The New Aging Partnership is dedicated to bringing to light issues associated with the caregiving crisis. In the course of our ongoing investigation into the manifold challenges surrounding caregiving, certain issues emerge as the most critical and threatening.
We seem to be on our usual incremental course in the US in which strategic planning is thrown to the wayside in favor of piecemeal tinkering predicated on compromise among the “Big Influencers” which at this point seem to represent an exclusive club of Corporate Rationalizers: Insurance, Private Equity and Big Pharma whose primary motive, arguably, is to protect their profit margins.
The fact that health care does not meet any of the standards that define a free market system, beginning with the fact that health is not a marketable commodity and including, for example, the realities that health care consumers likely do not have sufficient information to make good choices, demand is not regular or predictable, all suppliers do not have a profit motive and certain providers are establishing monopoly power does not seem to have any rational impact on either acknowledgment of the pitfalls of these developments or lack of regulatory remediation. (c.f. Health Care Market Deviations from the Ideal Market” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3210041/).
Rather, trends favor for-profit and monopolistic practices that have resulted in skyrocketing costs, diminishing accessibility and quality of care, while fragmentation and inefficiencies persist.
On the bright side it seems as if some states are taking health equity concerns into their own hands, with California, for example, considering a pretty substantial state sponsored long term care insurance plan for residents.
But will these small, unintegrated steps lead to a wave of reform throughout the country; or, are we more likely to become more fragmented than ever before with certain states providing more comprehensive health and long term care benefits, begging the question, “Are we going to have to remain geographically stuck if we are going to qualify for any benefits under a state sponsored system?”
With all of the issues that surround health care, you might ask why the caregiving crisis is a standout in terms of our concern. Here we address what have emerged as the main challenges to all Americans, and why it is so important for Americans to coalesce around a plan to resolve issues of compounding severity that surround the: CAREGIVING CRISIS
FIRST, THE CHALLENGES (Not in any particular order of significance)
Number One: Millennial Caregiving
It may seem odd that a Partnership aimed at promoting a better aging experience and defeating the demons of “ageism” finds the Millennial Caregiving Issues so disconcerting. We are not limited in our concern to Millennials, but they currently represent a growth industry in family caregiving, a trend which is undermining their capacity to meet life stage developmental milestones in deference to the demands of providing care to aging family members.
Number Two: Professional Turf Conflicts
We have been in the business of promoting interdisciplinary solutions to health care challenges for years, with the same old themes reasserting themselves over the decades. A colleague once said, “There is no collaboration; there is only turf.”
How can the health professions influence administrative and governmental policy if they fail to unite around an agenda? Medical doctors once wielded tremendous force in determining health policy and regulations, for better and worse, but no more! We all need each other to promote an agenda that serves the welfare of the community.
Number Three: Failure to Join Forces with Community Health and Public Health
There is no way around it. Without a strong community health presence, there will be no resolution to health issues, including the caregiving crisis in communities. We need to target environmental and social contributors to the health and caregiving crisis in order to provide any enduring solutions to our escalating costs and diminishing returns on investment in health care. We need to “expand health clinics and address gaps in Medicaid” according to Stuart M. Butler, Senior Fellow - Brookings, as well as address “upstream social factors that are linked to health.” https://www.brookings.edu/research/achieving-an-equitable-national-health-system-for-america/
Number Four: Need to Slow Down on Transition from Institutional to Home Care
There is much debate about the relative advantage of home care over office, hospital or nursing home care. There is no one size fits all solution, but the home health care movement clearly is gaining momentum. The argument is that people want to stay at home. Please refer back to our original statement that “health care consumers are not likely to have sufficient information to make good choices.” Besides, the bulk of responsibility for their care is likely to fall on their family members with Millenials being the fastest growing caregiving cohort at the present time. There are also the major issues associated with sandwich caregiving, and also employee-caregiving conflicts giving rise to burgeoning workforce challenges and financial business losses as well as employee losses.
We need more programs like the Program of All-Inclusive Care for Elderly (PACE), but families who are ineligible for Medicaid would have to pay privately for these services, which most can ill afford. That leaves them with the option of spending down the consumer’s (used to be patient’s or client’s) assets in order to qualify. Wonderful! Then what are they going to use for support? Stuart Butler proposed a national system of health care with state variation in 2020 and today there is some activity towards creating a national roadmap, but as far as organizing the country around goals and values, we have a long way to go.
We could consider nationalizing programs such as PACE which would provide nursing home level home health care on an ongoing basis to all medically eligible participants, as part of a capitated universal long term insurance plan. But, where is the money coming from, not to mention any legislative federal consensus regarding long term care funding?
Let’s at least get the discussion going.
We cannot promote this type of reform within the context of the present system.
Number Five: Need for Community Organizing
We get to the heart of the discussion. Nothing gets done without the support of the American people. We have read that the Clinton Health Reform Plan failed mostly because it was developed in the White House and not through Congressional negotiation. The message we take from this is that there needs to be grassroots support for any health care reform measures.
Our country seems to be more and more divided and yet, rich or poor, regardless of race or state of origin, people are going to continue to feel the escalating pinch of the failures of our health care system to provide solutions to our health and caregiving challenges.
Are we going to back into some type of action, or are we going to be proactive about advancing an agenda that will relieve us and our children of severe burden? These are the questions that remain unanswered.
Pastor et al (March, 2018) explain how the language of health equity has been deployed as an inclusive frame to advance the rights of immigrants and other marginalized groups in “How Community Organizing Promotes Health Equity, and How Health Equity Affects Organization” based on a universal sense of health as a human right (Health Affairs Vol. 37, No. 3).
If health equity has been deployed successfully to advance the interests of the marginalized, because of the universality of the value of health in the US, then imagine how it can be utilized to unleash the collective power of Caregivers in advancing a national agenda to support family caregiving.
Join us!
New Aging Partnership