Robert Kramer headshot
Robert G. Kramer

The creation of central doorways to existing long-term care services — including senior living, nursing home care, home-based care, transportation and meal services — is critical to supporting older adults and their families during decision-making and an “enormous opportunity” for senior living providers.

That’s according to a report published Thursday by Nexus Insights titled “Where Am I, Where Do I Go: The Missing Entry Point to Long-Term Care Solutions for Older Adults and Their Caregivers.” The report — the first to be issued by Nexus Insights since it was founded in 2020 by National Investment Center for Seniors Housing & Care co-founder Bob Kramer — calls for navigational hubs to help families better understand their long-term care needs and select the best options. The need for a solution is heightened, the report authors said, given changing demographics, longer life expectancies and a shifting political landscape.

“Older adults and their families enter a maze of twists and turns, dead ends and wrong way streets when a life crisis forces them to consider their care options,” Kramer said. “In many cases, critical decisions about long-term care must be made quickly, with scarce information or resources, let alone supportive guidance to assist them in their time of crisis.”

A daily crisis

Kramer told McKnight’s Senior Living that although there is a need to focus on rethinking and restructuring the long-term services and supports system, older adults and their families are in a daily crisis.

“People don’t know where to enter the system, they don’t know what they really need, they don’t know who pays for what,” he said. “The bottom line for senior living is that care coordination is going to be one of the keys for the future.”

Having the right care in the right place at the right time, Kramer said, is an “enormous opportunity” for senior living.

Navigation hubs

Navigation hubs, the report’s authors said, can help provide information and guidance about various long-term care settings, supports and services. The model would provide navigators  to help consumers identify and assess options, educate families and older adults on the full-range of services and associated costs, select and connect them with the best options based on preferences, and reevaluate needs as their health status and finances changed.

ATI Advisory CEO Anne Tumlinson, who brought the topic to the group, said that navigational hubs would fill a critical market gap in senior living.

“The gap being the absence of a trusted, impartial traffic cop that can bridge the educational and placement gap between consumers and senior living services,” Tumlinson told McKnight’s Senior Living. “This report is significant as the first to flag this as a systemic gap, to argue for a solution at scale, and to outline the key components of this solution. It should go a long way towards moving the ball down the road to partner public and private dollars to build what is needed for senior care and services.”

The report also states that the navigation hubs should be accessible, provide consistent services nationwide, focus locally on each community’s programs and providers, offer unbiased advice and guide users from start to finish.

“Older adults, their families and caregivers cannot wait for lawmakers and government agencies to build the comprehensive long-term care system we so desperately need,” NORC at the University of Chicago Senior Vice President of Health Care Strategy Caroline Pearson, a report contributor, said in a statement. “The reality is that long-term care services in this country are a patchwork of providers and funders, and we must act to give families accessible, trusted and neutral advice to help them navigate through the morass.”

Next steps

The report authors acknowledged that funding will be a barrier to establishing the navigation hubs they recommend. But Kramer said this is an opportunity for stakeholders to take the best from each of the existing public, private-pay and employer-based models and combine their infrastructure, experience and delivery to create a value-based, critical resource. 

“What we’re trying to do in this is bring attention to an issue that everyone recognizes but has not gotten attention,” he said. “We have this huge issue of access because of no one knowing where to turn.”

Kramer said that Nexus Insights is sharing the report with policymakers, providers and public entities with the hope that studies will further develop the navigation hub concept and develop measurable criteria.

The report is based on discussions earlier this year among long-term care providers, caregiver advocates, technology startups and policy experts on the complex and fragmented array of LTSS. Participants included representatives from the SCAN Foundation, LeadingAge, The Kendal Corp. and other representatives from the aging services and long-term care fields. Host committee members included Harvard Medical School professor David Grabowski, PhD, Kramer, Pearson, Tumlinson and Delight by Design/MezTal CEO Sarah Thomas.