The Blog to Transform Advanced Care
Advancing Care through Innovation, Observation and Collaboration.
One reason why the Coalition to Transform Advanced Care (C-TAC) continues to successfully achieve its mission is the diversity of its membership. Strong coalitions unite groups across a variety of disciplines to achieve common goals. C-TAC unites physicians, nurses, patient advocate groups and faith-based communities on behalf of people to broaden access to palliative and advanced illness care. The movement has even attracted support from lawmakers across the aisle—a testament to the compelling nature of the coalition’s goal to transform advanced illness care in this country.
Successful coalitions, such as C-TAC, continually seek new voices and perspectives, and a natural, though somewhat overlooked, partner is the seniors housing and care (SHC) industry. It comprises independent living, assisted living, memory care, skilled nursing, and continuing care retirement communities (known as CCRCs or life plan communities). These properties house and care for America’s frail elders. Even in independent living, housing the youngest and healthiest seniors, services are provided that support quality of life. In assisted living, as the acuity of residents continues to increase, these properties deliver higher and higher levels of care. Skilled nursing includes both short-term residents recovering from an acute medical episode and long-term residents, about two-thirds of whom use Medicaid to pay for their housing and care.
The advanced illness care movement and the SHC industry are a good match for several reasons; most notably, they serve the same population. For example, the typical assisted living resident is a woman in her mid-eighties, managing at least two chronic conditions, and who needs help with activities of daily living. She is at risk for emergency department visits and other consequences of declining health. And she is also a candidate for palliative care, as are many of her fellow SHC residents, close to three million of them, when you count the number of adults in all of the property types.
Unlike skilled nursing residents, who have the majority of their care paid for through Medicare and Medicaid, independent and assisted living are paid for almost entirely out of pocket. Reimbursement for palliative care through Medicare and Medicaid Fee-for-service is a challenge, as is the need to raise general awareness of the service. The independent and assisted living segment of the SHC population may be an opportunity for innovative financing for such care by combining public and private funding streams. As palliative and advanced illness care becomes more common among these residents, lawmakers may move to make these services more widely available under Medicare and/or Medicaid.
Palliative care provides services similar to many of those offered by SHC properties of all types to varying degrees. Providers may work with family members to understand the disease progression of Alzheimer’s or assist with advanced directives. They all typically have nurses on staff, some form of chapel or worship services, and in some cases, a co-located primary care physician or practitioner. Some providers even coordinate care for care recipients and their families.
SHC providers should have a seat at the table in the movement to improve palliative and advanced illness care delivery. These providers understand the challenges the aging population faces, and they know how to deliver services that improve quality of life. Within their walls is a needy population that should know about this valuable resource. The SHC industry can become an active participant in this movement and I look forward to discussing those opportunities with you at C-TAC’s Fourth National Summit on Advanced Illness Care.