Perspectives: TSF at 10 Years – A Look at the Path Forward

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In this Perspectives, Dr. Chernof discusses the Foundation’s efforts over the past 10 years to better the lives of vulnerable older adults and families. He also reflects on the Foundation’s priorities for 2019 and beyond.

Date Updated: 11/28/2018

As 2018 comes to a close, TSF celebrates its 10th anniversary. We are proud of the progress that has been made to better the lives of vulnerable older adults and families. We see powerful signs of positive change in health systems and community-based providers, as well as new leadership from policymakers. We are incredibly grateful to all of our grantees and colleagues who have worked with us to tackle seemingly impossible questions in new, smart, and innovative ways. We also remain incredibly impatient; the pace of change is simply not fast enough. The multigenerational impact of not delivering holistic, responsive, integrated care is becoming more evident every day. More can be done to positively affect people’s lives today.

What does this mean for TSF over the next five years? During the past 12 months, our staff and Board have thought deeply about this question. Three key learnings resulted from this review:

  • Our core work over the past few years focused on transforming care models for dual eligible and Medicare beneficiaries with complex needs, and this is not done—not by a long shot.
  • Similarly, our policy work to break down barriers at the state and federal levels and radically rethink how to finance the long-term care needs that families face as they age also continues.
  • Finally, we recognized that this really important work takes time. But the reality is that older adults face extraordinary challenges in their lives today, and have more immediate desires and aspirations for themselves and their families. They face worries and wishes that the health system is not prepared to address today (or tomorrow for that matter).

Across all our work going forward, we commit to taking a much more person-first orientation to trigger demand; without demand, supply goes unused and public policy does not change. Based on these learnings, here is a first look at where the Foundation is going in the next five years!

Establish person-centered, integrated models as the standard of care that all older adults with complex needs come to expect and receive. We strongly believe in the need for more person centered models of care, and that health systems are generally building a single program or approach for older adults with complex needs regardless of whether they have Medicare only, or are dually eligible for Medicare and Medi-Cal. In response to this reality, we will combine our work on transforming care for duals with our efforts advocating for person-centered care models for those with Medicare only into a single goal to increase demand and transform the delivery system.

Drive responsive federal and state financing policies to create meaningful care choices for the older adults of today and tomorrow. The Foundation recognizes that there have been important steps taken to improve financing policy, but much remains unaddressed to meet long-term care needs. For dual eligibles, the progress made by the Medicare-Medicaid Coordination Office and related demonstration projects should be routinized and expanded into every state, so that every dual has a meaningful alternative to the broken, uncoordinated, fee-for-service status quo. For those with Medicare only, the CHRONIC Care Act is a good step that still must be implemented, and there remains important unmet needs—particularly for those in fee-for-service Medicare. Finally, there remains the pressing policy question about the best ways to address the reality that almost 20 percent of Americans will face catastrophic long-term care needs that will last five or more years. The policy failure to think through public and private solutions to address this need will ultimately decimate families and put substantial pressure on Medicaid. Recognizing these challenges, TSF remains committed to this financing goal.

Build resilience and capacity in older adults, families, and communities. The Foundation will work on a new goal that takes a person-first orientation – as opposed to a system- or policy-first slant –and aims to improve the ecosystem that shapes the experiences of older adults. We recognize that the products and services being designed for individuals and families are rarely meaningful, helpful, or effective—and as a result, mostly fail. There is a pressing need to reimagine how we meet existential worries and deeply held wishes by designing “with” and not “for” older adults, and using a framework that takes a more enabling and expansive view as opposed to an approach focused on single limitations and deficits which defines most design today. Finally, we believe there must be an inclusive approach to how solutions are developed and scaled to meet the needs of as many communities as possible, particularly those that are marginalized when it comes to innovation.

It is time to design the world we all want for ourselves and our families. With the help of grantees, colleagues, and friends, we embrace this challenge. We welcome you to join us!


Bruce Chernof, MD, President and CEO of The SCAN Foundation, dedicated to creating a society where older adults can access health and supportive services of their choosing to meet their needs. The Perspectives Series provides opinions and observations about transforming the way in which we age. Follow Dr. Bruce on Twitter @DrBruce_TSF.


 

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