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					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
                                                       Robert Bertolette
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
                                                       John Diffey
                                                       CEO/President, The Kendal Corporation,
                                                       Kennett Square, PA
                                                       Keith Frndak
                                                       CEO, Concordia Lutheran Ministries,
                                                       Cabot, PA
                                                       Frances Roebuck Kuhns –
                                                       PANPHA Board Chair
                                                       CEO, WRC Senior Services, Brookville, PA
                                                       Stephen Proctor
         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: info@panpha.org             Oakmont, PA
                PANPHA’S Envisioned Future of Senior Services for Pennsylvania




Table of
  Contents:
About the North Star Project                                                     2
The Eight Points of the North Star                                               4
      Leadership                                                                 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
      Government                                                                 8
Navigating Towards the North Star: Driving Forces and Trends                     9
     Technology                                                                   9
     Financing                                                                    9
     Medical Breakthroughs                                                       10
     Regulating                                                                  10
     Where People Call Home                                                      11
     Lifestyle                                                                   11
     Population Trends                                                           12
     Labor                                                                       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                                                                                1
       PANPHA’S Envisioned Future of Senior Services for Pennsylvania




    About the Project
      North Star
                                       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.




       P
           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


           1
            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).


2
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.




2
 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                                                                                                       3
        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.




        L
            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
                                                          their residents.
            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.
                person-centered care.


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•   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
                                                      residents.
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.
                                                  financial health.
The North Star is reached when PANPHA
members are:                                      The North Star is reached when
                                                  consumers are:
•   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.
    meet them.
                                                  •   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.


PANPHA                                                                                               5
    •   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
                                                       members are:
    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.



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Sample Navigation Markers                            The North Star is reached when PANPHA
                                                     members are:
•   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
                                                         assurance.
•   Providers offer definitive career ladders
    and opportunities for people to advance.         •   Leading the field in the use of Electronic
                                                         Health Records.
                                                     •   Using telemetrics to flag resident needs
                                                         before they are evident such as through
                                                         smart sensors.
                                                     •   Providing telehealth for all residents to
                                                         promote health and encourage preventive
                                                         care.
                                                     •   Engaging telemedicine to bring specialty
                                                         and diagnostic care to nursing home
                                                         residents.
                                                     •   Offering assistive devices among all
                                                         settings to foster independence and
                                                         well-being.

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.
residents.
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.


PANPHA                                                                                                7
    •   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
                                                        government is:
        Improvement programs that go beyond
        minimum requirements.                           •   Regulating based on outcome measures and
                                                            flexibly accommodates culture change and
    •   Offering peer review by which high
                                                            innovation.
        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
                                                            of care.
                                                        •   Planning beyond year-to-year time frames and
                                                            outside of a fragmented, silo, departmental
                                                            approach.
                                                        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.


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         PANPHA’S Envisioned Future of Senior Services for Pennsylvania




Navigating towards
  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:




         T
         ✴ 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


PANPHA                                                                                     9
     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.

                                                           ✴ Regulating:
                                                                       ❝Government needs its own
                                                                               culture change.❞
                                                           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


10
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.


PANPHA                                                                                              11
     ✴ 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
     service delivery.

                                                                               Pennsylvania Percent of Total Population:
                                                                                   Working Age vs. Retirement Age
      400,000                                                   80%
      350,000                                                                                                                18-64
                                                                                                                             65+
      300,000                                                   60%
      250,000

      200,000                                                   40%
      150,000

      100,000                                                   20%
       50,000

           0                                                     0%
                 2000      2005      2010      2015      2020           2000             2010           2020               2030
            Source: U.S. Census Bureau, Population Division,
              Interim State Population Projections, 2005.


12
             PANPHA’S Envisioned Future of Senior Services for Pennsylvania




Navigating towards
  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:




          M
              ✴   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.


              3
                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
              report.


PANPHA                                                                                                     13
     ✴   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
         members.
     ✴   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
         too high.
     ✴   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
         advice.




14
         PANPHA’S Envisioned Future of Senior Services for Pennsylvania




Where do here?
  we go from




         T
         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
                                                    North Star.
                                                    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.

PANPHA                                                                                       15
     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.
     December 2005.
                                                                         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).



     4
         Go to www.panpha.org/northstar and click onto the Resources navigation bar to hyperlink all of the reports cited.


16
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
reduce hospitalizations.
                                                           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
(April 2005).
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
ID: D18211)
These Four Walls... Americans 45+ Talk About
Home and Community/ Research Report
(May 2003).
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
(December 2001).
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)




PANPHA
  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.
                                                                                            providers.
■ 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
  insurance products.
                                                                                            homes.
■ 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.

				
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