Of course, one effective response to this challenge is to place greater emphasis on getting healthcare right—to acknowledge that the healthier you are throughout your life, especially when approaching your senior years, the better off you and your family will be. At the national level, there has been—and will continue to be—much discussion about healthcare policy and changes proposed by physicians, hospitals, health systems and insurers.
Another area that requires a thorough response is our “built environment,” that is, the homes and communities we live in. Most surveys show that the overwhelming majority of Americans will seek to age in place in their own homes and communities out of a strong desire to remain close to family and friends. Understandably, many prefer the familiarity of home and to receive care on an outpatient basis rather than at a nursing home or other institutional setting.
This desire to age in place, however, runs into the reality that many of our homes lack important structural features, such as no-step entry, extra-wide doorways and halls to accommodate wheelchairs and walkers. Many of our communities are ill-suited to older citizens' needs, because they lack such basics as adequate street lighting, accessible sidewalks, access to public transportation, convenient shopping and safe public spaces.
Looking ahead, a key issue is how best to finance home and community modifications to make independent living a viable option. If we consider that falls are the primary cause of injury and injury-related deaths for those 65 and older, taking preventive steps to make our homes and communities safer should lead to better health and cost savings. Investments in public infrastructure that are safe and accessible are essential as well.
Complicating the desire to age in place will be the need of many seniors for long-term services and supports–that is, help with normal everyday activities such as bathing, dressing and medication management.
Medicare does not cover these types of services, except in very limited circumstances. Instead, seniors and their family members manage as best they can with their own resources. For low-income seniors, Medicaid (a state-administered program that uses a combination of state and federal funds) is the primary funding source for these services.
Historically, Medicaid-covered long-term services and supports were provided in nursing homes or other institutions. In the 1980s, states began to shift from institutionalized care toward care in the home and other community-based settings. That transition, however, has been slow, with ongoing concerns about cost inhibiting significant changes.
The good news is that America is waking up to the challenge and the opportunity that an aging population presents to our society. As members of the BPC's task force, we look forward to participating in this national conversation and hope to provide recommendations on the best way forward.
Allyson Schwartz is a former U.S. representative from Pennsylvania. Mel Martinez is a former U.S. senator from Florida and former secretary of the U.S. Department of Housing and Urban Development. Both are members of the Bipartisan Policy Center's Health and Housing Task Force. Schwartz also serves as president of the Better Medicare Alliance.
