Long-term care, including home-based and residential models is unattractive, inaccessible and / or unaffordable; it’s time to rip it up, and start over. The recent experience with COVID-19 is driving home this point – change is needed.
Systems for regulation and payment in the US, the UK and many other places have been cobbled together over decades with little or no concern over what the consumer wants, true efficiency, operational outcomes or quality. Government funding sources have empowered or contracted with various intermediaries (local authorities, state agencies and private claims management companies) to help manage payment and control utilization. The result is a hodgepodge that costs too much, includes perverse incentives, and is almost impossible to navigate. As developed economies reel from disproportionate COVID-19 related deaths among the elderly in congregate care settings, isn’t it time to rip up the old models, which weren’t working anyhow, and start afresh with creative ideas and 21st-century innovation? From an ethical point of view, the vulnerable elderly and disabled in our midst deserve better. The post-World War II Baby-Boom cohort is entering their 70s and could overwhelm the existing age care & support systems. From an economics point of view, we need to do something to bend the cost curve. Doesn’t everyone deserve better long-term care than what we have now?
On Wednesday 29 July at 4:00 PM EDT – Rip It Up and Start Over. This program will take a brief look at how we got here and chart a new course for service delivery models in the long-term care sector.
Starting over in long-term care will include:
- Structures – the property plant & equipment in most congregate, long-term care settings is old and unattractive. Recent additions of purpose-built assisted living and other types of properties stand in contrast to the “Fawlty Towers” properties. Most owner / operators don’t have access to capital markets and would not be able to make the debt payments for the kinds of upgrades that have been put off for 30+ years. Imagine staying in a hotel that hadn’t had more than a paint job for 30 years? You get the picture.
- Programs – most of the programs in long term care aren’t at all designed to meet the needs and desires of consumers or their families, but are, instead, designed to restrict government funding to a specific class of individuals and / or to monitor and control payment through utilization measurement. For example, in the US, a typical 85-year-old who needs post-operative care will be covered by 5 or more different programs, including nursing home, pharmacy, medical equipment, physical therapy, home health care and community-based services. None of these talk with each other and very often actively compete with each other.
- Technology – technologies, including “ambient assisted living” are currently available to enable surveillance and physical safety of consumers in their homes. Remote patient monitoring, digital health and telehealth solutions have clear returns on investment and (because of SARS-CoV-2 / COVID-19) are meeting with widespread acceptance and adoption. Public health principles applied in long term care (relabeled as social determinants of health) are finally being applied in risk-based experiments and demonstrating their importance to improving health, safety and lowering overall costs.
- Information infrastructure – grocery stores have better technology than most congregate care centers. Why? Because the sector has been embarrassingly neglected by policymakers and politicians for decades. Country-wide investments in health information technology (HIT) for things like telemedicine and electronic medical records in the US and the UK have specifically excluded congregate long-term care.
- Outcomes – the minimum data sets required of and recorded by long-term care centers are just that – minimum. There is no data about the overall outcomes of care. Even where the data about clinical conditions is recorded, (e.g., PDPM), unlike hospitals, and medical practices there’s no attempt to measure customer or consumer satisfaction.
- Economics – how will care be funded? The most important component of any long-term care operating budget is labor. The human resources needed to care for vulnerable elderly represents 60 – 80% of every long-term care Operating Statement. These individuals are often poorly paid, foreign workers at the bottom rung of the socio-economic ladder. Why? Because operators are paid as little as possible, based on the “heads in the beds” or the (truly perverse) insurance or pension category of the consumer. A few bad actors aside, long-term care workers are paid so little not because of greedy owners but because the system doesn’t allow the owners to pay them more!
We need to do better, and moralizing and pointing fingers is futile. The current COVID-19 crisis is an inflection point where thought-leaders can and should step up and speak out. Join us, speak out for change and become part of the dialogue.
Watch the recording of this webinar here
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