Aging in Place might be called present time planning. This idea came from a nearly mind blowing conversation with Barb Stucki last week. She explained how the current discussion to fix long term care financing impedes efforts to seek better solutions to housing and care issues. Three recent reports from respected aging issues sources, summarized in a side by side comparison from the SCAN Foundation, helped Barb make her point. All three reports share the basic approach: revive and enhance long term care insurance and add publicly funded universal catastrophic coverage. How does the new long term care insurance conversation retard efforts to solve problems?
Because they talk about financial problems in a silo and insurance as the only solution. Insurance is about mitigating an unfortunate situation that has occurred. Reducing the risk of the situation occurring can be included in the conversation but these three reports do not. By representing themselves as leading the conversation but failing to take a holistic view they perpetuate the aging world’s problem of thinking and delivering in silos.
Talking about insurance pushes the conversation to catastrophe. Whether health, auto, home, life, trip cancellation or long term care – insurance assumes some possibility that things will go badly – for some of us. That is true in this case. They have the stats. By focusing the conversation out there…far away, in a place we don’t want to go…we are distracted from any conversation about the short term, the near, the pretty good or even not so bad. We need both conversations together, but the current one focuses only on financial problems reaching catastrophe then solved by insurance.
Insurance companies know avoiding catastrophe saves money. They reduce premiums for burglar alarms, safe driving records and not smoking. Wellness programs show promise for avoiding poor health AND healthcare costs. The longer you avoid an incident that qualifies for a claim the more premiums the company collects and invests before paying the benefit. That is an important lesson we need before we fund universal catastrophic coverage. Dare we say these aging leaders need to learn from insurance companies?
Health systems and payers are very interested in technologies to keep people from getting sick and being admitted – but haven’t figured out the payer, motivation or value model -yet. These stakeholders are just dipping their toes into home design updates.
If we are willing to go down the road of publicly funded universal catastrophe coverage we should first go down the path of policy and investment to reduce the risk by updating our housing infrastructure and encouraging technology use. We might call the Aging in Place 2.0 alternative present time planning. By investing to update our homes now we enhance our lives and, possibly, avoid the misery, catastrophe and cost insurance is designed to mitigate. That is a different conversation. One it is time our leadership begins in earnest.
Homes Renewed is about that new conversation. Instead of the persistent and nearly fruitless conversation about aging, frailty, poverty and individual responsibility Homes Renewed talks about civic responsibility, policy, private investment, market-based solutions, jobs and infrastructure revitalization. That is different. It is positive. Check it out.
Of course, this isn’t revolutionary thinking. But it is really smart. To the degree we limit the conversation to unpleasant possibilities we avoid any discussion at all. Barb and I want a conversation about action steps our country and individuals can take in current time, with existing resources. I hope we all do.