posted by Richard Burke, Fallon Health
on October 4, 2016
As we age, we face increasingly complex health issues that impact our quality of life while stretching our individual, family and societal resources. And the challenge is growing all the time. From 2000 to 2050, the senior population is projected to grow by 135 percent, according to the International Journal of Epidemiology. The population aged 85 and over – the group most likely to need health and long-term care services – is projected to increase by 350 percent.
The struggle for Medicare and Medicaid to keep pace with a growing senior population has been well-documented. Less attention has been paid, however, to the burden willingly and lovingly taken on by families of frail seniors – a space Fallon Health has been a leader in for years.
The burden on caregivers is both real and overwhelming. A recent study by the Johns Hopkins Bloomberg School of Public Health found that the 14.7 million people in the United States who care for an elderly loved one are twice as likely to experience physical problems, three times as likely to suffer lost productivity at work, and five times as likely to miss an important event like a wedding or a birthday than the population as a whole. Caregivers are working hard, providing $470 billion in unpaid care and support every year, according to AARP.
The good news is that a model of care for frail elders has been proven to improve the quality of seniors’ lives while reducing the strain on families as well as Medicare and Medicaid. PACE, which stands for Program of All-Inclusive Care for the Elderly, is a government program available in 31 states. Fallon, one of two health plans in the country to offer PACE, operates six sites under the program name Summit ElderCare in Massachusetts and one, Fallon Health Weinberg-PACE, in New York.
PACE is available to those 55 and older who qualify for a nursing home level of care. Its goal is to keep seniors healthy – and living independently at home – by providing comprehensive, coordinated, person-centered care using community health care providers and support agencies. It also aims to support the caregiver by lessening their day-to-day responsibilities and stressors. Each participant has an individually tailored care plan and a care team that navigates the system while serving as a point of contact for the participant and family. The care team includes a geriatric physician, therapists, social worker, home care coordinator and day center staff.
Ninety-six percent of Fallon’s PACE enrollees and their families say they are highly satisfied with the program and 93 percent of PACE enrollees remain living in the comfort of their homes. Not only does PACE lead to better outcomes for participants and their families, but it generates savings for the cash-strapped Medicare and Medicaid programs by avoiding more expensive medical care such as emergency room visits and hospital admissions. This is particularly important in regions of the country with shortages of primary care and preventive services.
One example of PACE’s approach is how the program deals with falls, which happen to nearly one in three seniors and are the leading cause of both fatal and non-fatal injuries in older adults. PACE staff perform multiple assessments through the screening and enrollment process and check to see whether the person has a history of one or more serious falls. Nurses and occupational therapists follow up with a home safety assessment. An entire team works to solve the problem. Interventions may include home modifications such as a different bathtub or the installation of a ramp, the use of hip protectors or the installation of bed positioning devices to prevent falling out of bed. Family members and caregivers participate in the care plan.
This comprehensive, individualized approach allows for creative solutions that would not be covered under traditional Medicare or Medicaid coverage. It’s also an approach that is increasingly being encouraged by government and adopted by forward-thinking health care organizations, such as Fallon, as a long-term solution for our entire health care system. An estimated 1.7 million people in the U.S. are eligible for PACE but only 40,000 are taking advantage of the program.
Our frail elderly population is growing and so is the challenge of providing quality care for them. Society needs to think differently about how we structure senior care if we hope to keep up – not only for seniors but the loved ones responsible for their care. All of us in health care need to do a better job of raising awareness about PACE so that more elders and their families can begin to realize the benefits of tomorrow’s health care system today.
Richard Burke is the President and CEO of Massachusetts-based Fallon Health, the country’s fifth-largest PACE provider.