Meet Dot, a 78-year-old recently diagnosed with dementia. Dot lives at home with her husband, Vincent, in St. Charles, MO. Their son lives nearby, but isn’t always available, due to his hectic work schedule. The family currently serves as Dot’s informal care team, supplementing the small bit of formal care Dot is receiving. Due to workforce shortages, they’ve had trouble finding adequate in-home support as Dot’s dementia progresses. Dot’s family wants to keep her at home “as long as we possibly can,” but Vincent is demonstrating signs of caregiver burnout.
Unfortunately, this scenario is very common.
For years, experts warned about workforce shortages that would result from a growing number of aging Americans. Add in a global pandemic and now, more than ever before, there is a severe need for caregivers, nurses, occupational therapists and other healthcare professionals, specifically for elder care.
In every market across the country, the pandemic exacerbated problems that already existed within long-term care (LTC). Whether in-home or facility-based, urban or rural, long-term care faces increased demand for services, as well as rising costs for care. Families, the largest payers of LTC, now find themselves in the unenviable position of trying to navigate the complexities of long-term care while cobbling together suboptimal support from overwhelmed family members.
But it doesn’t have to be this way.
If industry insurance carriers begin to harness more approaches that combine traditional and supplemental home care services, as well as newer tech, aging in America can change forever. For the better.
Caregivers are not the only answer for aging at home
Studies show an overwhelming number of older adults want to age independently at home. Most believe that to age in place, they’ll only need a caregiver to help out from time to time, but this is simply not the case, more often than not. In actuality, aging in place requires a variety of community-based services that must be brought into the home to ensure the needs of older adults are met.
Insurance often will cover these services; however, for those with long-term care policies or those enrolled in a public or Federal program like Medicaid or Medicare, navigating policy details can be complex. Many older adults lack a complete understanding of the services and benefits that may be available to them. Consequently, it’s very common to see a misuse or underutilization of these benefits.
Continuing the example from above, Dot has a long-term care insurance policy through her former employer and recently enrolled in a Medicare Advantage plan. But instead of utilizing her MA plan to support her with daily tasks like grocery shopping, errand running and light housekeeping, Dot relies heavily on the caregiver she hired as part of her LTC policy and is steadily increasing their hours. By doing this, Dot diminishes the lifetime value of the long-term care support she will receive.
The power of many
Recently, Medicare has focused on options that provide more flexibility and control for policyholders in and around the home, and the long-term care industry is following Medicare’s lead. But the question remains: How should these services be administered? It’s clear that in order to respond to the growing and changing needs of older adults, all insurers must evolve and rely more heavily on new innovations.
For example, by accessing a digital aging-in-place network, insurers can provide their members with a diverse range of in-home services, making it easier to monitor service delivery and improve quality. In addition, service providers who weave technology and data into their offering will allow insurers to better anticipate future care needs and respond accordingly.
This “power of many,” or a network of both technological and human-based resources, serves as an ecosystem within long-term care, providing facilities, agencies, and carriers with the right mix of solutions that are more aligned to their goal of quality care.
Making use of technology innovation
Realistically speaking, the long-term care industry is behind in terms of technology innovation. Most of the information payers currently receive from the home either comes through claims, which provides only a sliver of insight into the bigger picture, or remains siloed in the different encounter documentation systems deployed by each service provider — none of which talk to each other.
The result is that long-term care agencies, facilities and insurers are wasting significant time and money dealing with administrative inefficiencies. Instead of investing in precise, agile platform technology that streamlines their work and significantly improves the lives of older adults, they are either 1) dependent on manual processes that have been in place for too long, or 2) hesitant because they think a new integration will totally restructure their systems.
In the care industry, time is money. So these inefficiencies compound over time to create greater cost burdens, which prevents insurers from investing into more staff or new infrastructure. At a time when costs are rising and agencies are calling for more oversight — all when demand is growing — this is a recipe for disaster.
The bottom line
By using technology innovation and the “power of many” to better manage services and caregivers into the home, insurers can control costs, gain greater access to data, and ensure better health outcomes for their policyholders. But even more important, this will help reduce the unnecessary pressure on caregivers, and empower older adults to age with dignity and independence.
Char Hu, PhD, is the co-founder and CEO of The Helper Bees, an in-home care platform allowing older adults to age in place and live comfortably. The Helper Bees solves for the complexities of providing in-home care, connecting the dots between insurance plans, non-medical care providers and caregivers so that older Americans can age in place and maintain their independence. The Helper Bees works with 12 of the top 20 long-term care insurers and three of the top 6 Medicare Advantage plans, as well as more than 20,000 providers that offer services ranging from meal delivery to pest control to home repair.