The Future of the Aging Network

If those in the healthcare sector want to bring services in under one roof, how does the aging services sector ensure it's not left out of the action?he health and social service systems for older persons are undergoing radical changes, stimulated by the realization that demographics will not permit business as usual. If there is a unifying theme, it is probably value-purchasing or efficiency, leaving aside the multiple defini- tions of what constitutes a desirable end point.The aging network faces a strategic choice. Does it continue to maintain its strong base in social care, or does it venture deeper into the lucrative but alien world of medical care? Although it is tempting to try to do both, that strategy may create problems. At the very least, it will lead to organizational confusion.How Did We Get Here?Historically, the network served a mixed popula- tion. Its origins were strongly tied to a combina- tion of social services and life enhancements (built around senior centers). Its portfolio has included addressing the well and the disabled with prevention and care coordination services, as well as a range of programs to enrich elders' lives. The aging network's agenda has undergone a number of transformations, driven in part by the philosophy of the person leading the Admin- istration on Aging (AOA) at a given time, and partly by the temper of the times.Its social service mission brought it into long-term care, especially care coordination, but it has gradually followed the money to more lucrative medically involved care. Meanwhile, the AOA has become the Administration for Community Living, bringing the disability perspective into sharper focus for older people.The policy environment complicates the picture further. Whereas services for younger people with disabilities rely upon claims of social justice and equal access to all of life's opportunities, the care of frail elders has evolved in a largely medical context (catalyzed by an association with Medicaid) in which the recipi- ent of services is deemed vulnerable and in need of protection. Social services are typically viewed as adjunctive. Costs and use are clustered in a small number of highly frail persons. The more social the care and support, the less it is valued. Because medical care is so expensive, it is the natural target for efforts to save money. Hence, the value of social care is typically mea- sured by its contribution to saving money, or at least being efficient. But such a philosophy is actively rejected by younger persons with disability who view medical care as adjunctive to their social goals (Butler et al., 2012).Long-term social supports have evolved unplanned, driven by opportunities in response to perceived niches. The situation is complicated because some components serve multiple con- stituencies with different needs.The most glaring example is the nursing home, which purports to be a source of post- acute rehabilitative care and an institution to serve long-stay residents who need supportive services and an enhanced quality of life. Few organizations can multitask well, especially if they have no strong record in either realm. The issue is almost as confusing with homecare, with its blurring of post-acute and longer term care. Part of the problem can be traced to the fact that Medicare pays much better than Medicaid. Many older people are reluctant to spend their own money on homecare, argu- ing that they can make do. We might then ask why professionals are so anxious to provide a service that people are hesitant to purchase with their own money. (Of course, the same could be said about prevention.)There is growing interest in the medical sphere in strategies to bring services under one roof. Simultaneously, there is a shift to provider organizations, like hospitals or medical centers instead of insurance plans, being at the center of the action. The different strategies for bringing services under one umbrella include coordina- tion, cooperation, collaboration, and consoli- dation through both vertical and horizontal integration. …