By Larry Zielinski
Special to The News
Like many of my fellow baby boomers, I recently experienced the loss of a parent. My siblings and I were able to make sure that our beloved mother passed away on her own terms in her own home, with the help of a great palliative care team from Hospice Buffalo. However, there are some things I would have done differently in retrospect. In caring for Mom, were we too focused on our own concerns, and our own fears, rather than on what she really wanted out of her remaining time?
You can’t help thinking of your own mortality when hit with the death of a family member. As someone who has spent his career in health care, I think about it in broader terms. A tsunami is coming to America, and this one doesn’t have anything to do with climate change. The “silver tsunami” is the aging of my baby boomer generation: we will add 10,000 people to the Medicare program every day between now and 2029.
By 2030, 20 percent of our population will be over age 65 – nearly 70 million people, an increase of 30 million since the turn of the century. The fastest growing age group is the super-elderly – those over 85 – who will grow to 10 million by 2030. Per capita spending in Medicare and Medicaid grows with age, peaking at age 96.
University at Buffalo health policy expert Dr. Nancy Nielson is very concerned about the current Medicaid debate in Washington.
“Medicaid is not just a program for the poor – it funds over half of long-term care for the elderly in this country. Watch the current push to block-grant Medicaid very closely” in the face of this upsurge of elderly patients, according to Dr. Nielson. At the same time, Medicaid is already severely challenging state budgets all over the country, including here in New York.
How will our already overstressed health care system deal with caring for this booming elderly population in a patient-centered, yet affordable way? The answer lies in a very different view of aging and medical care, one that is focused on individual priorities and goals.
I recently participated in a panel discussion on this critical topic with some regional experts on aging. Frequent hospitalizations for elderly patients clearly isn’t the answer. Dr. Bruce Troen, the director of the UB Center for Successful Aging, emphasizes how ineffective traditional hospitalization is for elderly patients. According to Dr. Troen, “one-third of patients over 70 and more than half of patients over 85 leave the hospital more disabled than when they arrived.” Dealing with the tsunami will require the specialized skills of an interdisciplinary team of geriatric and palliative specialists. Under current reimbursement rules, these services are not well-paid and a critical shortage has ensued.
Care needs to be individualized and patient-centered, based on the patient’s preferences and life goals. This kind of care has been proven to not only improve quality of life, but also reduce costs – especially unnecessary hospitalizations.
Shirley Johnson, Roswell Park Center Institute’s chief nursing officer, has some sobering projections: 60 percent of cancer diagnoses occur in adults over age 65. While the increase in cancer incidence is forecast at 11 percent from 2010-2030, the increase will be six times that much in patients over 65. Older patients should be asked what they are willing to sacrifice, or not sacrifice, for more time.
“We must create awareness regarding the unique needs of the older cancer patient and their caregivers, incorporate geriatric assessments into routine clinic visits, and develop competencies in caring for older cancer patients at all levels of practice,” Johnson concludes.
Atul Gawande highlighted the Eden Alternative, a novel approach to eldercare in his best-selling book, “Being Mortal.” The Eden Alternative is a non-profit focused on creating quality of life for elders and their care partners, wherever they may live. The organization was started in upstate New York by Dr. Bill Thomas, who calls himself “a nursing home abolitionist.”
Their philosophy for caregiving is focused on eliminating the three scourges of aging: loneliness, helplessness and boredom. Eden’s approach strives to reverse societal biases toward the elderly. According to Eden, “An Elder is someone who, by the virtue of life experience, is here to teach us how to live.”
My siblings and I took good care of our mother in her last years. We made sure she was safe. We drove her to all her doctor appointments. We kept her in her home. But should we have done more to eliminate the three scourges?
The answer to the tsunami has to lie in models of caring for the elderly on their terms, focusing on what they want out of their remaining time. It means recognizing that while the health care system is focused on cures, the elderly often can’t be “fixed.” It means really thinking through the pros and cons of a major procedure, or even a screening test, before performing one on an elderly patient. It means focusing on life quality, not just medical care. It means keeping elders in their homes and communities as much as possible. And it means reversing cultural bias toward the elderly, recognizing them not as a burden, but rather as wise counselors in the struggles we all face in life.
There are many experiments going on all over the country focusing on keeping the elderly engaged and living in their communities.
A terrific program is right in our backyard: the Catholic Health System’s Life Program not only wraps a comprehensive care-giving team around the elder, but also emphasizes social engagement and physical activity.
The success of these kinds of models will require a change in the way we reimburse for eldercare. Can we train and better fund more palliative care and geriatric care teams? Can we better engage existing community programs to complement these teams? Can we successfully shift payment for expensive hospitalizations and nursing home care into programs that focus on what we all want out of old age? That will be the key to surviving – and prospering – in the silver tsunami.
Larry Zielinski is executive in residence for health care admin-istration at the University at Buffalo School of Management’s Jacobs Management Center.