Integrated Care and the Aging Network: The Next Frontier or the End of an Era?

How integrated care will affect elders, their families, and the aging network remains unclear, but evolution is imperative.Founded in 1881, the Eastman Kodak Company was not only profitable, it was very much a part of American culture-even having its own "branded" song (the 1975 hit, "The Times of Your Life"), which was piped into countless elevators across the nation. For many of us, that little yellow box of Kodak film was a trusted companion at important and memorable life events-birthdays, graduations, vacations.Today, however, Kodak is in bankruptcy. Its core business of manufacturing photographic film products has practically disappeared. The Kodak Carousel slide projector, another stalwart product, is now displayed in New York's Museum of Modern Art, purchased no more. Why, despite its good products, did Kodak fail? Simply stated, the world changed, but Kodak did not.It is important to provide a good product or service, but it is essential to continually evolve in a dynamic world. It is our contention that the aging services network's system changes of today are no less dramatic than the previous decades' shiftfrom the heyday of photographic film to the present digital world that has so daunted Kodak.System Changes Usher in a New Era of CareWith a half-century mission deeply rooted in the Older American's Act, the aging services network has been the major provider of information and services to older persons, with a special focus on assisting low-income elders and elders with disabilities. With limited funds available from the Older Americans Act, the aging services network and area agencies on aging initially had very little competition in their efforts to serve.The tremendous expansion of home- and community-based services (HCBS) in the 1980s and 1990s brought a new level of attention to providing aging services. During this second phase, interest in serving older Americans remained the primary responsibility of area agencies on aging, but other elements of the public sector-typically welfare or health departments-became more heavily involved. This expansion of HCBS, along with a large infusion of new funds, also brought a new set of businesses into the aging enterprise (Estes, 1993). In this phase, service provision now included many proprietary companies, but the care management function remained in the public or private nonprofit sectors.The emphasis on integrating long-term services with acute care represents the third major transition faced by the aging services network. A recent AARP survey found that two-thirds of the states were either integrating, or planning to integrate, Medicare and Medicaid services (Walls et al., 2013). These changes have given rise to many new organizations interested in providing publicly funded health and longterm services to older people. Not only has this development continued to alter who provides the services, but also it has resulted in an expanded set of organizations involved in the management of care for older people.Many of these new entities are proprietary and have their roots in managed healthcare, bringing to the table extensive experience in the acute care arena but limited work in the traditional services provided by the aging services network. Proposed integrated care programs represent the first time, since the 1972 inception of the area agency network, that, on a wide-scale basis, the independent care management role for publicly funded services could be combined with service provision under the auspice of a proprietary entity.What will this new era mean for the aging services network as it approaches its fiftieth birthday? Some have argued that these changes will more efficiently and effectively provide a new array of resources to serve older people, and that the aging services network can have a critical role in this new approach to providing care. Others, however, have argued that the proposed changes could hurt consumers and weaken the traditional aging services network, placing area agencies in a marginalized role (Summer and Alker, 2012; Polivka and Zayac, 2008). …