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USA Today: Gloom and Doom

by Louis on October 11, 2007

Tuesday’s USA Today had a front page gloom and doom story about federal programs for older Americans. Kathleen Casey-Kirschling, widely recognized as the first baby boomer, turned sixty two and took the early option for social security. The story spells out the financial disaster facing federal programs designed to provide for older Americans. It is widely reported that Social Security, Medicare and Medicaid may bankrupt the American economy over the next few decades.

The mix of culprits is pretty clear. More and more older people. Older people are living longer. The cost of medical care at the end of life is extreme and getting worse. The ratio of younger workers to older folks taking benefits is far different than it was when the programs were designed and getting much worse. You could quibble over some details but for the most part it is all true. The situation is bad and will get worse. Some predict generational warfare among the young who will be paying too much of their hard earned dough to care for the old.

What are we gonna do about it? Most of the fixes suggested in the article and similar pieces I have seen over the years accept the matrix of costs as inevitable. Changing the age at which benefits are available and raising taxes are the only cards on the table. These are not enough to fix the problems. The political fallout is too tough to face.

My suggestion? Two things.

1. Expect no silver bullet. One thing is not going to fix a problem of this magnitude. Many small things will shave away at the problem until it is manageable. On the way we will learn things. Once chipped at, the core problems will seem different. More solutions will emerge as we go down the path.

2. Shift our national focus to Aging in Place. How does Aging in Place contribute to the fix? Aging in Place makes better use of all types of resources. The management system that emerges will reduce and control costs. That system will manage design, equipment and technology, as well as services to coordinate resources for efficiency.

The management system can also be described as a contact system. There are three stages at which Aging in Place contact works to be comprehensive over the course of people’s lives.

a. Self Management. This is the preliminary stage. Folks are helped to take stock of their assets including physical capabilities, home, finances and family resources. People learn about home modifications, preventative medicine, available services and exercise. Everyone is aided and encouraged to take action. Personal and community resources are used to avoid injuries and illness that steal dreams and cost money. Everyone benefits.
b. Monitoring includes regular check ups but more importantly a technological component that helps track changes in activity and health on a database. Anomalies are checked out before they turn into health crises. Acute care costs and misery are avoided. Everyone benefits.
c. Orchestration of care and rehabilitation in homes. Universal Design based home modifications which preserve independence allow earlier discharge from facilities to finish rehabilitation at home. These homes are also much better ergonomic care environments. The contact system coordinates services and care for utmost efficiency. Services can be ramped up and withdrawn appropriately. ‘Just in Time’ services for the home results.

Yes it seems pie in the sky right now. It is not like getting to the moon. It is only realignment of systems, funding and priorities. The technology is available. It just needs to be adapted and deployed.

What are the impediments? Round up the usual suspects. Complacency. Inertia. Unwillingness to change. Lack of Leadership.

What are the alternatives? Not good.
See Tuesday’s front page gloom and doom story in USA Today.

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