I was struck by the statement by a guest on the Today Show recently that more than 44 million Americans over 18 years of age are caring for another adult.  And they are doing so without pay. According to AARP 10 million of these cared-for adults are unable to perform activities of daily living, and 30 million plus have seriously reduced activity levels. 

During the last 2-3 years newspapers, magazines, and radio/TV outlets have been replete with teasers about changes or the need for changes in health care treatment options and delivery systems.  Even so the nation faces a crisis in health care, and the pace of change is painfully slow.

In this article I will focus on one significant change, possibly a trend, in the use of funds, especially government funds, for care of ill or disabled adults.  The trending focus is “aging in place.”  It means receiving necessary health care in the place we call home.  Two different groups of people are affected by the awareness of changes needed in our care options.

First, the more financially able aging adults are seeing more viable options develop.  Assisted living facilities are increasingly offering upscale and broader care services.  They may be independent or a part of a progressive care community which allows the aging adult to move progressively from an independent living style to total care when it is needed.  These options will probably continue to diversify as baby boomers flood the health field, and as the desire to “age in place” intensifies.  This more elite population usually has long-term care insurance to augment their desire.

The other part of this significant trend is the recognition that people with lesser financial means also long for and deserve diversity.  Therefore, health care systems are being examined by more and more states and policy shifted to provide more in-home and community-based options.  “Home” is the first choice of most adults and is being recognized by law as part of a viable model for long-term care for the moderate to less financially able citizens. 

Hopefully, at some point this reallocation of funds will also bring assistance and relief to all caregivers in home settings.  Legislation is currently being considered.  The onus is on state and federal lawmakers and health care providers to balance spending between home and community based services and those delivered in institutional settings.  Nursing homes seem to comprehend the shift taking place.  As clients act on their impulses to “age in place,” nursing homes must be flexible enough to deliver services where the clients choose to be.

In his article in the July 15, 2008 Tennessean, Patrick Willard, advocacy director for AARP Tennessee, said, “The states that have shown the greatest success are those that recognize the importance of participants having a choice in how their services are provided.” Generally, the same Medicaid dollars can provide services for nearly three adults in home and community settings for the cost of one in an institutional setting.  Other insurance sources can also be tapped. 

I will add a strong appeal for facing the good news/bad news elements in this trend.  The management of diversity in long-term home care is complex, time consuming and perhaps not as efficient as it first appears to be.  Maintaining quality in-home services is a challenge when coordinators and supervisors are not onsite nor easily observant of care delivery practices.  Overall, the trend is positive and conveys hope to all of us. 

The Alzheimer’s Association in your area can guide you to information about policy and options in your state.