Aging in Place in Rural America
For older adults living in rural communities, the challenge of aging in place is often magnified. What specific programs and policies have proven successful and could be replicated? View the full forum.
By Terry Hill
For older adults living in rural communities in the United States, the challenge of living independently as long as possible is magnified. Long distances, lack of transportation, as well as limited senior housing options, create barriers that too often find rural seniors in housing options that do not maximize their independence, and sometimes separate them from their families. Ironically, people who live in rural America and have strong independent values often find themselves in highly dependent situations in the final stages of their lives.
Fortunately for rural seniors, two major trends are transforming the health care industry in this country, and will have a major impact on the challenges described above. The first major trend is the transformation of the U.S. health reimbursement system from “pay for volume” to “pay for value.” The federal government’s Medicare program, state Medicaid programs, and increasingly private insurance companies are now providing incentives to keep seniors in their homes as long as possible. In Medicare’s Accountable Care Organizations (ACOs), for example, specific groups of health care providers (usually hospitals and/or clinics) are accountable for the cost and comprehensive care of large groups of Medicare recipients. If the providers can provide comprehensive care to the recipients with higher overall quality and satisfaction, at less total cost than the previous year, they gain bonuses based on this documented value.
Given the ACO model, which has been copied by many state Medicaid programs, helping keep people in their homes as long as possible has become an important business objective. The home-based seniors and their families tend to be happier, the cost is substantially less, and the quality and safety can be provided with the use of a second major trend: technology.
The Lutheran Home Association, located in Belle Plaine, Minnesota, south of the Twin Cities, has more than seven years of experience using health monitoring technology to keep seniors and chronically ill patients in the least restrictive housing settings. Their federal and state demonstration projects include “Advancing Technology Resources and Assessment for Alzheimer’s and Dementia,” as well as “Live Well at Home.” They are also partnering with the University of Minnesota to use noninvasive, sensor based technology to help family caregivers monitor the daily functions of rural persons with Alzheimer’s disease or related dementia. The technology platform they’re using includes a combination of remote sensors located in key areas of a patient’s home (e.g. bed, bathroom, kitchen, living room) that can communicate patient activity and other information to a family caregiver and a care professional. This proactive intervention model is designed to monitor and prevent negative events such as falls or wandering, and will allow these individuals to stay in their homes as long as possible.
According to Catherine Berghoff, Lutheran Home Association’s director of development, a current state funded initiative will allow the Association to build a comprehensive health technology resource center, thereby enabling other service providers and family caregivers to access the knowledge, processes and technology that has been produced by the demonstration projects. This web-based center is scheduled to be completed in 2016.
Other types of mobile health monitoring technology is predicted to be used widely in the near future. Health care providers are already capable of monitoring the vital signs of patients remotely; technology that can be worn by or attached to patients will provide daily readings of blood pressure, blood sugar, and a variety of other patient information to health care providers in rural clinics and hospitals. This ongoing monitoring of medical conditions combined with sensor technology will enable rural seniors and chronically ill patients to live safely in place as long as possible.
In summary, rural seniors have historically faced formidable challenges to staying in their homes when sick or chronically ill. Two major trends will effectively overcome many of these challenges: 1) rapidly changing value-based health care reimbursement, which will financially reward health care providers to more effectively support home-based services; and 2) the growing use of health monitoring technology, that will enable the remote monitoring of both patient activity and patient vital signs. This is all good news for rural seniors, for their families and for their health care providers.
Terry Hill is executive director of Rural Health Innovations and senior advisor for health leadership and policy for the National Rural Health Resource Center.
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Any views expressed on this forum do not necessarily represent the views of the Senior Health and Housing Task Force, its co-chairs, or the Bipartisan Policy Center.