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Supporting Older Adults: It's Time for a New Response

12 February 2018

BLOG POST by Jean Galiana, Chief Scientific Writer, EasyCare Academy

The Challenge

Due to the growing population of older adults, health systems around the world are exploring methods to reign in unsustainable costs and create care delivery channels beyond curing disease that support the entire health of older adults including biological, psychological, social, and environmental. This assets-based approach challenges the ageist and prejudicial views of older adults that focus on disease, deficits and frailty. Such views drive many outdated and bloated systems of care.

The need for health system change is especially vital in the United States because the U.S. spends more on healthcare than any other high-income country1 2 but produces health outcomes that rank last.3 4 Many of the poor outcomes can be attributed to the fact that the U.S. spends considerably more to treat people after they become ill than it does to support them in a way that delays or prevents illness. This inefficient system with misdirected resources could be referred to as illness care rather than healthcare.

A More Comprehensive View

The World Health Organization’s broader perspective teaches us why diseased-based systems of care have a myopic view of health: “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."5 Armed with this whole-person perspective of health and the understanding that medical-related healthcare is only responsible for 20 percent of health outcomes, many innovators and policy makers are focusing their efforts on the drivers of the other 80 percent of health outcomes. Much of that 80 percent can be attributed to the biopsychosocial and environmental determinants of health in which older adults live. Those determinants are needs that may include safety in one’s neighborhood and safety in relationships, secure financial standing and financial literacy, access to nutritious food, access to healthcare, access to healthy lifestyle and chronic disease management support, access to transportation, the ability to get around one’s home and to perform the activities and independent activities of daily living, mental health support, and connection to a community and a social network. These needs, when unmet, lead to illness and adverse health events resulting in dangerous and expensive emergency room visits, hospitalizations, and skilled nursing stays. This cycle often leads to a decline in function and cognitive capacity for older adults, which leads to greatly reduced independence, quality of life, and well-being.

Unmet Needs in All Settings

In a survey of 1,590 older adults, AARP found that each additional unmet social need increased the likelihood of fair or poor health. This finding is not surprising, but the percentage of those living with unmet needs is. The report found that 51 percent of older adults surveyed had at least one unmet need: 24 percent were strained financially, 22 percent reported being lonely often, 16 percent were food insecure, and 12 percent had inadequate transportation.6 Unmet needs are not limited to older adults living at home. Although the unmet needs of caring for oneself, getting around, and performing domestic activities are present in all settings, they are twice as prevalent in residents living in senior housing.7

Evolving Policy

Recently, a ray of hope shined in the direction of meeting the holistic needs of older adults with the release by the Bipartisan Policy Center’s recommendations on how to support those with complex care needs. One of their six recommendations that was particularly insightful reads: “Creating a path from medical-driven models that provide care based on what is reimbursed to person-centered models that provide what people need and want.” The report also recommended that Medicaid, Medicare Advantage, and Medigap reimbursement policy should enable better access to community-based long-term services and supports, and to programs that support the family caregiver.8

Another bit of promising reimbursement policy news came last week with the announcement that, in 2019, Medicare Advantage (MA) plans will reimburse for non-skilled home-based support including home modifications. CMS Administrator Seema Verma referred to these additions as ‘health-related benefits’. This is good news for the 19 million older adults who are enrolled in MA plans who want to age-in-place. An AARP survey found that nearly 90 percent of older adults wish to age in place,9 which means that the market is historically poised to engage multidisciplinary resources to support the needs of older adults in the home and community.

An Evidence-Based Solution. Respond 4.1.

With a dedication to engaging older adults in directing their own care and honoring their individual health and life goals, Professor Ian Philp designed Respond. This tech-enabled tool is used to assess the biopsychosocial and environmental needs as prioritized by older adults and provide community-based solutions to those needs.

The aim of the assessment is to engage the person and his or her caregiver, family or designated assessor in a support plan that relies on the assets and capabilities of the older adult to improve his or her functional capacity, quality of life, and level of independence for more years, thereby extending healthy life expectancy. The assessment is standardized, but the recommendations resulting from the assessment are personalized and localized to each individual.

The newest version of Respond, Respond 4.1, produces a 4-part score for older adults that includes: well-being, independence, social engagement, and health (WISH). Notably, 75 percent of the WISH score is not medically (or disease) focused. The person-centered solution seeks to identify the needs that lead to the other 80 percent of health outcomes that are not commonly the focus of most elder care interventions.

The Respond 4.1 assessment is built on a 29-year history of enabling the health, independence, and well-being of older adults. Respond has been used in research studies in nearly 50 countries involving over one million older adults to date. It has been validated in 90 scientific publications. Some outcomes of the assessment include improved function and independence as well as reduced healthcare utilization.

Cost Savings Demonstrated in the UK:

In their report Towards Affordable Healthcare: Why Effective Innovation is Key, the International Longevity Center UK recognized the EasyCare Respond Assessment intervention as a one of the seven high-impact innovations for affordable and sustainable healthcare in the 21st century. The authors assert that the Respond Assessment can:

  • improve access to financial benefits;
  • reduce loneliness and pain;
  • improve health, independence, and well-being; and
  • extend health active life.

In addition to benefits for older adults, the study estimated significant cost savings. Emergency hospital admissions for adults over age 75 in the UK cost the National Health Service approximately £563 ($770) million in 2012-2013. In contrast, a UK trial in Bridlington showed that the implementation of the EasyCare Respond Assessment could help reduce hospital admissions and lead to a reduction in long-term care costs of £30,000 ($40,000) per individual, making an estimated impact of £3.3 ($4.5) billion in savings to the UK economy between 2014 and 2030.

Accessibility and Convenience

The assessment can be administered by anyone who has successfully completed the assessor training course and subscribed to the Respond platform. Assessors might be neighbors, family members, volunteers, paid care workers or other healthcare professionals. The assessment typically lasts from 20-60 minutes and can be administered face to face or via phone or video chat. This makes it convenient for older adults, who overwhelmingly report high levels of satisfaction with the assessment process and recommend the assessment to friends.

Why Respond Now?

The changing world’s demographic shift puts us face to face with today’s siloed unsustainable systems of care that produce unsatisfactory health and well-being outcomes. EasyCare Academy’s broader vision of health is well-aligned with the WHO definition. We focus on preventative upstream interventions to provide care and support that meets the biological, psychological, social, and environmental needs as prioritized by older adults and their families before they lead to poor health. This thought model forces us to cast away the ubiquitous paternalistic models of ‘care’ and defer to the dignity and wholeness of the older adults with whom we partner to serve.

EasyCare Academy is on a mission to change the future of aging. Come join us.

 

Jean Galiana is the Chief Scientific Writer for EasyCare Academy. She is a Masters of Gerontology candidate at the USC Leonard School of Gerontology. Her book Aging Well. Insights from Experts in Elder Care and Optimal Aging in the United States is soon to be published by Palgrave Macmillan.

 

1 OECD (2017). Health at a glance. How does the United States compare?
2 Commonwealth Fund (2015). U.S spends more on health care than other high-income nations but has lower life expectancy, worse health.
3 Commonwealth Fund (2014). US health system ranks last among eleven countries on measures of access, equity, quality, efficiency, and healthy lives.
4 Commonwealth Fund (2014). Mirror mirror on the wall, 2014 update: How the U.S. health care system compares internationally.
5 World Health Organization. Constitution of WHO: principles.
6 AARP. Issue Brief. Older adults and unmet social needs. Prevalence and health implications.
7 Freedman, V. & Spillman, B.C. (2014). The residential continuum from home to nursing home: Size, characteristics and unmet needs of older adults. J. Gerontol B Psychol Sci Soc Sci, 69(Suppl 1), S42-S50.
8 Bipartisan Policy Center (2018). A policy roadmap for individuals with complex care needs.
9 AARP (2012). The United States of aging survey.