Sally Schaefer is chair of the Colorado Health Foundation's Board of Directors.
Meeting the needs of an aging population is a hefty challenge that demands innovative, homegrown solutions. Communities can tackle that challenge by focusing on what's "big enough to matter but small enough to solve."
Unfortunately, too often our approach toward long-term services and supports (LTSS) is unnecessarily tethered to a costly and unsustainable "medical model" rather than a community-based approach.
According to the U.S. Department of Health and Human Services, almost 70 percent of people 65 and older will require some form of LTSS. Meanwhile, Colorado's 65-plus population is expected to be three times larger by 2030. In short, this means up to 930,000 older Coloradans will need LTSS in 2030 and beyond.
Such care would likely include informal family care-giving as well as paid assistance, including short-term stays in nursing homes and home and community-based care. The portion of the aging population that qualifies for Medicaid-funded LTSS will have major implications for the state's Medicaid budget.
The important question is not whether we'll spend enough on long-term care, but whether people using LTSS are happier and healthier.
I'd argue that helping the elderly and the disabled live to their full potential doesn't mean pouring more money into the system or building more elaborate bureaucracies. In my experience as a nurse and as the president and CEO of Hilltop Community Resources Inc., I've learned the opposite can be true.
For example, at Hilltop, we tried an experiment with other community partners. We vowed to keep people on Colorado's Western Slope out of nursing homes and off Medicaid by simply providing what they needed in their homes. By the end of the first year, we kept more than 100 individuals out of nursing homes and off Medicaid (even those who qualified). If we allowed them to go to nursing homes and enroll in Medicaid, the average costs of care would have totaled $70,000 per-person, per year. By contrast, the community collaboration cost an average of $70 per person per year.
Through this experiment, we learned that it often takes very little in the way of cash resources to keep people in their familiar surroundings. People were inspired to work harder and to stay healthy to continue to receive the love and support of a community-based network.
We also reinforced the notion that social isolation is the mortal enemy of the elderly. Once isolated, loneliness and depression set in, meds get mismanaged, meals are forgotten and chronic illnesses flare up.
We were able to avoid such costs through sweat equity and by providing a lot of different services that were already available. Some patients needed someone to come in twice a week or take them to the grocery store. Or they needed someone to come in and clean their house. Mostly, they just needed caring human connections.
Frankly, the way we approach LTSS is too complicated. Instead, we need to look at how to get people what they need. That's why the Colorado Health Foundation has launched a special funding opportunity to help Colorado design a high-quality, cost-effective and person-centered LTSS system.
This special funding opportunity will provide $6 million for innovation grants to build an LTSS system that will ensure people with disabilities, chronic conditions and age-related challenges have choice, control and access to a full array of quality services that assure optimal outcomes, such as independence, health, quality of life and community integration.
Though Colorado's LTSS system ranks No. 7 in the nation, according to a scorecard sponsored by AARP, the Commonwealth Fund and the SCAN Foundation, Colorado has an opportunity to become a true innovator that could improve individual lives and the quality of care – all while reducing costs.
Again, doing so doesn't require a great deal of money. We simply need the will to do things differently.