The social needs of older adults are multifaceted, diverse and, more often than not, unmet. This is especially true for older adults living with disabilities, low incomes or multiple chronic conditions. For many, day-to-day mobility is restricted to the community or the home, limiting their access to elder care services outside the scope of either.
Fortunately, emergent solutions such as person-centered long-term care are helping caregivers accommodate the full complexity of the people they serve. There is no escaping the fact, however, that it will take systems-level change for a solution so individualized to reach the entirety of an aging population. A new report published by the National Academies of Sciences, Engineering, and Medicine proposes a paradigm shift that might just fit the bill — the integration of social care and medical care.
The report urges public health leaders and healthcare providers to acknowledge the relevance of social needs to medical needs and adjust their service delivery systems accordingly. Because social care and person-centered long-term care are both designed to give residents and patients the fullest continuum of supports and services possible, elder care providers would have much to gain from social care integration.
To help meet this need Medicare and Medicaid now offer Programs of All-Inclusive Care for the Elderly (PACE). PACE provides comprehensive medical and social services to certain frail, community-dwelling elderly individuals, most of whom are dually eligible for Medicare and Medicaid benefits. An interdisciplinary team of health professionals provides PACE participants with coordinated care.
For most participants, the comprehensive service package enables them to remain in the community rather than receive care in a nursing home. Financing for the program is capped, which allows providers to deliver all services participants need rather than only those reimbursable under Medicare and Medicaid fee-for-service plans. PACE is a program under Medicare, and states can elect to provide PACE services to Medicaid beneficiaries as an optional Medicaid benefit.
The PACE Model of Care is centered on the belief that it is better for the well-being of seniors with chronic care needs and their families to be served in the community whenever possible. It serves individuals who are age 55 or older, certified by their state to need nursing home care but able to live safely in the community at the time of enrollment, and live in a PACE service area. While all PACE participants must be certified to need nursing home care to enroll, only about 7 percent of PACE participants nationally reside in a nursing home. If an enrollee needs nursing home care, the program pays for it and continues to coordinate the enrollee’s care.
Delivering all needed medical and supportive services, a PACE program provides the entire continuum of care and services to seniors with chronic care needs while maintaining their independence in their home for as long as possible.
Services include the following:
- adult day care that offers nursing, physical, occupational and recreational therapies, meals, nutritional counseling, social work and personal care
- medical care provided by a PACE physician familiar with the history, needs and preferences of each participant
- home health care and personal care
- all necessary prescription drugs
- social services
- medical specialties, such as audiology, dentistry, optometry, podiatry and speech therapy
- respite care
- hospital and nursing home care when necessary
According to the National Academies report, enveloping social care organizations into the fold of the traditional healthcare systems would rebalance services between clinical and community settings, on the one hand, and make them more responsive to the social conditions of patients on the other. Older adults who have easy access to social and medical services as they age stand a better chance of managing certain health risks and behaviors early on, as well as remaining an active participant in community life.
Home- and community-based services also make it possible for older adults to spend as much of their lives as they can in the comfort of their own homes. Caregivers who provide home-based care, a branch of healthcare that generally falls under social care, are trained to identify and honor the natural rhythms and preferences of individuals. This example of person-centered care functions as a much-needed corrective to the current reality for many older adults, in which they shuffle from provider to provider and never come away fully satisfied.
One company helping programs like PACE keep elderly in the community is Grane Rx. Grane Rx has been leading PACE pharmacy solutions since 2006. They help PACE personnel streamline their operations, maximize their savings, and free-up staff time to focus on participant care. Through at-home medication adherence systems, their Meds2Home program is revolutionizing senior care pharmacy by enabling participants to age safely and comfortably from home.
Social care integration, like person-centered elder care, can equip healthcare providers and systems around the world with the tools, knowledge and capabilities needed to treat older adults with the comfort, respect and dignity they deserve. It also is cost-effective, as demonstrated by initiatives such as PACE.
A care philosophy that emphasizes the whole of a person, rather than reducing an individual to his or her health problems and limitations, is precisely what older adults deserve. Although it will require substantial policy support and organizational buy-in, countries that integrate social and medical care are building health systems that can live up to that philosophy — for the aging populations of today and for future generations.