Friday, October 24, 2008

Building an Aging Friendly Community

John Carney
Vice President for Aging and End of Life

October 24, 2008

The Center for Practical Bioethics recently hosted a community forum to present an update on the KC4 Aging in Community initiative. A PowerPoint presented that evening can be viewed by clicking here.

During the Q & A portion of the meeting a number of questions were raised. The first installment of these questions and answers are available with this; the remaining questions will be addressed in the October 31 edition.

Answers are provided by John Carney, the Center’s vice president for aging and end of life.

Please feel free to ask additional questions and share comments by clicking here.

Insurance companies have a requirement for community investment – how can we get them involved?

Blue Cross/Blue Shield of Kansas City has been participating in some local groups who meet regularly with our steering group members, but we’ve not really reached out to them or other local carriers.

This is a good reminder for us to get them at the table - especially as we look at the growing Medicare Advantage enrollees and our need to support healthy aging - walking and exercise programs.

Thanks for the nudge!

In Orange County, California, very inexpensive transportation (door to door if necessary – or corner) to hospitals, doctors, store, even friend’s house; why can’t we do that too?

The initiative is exploring a number of models that might be replicated in KC. For subsidized transit we have the added challenge of state lines and more than 100 jurisdictions to contend with.

Locally, Jewish Family Services identified volunteer programs, taxi and on-demand public transit within the KC region that provide curb-to-curb or door-to-door services.

Our challenge is to find ways to strengthen those programs so they can expand and meet the demand of the entire region. It will also be important for other assets to be developed that allow walking, slow moving vehicles, bikes and public transit to grow which will help keep demand for the more personal services to a sustainable level.

The local survey we conducted as part of this work group’s effort identified more than 45 different entities providing some form of transportation services in the area.

In today’s world, why did you choose “50” as minimum age? It should be much later, I feel.

It’s not so much designating a minimum age as it is identifying those in the latter half of life for whom these issues are of growing importance. We agree in principle that “50+” isn’t considered aged, but are seniors 55, 60, 62, or 70 years of age?

Consider these factors:

1) Ageism creeps in with terms like “elderly” and “seniors” and many older adults reject the designation of being “old” as demeaning or portraying them as dependent . Their objection affects our ability to engage them, though it points to our need for acceptable language to describe persons in a later stage of life.

We’re following the lead of national organizations that have adopted 50+ as a way of achieving uniformity in messaging.

2) Another issue is that as we grow older, persons are in myriad stages of health. We focus on those who are “needy” and “at risk” but also those with ability, strength, wisdom and resources.

While reducing discrimination we emphasize inclusiveness associated with the natural transitions that occur, for most of us, in the latter half of life – such as “empty nesting”, downsizing, increased caregiving roles (attendant to the aging process or chronic disease), and mobility and transportation limits (eyesight acuity and response reflex).

For the benefit of KC, it is important that persons 50 and older become familiar with the effort because we will be engaging them first. Building a safe future for a community that all ages can enjoy is part of building an aging friendly community. It is our legacy.

John, I know you had to hurry through your presentation, but there is a lot of interest in seniors (and others) having a “medical home.” This gives them a tremendous amount of comfort, that they know they will be both welcome and known by their primary care provider. Should this be a key part of any project for our aging?

Medical homes need to become a part healthcare fabric for persons of all ages, but most certainly for seniors who consume a disproportionate share of healthcare resources. The emerging Medical Home model has a long way to got before taking root, but a recent issue of the New England Journal of Medicine dedicated a number of articles proscribing what it will take to make this happen.

CMS (Medicare and Medicaid) Demonstration Projects are leading the way and it may be possible for us in Kansas City to piggyback on some of those efforts due to the American Academy of Family Physicians headquarters being here. Time will tell.

According to experts, one challenge facing the Medical Home model is the right mix of financial incentives that will encourage primary care physicians (or the few available geriatricians) to take on the role of coordination. Expanding the roles of other professionals and not defining Medical Home as the exclusive domain of a physician (medical) model but more of an interdisciplinary team will also help.

Palliative care expertise is growing in a number of professions and many seniors need help with self-managing their chronic diseases. But seniors and their caregivers have to better understand disease progression to improve decision making. Advanced Nurse Practitioners and Physician Assistants can assist in that effort.

Technology (and respectful remote monitoring) is becoming more affordable, so with the advent of electronic medical records we should see enhanced capacity for collecting, retrieving and analyzing medical data to help primary care physicians and their teams as well.

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