The Future of Elder Care: A 2-Country Comparison
American College of Healthcare Executives
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Ten thousand people will turn 65 every day from 2011 to 2029. Remember this statistic? We are living that right now. By 2030, all the Baby Boomers will be over 65 and Medicare will be supporting the largest number of beneficiaries in its history. While the youngest of the Baby Boomers will still be playing pickleball and traveling, the leading edge of the Baby Boomers will be 84 and statistically will be utilizing a tremendous amount of healthcare.
The United States is not alone on this journey. I recently visited the Netherlands to learn about the healthcare system there. The team I met shared that to care for their country’s aging population in the coming 10 years, they will need one out of every four citizens to work in healthcare. That number is just not feasible, so they are actively looking at ways to deliver care in a new way, likely in homes and with the support of caregivers. And “caregivers” for them is larger than immediate family; it includes the community, church and neighbors around a citizen.
Having worked with frail elderly patients for the past decade, I have two observations that go along with my Dutch colleagues’ plans.
First, we need to rethink the delivery of care. And it’s not just about technology, though that will play a hugely important role. Care providers, especially for the frail elder population, will need to be mobile. Frail elder patients—regardless of their age on paper—need to be seen in person sometimes. They need to be touched. They need care that is responsive to their real lives and living conditions.
Home-based primary care is the forefront of mobile care. Supported by technology, home-based primary care can truly reduce cost, improve quality and improve patient adherence to a shared plan. We can define what we do in the home in our process to solve this: it could be certain hospital diagnoses through “hospital at home” care, primary care, some specialty care or chronic condition, or care coordination and social work support. Our opportunities to stratify our patients based on who needs us today can allow us to provide more direct, mobile and adaptive care in the home.
Second, we need to rethink who is responsible for frail, older adults by looking at our providers and caregivers. What credentials do they need, what supports need to be put in place and who is approved to help? In addition, who are the caregivers? Is everyone who has a child who lives out of state supposed to move into an assisted living or nursing home? We may not have the capacity for that, and we need to rethink who the support system is for U.S. citizens.
This is a tough ask because, generally speaking, the U.S. does not have a culture of caring for frail, older adults. We do not have a culture of respecting and caring for our historians and can deem unworking citizens as “less-than.” However, to adapt to a new world where people are living longer and need more care, we need to also adapt how we think about our loved ones, our neighbors and our community members.
The U.S. and the Netherlands are only two countries highlighted, but we are joined by many, many others trying to figure out how to care for our aging populations with fewer working people and less money coming into the system to support that care. I am excited about the potential delivery and provider/caregiver opportunities that lie in front of us, but it will require us all to rethink care and to rethink populations.
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Amanda S. Tufano, FACHE, is CEO, Genevive, Minneapolis. Check out her 2020 blog post, “Reflections on Leadership During a Pandemic ” for additional insights.
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Principal Emeritus at HKS, Inc.
5moCongratulations on an outstanding career in the military Healthcare system! Joseph G Sprague, FAIA, USAR, MSC, retired!
Empowering Leaders in Long-Term Care | From Aide to Administrator | Board Member l Consultant
1yThe last point about the U.S. lacking a culture of caring for older adults resonates deeply with me. We need to change the narrative around aging and understand that investing in elder care is an investment in the well-being of society as a whole. Are there other countries whose strategies we could learn from?
National Director | FACHE | CPHQ | CPPS | PMP | PMI-ACP | Lean Six Sigma | Value-based & Managed Care | PACE | Improving operational excellence through quality improvement, patient safety, high reliability, & compliance.
1yThank you, Amanda, for starting the conversation. In the US, we have the Programs of All-Inclusive Care for the Elderly (PACE) that have demonstrated the ability to provide quality, effective, and efficient care to our geriatric population in a community setting. It is a CMS-approved care model available only in 38 states and the District of Columbia. And many states that have authorized PACE programs have a handful of active programs. We need to expand the use of programs like PACE to meet the needs of our growing senior population.
BSN,RN,CCRN
1ySo much work needs to be done!!these frails individual fall through the cracks; We can do so better!