Lots of Ideas, Not A Lot of Strategy

A few days ago, one of the city and state’s most experienced health experts over the past three decades stopped by Village Care of New York’s board of directors meeting for an “off the record” discussion.

He had a lot to say about the state of health care and, in particular, long-term care, which is of special interest, of course, to us at Village Care.

One point, however, that he made struck home, and it’s something that the general public really isn’t aware of.

There’s been a lot of talk about reallocation of resources and in perhaps trying to save money in health and long-term care. In nursing homes particularly there’s been a great deal of effort to reform care away in the traditional institutional setting with concepts that are variously called “culture change,” “patient-centered care” and other terms conveying a sense that there’s major change afoot. Considerable thought and exertion is going into rethinking how we provide long-term care in the first place, with the belief being that it’s better to offer services and such that allow people to stay in their own homes, to support families caring for loved ones at home and to create other community-based options.

All with the idea of delaying, even preventing, a nursing home admission.

What our expert friend told us, however, is that we’ve only done a good job in coming up with new ideas. “We’ve got a long list of programs now for long-term care,” he said. “But, we’ve not captured a strategy. All we have is a bunch of initiatives.”

From a provider perspective, it’s certainly not for a lack of trying.

Our colleagues to the far north, at Isabella Geriatric Center, and to the east at Cabrini Nursing Home, are engaged, just as those of us at Village Care, in exploring ways to make life for those growing old better, to give our seniors the prospect of continuing on with fulfilling lives in the community for as long as possible, and to offer an array of choices that fit an individual’s need at the right time with the appropriate service.

That’s true across the city, across the state and across the nation.

What’s also true is that it’s a bottom up approach, where individual providers are trying to convince government that they have a good idea and let’s figure out a way to pay for it.

And there lies the rub. How to pay for it.

Right now, there are two ways we pay for long-term care: Out-of-pocket or, if you are poor enough, with Medicaid. A relative handful of people have purchased long-term care insurance policies, but that program has been a hard sell and recent scandals in the long-term care insurance industry haven’t helped.

What hasn’t happened is the creation of a policy, a plan, something that says these are our goals for care of older adults and the disabled, this is how we’re going to get there and, most importantly, this is how we are going to pay for it.

Until that’s done, those of us who provide care are left to, in a sense, flail about with great ideas and trying to make them fit within the constraints of an existing set of rules that was designed with institutional care as the top dog, getting, and needing, the biggest bone.

What our health expert told Village Care’s board is that, from his perspective, there really isn’t another funding source other than Medicaid. If we’re going to meet the care needs of the growing number of older adults as the Baby Boomers age, no matter what the location of services – nursing home or in the community – we’re going to need to spend more money. Read that as “taxpayer money,” because there isn’t a market solution.

Or, face rationing.

We already have rationing in health care, although we don’t call it that. It’s called “the uninsured.” They get worse care and they are not as healthy, according to the Institute on Medicine.

Not everyone, for sure, has to stand in line, our expert told us, “but for those who do, it is a very long line.