Health care readies for aging boomers
The population of the Diocese of Rochester's 12 counties is getting older and more diverse, according to the 2010 U.S. Census, prompting area health-care planners to look at ways to help seniors age in their homes and in their communities.
Key among the questions for planners is whether the health-care system currently is best configured to meet the needs of aging baby boomers. The oldest members of this demographic began reaching Social Security/Medicare-eligibility age in January.
Although results from the 2010 Census show that the population of the diocese's 12 counties increased only 1.3 percent between 2000 and 2010, the number of people younger than 15 fell, the number of people 85 and older grew by 30 percent, and the number of people 65 and older grew by 10 percent. The average age of people in the area is now 40.3, as compared to 36.8 in 2000.
This trend toward an aging area prompted those who make up the Sage Commission -- representatives from nursing homes, social-service agencies, volunteer agencies, industry groups, government and insurance companies -- to say that the area’s health-care system is financially unsustainable as it is now configured, and that it should be reconfigured in several ways to meet the needs of aging baby boomers.
"What we are seeing is that the baby boom generation clearly expresses very strong preferences for aging in place, and that is probably a good thing," said Dr. Thomas Mahoney, director of community health for the Finger Lakes Health System Agency, which chartered the commission. "If we continue to deliver care at the same settings we do now, the financial burden of delivering institutional care, which is at the most expensive end of the spectrum, begins to look very scary in terms of the cost."
If no changes are made, health-care and housing costs for seniors are projected to grow by more than $110 million by the year 2025, the report said.
Overall, the Sage Commission report advocates using a model of person-centered care in which health care is delivered according to a patient’s needs and wants, rather than requiring the patient to adapt to the structure of the health-care system.
The report recommends:
- Reducing the number of skilled-nursing beds in the region by more than 2,000 by 2025. The commission noted that the Finger Lakes region has more than 50 beds per 1,000 people 65 and older, while most states have about 40 beds per 1,000 people 65 and older. Yet the reductions in nursing home bed numbers must be coupled with expansions in funding for senior housing and home- and community-based services, which are more cost-effective, Mahoney said.
"Some of the population that is currently in institutional care has relatively low needs in terms of services, but financially is unable to access (care at home) because a lot of home care is currently not covered" by public and private insurance plans, he said.
Betty Mullin-DiProsa, president and CEO of Rochester's St. Ann’s Community, which had a representative on the Sage Commission's housing work group, said the state also needs to streamline its complex system of regulations to make possible a reduction in the number of skilled-nursing beds. Mullin-DiProsa noted that seniors who need 24-hour personal care and assistance using the toilet and feeding cannot receive such care from a state-licensed assisted-living facility, so they are forced to move into a skilled-nursing facility.
"We need flexibility in regulations that allow people to receive services and manage in a home setting," she said.
- Expanding naturally occurring retirement communities, which provide case management, health-care management, prevention activities, transportation and volunteer opportunities. The commission has found interest from urban Rochester, suburban Monroe County and Steuben County to develop new communities, but regulatory changes are needed to make such communities viable, the report noted.
- Encouraging and highlighting preventive programs that promote good health, manage chronic diseases and prevent falls.
- Training more geriatric specialists for the health-care and human-services fields.
- Supporting families and informal caregivers with information on resources available to them. Care provided informally at home, often by children caring for aging parents, decreases costs to the health-care system, Mahoney said.
- Creating a regional transportation alliance to better coordinate transportation services provided by agencies and volunteer organizations. The Genesee Transportation Council already has incorporated this recommendation into its long-range transportation plan, which it approved in June.
"Access to transportation is key to helping people remain independent," noted commission member William McDonald, executive director of the nonprofit agency Medical Motor Service, which provides 500,000 trips of nonemergency transportation a year to seniors and the disabled.
He said that Medical Motor Service is the lead agency on the TRAC Program, a collaborative effort among the Monroe County Office for the Aging, Catholic Family Center, Lifespan and Eldersource to coordinate transportation services for older adults and their caregivers. That program could grow into a larger mobility-management system.
"The goal is to pick up the phone, call one number and say, ‘I’m going from here to here. What are my options?’" said Richard Perrin, executive director of the Genesee Transportation Council. He said plans are being made to develop a Web-based system as well.
Transportation services are at a premium in rural counties, where public transportation is limited, said Christa Barrows, program director for Catholic Charities of Livingston County’s Faith in Action program, which pairs volunteers with seniors to provide home modifications, companionship and transportation.
"Our main service is transportation, because it is one of the biggest needs in our community," she said.
Some doctors also are turning to telemedicine -- in which doctors and patients connect through interactive video equipment -- as a way to decrease the transportation needs of those living in rural areas. Mahoney noted that a telemedicine pilot project is currently underway between the Rochester General Hospital and Newark-Wayne Community Hospital.
- Reducing disparities among minorities. Health-care officials are working to improve medical outcomes among minorities through programming designed to target their higher incidences of chronic disease.
For instance, Ibero-American Action League offers health services and programming to Latino seniors who attend its senior center, Centro de Oro. The services -- including nursing, physical therapy and exercise -- are provided by students from Nazareth College.
Ibero also runs the Promotores de Salud (Health Promoters) program, which connects uninsured Latinos with health promoters who can refer them to doctors or clinics, help arrange transportation to doctors' offices and provide translation services if needed, work with them to get insurance, and connect them with support groups or health fairs, said Elisa DeJesús, vice president of Ibero’s Family Services Division. This year, budget cuts forced the agency to reduce the Promotores de Salud staff from seven to two, DeJesús said.
"Even though we reduced staff, we always find a way to see the person," she said.