Our nation is aging at a dramatic rate, just as it grew at a dramatic rate between 1946 and 1964 with the birth of the Baby Boomer generation. Currently, Iowa is ranked by the U.S. Census Bureau as number one for the highest percentage of population over age 85 in the United States and number four for population over age 50. Iowa is an aging state, and this trend will persist for the foreseeable future. The issue of how best to offer lower-cost health care with better health outcomes in the patient-preferred setting should be at the center of all aging and health-care policy for years to come.
Policy decisions should be aligned with patient-centered needs. Iowa has an opportunity to lead the way with innovative strategies related to care delivery to rural elderly through more efficient utilization of existing systems - both our health-care and educational systems.
It would be better for each of our individual states to work toward crafting comprehensive systems that provide long-term services and supports (LTSS) that also allow older adults to remain in their homes as long as possible - to "age in place," regardless of their health status or age. According to the Iowa Department on Aging, 93 percent of Iowans age 50 and over desire to "age in place" and receive care in their home.
The nursing home industry has an opportunity to adapt and realign its business model to support the policy goals of lower-cost care with better outcomes in the patient-preferred setting. Typical to Iowa is that nearly every small town has a little care center out at the edge of town. We have all heard the story of the retired farmer and his wife who moved to town because they now have health conditions that make it difficult to remain in their home without assistance. They are moved to the nursing home to receive that care because other home and community-based services (HCBS) options in their little rural Iowa town are limited.
The nursing-home industry should consider converting a wing of their care facility and turning it into an adult-daycare program or applying to be a Program of All-Inclusive Care for the Elderly (PACE) site as they coordinate care with local primary care providers or regional Medicare accountable care organizations (ACOs) and the statewide Medicaid ACO. They should invest in some small vehicles and additional telemedicine equipment and send their Certified Nursing Assistants (CNAs) and Registered Nurses (RNs) out into the community to provide HCBS and fill these gaps in needed services. They will still be able to bill Medicare and Medicaid and other private insurance as they have been, but the types of services they bill for may change.
Students attending community colleges or universities often come out of their programs without any practical experience in their new field. By requiring just three service-learning credit hours for all students in various curriculum programs, the needs of rural elderly could potentially be met at a tremendous overall social savings. If nothing else, a demonstration project in one area of Iowa could give important feedback on whether or not such a program could be successfully implemented and create a win-win-win situation for the state's budget, the patients who want to "age in place," and the students who would gain valuable real-world experience to help them secure paying positions in our expanding health-care sector of the economy. This is a good idea whose time has come. It deserves a try by our politicians and health-care educators and administrators.
Shawn M. Zierke is Interim Executive Director of Iowa Counties Public Health Association.
Her editorial was provied by the Public Interst Institute in Mt. Pleasant.