Midsection of elderly woman holding hand of nurse. Caregiver is supporting senior female. They are at home during coronavirus lockdown.
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Assisted living communities and other congregate care settings are “vital” and should be more fully integrated into surrounding communities through short-term respite care, adult day services, and mental health and cognitive care resources, recommends a new report released Wednesday by the Convergence Center for Policy Resolution.

The report, titled “Improving Care for Older Adults: Convergence Dialogue on Reimaging Care for Older Adults Final Report,” aims to provide actionable solutions to improve the nation’s systems of care. The recommendations, according to the authors, reflect the unique needs and realities of aging adults today and in the future.

“Everyone deserves to age with security and dignity, but our current systems of care are woefully inadequate to meet the contemporary realities of this stage of life,” Convergence CEO David Eisner said. “With these recommendations, leaders have created an actionable path toward realizing a system of care that works for older adults in America.”

When it comes to care settings, according to the report, a “constellation” should be created, with adaptable business models to provide options, including home- and community-based services.

Specific to assisted living, the report suggests:

  • The US Department of Housing and Urban Development should encourage the use of project-based vouchers to support partnerships with long-term care providers to enable more efficient use of Medicaid assisted living waiver funds.
  • Assisted living communities and nursing homes should be integrated more effectively into the local community to reduce the isolation felt by many residents and give older adults in the greater community more access to resident services in congregate residential buildings.
  • The Department of Health and Human Services should survey existing examples and the potential for services that assisted living communities and nursing homes could provide to their local communities, either directly or in partnership with community institutions such as federally qualified health centers, volunteer villages and Programs of All-Inclusive Care for the Elderly.
  • The home- and community-based settings rule should be reviewed in the context of integrating community and institutional services to determine whether barriers still exist for assisted living communities and nursing homes to provide co-located HCBS in their communities.
  • The federal government and states should devise standards that would enable care workers to be licensed to work across different care settings, which also would encourage greater integration of assisted living communities and nursing homes into the greater community.

In addition to recommendations related to care settings, other recommendations from the suggest improvements related to:

  • Caregivers: Ensure enough qualified direct and family caregivers, including increasing wages, standardizing training and licensing, educating the public about the caregiving workforce, expanding apprenticeship opportunities, and elevating the caregiver profession.
  • Funding: Adequately fund the system of care. Options include a transparent payment system, public and private funding, and financial protections for older adults through insurance products that cover long-term care costs.

“The recommendations in this report are not only a concrete blueprint for improving the lives of older adults; they are also the result of true collaboration among people who came to this process with very divergent interests and indicate which reform ideas can attract wide support,” said Brookings Institution Senior Fellow Stuart M. Butler, one of the participants in the project.

Convergence served as a neutral third party for the project, which brought together almost 50 long-term care experts in October 2020 to brainstorm in a series of meetings on the topic of rethinking care for older adults. Those conversations framed the challenges and opportunities to improve the care of older adults by creating a long-term services and supports system that enables them to live with dignity and choice.

Thirty stakeholders from the fields of aging care and services, along with policy experts, met in the summer of 2021 to explore issues in caregiving and identify concrete steps in the area of policy and practice actions. The goal was to trigger immediate change and reframe the public discussion of longer-term reform.

Among the participants were the American Health Care Association / National Center for Assisted Living, LeadingAge and the LeadingAge LTSS Center @UMass Boston, and Nexus Insights.

The Convergence Dialogue on Reimagining Care for Older Adults is supported by the John A. Hartford foundation and the SCAN Foundation.