Perspectives on Aging with Dignity
Great struggles sometimes result in unexpected opportunities.
Too often vulnerable older adults are left to fend for themselves when it comes to transitioning from the hospital to the next appropriate care setting. Stories abound of people being shipped back and forth from the hospital to temporary care to their homes and back to the hospital again when it all goes wrong. In California, approximately one in five or 81,000 Medicare beneficiaries every year end up re-hospitalized within 30 days of discharge for a medical condition that led to the original hospitalization. This figure increases to 2.5 million Medicare beneficiaries nationally, at a cost of nearly $17 billion a year. These figures do not account for the human, health, and financial toll that individuals and their loved ones face when stuck in this revolving door.
It’s been said that as goes California, so goes the nation. Right now, Californians are not prepared to grow old. A recent poll of voters in the state over the age of 40 shows that nearly half will need long-term care for a close family member within the next five years, yet the same amount say they couldn’t afford even one month of nursing home care. Regardless of political party or income level, voters are also struggling in the current economy to meet their daily living expenses. More than 40 percent of California voters over 40 have had to cut back on food and other basic expenses over the past year. Of those who currently help pay for a loved one’s care, 70 percent are facing financial hardship. The wakeup call for the state is that the increased demand for support will come sooner than expected, and requires immediate and thoughtful action by state leaders.
Over the last 18 months, the Patient Protection and Affordable Care Act (ACA) has been praised, vilified, promoted, and distorted. Yet today the law was upheld by the Roberts Court as constitutional, clearing the path for transforming our health and long-term care system into one that works for all Americans, young and old alike.
Margaret Mead, the pioneering anthropologist, once said, “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.” Last month, Washington, D.C. hosted the 2012 American Society on Aging Conference, and The SCAN Foundation brought together one such group of inspired individuals.
Chances are you know and love an older person with needs. Maybe it’s that neighbor of yours whose trash cans you help bring in once a week. Perhaps it’s your grandparent or even a parent who needs help understanding the bills or getting the groceries up the stairs. The reality is the population of older adults in this country is growing rapidly due in large part to the aging of baby boomers – a demographic shift that affects us all.
As we ring in 2012, most of us take stock of this new beginning by creating New Year’s resolutions. We think about life’s everyday realities, such as what we eat, our exercise habits, our aspirations, and vow that this year will be different – better. As a physician, I encourage New Year’s resolutions, especially when they involve altering your lifestyle to support healthy aging. This year, I suggest a different kind of resolution, one that may be more difficult to consider. I invite you to think about what aging with dignity and independence means. Then take time to have the tough conversations with your loved ones about what is important to you as you grow older, and how you will get help should you require daily assistance.
High quality, cost effective health care delivery is all about targeting – the right care, by the right provider, at the right time, in the right place, and for the right cost. It sounds straightforward, almost easy. The challenge to getting it right is understanding the range of variables in a person’s life that drive health care use and costs.
How many times in our lives have we been on the giving or receiving end of this inscrutable little question? Given our web-enabled lives, the answer often comes easily.
The cornerstone of a more effective and efficient system of care is to engage people in making decisions about their life and health in a way that upholds their dignity, independence, and right to self determination.
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In this series, Dr. Bruce Chernof discusses issues impacting health and long-term care policy for our aging population, and highlights opportunities that encourage independent living and promote individual control over decisions that impact the lives of older adults. 
