Reimagining Care for Older Adults

Generously Supported by The John A. Hartford and The SCAN Foundation.

The Vision

The Dialogue’s vision is to improve supports and services for older adults so that, wherever they call home, they may live with dignity, choice, and self-determination.

The needs, lived experiences, goals, and preferences of older adults must shape the resources needed to achieve this vision. We envision a more inclusive system where older adults can, as much as possible, control their own destinies.

Achieving this goal requires coordination by all partners in care. Family caregivers, paid caregivers, providers, community-based organizations, state, local, and federal government agencies, and private payers all support older adults with care needs. As much as possible, social supports must be available, well-coordinated, affordable, and supportive of both paid and unpaid caregivers.

The Problem

Too many older Americans spend many of their later years in institutions ill-suited to fulfil their desires and enhance their social connections. Regulations, payment systems, and outdated models of care massively contribute to this issue and make it challenging to provide an efficient and supportive array of options.

America needs a system of care that reflects the unique needs and realities of aging adults today and in the future.

There is one RN for every 43 residents at most for-profit facilities, with the ratio being one RN for every 23 residents in nonprofit facilities.

1 in 3 older adults are economically insecure, with incomes 200% below the poverty line.

Percentage of Americans that are considered older adults.

$375 billion is the value of services provided by unpaid family caregivers.

Challenging these systemic problems requires creative thinking, problem-solving, and a willingness to collaborate to find common ground. Our proven, consistently successful process brings top leaders from across the political spectrum to consensus, helping the group identify critically needed changes, such as reforms to federal programs, tough policy choices, and realigning funding.

Establish a broad constellation of financially sound and adaptable care settings that reflect the desires and needs of older adults

Most people in America want to age in their own communities and in their preferred home setting. To give older adults autonomy and dignity, there needs to be a wider array of financially viable living and care service arrangements.

Ensure There Are Enough Caregivers

Near-term, high-priority actions are needed to address economic insecurity among paid caregivers, workforce shortages, burnout and exhaustion, and turnover. In parallel, longer-term actions are needed to broaden the “pipeline” of caregivers and create a true caregiving profession with ladders of advancement.

Finance the Future Care System

Over the coming decades, the nation needs to commit significantly more resources and use those resources more efficiently and creatively to pay for older adults’ supports and services. This funding must come from a mixture of public and private sources.

Project Outcomes

Measuring Bereavement and Building Caregiver Resilience Paper

This paper highlights ground-breaking research into bereavement exposure, bereavement measurement, and strategies for building resilience.

Improving the CMS Rating System for Nursing Homes

This paper reimagines the Centers for Medicare and Medicaid Services (CMS) rating system to capture and reflect the quality of life and the lived experience of older adults and adults with disabilities in our nation’s nursing homes.

Strategies for Housing Based Support

Dialogue participants identified housing-related areas where collaboration is possible. They also suggest strategies involving federal programs and policies that could reach systems and providers serving older and disabled adults.

Rethinking Care for Older Adults

Building on Convergence’s Long-Term Care Financing Collaborative Dialogue in 2016, we brought together almost 50 experts on aging and caregiving for older adults in three meetings in 2020 to brainstorm on the practice, policy, and business model changes needed to transform the system of care and the range of institutions. The conversations generated ideas for expanding opportunities for home and community-based care, advancing alternative business models in the institutional sector, and transforming the caregiving workforce. In December 2020, Convergence published a report, “Rethinking Care for Older Adults,” summarizing the series of conversations.

Supplement to Rethinking Care for Older Adults

Many of the ideas in the "Rethinking Care for Older Adults" report would require legislation or changes in business practice, but others could be advanced at least in part by administrative or regulatory actions at the federal, state, or local level. To further develop some of these latter ideas, Convergence again invited experts from the original conversations, and some other experts, to flesh out their ideas for administrative actions consistent with the broad themes of the original conversations. The result is the “Supplement to Rethinking Care for Older Adults: A Menu of Ideas for Administrative Actions.” Like the ideas in the original report, the proposals in this collection do not represent a consensus and they are not endorsed by nor represent the views of Convergence. Each proposal represents solely the views of the author. Convergence’s purpose in publishing this collection is to spur productive conversation about the future of care for older adults.

Testimonials

"Too often, reports like this ignore or take family caregivers for granted. This one doesn’t. This one recognizes quite explicitly how important family caregivers are to the long-term care system and thinks about how we can help them".

"Incomes disparities for paid caregivers really reflect systemic barriers. When you look at these recommendations, like having a career ladder for paid caregivers, you’re not only looking beyond the systemic barriers that have traditionally existed".

"There is a lot of fear among older Americans about not being able to make choices about how they age, and these recommendations really would change that".

Assisted Living Communities Should be Integrated into Greater Community

Assisted living communities and other congregate care settings are “vital” and should be more fully integrated into surrounding communities through short-term respite care, adult day services, and mental health and cognitive care resources, recommends a new report released Wednesday by the Convergence Center for Policy Resolution.

Rethinking Long-Term Care Starts With 5-Star Redesign, Adequate Funding, Community Tie-In

Beyond the obvious call for more direct care workers and adequate funding of care, today’s aging population needs a broader range of living arrangements than what is offered now within the care continuum. In other words, more options that keep residents connected to their community and family while still receiving the right level of clinical care.

A Valuable New Framework For Improving The Care Of Older Adults

Imagine, for a moment, a functioning, well-developed system for improving the lives of frail older adults. Imagine that, instead of our current chaotic, dangerous, and needlessly expensive patchwork of care for seniors, the U.S. had a well-coordinated care model that leverages and supports paid aides, family caregivers, safe and appropriate housing, and new technology.

Program Funders

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