A Well-Coordinated Care Model for the United States

Now imagine that the United States had a well-coordinated care model that leveraged and supported paid aides, family caregivers, safe and appropriate housing, and other necessary services. This would be a huge improvement over our current situatio[...]

A young man and his senior father in wheelchair on a walk in town at sunset.getty
The young man and his senior father in wheelchair enjoy a lovely walk together in town at sunset. The father is so proud of his son and they share a special bond that is strengthened by moments like these.

A well-coordinated care model would support paid aides, family caregivers, safe and appropriate housing, and new technology to improve the lives of frail older adults. This would be a significant improvement over the current chaotic, dangerous, and needlessly expensive patchwork of care for seniors.

A system that makes it possible for older adults to live in the setting most appropriate for them, links their personal care with medical treatment, and provides the financial support to pay for it would be an incredible boon for the elderly population. It would allow them to age in place more easily, receive the care they need, and not have to worry about the cost.

I am excited to see the results of the long-term care policy experts' work. I hope that this framework will help to improve access to quality long-term care for all Americans.

The report presents a framework for improving the quality of care for older adults, with a focus on five essential themes: person-centeredness, community support, workforce development, financing, and data and measurement. It provides policymakers and care providers with guidelines for reform, and includes some specific examples of ways to improve care.

  • As our population ages, it is important that we have safe and supportive housing options available for older adults. Facility-based care should be financially sustainable so that it can provide the best possible quality of life for residents. The government should encourage new models of care for those living at home, as well as provide appropriate incentives for high-quality care in nursing homes, assisted living facilities, small group homes, and other congregant settings.
  • There is a growing need for better integration of long-term care into our communities. The government should encourage models that better link subsidized housing with long-term care and health care. Operators of long-term care facilities should strive to better engage with their neighbors. This would create a stronger support network for our aging population and help to ensure that they can remain independent and active members of our society.
  • Policymakers should recognize the vital role that family caregivers play in our society and develop models that support and train them. Support and training must be culturally sensitive and responsive to the needs of different families. By doing so, we can ensure that all caregivers have the knowledge and skills they need to provide the best possible care for their loved ones.
  • It is crucial that direct care workers are paid appropriately, well trained, and given opportunities for career advancement. These workers are the backbone of the long-term care system, and they play a vital role in ensuring that those in need receive the care and support they require. By investing in direct care workers, we can ensure that our long-term care system is strong and can provide quality care to those who need it.
  • There is no doubt that reforming the long-term care system will require significant financial investment. Low-income nursing home residents must be able to rely on Medicaid payments that will cover the costs of quality care. In addition, a public catastrophic long-term care insurance program must be fully funded in order to work together with private insurance and Medicaid. This is similar to what was recommended by a 2016 Convergence project. Only by making these kinds of investments will we be able to truly reform the long-term care system.

The Five-Star paper urges the Centers for Medicare and Medicaid Services (CMS) to refocus its nursing home rating system from primarily measuring safety to including quality of life metrics as well as more transparency about staffing. We believe that this shift is essential in order to provide a more comprehensive picture of the nursing home experience for potential residents and their families. Quality of life metrics are important indicators of the overall care and experience that residents can expect to receive.

The National Academies of Science, Engineering, and Medicine recently released a report on nursing home reform. The main report is much more of a broad roadmap than a turn-by-turn set of specific policy recommendations. In that way, it is quite different from the National Academies' recent report on nursing home reform.

The ecosystem is a complex and ever-changing network of living organisms and their environment.

The National Academies report was narrow and deep: More than 600 pages of specific recommendations for improving the care of nursing home residents. The Convergence framework looks at the entire ecosystem of care for older adults in only about 16 pages, plus its package of more specific recommendations. What this means is that the National Academies report provides a wealth of detailed information on how to improve nursing home care, while the Convergence framework offers a more general overview of care for older adults. Both reports are valuable in their own way, and together they provide a comprehensive look at the state of nursing home care in the United States.

It is encouraging to see that both the National Academies report and the Convergence paper anticipate that federal and state regulators and Congress will address the complex issues of long-term care in a more holistic way. However, given the current political climate, it seems unlikely that broad-based reform will be possible in the near future. Instead, the focus will likely be on smaller, incremental changes that can improve the care older adults currently receive. While this may not be the sweeping reform that is needed, it is a step in the right direction that could make a real difference in the lives of older Americans.

The Convergence group was a diverse and experienced group of experts who came together to discuss the challenges of long-term care. They ranged from conservatives to progressives, and their combined expertise represented hundreds of years of experience in the field. Their work was essential in identifying potential solutions to the many challenges facing long-term care today.

The most important outcome of this project is that a diverse group of policy experts could reach broad consensus on many critical long-term care issues. This is a significant achievement, and it is one that Congress should take note of. The project has the potential to inform and improve future policymaking on long-term care, and it is an important step forward.