To help the United States achieve social arrangements that ensure that, when we must live with serious chronic illnesses associated with advancing age, we can count on living meaningfully and comfortably, at a sustainable cost to our families and society.
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Making it Safe to Grow Old: Better Care for Frail Elders
Our current health care system, developed to treat and cure acute illness and injury, is not prepared to care for the age wave. Even as we face an opportunity to learn from aging adults and their experiences of long life, we face the challenge of supporting millions likely to experience ongoing, chronic diseases that lead to disabling and eventually fatal illness. Demographics and increased longevity will challenge American ingenuity and resourcefulness in years to come: We face burgeoning numbers of dependent elderly, diminishing numbers of family caregivers who have limited resources, and a health services and delivery system that cannot meet their needs. Instead of making continuity, comprehensiveness, and caregiver support a priority, the dysfunctional system focuses on short-term outcomes from costly and often ineffective medical interventions. The Altarum Institute Center for Elder Care and Advanced Illness (CECAI) aims to create the fundamental changes needed to build a compassionate, effective, affordable, trustworthy system.
What Are Our Core Strategies for Addressing This Work?
- Designing and implementing demonstration projects in communities nationwide, with a particular focus on creating reliable, community-based, integrated elder care models that provide tailored, goal-oriented care and ensure funding for and delivery of the social supports that are vital to the quality of life of older adults;
- Reshaping the framework in which we consider, design, and deliver care for frail elders, recognizing that this aim will require both a profound change in how we organize such care and a shift to making that care more focused on population health with elements of locally control and monitoring;
- Developing and implementing comprehensive care plans that connect medical care providers, social services providers, frail elders, and family caregivers to go beyond the typical retrospective list of medications and problems and expand to consider the likely future, quality-of-life goals, and preferred treatments;
- Promoting and informing public perspectives and dialogue on specific, innovative approaches to improving systems and services and addressing costs; and
- Advocating to inform and guide leaders as they shape policies that will affect all of us as we age.
Where Are We Now?
Since its launch in 2011, CECAI has sharpened its focus while building on several key concepts. Through community-based work nationwide and with public and private funds, we are working with cutting-edge groups to improve how the society conceives of and responds to the challenges of late life. Based on our early studies of how to improve care transitions across health care settings, we now work with communities seeking to apply community mobilization approaches to create change, galvanize systems, and engage family caregivers. Among our many activities, recent projects have included the following:
- Working with thought leaders to reframe how to envision the lives and experiences of frail elders and using this perspective to develop policies and responses that promote a better quality of life and increased community control.
- Supporting community efforts to improve patient care across settings (e.g., from hospital to home). Such error-prone care transitions are particularly difficult in current systems. CECAI now helps scores of communities nationwide to respond to this Centers for Medicare & Medicaid Services initiative and move to create seamless, comprehensive care.
- Building a stakeholder network that can analyze issues quickly and thoughtfully and, when appropriate, responding to calls for public comment on proposed federal regulations.
- Writing a book that characterizes CECAI’s approach to care of frail elders.
- Publishing ideas, findings, and commentary in an array of professional and lay publications, both in print and online, including the Journal of the American Medical Association, The Washington Post, and The New York Times.
- Launching the Family Caregiver Platform Project (FCPP), a grassroots, nonpartisan initiative to raise public and policymaker awareness of aging, family caregiving, and long-term care challenges by inserting these issues into the platforms of both parties in many states. The FCPP uses an educational and outreach approach to find, engage, and empower citizen volunteers who are interested in giving voice to the key health, economic, and community issues that matter to families living in an aging society.
Altarum is a nonprofit research and consulting organization with decades of experience modeling, managing, and evaluating systems change in health care. Altarum has repeatedly demonstrated the expertise, credibility, partnerships, and resources required to tackle the most difficult and pressing issues that affect human health.
How Will the Center’s Work Contribute to Broader Systems Change?
No single organization will be able to prevent or resolve the looming crisis of an aging America. However, CECAI is convinced that solutions are to be found by catalyzing key improvements fundamental to progress in the quality, structure, delivery, and financing of care for this phase of life. In particular, the Center will do the following:
- Frame issues and choices in ways that are uncompromising, well researched, objective, and helpful to progress;
- Share what we—the Center and others—learn in order to engender creative conversation and lead to modeling and testing of alternative approaches;
- Build the public will for comprehensive and pragmatic solutions, making it appealing for political leaders to take on these topics in thoughtful and effective ways; and
- Develop and deploy an effective Web-based platform and social media outlets to support the field as it works to change and improve the course of aging in America.
Center Director Dr. Joanne Lynn is a geriatrician, health services researcher, clinical improvement advisor, and policymaker with a distinguished history of service to frail elders and a lifelong commitment to finding practical ways to improve health and health care at a sustainable cost. Her methodological expertise, including rapid-cycle quality improvement as well as quantitative and qualitative study methods, means that the Center’s work will be reliable, practical, and sustainable.
Anne Montgomery is the Deputy Director of CECAI. She has decades of experience in health and aging policy, having served in several positions on Capitol Hill, where she developed hearings and legislation on nursing homes and home- and community-based services in Medicaid, care for dually eligible beneficiaries, health care workforce issues, elder abuse, dementia care, and community and social support services for older adults.
Products and Services
The Center produces products and services for clinicians, policymakers, and the public, such as the following:
- The book - MediCaring Communities:Getting What We Want and Need in Frail Old Age at an Affordable Cost makes the case for reform and describes the MediCaring Communities approach. To view and order your book, click on the cover image (left).
- The website - http://www.medicaring.org describes the MediCaring Communities project and highlights important policy issues related to the development of a reliable, sustainable, and integrated care system for older adults and their families.
- Handbook for Mortals: Guidance for People Facing Serious Illness. Recipient of the 2012 American Medical Writers Association award for a book for the general public, this book provides clear and compassionate guidance for patients and caregivers faced with a serious illness that will lead to death. Readers will find practical recommendations for the words that they can use and the actions that they can take to ensure comfort, meaning, and dignity for this phase of life. The book is made personal with the inclusion of photos, poems, and quotations that help humanize difficult issues.
- On-the-ground or online consulting and coaching from Dr. Joanne Lynn and her team of experts.
To learn more about the ongoing work of the Center for Elder Care and Advanced Illness, please email firstname.lastname@example.org or phone 202-776-5100. Additional information about the Center’s work is also available at www.medicaring.org or on Twitter @Medicaring.