Miniature house, calculator close-up

Successful aging requires a range of support services and housing options. But the system is rigged toward nursing homes, with many older adults spending their later years in those institutions because regulations, payment systems and outdated models of care make options difficult to provide.

That’s according to Stuart Butler, a senior fellow in economic studies at the Washington, D.C.-based Brookings Institution, who during a LeadingAge membership call on Thursday discussed a report from the Convergence Center for Policy Resolution that looks at revamping the caregiving model.

“Rethinking Care for Older Adults” brought together almost 50 experts on care for seniors last year to brainstorm on the practice, policy and business model changes thought to be needed to transform the system of care.

“We need to move towards a system of care for older adults in which the financing is adequate and efficient, but also as neutral as possible regarding people’s preferences,” the report reads.

Housing options

Finding better housing options for older adults — housing that falls between traditional single-family homes and institutional settings — along with providing a wide range of coordinated services is necessary to provide options for older adults based on their preferences, according to the report.

Attempts to move older adults out of nursing homes and assisted living communities and into affordable housing and other housing arrangements have encountered major regulatory and financial obstacles, according to the report. Outdated regulatory and financial systems result in a lack of incentives to make it easier for older adults to enter non-institutional settings, the authors said.

To tap into the opportunity for age-friendly housing, the authors suggested focusing more on customized, person-centered supports and services needed for aging rather than on medical care. In addition, government programs and departments need to collaborate, and payment systems need to be more flexible, they said.

The report noted that although assisted living is an increasingly important part of the institutional equation, it is a “somewhat chaotic sector” in terms of regulation, oversight and quality. The authors suggested developing plans to seek Medicaid waivers, overhaul regulation, and conduct cost-benefit analyses across programs to expand the variety of non-nursing home options for residents.

The goal, the report noted, should be creating a continuum of care model with residents in a variety of assisted living communities and other settings, including HUD Section 202 housing.

Careers in caring

Revamping compensation and training for the direct care workforce is another way to change the narrative on senior living, Butler said. Workers, he added, need to see caregiving as a career and not just a job. 

“Very few people go into caregiving thinking it’s going to be a career,” Butler said. “We’ve got to recognize the caregiving workforce is not just a group of unskilled people doing this for a few years. We’ve got to turn it into a career.”