For the past few weeks I have been using ChangingAging to ask some pretty basic questions inspired by the theme #DisruptAging. Perhaps the most important of these is: “If Americans want universal access to services for elders that provide higher quality, greater dignity and more choice– why haven’t they appeared?”
In Part One of this series I discussed my frustration with my twenty years of asking (as nicely as I knew how) for the Long Term Care industry to reform itself by embracing person-centered models of care. In Part Two I presented “Tiger,” the aggressive, pro-active approach to change that I will be using to guide my work going forward.
In this third installment I am going to describe the contours of a post-nursing home world and how we can get there.
The Tiger strategy defines two barriers that are currently preventing the much needed and long overdue disruption of the long-term care industry.
Let’s start with the people we are serving. Almost all of the elders and families first engage with the long-term care system shell-shocked, overwhelmed and knowing very little about the breadth of options that are available to them or the rights they possess.
We can say whatever we like about the power of the free market to create quality and choice but people who feel helpless and alone in such a way are incapable of exerting effective pressure on incumbent long-term care providers.
This “market failure” explains why archaic models of care continue to dominate the field even though innovators have developed a range of person-centered, evidence-based alternatives to conventional practice. The spread of innovative models has been and is being stifled by local monopolies of providers who are protected by Certificates of Need. They face limited local competition and enjoy an ever-growing demand from our aging population. Most disturbingly, they are actively co-opting the rhetoric of person-centered culture change… but not the practice.
Creating the change we all need and want will require us to pull two levers simultaneously.
1) Activate, engage, educate, organize and support elders and their families– at the local level. We can initiate a new era of local, community-oriented engagement that is based on the millennia-old idea of the “Friendly Society.” This type of community-based mutual-support organization has long been relied upon by people around the world when confronted by the twin plagues of powerlessness and social isolation. Friendly societies played a key role strengthening communities during the upheaval of the industrial revolution. AARP originated in the mold of a friendly society for retired teachers. Today, the Village to Village Network is creating hundreds of community-based friendly societies nationwide. Tiger can help us to create a new generation of Friendly Societies that are dedicated to increasing the ability of people to understand, navigate and advocate for change within the constellation of aging services being provided in their communities.
2) Create healthy competition in local markets so that incumbent providers are compelled to compete with evidence-based, person-centered, 21st-Century models of care. The local monopolies that dominate long-term care need a good stiff dose of Healthy Competition. Fortunately, it is in our power to foster this kind of competition because we understand and can replicate 21st Century models of care. We can create alliances that advocate for, facilitate the creation of and help to capitalize new models of care in underserved communities.
I am willing to put my trust in well-informed consumers choosing among high quality options in a free and open marketplace. How about you?
Let me know if you’d like to be part of the conversation – I’m heading on the road starting in April to visit 30 cities by the end of the year and I hope to see many of you along the way.