Creating a more coordinated system of care for the elderly is a top priority for Florida health care leaders, especially when 1 in 5 residents in the country’s 3rd most populous state are over the age of 65.
Four elder care experts held a roundtable discussion at our 2022 Florida State of Reform Health Policy Conference last month to identify flaws in the current system and bring attention to innovative solutions.
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AARP Florida State Director Jeff Johnson said a widespread issue in elder care is seniors’ ability to remain independent, especially when the COVID pandemic led many community services to shut down. For example, seniors who are unable or unwilling to drive themselves are limited to seeking services in the immediate area, which are not always available—especially in rural areas of the state.
“[Seniors] would love to be able to remain independent at home in their community,” he said. “Our systems aren’t set up that way. We can talk about that in terms of long-term care systems and the Medicaid bias towards nursing home placement versus home and community-based services.”
Matt Hudson, Executive Director of the Florida Programs for All-Inclusive Care for the Elderly (PACE) Association, is concerned about the lack of safety net resources for seniors who live away from family members, or if their primary caregivers themselves become ill.
“We’ve got a Medicaid managed care program, we have a PACE program available to that individual, and they have a caregiver,” he said. “But what happens to that caregiver if something happens to them? We don’t take it to that next step … it’s a huge amount of stress [on the caregiver].”
Panelists acknowledged the success of several programs providing navigation and wraparound services for seniors. In addition to the PACE program—which provides seniors with home health care, transportation, meals and nutritional counseling—the Florida Department of Elder Affairs (DOEA) operates the Home Care for the Elderly Program, which provides participants with a $160 per month subsidy for medical supplies and other home care needs.
DOEA also administers Aging and Disability Resource Centers (ADRCs) statewide through 11 Area Agencies on Aging. These ADRCs work as a coordinated system to provide participants with long-term care resources.
However, panelists concurred that a widespread health workforce shortage is keeping programs from expanding their scope. Additionally, state-run programs that receive funding from the General Assembly are also limited by the lack of in-depth analysis in the state legislature. Hudson, who served in the House of Representatives from 2007-2016, spoke of limitations at the policymaker level. With only 60 days to draft a budget and a lack of data on how successful these programs are, they often miss out on receiving funding from the state.
As far as solutions to improve the elder care system, David Rogers, President of Independent Living Systems (ILS), highlighted a care model that integrates Medicaid and Medicare—providing dual-eligible members with a single case manager that can navigate resources in a more holistic way.
“I was talking to someone whose mom had just entered the long term care program, and they had 3 different care managers … Having just a thin level of coordination could be a tremendous benefit and something to look at.”
Rogers said Florida should also invest in the use of technology as a tool to strengthen the care system. Increasing the use of televisits between patient and provider could both ease workforce shortages and allow providers to remotely assess the environments where elders receive their care.
Deb Hatton, who represents the managed care perspective as the Director of HCBS Waiver and Specialized Recovery Services at CareSource, advocated for a care system that prioritizes the social determinants of health. She also urged stakeholders to improve a senior’s transition from a long-term care facility back into their community.
“You should be planning, not the day of discharge, but 3 months ahead of time on what you’re going to do,” she said. “How are they going to safely go home, not to a home that no longer has electricity on because they haven’t lived there for 3 months … You have to look at that entire picture to make sure that they get home safely and can stay home safely.”
Panelists also discussed ways the private sector is supplementing gaps in the care system. Sites such as caring.com serve as a one-stop shop for finding assisted living facilities, providing resources for caregivers, and home care support.