PANPHA gratefully acknowledges the following individuals and organizations for
their participation and contributions to the development of our North Star Vision:
Dr. Linda M. Rhodes PANPHA North Star Thought Leaders –
Director, The Hirtzel Institute our volunteer member advisory
on Health Education and committee – for their guidance and
Aging, and former PA support of the project.
Secretary of Aging –
our primary consultant in Patti Adami
the development of the Principal, Third Age, Inc. , Harrisburg, PA
North Star Vision Ronald Barth
President/CEO, PANPHA, Mechanicsburg, PA
The Hirtzel Institute on Health President/CEO, Riddle Village, Media, PA
Education and Aging, Mercyhurst
College, North East Pennsylvania – Tama Carey
our partner for data research and VP Operations, Senior Living Services,
survey development, interpretation Diakon Lutheran Social Ministries,
and application Allentown, PA
CEO/President, The Kendal Corporation,
Kennett Square, PA
CEO, Concordia Lutheran Ministries,
Frances Roebuck Kuhns –
PANPHA Board Chair
CEO, WRC Senior Services, Brookville, PA
an association of nonprofit senior services President & CEO, PHI, Camp Hill, PA
1100 Bent Creek Boulevard
Mechanicsburg, PA 17050 Paul Winkler
717.763.5724 • Fax: 717.763.1057 President & CEO, Presbyterian SeniorCare,
www.panpha.org • E-mail: firstname.lastname@example.org Oakmont, PA
PANPHA’S Envisioned Future of Senior Services for Pennsylvania
About the North Star Project 2
The Eight Points of the North Star 4
Facilitating Consumer Choices and Transitions 5
Personal Responsibility 5
New Senior Living Communities 6
Transformed Care Organizations 6
Technology Applications 7
Quality Improvement 7
Navigating Towards the North Star: Driving Forces and Trends 9
Medical Breakthroughs 10
Where People Call Home 11
Population Trends 12
Navigating Towards the North Star: Consumer Demand and Opinion 13
Where Do We Go from Here? 15
Sources and References for Further Reading 16
PANPHA’S Envisioned Future of Senior Services for Pennsylvania
About the Project
The North Star is the star that the earth’s axis points
toward in the Northern sky. For thousands of years,
explorers and travelers have used the star as a
navigational aid to chart the direction of their
travel. And over time, many cultures have created
fascinating folklore honoring the brightest star
in the night sky that seemingly stands still as a
steadfast beacon of light.
PANPHA members have created a principle in mind, PANPHA sought
vision of long term care and senior opinions among its members and
services that will serve as a guiding stakeholders as to how they envision
light among their organizations a preferred future of long term care
individually and for the association and aging services. To begin the
collectively. A vision guides process a group of Thought Leaders
an organization’s path towards among the association’s membership
achieving their preferred future by met with the Hirtzel Institute on
presenting a clear picture of what Health Education and Aging1 to
that future looks like so that all will review state and national studies,
recognize it once they’ve reached reports, trend data, public opinion
their destination. That clear picture surveys, and policy papers on the
is our North Star. future of long term care and senior
A compelling vision is embraced services.
by those who believe in it because it As a result of those meetings, the
resonates with their values, purpose Institute created and conducted an
and way of thinking. With this electronic survey of all PANPHA
The Hirtzel Institute on Health Education and Aging is based at Mercyhurst College,
North East Pennsylvania and is directed by former Secretary of Aging Dr. Linda M. Rhodes
www.hirtzelinstitute.org and author of Caregiving as your parents age (Penguin 2005).
members and statewide stakeholders to solicit What the North Star is not
their views on how they see a preferred future.
Projects can also be deﬁned by what they are
During the summer of 2006, a visioning
not: This is not a strategic plan with goals,
process was launched at the PANPHA annual
objectives, benchmarks and time tables. It is
convention by which members were given a
not about creating and identifying strategies
North Star Tool Kit consisting of a powerpoint,
to achieve an organization’s goal or mission.
e-survey and a discussion guide to facilitate
It can, however, shape an organization’s
a dialogue among their board members, staff
strategic planning process by offering a
and residents as to how they perceive the North
vision that strategies are directed towards.
Star picture of a preferred future of long term
The North Star vision is more robust and
care and senior services. PANPHA association
panoramic than a succinct vision statement
leaders also sponsored nine presentations and
that encapsulates an organization’s mission
feedback sessions across the state that drew
and purpose in just a few sentences.
members from eighty-seven PANPHA member
communities. The ten month process involved We do offer what we call “navigation
well over one thousand people through markers” throughout the eight components of
thought leader sessions, survey responses, the North Star Vision. These are examples of
key informant interviews, local board retreats how organizations can identify benchmarks
and meetings, staff sessions, resident council or “sign posts” that show how they are
meetings, PANPHA feedback sessions and advancing along the path towards their
convention attendees at the featured North Star preferred future.
presentation. The AAHSA Scenario Planning2 project that
In response to the wealth of good ideas provides perspectives on possible futures (best
yielded by this process, the picture of the case to worse case) and offers tools to help
preferred future of long term care and senior organizations succeed under any set of future
services came into clearer focus and was circumstances, can be used as an adjunct
reﬁned. Eight components of the future to our North Star project. Testing various
evolved in the areas of leadership, facilitating scenarios against our preferred vision will
choices and transitions among consumers, help local leaders think through the kinds of
personal responsibility, senior living strategies needed to stay the course towards
communities, transformed care organizations, the North Star.
technology, quality improvement and
government. These are presented as the
Eight Points of the North Star and, together,
they form the overall vision of PANPHA’s
preferred future of long term care and senior
services for Pennsylvania’s older citizenry in
the near and distant future.
Services for the Aging in America: Four Scenarios for the Next Decade, 2002-2012, American Association of
Homes and Services for the Aging, 2002.
PANPHA’S Envisioned Future of Senior Services for Pennsylvania
The Eight Points
of the North Star
PANPHA members were actively involved in an
invigorating dialogue throughout the state discussing
what they’d like to see as the preferred future of long
term care and senior services. Their major focus was upon
themselves – how they could position their organizations
to best meet the new challenges of aging. Two other major
partners were identiﬁed that inextricably affect their vision:
government and consumers. Among all three sectors, eight
core components emerged that make up the overall vision
of the North Star and are described below. Each is introduced
by the “PANPHA Perspective” - what we learned from PANPHA
members through survey responses and feedback sessions.
1. Leadership • Collaborating with government,
providers and advocates to
Members believe that providers need
advance the quality of life for
to take ownership of the long term
care issue by going on the offensive;
no longer waiting in the wings for • Providing the quality choice and
government or market forces to gold standard in the long term
cause change within the ﬁeld. care and senior services ﬁeld.
They are committed to becoming • Offering rewarding career
proactive leaders within their opportunities, living wages,
communities espousing a new and competitive beneﬁts and high
thriving vision of long term care and morale work environments.
senior services backed by a robust • Upholding corporate
plan to reach it. responsibility and accountability
The North Star is reached when in running organizations that
PANPHA members are: practice not for proﬁt values.
• Operating mission driven Sample Navigation Markers
organizations that are based • Consumers see the non-proﬁt
upon values of integrity, quality, advantage as the gold standard
innovation, solvency, and in the ﬁeld.
• PANPHA leaders prompt the state to Sample Navigation Markers
establish a Blue Ribbon Commission • Providers offer Life Plan Coaching,
charged to develop a blueprint for adequate Geriatric Care Management and
funding of senior services and collaborates collaborate with specialists for chronic
with it in crafting revenue solutions. care management on behalf of their
2. Facilitating Consumer Choices
• The social health model takes over the
and Transitions medical institutional model especially in
PANPHA members ﬁnd that most consumers long term care communities.
are unaware of the growing array of
services available to them that can foster 3. Personal Responsibility
an independent lifestyle at wherever they
A preferred vision of the future in long term
call home. When they do need care, they
care and senior services will require that
ﬁnd the health care system confusing and
consumers accept more responsibility towards
overwhelming as is the insurance system
maintaining their health. Heart disease,
that purports to pay for that care. Assisting
strokes, and diabetes - three leading chronic
consumers in making smart choices about
and debilitating conditions affecting the
their long term health care needs and
elderly - are directly linked to poor lifestyle
facilitating their transitions in lifestyle
choices. Due to the huge numbers of baby
and living arrangements is a new role that
boomers requiring care in their senior years
PANPHA members readily embrace. They
faced by a shrinking workforce to care for
want consumers to see them as a partner
them and the unsustainable demand it will
that helps them remain healthy and active,
place on Social Security and Medicare; it
navigates them through the health care maze
will become paramount that boomer’s are
and educates them on all of their options so
held accountable for both their physical and
they can make sound choices.
The North Star is reached when PANPHA
members are: The North Star is reached when
• Anticipating and responding to evolving
• Practicing healthy lifestyles to prevent and
needs of consumers.
reduce the effects of chronic disease.
• Navigating the government, insurance and
• Purchasing affordable, quality long term
healthcare maze on behalf of consumers.
care insurance in mass numbers.
• Integrating, connecting and bringing all
• Avoiding sheltering assets to receive
parts of the senior services and chronic
Medicaid funding for nursing home care.
care continuum to the consumer.
• Interpreting quality measures of care
• Educating consumers on their needs
communities to make informed, realistic
and the appropriate, feasible options to
and sound choices.
• Volunteering in response to meaningful
• Offering social health models of care in
opportunities provided by senior service
place of institutional medical models.
and long term care providers.
• Appreciating the value of the whole Sample Navigation Markers
continuum of care, including nursing homes. • Public resources such as banks, libraries and
• Embracing end of life care by accepting stores locate onto senior living campuses
palliative care over expensive, technology- creating small town connectivity.
driven life prolonging care. • Affordable housing is renovated to include
Sample Navigation Markers smart housing technologies.
• Baby boomers buy long term care insurance
in mass. 5. Transformed Care Organizations
• Lifestyle ﬁtness, brain ﬁtness and nutrition Members representing long term care
go mainstream. communities believe that high quality care
must skillfully apply medical and information
4. New Senior Living Communities technology in the practice of good patient care.
At the same time, communities that currently
“Where people call home” will continue to be the
favor a more medical model must transform their
mantra of the senior housing profession giving
communities and practice towards the principles
consumers a myriad of housing options and living
of person-directed care espoused by the “culture
arrangements as they age. Baby boomers will
change” movement. This will also require
be looking for a wide range of services that can
investing in staff to increase quality of care and
be brought to them no matter what their health
subsequently reduce staff turn-over rates. One of
condition and where they live. Senior living
the top ranked priorities among members during
communities will need to be ﬂexible, innovative
the next ﬁve years is completing a culture change
and accommodating to its customers as the
program at their community and offering new
deﬁnition of “community” continues to evolve.
services to replace unused nursing home beds.
One of the top three planning initiatives during
the next ﬁve years among PANHPA members is The North Star is reached when PANPHA
to offer service enhanced supportive housing.
The North Star is reached when PANPHA • Transforming nursing homes through culture
members are: change person-directed care models.
• Offering affordable housing with supportive • Investing heavily in staff education, skill
services including wellness and ﬁtness. training, and competencies.
• Building and/or renovating housing with • Creating career ladders for long term
smart technology fostering independence. care positions.
• Creating integrated communities that draw • Adopting telemedicine, telehealth, telemetrics,
the local community onto the senior living assistive devices and electronic health records
campus. at full scale.
• Providing living arrangements that match the • Integrating complementary alternative
individual’s wants and needs. medicine with conventional medicine.
• Connecting the parts of the long term care • Offering consumers easy-to-understand
continuum to wherever their consumer quality outcome measures of care based upon
calls “home.” a rigorous and valid self-monitoring system.
Sample Navigation Markers The North Star is reached when PANPHA
• Over half of all PANPHA member
organizations meet new CMS criteria of • Infusing Information Technology (IT)
undergoing culture change. into care plans, nursing care, and quality
• Providers offer deﬁnitive career ladders
and opportunities for people to advance. • Leading the ﬁeld in the use of Electronic
• Using telemetrics to ﬂag resident needs
before they are evident such as through
• Providing telehealth for all residents to
promote health and encourage preventive
• Engaging telemedicine to bring specialty
and diagnostic care to nursing home
• Offering assistive devices among all
settings to foster independence and
6. Technology Applications Sample Navigation Markers
Members heartily embrace the efﬁciencies • Most PANPHA providers use Electronic
and quality of life advantages delivered by Health Records and IT for care planning.
new technologies. They believe that if applied • Telemedicine is used among the majority
properly, it will assure quality of care for their of rural nursing homes.
No longer is technology seen as a distant 7. Quality Improvement
“Star Wars” like phenomenon as communities When members were asked to rank order
actively implement a wide range of the most important factors that will promote
information technology applications. Most quality by 2015 they cited four initiatives:
also believe that the use of electronic health the adaptation of information technology
records is vital to assuring quality of nursing to measure quality, providers adopting an
care. Members overwhelmingly believe that outcome based self-monitoring system to share
government can be a key player in growing with consumers, the utilization of meaningful
technologies in the ﬁeld of long term care by customer satisfaction surveys, and government
offering seed money and challenge grants to regulations becoming outcome based.
both develop and apply technology in long
The North Star is reached when PANPHA
term care and independent living settings. members are:
• Offering consumers an easy to understand
rating system on quality and outcomes.
• Conducting robust consumer satisfaction short-changing everyone. The members look
surveys and exit interviews with families. forward to a collaborative, pro-active relationship
• Executing a self-monitoring system based on with government that can shape the North Star
outcome measures for nursing home care. future for providers and consumer’s alike.
The North Star is reached when
• Operating formalized, meaningful Quality
Improvement programs that go beyond
minimum requirements. • Regulating based on outcome measures and
ﬂexibly accommodates culture change and
• Offering peer review by which high
performers mentor low performers.
• Preventing asset sheltering to protect the
Sample Navigation Markers
state’s safety net for the poor.
• A consumer friendly, self-monitoring rating
• Creating strong incentives to promote
system of nursing homes is launched.
affordable, quality long term care insurance
• PANPHA members operate a formal Quality products.
Improvement program such as AAHSA’s
• Investing in technology by offering grants,
“Quality First” program.
tax incentives and a regulatory environment
that promotes its use.
• Providing incentives and promoting career
opportunities and ladders in the ﬁeld of
geriatrics and long term care.
• Guaranteeing a safety net for the indigent and
fairly reimbursing providers for the true cost
• Planning beyond year-to-year time frames and
outside of a fragmented, silo, departmental
Sample Navigation Markers
• Legislation enacted that enables providers
to pay competitive wages of care workers
8. Government through reimbursement strategies.
PANPHA members earnestly want a future that • Regulators have gone through a type of
moves past its current adversarial, wait-and-see “culture change” redirecting surveying from
relationship with government. They believe that process focus to outcome-based measures.
the public and private sector in partnership with
consumer advocates must engage – together – the • Government surveying resources are allocated
huge impact that the Age Wave demographic to allow more intensive intervention in poor
will have on the ﬁnancing and provision of long performing providers and less obtrusiveness
term care and senior services in Pennsylvania. in high performing organizations.
Regulations that are steeped in “look-back, • Granting funds for renovating facilities and
gotcha” methodologies and philosophies are technology to meet new consumer demands.
PANPHA’S Envisioned Future of Senior Services for Pennsylvania
the North Star:
Driving Forces and Trends
PANPHA members will encounter hundreds of trends along the path
towards the North Star that will affect how and when they reach their
preferred future of long term care and senior services. Here are eight
abstracted mega trends to consider during strategic planning efforts:
✴ Technology: by technology matched by consumer
demand, even acute care offered
❝Technology will be in the hospital setting may be
infused into care giving, provided at home. Barriers of costs,
care planning, and inaccessible broadband in some
geographic areas, insurers’ non-
adult daily life.❞
acceptance, professional licensing
Assistive devices, robotics and laws and lack of a national policy
sensors become mainstream may impede progress.
fostering independence and
mobility; Electronic Health Records ✴ Financing:
scale-up; telemetrics are used to
ﬂag resident needs before they are ❝Breaking the bank
evident; Information Technology will give way to
is infused into care plans and universal long term care
caregiving, pharmacology, nursing insurance coverage.❞
care and quality assurance;
telemedicine is widely used bringing By 2015 total health spending will
specialty and diagnostic care to be nearly 20 percent of the Gross
nursing home residents, online Domestic Product. Government,
doctor visits via monitors at an insurers and employers will
individual’s home, telehealth is continue to look for less expensive
accessed by older people and their approaches to health care and will
families in all settings to promote shift more and more responsibility
health and preventive care. Boutique for cost and decision-making to
health care services become enabled consumers and providers. States
will aggressively reposition Medicaid spending ✴ Medical Breakthroughs:
from skilled nursing care to community-based
care while nursing homes are forced to care ❝Implants, genetics, nano-robots,
for residents with costly complex acuity needs. and the search for the aging gene
Enrollments in Medicare managed care plans will stretch life expectancy in
will more than double today’s rates at a projected
ways we only imagined.❞
thirty percent by 2014 and these plans will
control the Medicare and Medicaid dual eligibles. The federal government and private sector
Forced by the huge Baby Boomer demand on will continue to spend billions to ﬁnd cures for
skilled nursing and home health care, national diseases and to understand the relationship of
and/or state public long term care insurance genetics to health, disease and longevity. The next
programs requiring universal participation will decade will lay the groundwork for new medical
be seen as a viable alternative to the current technologies and pharmaceutical advances (e.g.
Medicaid welfare model or the weak private pay “designer drugs” designed speciﬁcally to address
market. Less than a quarter of elderly Americans an individual’s genetic code) based on knowledge
have sufﬁcient resources to pay for 2.5 years of from the Human Genome project. We will enter
intensive long term care services. The current, the new age of neurotechnology implanting
haphazard way that Americans ﬁnance long term sensors in the brain to help the paralyzed, stem-
care will simply be unsustainable. The divide cell breakthroughs will regenerate nerve function
between the have and have nots will widen with in spinal cord injury patients, new cancer drugs
health care costs and access issues wedging them may replace chemotherapy by ﬁguring out
apart. Other pressures posing threats to ﬁnancial how to shut down a particular cancer’s growth
viability of long term care are: privatization of cycle, nano-robots will enter our bodies helping
Social Security, erosion of retiree health beneﬁts, physician’s get a bird’s eye view of what’s wrong
sluggish wage growth, rising out-of-pocket health and thumb size chips will carry all of our genetic
care costs and growth of the population prior to and medical information. Yet, for many people in
Medicare age eligibility who are under-insured or their seventies and eighties today – a population
who have no health insurance. especially relevant for Pennsylvania – the big
medical breakthroughs will likely elude them.
❝Government needs its own
States aggressively seek Medicaid waivers to
transfer from and prevent admissions to nursing
homes in deference to home and community
based care while the federal government continues
to offer more ﬂexibility in caring for Medicaid
populations. Experts at the recent “LTC 100
Conference,” predict that by 2015 the number
of nursing home residents will decline by half
or more. Providers and advocates may form ✴ Lifestyle:
alliances to push states towards outcome
based performance measures rather than the ❝The big bang effect of good
current after-the-fact procedural and process nutrition radicalizes the
focused regulatory system. A likely slow American Way of Eating.❞
government response could invoke provider
groups to create their own outcome measures Aging Baby Boomers will demand more
and accreditation program for nursing homes products and services promoting wellness,
and assisted living to meet growing consumer as more scientiﬁc studies prove that healthy
demand to easily search, compare, assess and lifestyles nurturing physical and brain ﬁtness
choose quality facilities. along with good nutrition have powerful
effects on longevity and quality of life. Look
✴ Where people call home: for greater scrutiny of the food industry and
the American diet as the public connects
❝Everything will go how each contributes toward preventable
consumer directed.❞ chronic degenerative diseases. More people
will take control of their health and expect
Affordable housing that offers integrated to share in their treatment decision-making
supportive services including wellness and making way for “consumer-directed” health
ﬁtness programs will continue to attract care. Consumers will look to the World Wide
consumers. Assisted living will continue to Web as a resource for health information,
grow; however, it will become consolidated report cards on quality, comparison shopping,
by several large companies controlling research on diseases and treatment options,
most of the market. Builders and designers ordering prescriptions and much more.
will focus their attention on constructing People will also embrace alternative and
housing stock and senior living communities complementary health as they seek control
that attract baby boomers. New housing of their aging. As a result, conventional
will feature smart technology that fosters medicine will begin including alternative
independence and current housing will be health care practitioners on their team and in
renovated to stay competitive. Integrated their corridors. Retirement will be completely
communities will draw the “locals” onto the redeﬁned by Baby Boomers; many will work
senior living campus by locating banks, shops part-time, start new careers and embark
and other services that create a small town upon civic engagement projects giving back
feel. The quest for community will continue to their communities – locally and globally.
to infuse nursing homes through the culture Caregiving for aging relatives will involve
change movement affecting not only the one in four American adults most of whom
environment but how people are provided perform it without any outside help at about
care. Senior communities that connect all ten hours a week for four and a half years on
parts of the long term care continuum and average. The older the relative, the more time
bring it to their residents will thrive. Reverse and resources are spent.
mortgages will be more frequently used to
personally ﬁnance services and renovations to
enable people to remain at home.
✴ Population trends: ✴ Labor:
❝The 85-plus age group dominates ❝We’ll see a new labor crisis:
long term care and bursts the the retirement of administrators,
either nursing home or community nurses, physicians, and seasoned
based care bubble.❞ leaders in the long term care ﬁeld.❞
According to the 2000 census, the percentage of The shortage of professional and assistive health
Pennsylvanians over the age of sixty-ﬁve is the care workers will continue to worsen in the health
second highest of all states next to Florida. It is care and long term care ﬁeld as less numbers of
one of the grayest states in the country in terms younger workers are able to meet the demands of
of proportion and in sheer numbers clocking much larger aging populations. To make matters
in at 2.4 million people over sixty. But it is the worse, a new labor crisis is looming in the long
85-plus age group that will have the greatest term care ﬁeld – that of retiring administrators,
and most immediate impact on care providers: chief executive ofﬁcers, physicians, nurses and
Pennsylvania has the fourth highest proportion of other senior managers who will take with them
residents 85 years and older. It is also the fastest years of experience, leadership, knowledge,
growing age group increasing nearly 13 percent networks, relationships, organizational
between 2000 and 2004 while the rest of the memory and skills when they walk out of
population grew a mere 1 percent. By 2010, this the retirement door.
vintage age cohort will increase by 18 percent As a result, the Bureau of Labor Statistics
yielding 365,000 eighty-ﬁve-plus year olds. projects a shortfall of 10 million workers in the
This is the age group with the highest incidence United States by 2010. Flexible work schedules,
of Alzheimer’s and multiple chronic degenerative personalized beneﬁts, job sharing and retirees
diseases which will continue to heavily draw who work “on demand” or as consultants to their
upon the reserves of the entire health system. former employers will come in vogue. The search
The growing number of Hispanics and African- for direct care workers outside of the United
Americans seeking long term health care will States will continue.
underscore the need for culturally sensitive
Pennsylvania Percent of Total Population:
Working Age vs. Retirement Age
2000 2005 2010 2015 2020 2000 2010 2020 2030
Source: U.S. Census Bureau, Population Division,
Interim State Population Projections, 2005.
PANPHA’S Envisioned Future of Senior Services for Pennsylvania
the North Star:
Consumer Demand and Opinion
❝Baby Boomers will have to ‘get real’ about aging despite redeﬁning it.❞
Consumers play a vital role in realizing the North Star Vision as businesses,
government and the non-proﬁt sector all look towards developing
consumer-directed services. A review of recent national opinion surveys3
conducted by AARP, MetLife Mature Market Institute, Harris Interactive, The
Commonwealth Fund, Kaiser Foundation, National Public Radio and the
Kennedy School on how consumers 45-years plus view long term care
indicate the following major points for PANPHA members to consider:
✴ Most people do not have realistic optimistic views that they will
views regarding long term care sustain good health through their
along the whole continuum from old age and will have enough in
community-based care to skilled savings to pay for their care.
facility-based care. Nor are their ✴ Most Americans think our
assumptions about pricing, costs current three-pronged system
or sources to pay for that care consisting of the individual,
accurate. employers and government
✴ Most people’s attitudes toward should continue to help insure
long term care are inﬂuenced by health care and long term
their ability to pay: those with care. Many would reallocate
lower incomes report anxiety government budgets to make
about day-to-day expenses, these items a priority and are
inability to pay bills, access to willing to deduct a very small
care, quality of care, and no percent of their paycheck to
health insurance. Those with be dedicated to long term care
higher incomes express overly expenses.
Survey results denoting “most and many” mean at least 51 percent of survey respondents
indicated the view being described. For survey references see the resource section of this
✴ Most people do not have realistic views ✴ Most Pennsylvania retirees when they are told
regarding the likelihood of their future needs that the average cost of nursing home care is
for any type of long term care services, nor $65,000 a year, report that they can not afford
the kinds of lifestyle adjustments they must even one full year of care.
make as they age.
✴ Baby Boomers want more control, more
✴ Most people worry that they will not be choices and more “Consumer Report” type
able to afford needed medical care or health knowledge in making decisions about life
insurance in the future. Despite their anxiety long care and they’ll actively seek such
in not being able to afford it; they do not information online.
consider saving for long term care right now
✴ Baby Boomers will be less care-focused and
as a priority.
more service-focused wanting customized
✴ Most people share a distrust of insurance delivery of services and products along the
companies and big business including entire continuum of long term care with
the management of nursing homes. The technology-driven applications wherever they
perception of fraud in business and service consider home.
delivery is a factor in this distrust.
✴ Baby Boomers recognize they will eventually
✴ Most people think they will be able to remain need long term care but only one in three
in their homes by relying on family and believe they will likely need nursing home
friends to help them, yet they don’t plan on care and half of them mistakenly believe that
their children being the primary caregivers. Medicare will pay for it. One in three plan on
Nor have they discussed their preferences Medicaid paying for their nursing home care.
regarding long term care with their family
✴ Many people recognize the need to buy some
form of long term care insurance but they
report they are confused about the range of
beneﬁts and that the cost of the premiums are
✴ Many people believe that the population
needing long term care is growing and that
ﬁnancing such care will become a serious
problem for the nation.
✴ Most consumers report that they don’t know
where to go for advice or information if a
family member needs nursing home care but
they’d ask family, friends and their doctor for
PANPHA’S Envisioned Future of Senior Services for Pennsylvania
Where do here?
we go from
The PANPHA Board of Directors
reviewed and approved the North
Star Vision in the fall of 2006 after
considerable input and dialogue
among its members representing
boards of directors, staff, community
stakeholders and residents of
communities across the state.
PANPHA members are now
encouraged to use the components
of the eight points of the North Star
timetables on how soon they intend
to reach the North Star preferred
vision. Use the North Star Check
List, located on the back cover
of this publication, during your
strategic planning efforts to identify
what goals and objectives ﬂow
from the eight components of the
The PANPHA membership
and leadership also hope
to steer their strategic plans and that government leaders and
create their own navigation markers policy makers along with other
(benchmarks) to guide their path stakeholders in the aging ﬁeld will
towards our collective preferred embrace the spirit and content of the
future. During the process of North Star Vision. We trust it strikes
strategic planning, each organization a resonant chord among all sectors
will assess its resources, threats, in the ﬁeld offering a preferred
opportunities and strategies to enact future of long term care and senior
any or all of the eight points of services that respects the needs and
the North Star. PANPHA member wishes of those who deserve our
organizations will set their own best – our parents and grandparents.
Sources and References for Further Reading
Survey References for Consumer Kaiser Family Foundation, The Public’s View on Long Term
Care, Health Poll Report , June 2005.
Demand and Opinions Section:
MetLife Mature Markey Institute & Zogby International,
AARP, Perspectives Past, Present and Future: Traditional and MetLife Survey of American Attitudes towards Retirement:
Alternative Financial Practices of the 45-plus Community, What’s changed between 2001 and 2005? (October 2005).
(September- October 2004).
NPR/Kaiser Foundation/Kennedy School Health Poll,
AARP, The state of 50-plus America Americans Face Problems but Don’t Want Radical Change,
(April 2005). March – May 2002.
AARP, The Costs of Long Term Care: Public Perceptions
versus Reality, December 2001.
Suggestions for Further Reading4
AARP, Perceptions and Opinions of Long Term Care:
A Survey of AARP Members in Pennsylvania, April through A Road Map for Health Information Technology in
June 2003. Long Term Care (2005). For ongoing information about
the development of IT in Long Term Care go to the
Commonwealth Fund and Harris Interactive, Assessing American Health Information Management Association’s
Health Care Experts Views on Long Term Care, web site at www.AHIMA.org.
Perspectives Past, Present, and Future: Traditional
Commonwealth Fund, Will you still need me? and Alternative Financial Practices of the 45+
The Health and Financial Security of Older Americans, Community Findings from a Multicultural Survey of
November 2004. Americans 45 and older (Source AARP 2004).
Commonwealth Fund, Paying more for less: Older Adults in The Kaiser Poll Report: American Views of Long Term
the Individual Insurance Market, November 2004. Care (May/June 2005).
Greenwald & Associates for AARP, Americans 45-plus NPR/Kaiser/Kennedy School Poll on Health Care
Talk About Home and Community, May 2003. Americans Face Problems, But Don’t Want Radical
Change (June 5, 2002). A survey by NPR, the Kaiser
Family Foundation, and Harvard’s Kennedy School of
Government points to a signiﬁcant medical divide in
the United States along socio-economic lines. The vast
majority of people in the top income categories have
very few problems getting health care or paying for it.
An Update on Public Policy Changes Affecting Long-
Term Care. This paper examines the opportunities and
challenges remaining in the long-term care insurance
market 20 years since its debut. It explores the inﬂuence
of regulatory and legislative changes during that time,
as well as forthcoming proposals that ﬁnancial planners
need to be informed about to better serve their clients.
Kaiser Family Foundation: National Survey of the
Public’s Views About Medicaid. This national survey
of the public reveals that Americans view the Medicaid
program positively and are reluctant to see state and
federal cuts to the program. The survey also asked the
public about their knowledge of the Medicaid program.
The MetLife Retirement Decisions Study: The Silent
Generation Speaks (2005).
Go to www.panpha.org/northstar and click onto the Resources navigation bar to hyperlink all of the reports cited.
Kaiser Foundation: Comparing Projected Growth The Commonwealth Fund Survey of Older Adults.
in Health Care Expenditures and the Economy The Commonwealth Fund Survey of Older Adults,
Smart Home Technology for Aging in Place conducted from September to November of
Longer and Better. 21st Annual Summer Series on 2004, presents new information on the health and
Aging Sanders-Brown Center on Aging University of ﬁnancial security of adults ages 50 to 70. On average,
Kentucky June 16, 2004 (82 Powerpoint slides). older adults have high rates of chronic disease and
high out-of-pocket medical spending. Rising out-
Best Practices in Coordinated Care
of-pocket health costs, sluggish wage growth, and
(Mathematica for HCFA, 2000). This study offers a
erosion of retiree health beneﬁts threatens older
best practice model to coordinate the care of the
adults’ ability to save for retirement. The survey ﬁnds
chronically ill to enhance the quality of their life and
widespread support among older adults for policies
that would help them save for their future health
2004 Perspectives Past, Present, Future: and long-term care costs not covered by Medicare.
Traditional and Alternative Financial Practices of It also ﬁnds broad support for policies that would
the 45+ Community Research Report (May 2005). allow them to buy into Medicare before age 65.
Spending, saving and borrowing patterns of age 45+
The Picker Institute: Patient-Centered Scenarios
consumers – with an emphasis on past and future
for 2015 (June 2004).
ﬁnancial activities including purchasing homes,
saving for retirement, and paying medical bills – are Progress and Possibilities: State of Technology
explored in this multicultural AARP telephone survey and Aging Services 2003. The Center for Aging
of 2,609 midlife and older individuals. Services Technology (AAHSA).
The State of 50+ America 2005/Research Report
AARP’s second annual survey of the quality of life
of Americans age 50 and older ﬁnds that the 50+
population has lower income today than they
had in the late 1990s, are more dependent on
Social Security today than a decade ago, and are
concerned about their ability to afford health costs
in light of stagnant incomes. (53 pages) (Publication
These Four Walls... Americans 45+ Talk About
Home and Community/ Research Report
Most midlife and older people say they want to
stay in their own homes as they grow older. In
this national study, over 2,000 age 45+ Americans
were asked what home features, community
characteristics, and community services they
think they will need to age in place – and their
expectations of being able to do so. (116 pages)
The Costs of Long-Term Care: Public Perceptions
Versus Reality/Research Report
Americans age 45 and older may not know as much
as they think about long-term care (LTC), what
it costs and how to pay for it. In this AARP study,
researchers compared what people think they know
with currently available data about LTC costs and
funding sources. (127 pages)
NORTH STAR VISION CHECKLIST:
HOW DOES OUR STRATEGIC PLAN PROMOTE
THE COMPONENTS OF OUR PREFERRED VISION?
Leadership: New Senior Living Communities: Technology Applications:
■ Operating mission driven organizations ■ Offering affordable housing with ■ Infusing Information Technology (IT)
that are based upon values of integrity, supportive services including wellness into care plans, nursing care, and
quality, innovation, solvency, and and ﬁtness. quality assurance.
person-centered care. ■ Building and/or renovating housing ■ Leading the ﬁeld in the use of
■ Collaborating with government, with smart technology fostering Electronic Health Records.
providers and advocates to advance independence. ■ Using telemetrics to ﬂag resident
the quality of life for their residents. ■ Creating integrated communities that needs before they are evident such as
■ Providing the quality choice and gold draw the local community onto the through smart sensors.
standard in the long term care and senior living campus. ■ Providing telehealth for all residents
senior services ﬁeld. ■ Providing living arrangements that to promote health and encourage
■ Offering rewarding career match the individual’s wants and preventive care.
opportunities, living wages, needs. ■ Engaging telemedicine to bring
competitive beneﬁts and high morale ■ Connecting the parts of the long term specialty and diagnostic care to
work environments. care continuum to wherever their nursing home residents.
■ Upholding corporate responsibility and consumer calls “home.” ■ Offering assistive devices among all
accountability in running organizations settings to foster independence and
that practice not for proﬁt values. Transformed Care Organizations: well-being.
■ Transforming nursing homes through
Facilitating Consumer Choices and culture change person-directed care Quality Improvement:
Transitions: models. ■ Offering consumers an easy to
■ Anticipating and responding to ■ Investing heavily in staff education, understand rating system on quality
evolving needs of consumers. skill training, and competencies. and outcomes.
■ Navigating the government, insurance ■ Creating career ladders for long term ■ Conducting robust consumer
and healthcare maze on behalf of care positions. satisfaction surveys and exit interviews
consumers. ■ Adopting telemedicine, telehealth, with families.
■ Integrating, connecting and bringing telemetrics, assistive devices and ■ Executing a self-monitoring system
all parts of the senior services and electronic health records at full scale. based on outcome measures for
chronic care continuum to the ■ Integrating complementary alternative nursing home care.
consumer. medicine with conventional medicine. ■ Operating formalized, meaningful
■ Educating consumers on their needs ■ Offering consumers easy-to-understand Quality Improvement programs that go
and the appropriate, feasible options to quality outcome measures of care beyond minimum requirements.
meet them. based upon a rigorous and valid self- ■ Offering peer review by which high
■ Offering social health models of care in monitoring system. performers mentor low performers.
place of institutional medical models.
HOW ARE WE HELPING GOVERNMENT AND
CONSUMERS REACH THE NORTH STAR?
Government: ■ Guaranteeing a safety net for the ■ Interpreting quality measures of care
indigent and fairly reimbursing facilities to make informed, realistic and
■ Regulating based on outcome
providers for the true cost of care. sound choices.
measures and ﬂexibly accommodates
■ Planning beyond year-to-year time ■ Volunteering in response to
culture change and innovation.
frames and outside of a fragmented, meaningful opportunities provided
■ Preventing asset sheltering to protect
silo, departmental approach. by senior service and long term care
the state’s safety net for the poor.
■ Creating strong incentives to promote
Personal Responsibility: ■ Appreciating the value of the whole
affordable, quality long term care
■ Practicing healthy lifestyles to prevent continuum of care, including nursing
■ Investing in technology by offering and reduce the effects of chronic
disease. ■ Embracing end of life care by accepting
grants, tax incentives and a regulatory
■ Purchasing affordable, quality long palliative care over expensive,
environment that promotes its use.
technology-driven life prolonging care.
■ Providing incentives and promoting term care insurance in mass numbers.
career opportunities and ladders in the ■ Avoiding sheltering assets to receive
ﬁeld of geriatrics and long term care. Medicaid funding for nursing home care.