The next President of the United States will take office at the start of one of the greatest shifts in demographics in the history of our country. The number of people in the United States age 85 and older will mushroom from about 6 million to over 15 million in the 25 years following inauguration. How the next President responds to this population shift will have an enormous impact on the quality of life of America's seniors and their families, the Federal Medicare budget, and the overall economy for decades to come. Simply put, today we are quite challenged to make America great for the current group of oldest Americans and their families--it will take real focus and Presidential leadership to avoid catastrophe and hopefully do much better for a much larger group of people age 85 and older.
Many of the solutions will require several years to bear fruit, so much of the opportunity to navigate this demographic shift will rest on the next President. The Affordable Care Act or "Obamacare" has dominated the debate and discussion about health and human services for several years, but Obamacare is primarily focused on policies related to younger people, and the issues facing the oldest Americans have gone largely unaddressed. In fact, while not widely reported, in order to pay for some of the subsidies for younger people, Obamacare took monies away from elder home health care and has steadily added new paperwork barriers to qualify for home health care. Home health is a program that is primarily used by the oldest and most vulnerable Medicare recipients and their families. Cutting home health is a foolish cost-control strategy, home health needs to be harnessed as a lower cost way to help vulnerable elders stay out of much more costly hospitals and nursing facilities.
The 2016 Presidential primaries are winding down, and the crucial national strategic issue of the growing population of people over age 85 hasn't yet received much attention. As we head to the general election and into the transition, I'm rooting for the next President to make this a priority. Issues facing the oldest Americans can also be thought of as important women's issues because most family caregivers, personal care workers, and older people are women. As a geriatric medicine doc and advocate for older Americans, here are some ideas I recommend our 2016 presidential candidates discuss on the campaign trail and try to achieve once in office:
1. Create a national strategy for long-term-care with clear measures of progress and timelines
2. Commission the 1st "Surgeon General's Report on Family Caregiving in America"
3. Strengthen the Medicare home health, home hospice, and home visiting physician programs by encouraging innovation, reducing paperwork burdens and adding flexibilities around the role of advanced practice nurses and "virtual" video home visits
4. Add measures of family caregiver well-being to Medicare "five star" rating systems for hospitals, insurers, and other providers
5. Trash Obama Administration proposals to add new co-payments for home health care that would disproportionately hurt Medicare's oldest and most vulnerable beneficiaries
6. Develop Medicare standards for making electronic medical record systems connect to one another to promote better safety, coordination of care, to reduce waste, and frustration
7. Focus Federal health education and health research funding on geriatrics and home and community based elder care
8. Develop public health education and outreach efforts on the topics of advance care planning and aging in place
9. Promote policies to encourage healthy older people to work as home health aides and personal care aides serving less fortunate older people who need help with the basics of life
10. Encourage grass roots community and faith-based initiatives to reduce loneliness, isolation, and neglect for the most vulnerable older people