“It Takes a Village”: New Global and Regional Models for Long-Term Care

More than 12 million older Americans currently need long-term care, and that number is expected to reach 27 million by 2050. By then, the youngest of the nation’s baby boomers will have turned 85 years and officially joined the ranks of the “old-old,” who are particularly likely to need such care. These demographic shifts raise difficult questions, including: “How can the United States meet the long-term needs of the growing population of older adults?” and “How will we pay for it?”

To answer these questions, Congress established a 12-member Commission on Long-Term Care headed by SCAN Foundation President Bruce Chernof, MD, earlier this year. Given only 3 months to do so, however, the commissioners—though able to identify a variety of potential changes that could improve care and save money—were unable to agree on how long-term care should be financed.

So what do we do now? With roughly 10,000 more baby boomers turning 65 every day, and family members unable to do all the caregiving on their own, there isn’t time to waste. With that in mind, the SCAN Foundation and PBS NewsHour’s MacNeil/Lehrer Productions recently broadcast a forum, “Global and Regional Models for Long-Term Care: Can They Work Nationally?”

Moderated by PBS’ Hari Sreenivasan, the forum brought together leading experts and innovators in elder care. Among these were Jennie Chin Hansen, CEO of the American Geriatrics Society and one of the pioneers of the highly successful On Lok Lifeways long-term care program. Established in California just over 25 years ago, On Lok led to the PACE program, which provides seniors in 29 states with medical care, meals, and programs they need in their homes and communities.

Taking a look at other innovations in the United States and abroad, the broadcast also turned an eye to innovative programs in Finland and Taiwan, as well as in Wisconsin, and in other communities throughout the United States. Older people in Finland can get long-term care services provided by the private sector and funded at the municipal level, the program explains. And since 2008, older adults in Taiwan have been eligible for similar services that are financed by employers, though some employers are now pushing back because of the cost.

With surveys finding that the vast majority of older Americans—as many as 90%—want to remain in their homes or communities, Americans are pursuing new approaches as well. One community-based model that is gaining ground throughout the United States is widely known as the “village movement.” In their most stripped-down incarnations, these villages are made up of older adults working with others near by, helping one another with transportation, shopping, and other necessities. Some “villages” are significantly more complex, with members paying fees for various services, including those provided by outside professionals, for example.

One potential drawback of the model, however, is that it doesn’t appear to be as applicable among less-affluent seniors with fewer resources, notes panelist Howard Gleckman, a journalist who writes about long-term care issues and is the author of Caring for Our Parents. “The one issue that concerns me a little bit about the village model is that, for the most part, it seems to be working for upper-middle-class, highly educated white people. [So,] maybe it’s not going to be viable for [other] populations [or] maybe it’s going to be different for different communities.”

And that could well be. All told, the panelists agreed, innovation will be necessary to meet the varied needs of the nation’s diverse population of older adults. Given this, the way one “village” runs may differ from the way another does. The approaches we take will have to be diverse, if we’re to provide care for the unprecedented number of older people in the United States, they concurred.

To watch the forum, visit https://thescanfoundation.org/pbs-newshour-global-and-regional-models-long-term-care-%E2%80%93-can-they-work-nationally. Or, to read excerpts from commentary provided by the six panelists, each of whom offers a “tip” for helping aging Americans get the long-term care they need, visit www.pbs.org/newshour/rundown/2013/11/6-tips-for-better-long-term-care-for-us-seniors.html.