Learned in 2014

At the risk of being a pariah in aging circles I see my most significant 2014 lessons bucking mainstream aging network mindset, policy and funding priorities. Dots are emerging. Our job is to connect those dots for good change.

1. Too much of gerontology – the field of study, the service offerings and infrastructure and the passion, is about poor people. I know this statement goes against the grain, but hold your reaction, please. I am not saying we should ignore people with less resources. I am saying that just because someone has resources does not mean they have an easy time aging as they wish-  with the control and dignity they want and deserve, and the opportunity to stick to their choice about where and how to live. It is far too difficult for far too many. Attention needs to expand beyond poverty.

I first learned part of this in the early 1990’s when I began to concentrate my remodeling business on aging in place. One market segment I approached was clients who were soon to be discharged, recovering from broken hips or strokes, and so forth. Regardless of income or total wealth many had purchased their homes many years before.  In some cases, real estate value increases meant equity of a million dollars or more. Of course these homes were not designed for older, frail and recovering occupants. Due to poorly communicated discharge process and timing, because it is so difficult to make decisions in a crisis, unknown prognoses and the difficulty of the remodeling process it was usually too difficult to remodel their homes in time for them to return. Even when money is available we too often cannot get people back in their homes. They are disappointed. I am frustrated.

The dot connecting aha! on this came from a meeting of the Long Term Quality Alliance. The conversation was about Long Term Services and Supports (LTSS) for *dual eligibles, as if these are the only people who need long term services. They are not…but they are the only people whose long term needs are paid by government, and the only group for whom aggregate data is available. In other words…people with money and the folks who care for them fly under the radar of economic awareness and analysis. I began to ask folks the dollar size of the private pay home and community based services/LTSS market. The people I asked took on a dreamy look and told me it was a good question. But no one has an answer.

2. Working out solutions for people with more is easier, not just because they have money to buy what they want (if they can find it and the time is available), but because trying new things is easier when eligibility and other requirements are not so rigid. Successful new ideas piloted among those who pay privately, can be applied in the regulatory funding world more easily with evidence of their efficacy.

On a percentage basis this is a HUGE demographic! By my calculations...20% of older people are dual eligible, and (let’s guess) 10% have enough money to buy all the 24×7 care they need (even if they cannot get in and out of their home easily and have a real bath or shower)…leaving 70% of the people over 65 not seen by market and business and policy. This is a blue ocean for innovation opportunity.

3. The businesses, government and not for profit agencies who serve this vast uncharted middle do not come across as an organized business sector. There are lots of dedicated, well meaning providers offering an array of needed services to people who want to receive long term care in their homes. The problem is they do not operate as a flowing system. They only work as fragmented, disconnected services. Their lead acquisition and inventory management practices are not modern or sophisticated. Crisis is the best description of the workaday atmosphere. These providers have a tough time conducting their activities in a very businesslike way because the connections that we see in other sectors (like auto, homebuilding) are not there. This makes these mission and passion filled enterprises tough places to work.

The other side of the equation is that their customers do not have good ‘customer experiences‘. I am stretching the term customer experience, generally applied to the sum total of a customer’s experience with one company or entity, to mean the sum total of their experience with the range of disconnected and silo-ed providers they need to age in place successfully. These services are difficult to access and nearly impossible to navigate, whether you have money or not!

There is room to improve this sector. People spend on products, equipment, assistance care, assisted living. They would spend more if it was easier to find, engage and manage. The separate providers need to deliver an integrated stream of product and service that appears functionally integrated to their customers. Systems – Coordination – Integration. Opportunity abounds!

In sum: We need to expand our policy, business and mindset to include the vast numbers of older Americans with real needs but not eligible for government long term care programs. The ‘network’ of home and community service providers must be elevated to modern businesslike entities inter-operating as dynamic systems providing their customers a much better experience.

We need to do it NOW. The systems we need can barely be developed in time to handle the coming hordes. I am working with some colleagues on strategies to push this agenda. I need to work with YOU too. PLEASE get in touch to play your part as we create the future of long term care.

Happy Holidays,  Louis

*dual eligible refers to medicaid (poor) and medicare (over 65)