By Richard Burke and Charles Yates
As we age, we face increasingly complex health issues that impact our quality of life while stretching our individual, family and societal resources. With the third-largest senior population in the country – one growing all the time – New York faces a particularly daunting challenge. Because of the sheer number of seniors, Erie County, like other regions in New York, is underprepared to care for this population, which has complex medical needs and disproportionately adverse health outcomes.
The struggle for Medicare and Medicaid to keep pace with this growing population has been well-documented. Less attention has been paid, however, to the burden willingly and lovingly taken on by families of frail seniors. A recent study by the Johns Hopkins Bloomberg School of Public Health found that the burden is both real and significant. The 2.6 million people in New York who care for an elderly loved one are twice as likely to experience physical problems, three times as likely to suffer lost productivity at work and five times as likely to miss an important event, like a wedding or a birthday, than the population as a whole. Family caregivers in New York provide $31.3 billion worth of care and support every year, according to AARP.
The good news is that a growing trend in elder care is improving the quality of seniors’ lives while reducing the strain on families, Medicare and Medicaid – the Program for All-Inclusive Care for the Elderly (PACE), a government program offered in Erie County by health plans, including Fallon Health Weinberg.
PACE is available to those 55 and older who qualify for a nursing home level of care. Its goal is to keep seniors healthy – and living independently at home – by providing comprehensive, coordinated, person-centered care using community health care providers and support agencies. Each participant has an individually tailored care plan and a care team that navigates the system while serving as a point of contact for the participant and family.
Not only does PACE lead to better outcomes for participants and their families, it saves money by avoiding more expensive medical care such as emergency room visits and hospital admissions. This is particularly important in a region where a shortage of primary care resources and preventive services are creating unnecessary hospitalizations, often with lengths of stay exceeding national benchmarks.
One example of PACE’s approach is how the program deals with falls, which are the leading cause of injury-related deaths, hospitalizations and emergency room visits among seniors in Erie County. PACE staff perform multiple assessments through the screening and enrollment process and check to see whether the person has a history of one or more serious falls. Nurses and occupational therapists follow up with a home safety assessment. An entire team works to solve the problem. Interventions may include home modifications such as a different bathtub or the installation of a ramp, the use of hip protectors or the installation of bed positioning devices to prevent falling out of bed. Family members and caregivers participate in the interventions and entire care plan.
This comprehensive, individualized approach allows for creative solutions that would not be covered under traditional health plans. It’s also an approach that is increasingly being encouraged by government and adopted by forward-thinking health care organizations as a long-term solution for our entire health care system.
The problem is that PACE programs are being severely underutilized because of a lack of understanding of the PACE model among consumers, providers, physicians and public and private brokers. An estimated 3,600 frail seniors in Erie County are eligible for PACE, yet only 273 individuals – roughly 7 percent – are enrolled in PACE.
Society needs to think differently about how we structure senior care if we hope to keep up – not only for seniors but the loved ones responsible for their care. All of us in health care need to do a better job of raising awareness about PACE so that more elders and their families can begin to realize the benefits of the health care system of the future today.
Richard Burke is the president and CEO of Fallon Health. Dr. Charles Yates is the medical director of Fallon Health Weinberg.