T H E P I T T S B U R G H F O U N D AT I O N 1 2 F O R U M THE FRAYING SAFETY NET AND THE SAVINGS SHORTFALL Long marked for having one of the oldest populations in the country, southwestern Pennsylvania has already confronted the challenges of providing care and support to the elderly. But the price of longevity is inexorably rising, for both individuals and health care payers. Medicareexpendituresnearlydoubledfrom2006levels to$675billionin2016.Despitepoliciesthathaveshiftedcosts awayfromexpensiveinpatientstaystooutpatientsolutions,the trajectoryisgrim:By2047,SocialSecurityandthemajorfederal healthcareprograms,principallyMedicareandMedicaid,willcon- sumetwo-thirdsofallfederalspending,upfrom54percentnow. Consequently,congressionalleadershavetargetedtheprograms aspartofloomingentitlementreforms. Whilesuchcutswouldbedevastatingtomany,theyaren’t theonlythreats.Medicaredoesnotcovernursinghomecare exceptforlimitedstaysafterahospitaladmission,anddoesn’tpay formostin-homecare.Medicaidisrestrictedtocoveringonlythe indigent,socoupleswithmorethan$3,000inassetsaregenerally ineligible.Thatleavesmanyfamiliesfacinghugeout-of-pocket costs.Increasingly,it’spayingforlong-termcarethat’smorelikely tobankruptthemiddleclass. Americans’ savings haven’t caught up with their life spans. Half of us have no retirement savings, while the rest of us average only $100,000. Although nearly 70 percent of people age 65 and older will eventually need some type of long-term care, few families can afford the estimated $100,000 bill for a year in a nursing home. For most people, long-term care insurance policies are prohibitively expensive. That leaves families frantically searching for free and low-cost aid. Whenanagingspouseorparentneedscare,theburdenusually falls on the closest family member. Even if a caregiver can juggle those responsibilities with a paid job, the personal toll is high. In 2016,forexample,thosewhotookcareoflovedoneswithdemen- tiaprovidedanestimated18.2billionhoursofunpaidassistance. ▪ Caregiving: Not forgotten in the push to keep seniors at home is the critical role of the care- giver. FamilyLinks’ Caregivers First Initiative, which received $75,000 from the Foundation, is a free service that helps caregivers manage stress and learn strategies to cope and care for themselves. The program has already aided 143 caregivers and has been honored nationally. Following individual caregiver assessments for depression, burden and self-care, each caregiver receives a series of in-home therapy sessions and case management services to coordinate care. A second screening and assessment is conducted within six months. The program also includes follow-up phone calls, and options for support groups as well as connections to transportation and respite. High Tech, High Touch: While technology has been applied to revolutionize health care deliv- ery, it has been slow to engage older patients. The Foundation’s $75,000 grant to Presbyterian SeniorCare Network regional locations supports in2L, (It’s Never Too Late), a picture-based, touch- screen interface that allows users to simply “touch” their way to educational, spiritual and personalized content. Technology is available for elders with a wide range of physical and cognitive abilities. Even those who have never used a computer are now enjoying technology, with systems adapted especially for them: using email and web cams to connect with family and friends, enjoying mind-stimulating activities, or improving hand-eye coordination as part of a rehabilitation program. Coordinating Social and Health Services: Comprehensive Care Connections (C3) is now coordinating the transition for the state’s Agencies on Aging to a new managed care model. The new program customizes services for clients, who choose the providers to help them stay in their homes, or to return home with support after a stint in a hospital, nursing home or rehab. “The promise for this approach is coordina- tion of social services with health care services. Historically, the two are siloed,” explains Executive Director Paul Cantrell. “This aligns everybody and should help participants.” A $75,000 grant from the Foundation will ease the transition. C3 contracts with a wide variety of health system payers, and ensures that all providers meet best-practice standards. Sophisticated data collection underpins quality assurance; system users can measure progress toward systemwide goals, such as a reduction in hospital readmissions within 30 days. “We’re working to collect and analyze data with researchers,” Cantrell says. “We’re also looking for clues as to who may need social services because of a health event, like an ER visit or a fall. It’s a broad system, and it can be hard for one person to see it all. But the flip side of that is the advantage of having everyone, social and health sides, in the same system, and the ability to use data analytics.” By Christine H. O’Toole | freelance journalist based in Pittsburgh Corrections published Apr. 4, 2018: Presbyterian SeniorCare Network's name was listed incorrectly and Deborah Winn-Horvitz's last name was misspelled in the original story.