care system is not set up to adequately care for older adults. Medicare and Medicaid were created out of the great society model of care in the 1960s and didn't anticipate the longer life spans and nuanced health needs of older adults today.
Under traditional Medicare, certain services—especially medication coverage—are hard for older adults to obtain unless they purchase a supplemental plan or a Medicare Advantage plan through a private insurer. Medicare also excludes coverage for long-term care, which becomes more essential as adults live longer and need help with daily activities. This make it difficult for the average older adult to shop around and understand what is available to them and at what cost.
We are making progress, but the industry needs to take collective action to keep from stalling
We've made meaningful progress as an industry across the past decade. Our conversations specifically focused on how the industry has better addressed social determinants of health. There's been an emphasis on leveraging technology to enable older adults to age in place, and to make sure the home environment is safe. However, despite this progress, leaders understand there is a long way to go. While there are many items on the to do list, there were a few things that everyone agreed were worth prioritizing.
1. Prioritize preventative care and chronic disease management.
The current system is designed to treat problems, not prevent them. However, we are living longer and have more complex care needs. To increase the amount of time that we are healthy, education around wellness and preventative care needs to be a priority. Not only does preventive care need to extend into older adulthood it needs to include earlier and more nuanced conversations about what to expect at end-of-life.
2. Give older adults more living choices.
The majority of seniors want to age in place—or live in their home independently for as long as possible. So, industry stakeholders should consider what changes they need to make to allow that to happen. However, we also know that many older adults will need to move into a senior living facility. Options for this are typically expensive, hard to find, and often do not give older adults the quality of life they desire. Industry leaders will only be successful if they can overcome competitive dynamics and the tendency to be adversarial against other options.
3. Break down silos and increase collaboration.
We heard of exciting initiatives to support older adults, many of which include eliminating silos across the industry. Despite progress, we know that improving collaboration has still been a major challenge. Here are some powerful connections that can help ensure success:
- Collaboration between health care providers and home and community-based services: Home and community-based services assist with activities of daily living, which can include eating, bathing, preparing meals, and transportation—all of which are critical in an older adult's health journey and their ability to age in place. Rather than simply creating new services, health care providers can look to partner with trusted organizations already operating in the community.
- Collaboration between acute and post-acute care providers: Partnerships between acute and post-acute providers can relieve capacity problems. This has been particularly true throughout the Covid-19 pandemic. Hospitals can also capitalize on the opportunity to reduce care variation and related readmissions by extending care protocols to their partner skilled nursing facilities.
- Collaboration between post-acute providers: Currently, post-acute providers see support for one part of the continuum as a zero-sum game. SNF operators and assisted living communities have lobbied against add-on payments for traditional home health options, seeing it as a threat to their business model. To move forward and create sustainable solutions for older adults across their entire care journey, they need to work together—not in opposition of each other.
This is both a business and societal problem—and the societal implications might be harder to overcome
Everyone we spoke with agreed that the way we care for older adults is both a business problem and a societal problem. On the business side, it's extremely expensive to take care of seniors and it hasn't historically been a profitable sector. However, on the societal side, it's hard to change the negative perceptions of aging.
Most people don't want to think or talk about getting old, and seniors often face discrimination based on their age. These negative perceptions also pervade the workforce, especially direct care workers. Often, these positions are not paid well, and are not recognized with the same esteem as other jobs within the health care industry. Shifting the mindset away from older adults being a burden to society will be challenging, but critical to overcome—especially if we are to scale progress and innovation.