10 Action Steps for Aging in Place in 2014

End of the year, or is it the beginning? I’m bullish that Aging in Place will advance in 2014.  How can we get the ball rolling? We need an action agenda to manage our way to a better future.  Here is my 2014 list of Ten action steps business and community can follow to encourage aging in place capability.

1. Al Gorify. The growing size of the aging population, the new longevity, the cost of care in later years, the undesirability of most ‘senior housing’ and the growing caregiver gap are not new information. Neither was climate change when Al Gore delivered An Inconvenient Truth. People paid attention. It is time the upcoming crisis in housing and care for older citizens comes to popular attention so doing something about it can become a mainstream discussion.  “Another Inconvenient Truth”, “A Reality to Face”. Maybe Joe Bidenize is better.

2. Shift Left. Intel smart guy Eric Dishman espouses this idea. It has nothing to do with politics, all to do with Return on Investment. Proactive wellness has a much better return than acute care.  Influencing people to better behaviors is the most cost effective way to save medical dollars. Helpful technologies are available. We need to put our money where it works.

3. Promote Visitability It has been over 20 years now, and though Eleanor Smith, the Mother of Visitability says she has retired, no single program has done so much to raise such clear awareness and make a concrete difference. Visitability may not be the end, but as a first step, it has no equal.

4. Support Family and Informal Caregivers. Estimates of the value of family and informal care keep growing, leaving little doubt that it is critical to stemming future care costs. The rapidly growing Village movement is an organized, non-family support network of informal care. Programs that support family and informal care should be multiplied and strengthened.

5. Work toward credits, incentives, subsidies, regulations. Building and other business do not get ahead of curves on their own. Zoning, building, financing, incentives, subsidies tax credits and regulations push new ideas to be built. These techniques can promote Universal Design based home remodeling, new building and community design for Aging in Place/Livable/Age Friendly Communities. It works for solar collectors, hybrid cars, burglar alarms, smoke detectors and seat belts. Home insurance premium breaks influence people to buy burglar alarms. Why not a break on your health premium if you install grab bars? Reduced falls will more than cover the program costs and provide a training ground for installers. Reduced fees or expedited permits will increase the supply of appropriately accessible housing. Financing incentives will draw developers to do the right thing. Regulations level the playing field.

6. Focus demonstrations on the out of pocket, in home market- The amount families spend out of pocket for long term care in homes is huge but largely undocumented. The industry is too fragmented for much good data to be available.   Concentrating demonstrations on the out of pocket market avoids emphasis on the requirements, eligibility and cost cutting aspects of government programs that make quick iterations and pivots difficult. Demonstrations in housing facilities don’t take community serving problems like varied environments, traffic, parking, weather and scheduling around those problems into account. Organizing demonstrations around out of pocket long term care in individual homes will more quickly identify real world models that can be taken to scale throughout the pay continuum.

7. Create Jobs Three job categories to get the trained resources we need and stimulate the economy

• (a) Careworkers- We recognize an emerging “care support ratio“, the gap between the numbers of those who need care and those available to provide it. Better trained workers do better work and are more dedicated to their jobs. Have we tried higher pay encouraging people to stick to their jobs and attracting better employees  who are more easily managed? It may cost less!
• (b) Home safety- We trained people to weatherize homes. Training folks to install grab bars and other safety features will reduce misery, save medical dollars and train a workforce to maintain our aging housing stock full of older citizens.
• (c)  Dynamic, systematic service delivery implies well trained hub managers capable and empowered to use data to deploy best solutions to use resources effectively. We must create the job and training.

8. Cross silos Business, not for profits and government agencies need to form partnerships, working relationships, coordinated business plans and integrated strategies across traditional silos and disciplines. When you are in a hospital, skilled nursing facility or assisted living, what you need- like meals, IVs, physical therapy – comes to you when you need it. That doesn’t occur in individual homes. Management is forced on unprepared families by handing them a list of possible resources. Willing providers wait for calls that always come in a crisis. Nothing works as a system resulting in waste, exhaustion and frustration. A better approach will improve provider operations netting better results for end users. Examples abound. Transportation agencies can work with electronic monitoring services to improve reporting and save trips to the doctor. Home health agencies can work with remodeling contractors to make homes safer and keep customers longer. Volunteer groups must recognize that businesses need profits to remain viable. All stakeholder’s should share the mantra that a rising tide floats all ships.

Like anything new, the detailed models for this care system do not yet exist. The exact benefits may not be obvious at the outset. The work will help find that out: Commit, try new things, try other new things, replicate what works, spread the word, adjust for new places and circumstances, repeat! And then do it again.

9. Learn to Leapfrog Too often I hear about a ‘new’ program that sounds familiar. Reinventing the wheel is never a good idea. We need better documentation and dissemination of trials, demonstrations and most important- results. Scarce funding should not be wasted learning things that have already been learned. Once we better document what works and what doesn’t, we can leapfrog from these programs to new, better and more advanced demonstrations. Time and money is short. We must use it better.

10. Pay attention to the third customer segment- Most effort toward enhanced Long Term Supports and Services in the community centers on two categories of stakeholders: The health systems, payers and insurers on one side and the clients and families on the other. But there is a third stakeholder segment – The technologies, transportation, home and health products and personal, home and community services poised to work in a growing home care industry. As health care reform pushes the site of care to individual homes there is an expectation that providers have the capacity to meet the opportunity. BUT no one is paying attention to the needs these providers have. The business to business sector that serves the providers that serve the clients in their homes is uncharted territory. That sounds like opportunity to me.

All these action steps are closely related. They are different entry points to the same ideas. That the future of housing and care is in individual homes, where control, dignity and respect is maximized for older citizens, health is maintained at lower cost, jobs are created at many scales and agencies and business do well by doing good. I predict exceptional progress in 2014.